A Survey of Clinical Prescribing Philosophies for Hyperopia

Abstract

Pediatric eye care providers show a lack of consensus on prescribing philosophies for hyperopic children.

Prescribing for Hyperopia in Childhood and Teenage by Academic Optometrists

“…12. There is also variation with regards to actual prescribing practices. Reiter et al 25 used a questionnaire to compare the prescribing practices of German ophthalmologists with a previous survey of U.S. ophthalmologists and optometrists by Lyons et al 26 The responses from German ophthalmologists and U.S. optometrists indicated that they would prescribe at similar levels of asymptomatic hyperopia whereas the U.S. ophthalmologists prescribed at higher levels. For example, for children of 4 years of age, 91% of German ophthalmologists, 89% of U.S. optometrists, and 42% of U.S. ophthalmologists would prescribe once the hyperopia was Ͼ3 D. Farbrother 14 used a questionnaire to study UK hospital optometrists prescribing practices.…”

The Effect of Lens-Induced Anisometropia on Accommodation and Vergence during Human Visual Development

“…4). The main effect of viewing condition on the accommodative gain was statistically significant (F (5,466) ϭ 14.7; P Ͻ 0.001), the main effect of age approached statistical significance (F (4,466) ϭ 2.3; P ϭ 0.06), and their interaction was not significant (F (20,466) ϭ 1.5; P ϭ 0.09). A post hoc Games Howell test for viewing condition indicated that the binocular accommodative gain was statistically significantly larger than the gains under Ϫ4 D (P ϭ 0.006), ϩ2 D (P ϭ 0.001), and ϩ4 D (P ϭ 0.02) anisometropia conditions.…”

“…Management strategies (e.g., preventative prescription of refractive correction) for anisometropia vary significantly among clinicians and are largely based on clinical consensus rather than objective evidence. For instance, in a survey of 59 pediatric ophthalmologists and 161 pediatric optometrists, Lyons et al 20 noted that 47.3% of ophthalmologists and 28.5% of optometrists are likely to prescribe refractive correction for hyperopic anisometropia Ͼ1 D in 6-month-old infants. These percentages change for a higher magnitude of anisometropia, with 38.6% of ophthalmologists and 56.9% of optometrists waiting until hyperopic anisometropia reaches Ͼ3 D to prescribe in the same age group.…”

“…Prescribing criteria for hyperopic anisometropia tended to become similar across the two professions for children aged 2 years and older. 20 An understanding of any abnormal visual experience resulting from anisometropia also depends on accommodative and vergence performance in the presence of the anisometropia because retinal image quality and retinal image correspondence are critically dependent on these motor responses. How might anisometropia lead to abnormal visual experience, and how much anisometropia might be required to disrupt oculomotor performance?…”

Effect of astigmatism on refraction in children with high hyperopia

“…Nevertheless, they cannot be sure how refractive correction might affect the development of very large hyperopic errors, which showed very variable degrees of emmetropization in their observations. Of note, children with hyperopic refractive errors with or more than +5 D would be taken into consideration for optical correction as general guidelines for most practitioners to improve visual acuity (22). Therefore, it would have been instructive to have studied matched groups of children with corrected and uncorrected refraction who have high hyperopic refractive errors.…”