Pediatric Ophthalmologist Glasses Prescribing Patterns

Abstract

 

Purpose

 

Correction of significant refractive errors in childhood aid visual development and prevent amblyopia. While consensus guidelines and practitioner surveys provide thresholds for prescribing glasses, patient level data are limited. We sought to describe patterns of glasses prescribing in children by pediatric ophthalmologists and to compare those patterns to recommended AAO guidelines.

 

Methods

 

Retrospective electronic medical record (EMR) study of children under age 18 yrs who had a cycloplegic refraction (CR) in an academic multi-office practice with 7 pediatric ophthalmologists, over 4 yrs. Children with esotropia, cataract surgery, monocular blindness, or already prescribed glasses, were excluded. The primary outcome was proportion of glasses prescribed, stratified by (1) type and (2) amount of refractive error and (3) age at CR. Variability was assessed by range of proportions across providers. Comparisons were made to AAO glasses prescribing guidelines for children under age 3 yrs.

 

Results

 

16,011 children with 19,372 refractions met study criteria. 7421 children were 0-3 years old, 6897 3-8 years, 5054 8-18 years. Separate tables (Fig 1) were created for myopia, hyperopia, astigmatism, and 3 types of anisometroia: myopic, hyperopic, and astigmatic. Refractive error thresholds for prescribing glasses decreased gradually with age across all categories. Proportion prescribed was very low (0-8%) under 6 months regardless of age/CR group, increased steadily with age, and was fairly stable for 5 yrs or older. For CR exceeding AAO guidelines thresholds, glasses were prescribed 15%-50% for children under 1 yr, but 65-100% for children 1-3 yrs, with the exception of astigmatism (40-57%).

 

Conclusions

 

Use of EMR enables direct, large-scale assessments of actual glasses prescribing patterns in children. Prescribing thresholds data from this study are helpful for self-assessment, practice-based improvements working towards standardization of care, and possibly reevaluation of consensus-based guidelines. Additional EMR-based studies may assess comparative clinical effectiveness of glasses prescribing approaches with regards to visual outcome.

 

 

Fig 1. Percentage of myopic refractions for which glasses were prescribed, categorized by degree of myopia in the more myopic eye and age at refraction. Range across 7 providers in parenthesis. Shadings indicate increasing proportions. Similar tables were created for the 5 other refractive categories.

 

Keywords: 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • 757 visual development: infancy and childhood • 676 refraction