Criteria for prescribing optometric interventions: literature review and practitioner survey

The core function of optometrists is the prescribing of refractive corrections, yet a literature review revealed a lack of evidence-based research on criteria for determining when a refractive correction is required. The reported criteria used by practising optometrists were investigated using a questionnaire to survey prescribing habits for borderline hypermetropia, presbyopia, astigmatism, and horizontal and vertical heterophoria. Thirty-eight questionnaires were returned and the results analysed. We calculated the 'cut off' point above which the anomaly would be corrected over 50% of the time that it was encountered. There was a large variation for each category, but it was clear that the presence or absence of symptoms was an important factor for most optometrists when deciding whether to correct a small error. It was found that for symptomatic patients, most optometrists would correct an anomaly if it reached: +1.00 D of hypermetropia, a reading addition of +0.75 D for presbyopia, -0.75 DC of astigmatism, 1.5 prism dioptres (Delta) of horizontal aligning prism, and 1 Delta of vertical dissociated heterophoria. For asymptomatic patients, optometrists would not correct any of the hypermetropic anomalies or heterophorias that were specified in our questionnaire. However most would correct a presbyopic error of +1.50 D or above, or an astigmatic error of -1.50 DC or above, even in the absence of symptoms. These results were compared with previously published guidelines.