Over prescribing

[maxwellfish]

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Uh oh, Now ophthalmologists are better at prescribing eyeglasses for children...

http://home.businesswire.com/portal...ewsLang=en&beanID=1868105982&viewID=news_view

 

[boston bound]

I Saw And Read That Article On Yahoo.news.com

 

[mdkurt]

That's a good article.

 

[cpw]

whatever 🙄 who's definition of "unnecessary" ???? there's no real evidence in that article.

 

[maxwellfish]

That's a good article.

Is it? Why is that kurt?

 

[Eyegirl2k7]

No kidding, cpw. There are prescribing guidelines, but not strict "YOU MUST PRESCRIBE FOR THIS AMOUNT OF REFRACTIVE ERROR" rules.

Sheesh.

🙄

 

[JennyW]

That's a good article.

That's a dreadful article. It basically attacks the program. When you look at the data, it says that out of 3600 kids referred 890 were given glasses, and out of those, 1 in 5 "didn't need them."

That basically says that 178 out of 100 000 children were treated inappropriately. That's 99.9% success. I don't know of any other screening program that is that successful. That's a lot better than most areas of medicine.

And what constitutes glasses that they don't need? If I have a 7 year old in my chair with reading trouble, and difficulty with close work, and he's a +0.50, and a CNP of 6 inches, you can pretty much bet that he's going to get a +1.00. How many strabismus specialists would say that's not needed? Probably a lot of them. There's no cutting and sewing involved.

Jen

 

[sammyiu]

Well said.
👍

 

[Andrew_Doan]

That's a good article.

I agree with mdkurt. This is a good article. Pediatric ophthalmologists do an outstanding job prescribing glasses to children. Certainly better than optometrists and general ophthalmologists.

After spending 10 weeks with pediatric ophthalmologists, I know for certain that it's rare to see ODs and general OMDs performing proper cycloplegic refractions. In addition, for the kids running around with +1.00 sphere glasses, most of the kids don't need them. The power of accommodation in young children well exceeds the +1.00 sphere prescribed to them.

 

[mdkurt]

I think it just helps to reinforce that unless a child is amblyopic or is developing strabismus, that child does not need glasses. The visual needs of a child are much different than those of an adult.

 

[cpw]

I think it just helps to reinforce that unless a child is amblyopic or is developing strabismus, that child does not need glasses. The visual needs of a child are much different than those of an adult.

but the goal is to correct the child BEFORE they become amblyopic

 

[Andrew_Doan]

but the goal is to correct the child BEFORE they become amblyopic

I agree if there is a large refractive need. However, +1.00 or even +2.00 spheres in a child with a refraction of +1.50 sphere OD and OS is not going to prevent amblyopia. This is what the article was referring to.

I think school screening programs are wonderful and catch problems early. On the other had, it's hard for me to agree with giving a child $250 glasses for "close-up work". If the child doesn't need it, then he/she will never use them. If you have worked with kids, then you'll know how hard it is to get them to do something that they do need. It'll be impossible to make kids use glasses that aren't helping. 😉

Over prescribing of glasses is a financial drain for families.

 

[JennyW]

I agree with mdkurt. This is a good article. Pediatric ophthalmologists do an outstanding job prescribing glasses to children. Certainly better than optometrists and general ophthalmologists.

After spending 10 weeks with pediatric ophthalmologists, I know for certain that it's rare to see ODs and general OMDs performing proper cycloplegic refractions. In addition, for the kids running around with +1.00 sphere glasses, most of the kids don't need them. The power of accommodation in young children well exceeds the +1.00 sphere prescribed to them.

I guess this is just one of those philosphical differences between OMDs and ODs.

I've had hundreds of children in my office who have struggled with reading and schoolwork due to eyestrain and headaches who were evaluated by OMDs and pediatric OMDs only to be told "there's nothing wrong." However, with their MEMs of +1.00 and their amplitudes of 6.00, and their CNPs of 6 inches, a low plus lens does wonders. I've seen it work hundreds of times.
Reading scores have shot way up, and their ability to do their homework increases from 10 minutes to 2 hours before eyestrain sets in.

This is not to say that all children with reading difficulties need reading glasses, but again, I'm not so sure that this is a responsible article because it's conclusion basically seems to be that "pediatric OMDs are right, while everyone else is wrong." when in reality, it's most likely just a philosophical difference.

And before anyone tries to accuse me of being motivated by profit, I should point out that I do NOT have a dispensary in my office.

Jen

 

[JennyW]

I think it just helps to reinforce that unless a child is amblyopic or is developing strabismus, that child does not need glasses. The visual needs of a child are much different than those of an adult.

Again, I have to respectfully disagree. I have to admit that I have not been able to access the full text of this study yet, but from the tone the press release, it seems that the authors have a philosophy of using glasses only to "correct a defect" while many ODs approach it from the perspective of using glasses as a way of "enhancing performance." And I've seen it work hundreds if not thousands of times.

Simply because a child is not strabismic or amblyopic does not mean that they may not be able to benefit from glasses.

And again, before someone comes at me with the tired old "profit motive" argument, I do NOT have a dispensary in my office.

Jen

 

[Richard_Hom]

I agree with mdkurt. This is a good article. Pediatric ophthalmologists do an outstanding job prescribing glasses to children. Certainly better than optometrists and general ophthalmologists.

After spending 10 weeks with pediatric ophthalmologists, I know for certain that it's rare to see ODs and general OMDs performing proper cycloplegic refractions. In addition, for the kids running around with +1.00 sphere glasses, most of the kids don't need them. The power of accommodation in young children well exceeds the +1.00 sphere prescribed to them.

Dr. Doan,

This is a good article in the context of the study design. However, as you know, the study design and its conclusion may be different from what the popular press concludes for its benefit.

Pediatric ophthalmologists and behavioral/pediatric optometrists have different mantras and therefore may rarely agree on the purpose of glassses for children.

Although I may agree with some of the conclusions of the article, an unfamiliarilty with the optoemtric model and glasses may obscure the value of glasses in many children.

IMHO of course,

 

[Andrew_Doan]

Although I may agree with some of the conclusions of the article, an unfamiliarilty with the optoemtric model and glasses may obscure the value of glasses in many children.

Again, I have to respectfully disagree. I have to admit that I have not been able to access the full text of this study yet, but from the tone the press release, it seems that the authors have a philosophy of using glasses only to "correct a defect" while many ODs approach it from the perspective of using glasses as a way of "enhancing performance." And I've seen it work hundreds if not thousands of times.

Simply because a child is not strabismic or amblyopic does not mean that they may not be able to benefit from glasses.

These are valid points. If a $250 pair of glasses can increase school performance and quality of life, then that's an inexpensive way to increase productivity! 😉