Stacy Lyons

A Survey of Clinical Prescribing Philosophies for Hyperopia

Background. Prescribing philosophies for hyperopic refractive error in symptom-free children vary widely because relatively little information is available regarding the natural history of hyperopic refractive error in children and because accommodation and binocular function closely related to hyperopic refractive error vary widely among children. We surveyed pediatric optometrists and ophthalmologists to evaluate typical prescribing philosophies for hyperopia. Methods. Practitioners were selected from the American Academy of Optometry Binocular Vision, Perception, and Pediatric Optometry Section; the College of Vision Development; the pediatric and binocular vision faculty members of the colleges of optometry; and the American Association for Pediatric Ophthalmology and Strabismus. Surveys were mailed to 314 participants: 212 optometrists and 102 ophthalmologists. Results. A total of 161 (75%) of the optometrists and 59 (57%) of the ophthalmologists responded. About one-third of optometrists surveyed prescribe optical correction for symptom-free 6-month-old infants with +3.00 D to +4.00 D hyperopia, but fewer than 5% of ophthalmologists prescribe at this level. Most eye care practitioners prescribe optical correction for symptom-free 2-year-old children with +5.00 D of hyperopia, and this criterion for hyperopia decreases with age. Most ophthalmologists (71.4%) prescribe the full amount of astigmatism and less than the full amount of cycloplegic spherical component, and most optometrists (71.6%) prescribe less than the full amount of both components. When prescribing less than the full amount of astigmatism, eye care practitioners do not tend to prescribe a specific proportion of the cycloplegic refractive error. Conclusion. Pediatric eye care providers show a lack of consensus on prescribing philosophies for hyperopic children.

Vision specific quality of life of pediatric contact lens wearers.

Purpose. Several studies have shown that children are capable of wearing and caring for contact lenses, but it is not known whether the benefits outweigh the risks associated with contact lens wear. The purpose of this article is to compare the vision-related quality of life benefits of children randomized to wear spectacles or contact lenses for 3 years using the Pediatric Refractive Error Profile. Methods. The Pediatric Refractive Error Profile was administered to 484 children who wore glasses at baseline. The children were then randomly assigned to wear contact lenses (n = 247) or spectacles (n = 237) for 3 years. The survey was administered at the baseline examination, at 1 month, and every 6 months for 3 years. Results. During 3 years, the overall quality of life improved 14.2 ± 18.1 units for contact lens wearers and 2.1 ± 14.6 units for spectacle wearers (p < 0.001). In all scales except the visual performance scales (Distance Vision, Near Vision, and Overall Vision), the quality of life improved more for older subjects than younger subjects. The three scales with the largest improvement in quality of life for contact lens wearers were Activities, Appearance, and Satisfaction with Correction. Conclusions. Myopic children younger than 12 years of age report better vision-related quality of life when they are fit with contact lenses than when they wear glasses. Older children, children who participate in recreational activities, children who are motivated to wear contact lenses, and children who do not like their appearance in glasses will benefit most.

Visual Function of Moderately Hyperopic 4- and 5-Year-Old Children in the Vision in Preschoolers - Hyperopia in Preschoolers Study.

PURPOSE To compare visual performance between emmetropic and uncorrected moderately hyperopic preschool-age children without strabismus or amblyopia. DESIGN Cross-sectional study. METHODS setting: Multicenter, institutional. patient or study population: Children aged 4 or 5 years. intervention or observation procedures: Visual functions were classified as normal or reduced for each child based on the 95% confidence interval for emmetropic individuals. Hyperopic (≥3.0 diopters [D] to ≤6.0 D in the most hyperopic meridian; astigmatism ≤1.50 D; anisometropia ≤1.0 D) and emmetropic status were determined by cycloplegic autorefraction. MAIN OUTCOME MEASURES Uncorrected monocular distance and binocular near visual acuity (VA); accommodative response; and near random dot stereoacuity. RESULTS Mean (± standard deviation) logMAR distance visual acuity (VA) among 248 emmetropic children was better than among 244 hyperopic children for the better (0.05 ± 0.10 vs 0.14 ± 0.11, P < .001) and worse eyes (0.10 ± 0.11 vs 0.19 ± 0.10, P < .001). Mean binocular logMAR near VA was better in emmetropic than in hyperopic children (0.13 ± 0.11 vs 0.21 ± 0.11, P < .001). Mean accommodative response for emmetropic children was lower than for hyperopic subjects for both Monocular Estimation Method (1.03 ± 0.51 D vs 2.03 ± 1.03 D, P < .001) and Grand Seiko (0.46 ± 0.45 D vs 0.99 ± 1.0 D, P < .001). Median near stereoacuity was better in emmetropic than in than hyperopic children (40 sec arc vs 120 sec arc, P < .001). The average number of reduced visual functions was lower in emmetropic than in hyperopic children (0.19 vs 1.0, P < .001). CONCLUSIONS VA, accommodative response, and stereoacuity were significantly reduced in moderate uncorrected hyperopic preschool children compared to emmetropic subjects. Those with higher hyperopia (≥4 D to ≤6 D) were at greatest risk, although more than half of children with lower magnitudes (≥3 D to <4 D) demonstrated 1 or more reductions in function.

School based vision centers: Striving to optimize learning

The successful delivery of comprehensive pediatric vision care after vision screening referral is a longstanding challenge that has significant implications for child wellness. In response to the many known obstacles that prevent the diagnosis and treatment of vision conditions, School-Based Vision Centers have been established in Framingham, MA and Boston, MA to provide easy access to comprehensive vision care following a failed vision screening. These on-site Vision Centers were developed to improve access to comprehensive vision care and treatment thereby correcting vision conditions that can adversely affect student academic achievement, athletic performance, and self-esteem. This paper highlights the collaboration between two public schools in Massachusetts and The New England Eye Institute and describes a multidisciplinary approach to comprehensive care delivery to high-risk pediatric populations in school-based settings. The ultimate goal of this model is to minimize visual barriers that may impede learning in order to maximize academic success and wellness.