Effect of Co-existing Clinical Signs on Prescribing Patterns for Pediatric Hyperopia

Abstract

Purpose : Hyperopia is the most common vision diagnosis in young children, yet there are no evidence-based prescribing guidelines for its management. The purpose of this study was to report current refractive prescribing patterns for children. Here we present prescribing patterns for hyperopia associated with near esophoria or reduced near visual function.

Methods : Pediatric eye care providers were invited to complete an electronic survey evaluating current pediatric spectacle prescribing practices. Questions included what magnitude of bilateral hyperopia the clinician would prescribe for in a child (ages 4 to 7 years and ≥7 years) with 1) age-normal near visual function and no strabismus, 2) moderate or high near esophoria, and 3) reduced near visual function (high accommodative lag, 20/40 or worse near visual acuity, 240” or worse near stereoacuity), the basis for prescribing, and how much hyperopia would be corrected. The distribution of responses given by optometrists (ODs) and ophthalmologists (MDs) was compared using Kolmogorov-Smirnov CDF test.

Results : 593 participants (46.8% ODs) completed these questions. For a child with age-normal near visual function, the level of hyperopia at which 50% of respondents reported prescribing for children 4 to <7 years was +2.5D for ODs, +4D for MDs and for children ≥7 years it was +2D for ODs and +3.5D for MDs. When a near esophoria is present, the level of hyperopia at which 50% of respondents reported prescribing for children 4 to <7 years was +1.5D for ODs and +3.5D for MDs and for children ≥7 years, it was +1D for ODs and +2.5D for MDs. When reduced near visual function was present, the level of hyperopia at which 50% of respondents reported prescribing for children 4 to <7 years was +1D for ODs and +2D for MDs, while for children ≥7 years it was <+1D for ODs and +1D for MDs. The level of hyperopia at which all eye care providers would consider prescribing ranged from <+1D to never. The distribution between ODs and MDs responses was significantly different (P<0.0001). Most ODs and MDs prescribed based on cycloplegic refraction for younger children or a combination of manifest and cycloplegic refraction for older children, commonly 1D to 2D less than the full cycloplegic.

Conclusions : The findings from this survey demonstrate that there are significant and clinically important differences in prescribing patterns for hyperopia among pediatric eye care providers.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.