儿科眼科保健提供者中儿童远视的处方模式。

The Ohio State University College of Optometry, Columbus, Ohio, USA.

Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA.

Ophthalmic Physiol Opt. 2023 Sep;43(5):972-984. doi: 10.1111/opo.13184. Epub 2023 Jun 19.

PURPOSE

To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia.

METHODS

Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test.

RESULTS

Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years.

CONCLUSION

Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

目的

调查儿科眼科护理提供者，以确定远视的当前处方模式。

方法

通过电子邮件邀请儿科眼科护理提供者参加一项评估基于年龄的屈光不正处方实践的当前情况的调查。这些问题旨在确定哪些因素可能影响调查参与者的处方模式（例如，患者的年龄、远视的程度、患者的症状、隐斜视和立体视），以及提供者是否会进行处方，如果进行处方，他们会开出多少远视矫正量（例如，全矫或部分矫正）。通过 Kolmogorov-Smirnov 累积分布函数检验比较专业（验光和眼科）之间的响应分布。

结果

738 名参与者提交了他们如何为远视患者开处方的信息。每个专业的大多数提供者在开处方时都考虑了类似的临床因素。报告经常考虑该因素的验光师和眼科医生的百分比有显著差异。验光师和眼科医生都认为相似的因素包括症状存在（98.0%，p=0.14）、散光和/或屈光参差存在（97.5%，p=0.06）和易被误诊的可能性（8.3%，p=0.49）。在每个专业中都观察到广泛的处方范围，一些提供者报告说他们会为低度远视开处方，而另一些提供者则表示他们永远不会开处方。当为视力正常且无显性偏斜或症状的儿童双侧远视开处方时，两种职业的处方阈值随年龄降低，眼科医生通常比验光师少开 1.5-2 D。当儿童有相关临床因素（例如，内斜视或近视力下降）时，两种职业的处方阈值都降低。验光师和眼科医生最常根据睫状肌麻痹验光来开处方，尽管验光师最常根据显性和睫状肌麻痹验光来为≥7 岁的儿童开处方。