Prescribing for hyperopia in childhood and teenage by academic optometrists

The purpose of this study was to examine the prescribing patterns of academic optometrists for infants, children, and teenagers with hyperopia and the factors that affected the decision to prescribe. A comparison was made to published guidelines for prescribing for hyperopia in children.

The Waterloo Eye Study (WatES) database is a database of all patients attending the Primary Care Clinic or the Pediatric Clinic at the School of Optometry, University of Waterloo, between February 2007 and January 2008. Records for 698 patients aged from birth to 19 years with hyperopia but without strabismus or significant anisometropia were extracted. They were analyzed to determine the factors that predicted whether a child was prescribed spectacles and the 50% prescribing points for hyperopia and astigmatism according to age.

Univariate analysis showed that the level of hyperopia, astigmatism, age, distance, and near phoria and presence of symptoms were associated with the prescription of spectacles (p < 0.05). Multivariate analysis showed that the prescription of spectacles was predicted by age, highest sphere (either right or left eye), highest cylinder, the presence of symptoms, and distance phoria. Among 0 to 3 year olds, all the children with 5 D or more of hyperopia had been prescribed spectacles. Among the 4 to 6 year olds, this point was 3.25 D; and for the 7 to 19 year olds, it was 2.25 D. The levels at which 50% of the population had been prescribed spectacles was 3.7, 1.8, and 1.1 D for the 0 to 3 year olds, 4 to 6 year olds, and 7 to 19 year olds, respectively. There was frequently a difference between the refraction and the prescription such that the younger children, in particular, were often under corrected for both hyperopia and astigmatism.

The optometrists in this academic setting appear to follow the available optometric guidelines for prescribing for hyperopia. They tend to prescribe for lower levels of hyperopia than U.S. ophthalmologists.