City Research Online

The role of optometrists in paediatric eyecare in England

Wilson, S. (2022). The role of optometrists in paediatric eyecare in England. (Unpublished Doctoral thesis, City, University of London)


Existing literature suggests that primary eyecare services in community settings are not easily accessible for young children. However, there is little information that can explain why community practices are selective when offering eye examinations to young children. An eye examination during the early stages of a child’s life is essential to determine that the child’s vision is developing as expected.

This research aimed to investigate the extent of primary eyecare services available to young children among community practices and explore the barriers and the corresponding enablers to optometrists providing paediatric eyecare. A mixture of methodological approaches were used. Qualitative and quantitative data were obtained via questionnaires (telephone survey and Delphi technique), focus group discussions, and a systematic review and meta-analysis were also performed.

A telephone survey (Study One) was conducted to investigate the accessibility of eye examinations for young children and children with autism (a child aged 1, 3, 5 years and a 13-year-old with autism). A total of 400 optometric practices were selected and telephoned to establish the availability of an eye examination for the child of concern (100 different practices for each scenario). A total of 397 optometric practices reported they examine children. However, out of the 400 practices, 14% of them were willing to examine a child of any age. The median age at which practices declared they would start to examine children was four years. However, all children under the age of 16 years are eligible for a National Health Service funded eye examination.

When examining children, objective tests are performed using cycloplegic drugs to ensure accurate refractive error measurements. Cycloplegic retinoscopy is the gold standard for assessing refractive errors. In the present study (Study Two), an agreement between non-cycloplegic and cycloplegic refractive error measurements was assessed. Bland and Altman's plots demonstrated that non-cycloplegic refraction is not sufficiently sensitive. The results indicate a significant difference between non-cycloplegic and cycloplegic conditions with the various types of autorefractors (Plusoptix, Retinomax and Canon) and the refractive error measurements obtained. An overall comparison of non-cycloplegic and cycloplegic autorefractors and agreement between non-cycloplegic autorefraction and cycloplegic retinoscopy demonstrated ≥0.50 Dioptres or more myopic findings in noncycloplegic conditions.

Globally, uncorrected refractive error is a leading cause of visual impairment. By exploring paediatric eyecare in England and its potential limitations, clinical guidelines were reviewed to establish their possible impact on eyecare services. The clinical guidelines on prescribing refractive error in young children were appraised using the AGREE II Tool to establish the quality of existing guidelines (Study Three). In addition, the clinical appropriateness of the selected guidelines was evaluated via the Delphi methodology. The Delphi technique is a robust method for gaining autonomous opinions amongst a panel of experts. This combined approach of using the AGREE II Tool and the Delphi study resulted in an assessment of quality and identification of gaps in existing guidelines on prescribing refractive correction. The appraisal of the identified guidelines highlighted several key areas that require improvement, particularly the domains ‘Stakeholder Involvement, ‘Rigour of Development’, ‘Applicability’, and ‘Editorial Independence’. The Delphi technique has facilitated in highlighting the gap and need to develop prescribing refractive error guidelines for practitioners.

Focus group discussions (Study Four) were undertaken to explore the perspective of optometrists working in community optometric practices. The barriers and enablers to providing paediatric eyecare within a community setting were explored using a topic guide. Findings suggest improvements are required to enhance primary eyecare services for young children. In addition, gaps in knowledge and awareness have been identified among primary eyecare providers and parents of young children. Moreover, funding problems have become apparent and need to be further investigated.

To conclude, these studies highlight various gaps and accessibility concerns within paediatric eyecare in a primary care setting. Children tend not to report their symptoms. Therefore, any visual problem that occurs during their development should be assessed to allow better prognoses during the sensitive period of the visual development process. Children learn primarily through the visual input they receive; therefore, it is paramount that their development is not hindered. Based on these research findings, several recommendations were identified to improve paediatric primary eyecare. Moreover, the findings may help optometrists examine more young children and inform future practitioners, the public, professional and educational bodies regarding paediatric eyecare in optometry.

Publication Type: Thesis (Doctoral)
Subjects: Q Science
R Medicine > RA Public aspects of medicine
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Optometry & Visual Sciences
Text - Accepted Version
Download (5MB) | Preview



Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login