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Janice Lee, Sylvia Kodsi, Steven E Rubin, Majida Gaffar; Assessment of Intraocular Pressure Surveillance in Children with Otherwise Normal Eye Exam. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1395.
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© ARVO (1962-2015); The Authors (2016-present)
A review of literature revealed no standardized guidelines for routine measurement of intraocular pressure (IOP) in children with a normal exam. We surveyed pediatric ophthalmologists nationwide to assess current practice patterns.
With IRB approval, a survey was sent to members of the American Association for Pediatric Ophthalmology and Strabismus in order to assess: surveillance of IOP, method of surveillance, age at initiation, modifying factors, frequency of elevated IOP, years in practice, practice location and type. Statistical significance was assessed by Fisher’s exact test.
181 (56%) routinely check IOP out of 323 respondents. The most common age groups when screening is initiated are 10-12 (38.7%) and 13-15 (28.3%). The preferred methods of monitoring were Goldmann applanation (38.3%), Tonopen (27.2%), and Icare (29.4%). 101 (55.8%) rely on patient cooperation “very heavily,” while 66 (36.5%) relied only “moderately.” 61 (33.9%) found elevated IOP once a year, 33 (18.3%) once every other month, while 29 (16.1%) reported “never” finding elevated IOP in their practice. 123 (68.3%) work with an orthoptist or optometrist who checks the child’s IOP. Out of all respondents, there was no correlation between a practitioner checking IOP routinely and: years in practice, region of practice and type of practice (p=0.93, p=0.13, p=0.82, respectively). Among physicians who do routinely check IOP, significant associations were found between years in practice and method of checking IOP (p=0.026), and between region of practice and method of checking IOP (p=0.0097). Those with greater numbers of years in practice (>16) and who practice in the Northeastern, Mountain and Western regions used Goldmann more than other methods. Those with fewer years of practice (<10) used Rebound and Icare more than the Goldmann method, while practitioners in the Southeast used Tonopen, Rebound and Icare more than other methods.
There is no consensus among pediatric ophthalmologists for routinely assessing IOP in normal children despite the fact that increased IOP is found infrequently in this population. This data demonstrates the importance of developing guidelines for a standard of care in monitoring intraocular pressure in children with otherwise normal eye exams.
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