Prescribing Patterns for Children with Astigmatism

Abstract

Purpose : The purpose of this study was to survey pediatric eye care providers to identify current patterns of prescribing for astigmatism when considering magnitude of astigmatism as well as other factors.

Methods : Pediatric eye care providers who were members of professional organizations or listservs were invited via email to participate in a Qualtrics survey study of current pediatric spectacle prescribing practices. Participants answered questions on “What factors influence whether or not you prescribe for bilateral astigmatism” and “What level of astigmatism do you think is clinically meaningful” (i.e. the lowest level they would consider prescribing for or closely monitor) for a child with no other significant refractive error and no strabismus. Chi-square testing was used for comparing proportions. The distribution of responses given by ophthalmologists and optometrists was compared using Kolmogorov-Smirnov CDF test (after excluding “would not prescribe” responses).

Results : Eye care providers reported that presence of symptoms, other refractive error, reading problems, strabismus, and neurodevelopmental problems as well as near visual acuity were most commonly considered when prescribing for astigmatism in children. Factors considered were reported in a similar order of frequency although rates often differed between professions. Ophthalmologists and optometrists showed the greatest differences for stereoacuity, accommodative function, and emmetropization (all p<0.0001), where optometrists were more likely to consider these factors than ophthalmologists (Table 1). The level of astigmatism at which more than 50% of providers reported prescribing decreased with patient age from 6 to <11 months up to ≥7 years (opthalmogists: 4D to 1.5D; optometrists: 2.5D to 1D)(Table 2). The distributions between ophthalmologists’ and optometrists’ responses were significantly different (p≤0.032), with the exception of children ≥7 years (p=0.18). The magnitude at which providers would prescribe varied from 0.5D to ≥4.0D. The percentage prescribing the full amount of the astigmatism increased with the age of the child, with more ophthalmologists overall (78.3-87.6% across age groups) reporting prescribing the full amount as compared to optometrists (35.4%-67.4%)(Table 2).

Conclusions : Prescribing patterns for pediatric astigmatism vary significantly among eye care providers both within and between professions, especially when prescribing for younger children.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.