Cycloplegia and spectacle prescribing in children: attitudes of UK optometrists

Abstract

Purpose To survey a large number of UK‐based optometrists, in a variety of settings, to determine current attitudes relating to the use of cycloplegia and spectacle prescribing in children aged ≤11 years. Methods One thousand randomly selected members of the College of Optometrists (UK) were invited to complete an electronic questionnaire. The questionnaire was comprised of 42 questions relating to respondent demographics, practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children aged ≤11 years. Results Three hundred and eleven practitioners (31%) completed the questionnaire. Practitioners agreed that they are confident carrying out cycloplegic refraction (60%) and instilling cyclopentolate (77%); are not concerned about the time the procedure takes (69%); feel parents are receptive to its use (65%) and are not discouraged by side effects (72%). Most practitioners agreed that they would carry out a cycloplegic refraction in pre‐school children (aged 2–4 years) at their first eye exam (34% vs 27%), but would not carry out a cycloplegic refraction in a child of school age (5–7 years: 25% vs 47%, 8–11 years: 12% vs 45%). More recently qualified practitioners are more likely to be proactive in using cycloplegia (Mann‐Whitney, p = 0.003). Community practitioners prescribed at slightly lower levels of ametropia in non‐strabismic children than those working in a hospital setting both in the present study and in comparison to previously published hospital optometry values, particularly for hyperopia at 1 year of age. Conclusions This is the first study to report practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children in a large number of UK‐based optometrists practising in a variety of settings. The majority of practitioners responded in a positive manner to the use of cycloplegia and reported patterns of use which adhere closely to available professional guidance. However, outcomes indicate practitioners may appreciate more comprehensive evidence‐based resources to inform their decision‐making relating to use of cycloplegia in paediatric examination.

How accessible is primary eye care for children in England?

“…With additional concerns about the presence of strabismus, this increases the importance of having an eye examination 7 . Our results are not surprising, given that Doyle et al 24 . reported that 66% of the optometrists who completed their questionnaire did not examine children under the age of 2 years.…”

“…Doyle et al . reported that most optometrists (77%) do not have a concern about using cycloplegia 24 . Qualified optometrists know the appropriate usage, administration practice, and contraindications of cycloplegic drops and have the skills to use an ophthalmoscope and retinoscope 56 .…”

“…Recent studies highlight gaps in accessibility of eye care for children, 23‐25 and concerns have been raised around school screening not meeting the PHE specifications 17,18 . Moreover, it has been evident that children with a learning disability have problems accessing eye care 28 .…”

A Study Based on CASIA2: What the Subtle Changes Has Taken Place in the Shape of the Crystalline Lens After Cycloplegia?

“…There may be for two reasons: One is the case that the PCL is small and the change value is not obvious when relaxing; Second, the circular bers of cycloplegia and relaxation mainly act on the anterior surface of the lens and have little in uence on the posterior surface. The change of human eye diopter is also related to the use of cycloplegia drugs, and the most suitable cycloplegia drugs should be comprehensively selected according to the patient's age, refractive state and other basic conditions [17,18].…”

Referral in a routine Italian optometric examination: towards an evidence-based model.

“…One additional reason for a referral might be the need for cycloplegic refraction, which, unlike in other countries (e.g. United Kingdom (Doyle et al, 2019)), cannot be independently performed by Italian optometrists. Although cycloplegia represents the standard procedure for the determination of refractive error in paediatric practice (American Optometric Association, 2017), clinicians can typically measure refraction reliably without cycloplegia from adolescence onward.…”