To prescribe or not to prescribe? Guidelines for spectacle prescribing in infants and children

Abstract

This paper discusses the considerations for prescribing a refractive correction in infants and children up to and including school age, with reference to the current literature. The focus is on children who do not have other disorders, for example, binocular vision anomalies, such as strabismus, significant heterophoria or convergence excess. However, refractive amblyogenic factors are discussed, as is prescribing for refractive amblyopia. Based on this discussion, guidelines are proposed, which indicate when to prescribe spectacles and what amount of refractive error should be corrected. It may be argued that these are premature because there are many questions that remain unanswered and we do not have the quality of evidence that we would like; the clinician, however, must make decisions on whether and what to prescribe when examining a child. These guidelines are to aid clinicians in their current clinical decision making.

Key words:

• amblyopia
• anisometropia
• astigmatism
• children's vision
• hyperopia
• myopia
• refractive error