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Refractive prescribing for pre-school children by optometrists in England

Thompson, A., Conway, M. A. ORCID: 0000-0001-5016-0529, Ctori, I. ORCID: 0000-0003-1523-4996 , Shah, R. ORCID: 0000-0002-6134-0936 & Suttle, C. M. (2022). Refractive prescribing for pre-school children by optometrists in England. Ophthalmic and Physiological Optics, 43(1), pp. 6-16. doi: 10.1111/opo.13050


Purpose: Correction of refractive error in children is important for visual and educational development. The aim of this questionnaire-based study was to explore paediatric refractive correction by optometrists in England.

Methods: An online questionnaire was piloted and then distributed to optometrists in England. The questionnaire asked about respondents’ characteristics (such as type of practice), management of refractive error in 1 and 3 year-old children, and sources of information used as a basis for decisions on prescribing refractive error in children.

Results: Two hundred and ninety-three questionnaires were returned, though only 139 (47%) of these were fully completed. In an average month, about half of respondents examined no children aged 0 to 2 years and about half examined no more than 5 children aged 3 to 4 years. A significant proportion indicated they would refer children aged 1 or 3 years with refractive error and no other signs or symptoms into the hospital eye service. Almost a quarter would prescribe in full or in part an isometropic refractive correction of +2D for a 3 year-old (within the normal range) with no other signs or symptoms, suggesting a degree of unnecessary prescribing. Almost none would take no action in cases of clinically significant refractive error. Respondents made similar use of their colleagues, undergraduate or postgraduate/continuing education, professional guidance and peer-reviewed research as sources of evidence on which to base decisions about prescribing for paediatric refractive errors. Most reported using Cochrane reviews ‘never’ or ‘rarely’.

Conclusions: These results suggest optometrists often defer management of paediatric refractive error to the hospital eye service, with implications in terms of under-utilisation of community optometric expertise and burden on the National Health Service. In some cases, the results indicate a mismatch between respondents’ reported management and existing guidance/guidelines on paediatric prescribing.

Publication Type: Article
Additional Information: © 2022 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords: optometry; prescribing; children; England, refractive error
Subjects: R Medicine > RE Ophthalmology
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Departments: School of Health & Psychological Sciences > Optometry & Visual Sciences
SWORD Depositor:
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