Proactive use of cycloplegia in children reported in UK survey
Click Here to Manage Email Alerts
Most optometrists report proactive use of cycloplegia but may still wish to have more evidence-based resources on which to base their decisions, according to a study in Ophthalmic and Physiological Optics.
“Despite considerable clinical benets, the use of cycloplegic eye drops incur a number of undesirable side effects for children,” Lesley A. Doyle, PhD, Biomedical Sciences Research Institute, University of Ulster, and colleagues wrote. “Whilst practitioners may be aware of the benets of cycloplegia when assessing refractive error, there is limited clinical guidance regarding when cycloplegia is essential to obtain an accurate assessment of refractive error and when it is safe to forgo.”
In a U.K.-based optometry study, 1,000 randomly selected members of the College of Optometrists were surveyed to determine current opinion regarding the use of cycloplegia on children. Each questionnaire comprised 42 questions answered via email.
Thirty-one percent of the selected members completed the survey. Study results showed 60% of practitioners agreed they were confident in performing cycloplegic refraction, and 77% were confident in instilling cyclopentolate. Further questioning showed 69% are not concerned about the length of the procedure, and 72% are not discouraged by side effects.
While most practitioners reported they would not test on children 2 years old or younger (66%) or in school ages 5 to 7 and 8 to 11 (25% vs. 47%, 12% vs. 45%), they were confident in carrying out cycloplegic refraction in preschool ages 2 to 4 years (34% vs. 27%).
Overall, a strong correlation was found between recently qualified practitioners and use of cycloplegia (P = .003).
“The majority of practitioners responded in a positive manner to the use of cycloplegic refraction, expressing condence in both instilling and using cyclopentolate without being discouraged by potential side effects,” Doyle and colleagues concluded. “However, the outcomes indicate practitioners may appreciate more comprehensive evidence-based resources to inform decision-making in relation to the use of cycloplegia in pediatric examinations.”
Perspective
Back to Top
Dashaini Retnasothie, OD, MS, FAAO
Doyle and colleagues created and administered a questionnaire to U.K. optometrists to assess their use of cycloplegia and methods of spectacle prescribing in children. Although survey results are subjective – the study is based in another country, and some who participated do not see pediatric patients – there are still key points that are universally helpful. Most optometrists in the study reported:
- Using cycloplegia to evaluate children up to age 5 years;
- No significant side effects; and
- Parents were receptive to the use of cycloplegia.
The 2017 American Optometric Association guidelines for a pediatric vision examination contain a consensus-based statement saying cycloplegic retinoscopy is the preferred technique for initial evaluations for preschoolers, but there isn’t sufficient evidence to support or refute this recommendation. The authors of this study report a similar issue with guidelines in the U.K. When recommendations cannot be based on evidence, we must rely on consensus, and this study sheds light on what that is, even if in a different country. Optometrists in the U.S. can look at the above points (as well as the spectacle prescribing results provided in the study) as a comparison to their own practice, especially until more evidence becomes available.
Collapse
Read more about
Click Here to Manage Email Alerts