Division of Optometry and Visual Science, School of Health and Psychological Sciences, City, University of London, London, UK.
Ophthalmic Physiol Opt. 2023 Jan;43(1):6-16. doi: 10.1111/opo.13050. Epub 2022 Sep 13.
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.
An online questionnaire was piloted and 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.
Two hundred and ninety-three questionnaires were returned, although only 139 (47%) were fully completed. In an average month, about half of respondents examined no children between 0 and 2 years of age, and about half examined no more than five children aged 3-4 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 +2.00 D for a 3-year-old (within the normal range) with no other signs or symptoms, suggesting a degree of unnecessary prescribing. Almost all would act in cases of clinically significant refractive error. Respondents made similar use of their colleagues, optometric 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 'never' or 'rarely' using Cochrane reviews.
These results suggest optometrists often defer management of paediatric refractive error to the hospital eye service, with implications in terms of underutilisation 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.
儿童屈光不正的矫正对于视觉和教育发展很重要。本基于问卷调查的研究旨在探讨英格兰验光师对儿童屈光不正的矫正情况。
对英格兰的验光师进行了在线问卷调查。问卷询问了受访者的特征（如执业类型）、1 岁和 3 岁儿童屈光不正的管理以及作为儿童屈光不正处方决策依据的信息来源。
共收回 293 份问卷，但只有 139 份（47%）完全填写。在平均一个月中，大约一半的受访者没有检查 0-2 岁的儿童，大约一半的受访者没有检查超过 5 岁的儿童。相当一部分人表示，他们会将 1 岁或 3 岁有屈光不正但没有其他体征或症状的儿童转诊到医院眼科服务。近四分之一的人会为没有其他体征或症状的 3 岁儿童（在正常范围内）开具完全或部分矫正 +2.00 D 的等像屈光矫正处方，这表明存在一定程度的不必要处方。几乎所有受访者都会在出现临床显著屈光不正的情况下采取行动。受访者在做出儿童屈光不正处方决策时，同样依赖于同事、验光或研究生/继续教育、专业指导和同行评议的研究等作为证据来源。大多数人报告说“从不”或“很少”使用 Cochrane 综述。
这些结果表明，验光师经常将儿童屈光不正的管理推迟到医院眼科服务，这对社区验光专业知识的利用不足和国家卫生服务的负担都有影响。在某些情况下，结果表明受访者报告的管理与现有的儿童处方指南/准则之间存在不匹配。
