Refractive prescribing for preschool children by optometrists in England

Abstract

Purpose Correction of refractive error in children is important for visual and educational development. The aim of this questionnaire‐based study was to explore paediatric refractive correction by optometrists in England. Methods An online questionnaire was piloted and distributed to optometrists in England. The questionnaire asked about respondents' characteristics (such as type of practice), management of refractive error in 1‐ and 3‐year‐old children and sources of information used as a basis for decisions on prescribing refractive error in children. Results Two hundred and ninety‐three questionnaires were returned, although only 139 (47%) were fully completed. In an average month, about half of respondents examined no children between 0 and 2 years of age, and about half examined no more than five children aged 3–4 years. A significant proportion indicated they would refer children aged 1 or 3 years with refractive error and no other signs or symptoms into the hospital eye service. Almost a quarter would prescribe in full or in part an isometropic refractive correction of +2.00 D for a 3‐year‐old (within the normal range) with no other signs or symptoms, suggesting a degree of unnecessary prescribing. Almost all would act in cases of clinically significant refractive error. Respondents made similar use of their colleagues, optometric or postgraduate/continuing education, professional guidance and peer‐reviewed research as sources of evidence on which to base decisions about prescribing for paediatric refractive errors. Most reported ‘never’ or ‘rarely’ using Cochrane reviews. Conclusions These results suggest optometrists often defer management of paediatric refractive error to the hospital eye service, with implications in terms of underutilisation of community optometric expertise and burden on the National Health Service. In some cases, the results indicate a mismatch between respondents' reported management and existing guidance/guidelines on paediatric prescribing.

Prescribing patterns for paediatric hyperopia among paediatric eye care providers

“…In our findings, some providers would prescribe a refractive correction for age‐normal levels of hyperopia even when no other clinical factors were present 1,2,3,4,48 . This is in agreement with Thompson et al 22 when surveying eye care providers in England. When clinical factors were present (such as high esophoria at near, reduced near VA, high accommodative lag and/or reduced stereoacuity) the threshold for prescribing decreased for optometrists and ophthalmologists across all ages, with optometrists still consistently prescribing for lower amounts of hyperopia than ophthalmologists.…”

“…It is possible that prescribing patterns have changed as a result of recent research. 13,15,16,22 The purpose of this study was to survey paediatric eye care providers to determine the current patterns of prescribing for bilateral hyperopia in children in the context of the magnitude of hyperopia, age of the patient and associated clinical findings. Results will enable clinicians to compare their individual approach with that of a large sample of experienced colleagues.…”

“…Previous studies have established that prescribing patterns for hyperopia in children differ among eye care providers. It is possible that prescribing patterns have changed as a result of recent research 13,15,16,22 . The purpose of this study was to survey paediatric eye care providers to determine the current patterns of prescribing for bilateral hyperopia in children in the context of the magnitude of hyperopia, age of the patient and associated clinical findings.…”