Spectacle non‐tolerance in clinical practice – a systematic review with meta‐analysis

Abstract

Purpose Spectacle non‐tolerance or adverse events to spectacle wear are serious concerns for both patients and practitioners. Non‐tolerance may contribute to a negative impact on the practitioner’s ability and practice. Therefore, a detailed understanding of frequency and causes of spectacle non‐tolerance in clinical ophthalmic practice is essential. This review aimed to determine the prevalence and causes of non‐tolerance to spectacles prescribed and dispensed in clinical practice. Method The current systematic review included quantitative studies published in the English language that reported spectacle non‐tolerance in clinical practice. A comprehensive search was conducted in PubMed, Scopus and the Web of Science database for studies published until 13 July 2020. An adapted version of the Newcastle‐Ottawa Scale (NOS) modified for cross‐sectional studies was used to assess the quality of each included study. Five investigations with 205,478 study participants were included in the review. The prevalence of spectacle non‐tolerance from individual studies was pooled using MetaXL software. The pooled prevalence of spectacle non‐tolerance was 2.1% (95% CI: 1.6–2.7) ranging from 1.6% to 3.0%. The papers were also reviewed to identify the potential causes of non‐tolerances. Nearly half reported that non‐tolerance (47.4%) was due to an error in refraction. Other causes identified were errors related to communication (16.3%), dispensing (13.5%), non‐adaptation (9.7%), data entry (8.7%), binocular vision (7.4%) and ocular pathology (6.4%). Summary This review improves our understanding of spectacle non‐tolerance in clinical practice. This is important because non‐tolerance may lead to spectacle wear discontinuation, which may deprive patients of optimal vision. Increased non‐tolerance in clinical practice may affect a clinician’s reputation and incur additional costs associated with reassessments and replacements. Spectacle non‐tolerance occurred due to a multitude of factors related to optical dispensing and wearer adaptation. Therefore, there is a need for vigilance while prescribing spectacles. The limited evidence highlights the need for more studies, especially in limited‐resource settings, to improve the quality of refractive error services.

What are patients' beliefs about, and experiences of, adaptation to glasses and how does this affect their wearing habits?

“…Patients are aware of the risk of not getting used to a new pair of glasses and it is a source of concern for many 14 . Recheck rates (the percentage of patients returning to an optometry practice because they are dissatisfied with their new glasses) have been reported to be between 0.7% and 5.7%, 5–9 with a recent systematic review finding a pooled prevalence for spectacle non‐tolerance of 2.1% 15 …”

“…Nearly 10% of spectacle dissatisfaction cases have been reported as due to “non‐adaptation” 15 and there are a number of reasons that a patient may be unhappy with their new glasses, even when their refraction has been carried out proficiently, their vision is good and there is no issue to be found with the dispensing of their glasses. Although subjective refraction is considered to be the gold standard methodology for obtaining a prescription, 17 it is certainly not infallible 18 and is subject to inherent measurement uncertainties 19 and variablility 17,20–22 .…”

“…14 Recheck rates (the percentage of patients returning to an optometry practice because they are dissatisfied with their new glasses) have been reported to be between 0.7% and 5.7%, [5][6][7][8][9] with a recent systematic review finding a pooled prevalence for spectacle non-tolerance of 2.1%. 15 These prevalence rates are based upon data from high-resource countries and settings, and the rates of dissatisfaction with glasses in lower resource settings is not understood and could be a significant issue. The authors of these reports accept that there are patients who are dissatisfied with new glasses but do not return to the original practice.…”

Seeing beyond 2020: what next for refractive error care?

“…1 The recent Lancet Global Health Commission highlighted a dearth of information on the eREC, as well as evidence on strategies to improve access to refractive error care. 3 In a systematic review and meta-analysis, Bist et al 27 contribute to closing this evidence gap, reporting that the proportion of people discontinuing spectacle wear shortly after dispensing ranged between 1.6% and 3.0%, mostly due to a refraction error or miscommunication. While this proportion is relatively low, the authors highlight the limited contexts in which the five included studies were conductedrefractive error care may be of lower quality in other contexts.…”

Guest Editorial: Defocus and daily life

“…17 Assessment of daily life seems more common in other areas, such as the tolerability of spectacle prescription errors. 18 Importantly, many of these studies did not rely solely on clinical measures of vision. They had subjects assess the spectacles in their genuine activities of daily life.…”