Modifications Made to the Refractive Result when Prescribing Spectacles

Using electronic medical record data to establish and monitor the distribution of refractive errors. JOURNAL OF OPTOMETRY 2022;15 Suppl 1:S32-S42. [PMID: 36220741 PMCID: PMC9732486 DOI: 10.1016/j.optom.2022.09.001]

OBJECTIVE

To establish the baseline distribution of refractive errors and associated factors amongst a population that attended primary care optometry clinics.

DESIGN

Retrospective cross sectional cohort study of electronic medical records (EMR).

METHODS

Electronic medical record data was extracted from forty optometry clinics, representing a mix of urban and rural areas in Ireland. The analysis was confined to demographic and clinical data gathered over a sixty-month period between 2015 and 2019. Distribution rates were calculated using the absolute and relative frequencies of refractive error in the dataset, stratified for age and gender using the following definitions: high myopia ≤ -6.00 D, myopia ≤ -0.50 D, hyperopia ≥ +0.50 D, astigmatism ≤ -0.75 DC and anisometropia ≥ 1.00 D. Visual acuity data was used to explore vision impairment rates in the population. Further analysis was carried out on a gender and age-adjusted subset of the EMR data, to match the proportion of patients in each age grouping to the population distribution in the most recent (2016) Irish census.

RESULTS

153,598 clinic records were eligible for analysis. Refractive errors ranged from -26.00 to +18.50 D. Myopia was present in 32.7%, of which high myopia represented 2.4%, hyperopia in 40.1%, astigmatism in 38.3% and anisometropia in 13.4% of participants. The clinic distribution of hyperopia, astigmatism and anisometropia peaked in older age groups, whilst the myopia burden was highest amongst people in their twenties. A higher proportion of females were myopic, whilst a higher proportion of males were hyperopic and astigmatic. Vision impairment (LogMAR > 0.3) was present in 2.4% of participants. In the gender and age- adjusted distribution model, myopia was the most common refractive state, affecting 38.8% of patients.

CONCLUSION

Although EMR data is not representative of the population as a whole, it is likely to provide a reasonable representation of the distribution of clinically significant (symptomatic) refractive errors. In the absence of any ongoing traditional epidemiological studies of refractive error in Ireland, this study establishes, for the first time, the distribution of refractive errors observed in clinical practice settings. This will serve as a baseline for future temporal trend analysis of the changing pattern of the distribution of refractive error in EMR data. This methodology could be deployed as a useful epidemiological resource in similar settings where primary eyecare coverage for the management of refractive error is well established.

What are patients' beliefs about, and experiences of, adaptation to glasses and how does this affect their wearing habits?

PURPOSE

It is well known that some patients experience difficulties adapting to new glasses. However, little is known about what patients themselves understand of the adaptation process, and how this influences their attitudes and the decisions they make when adapting to a new pair of glasses. Nor is it understood whether these factors affect their wearing habits.

METHODS

We conducted four focus groups. Participants were 22 glasses wearers (mean ± SD age 43 ± 14 years, range 21-71 years) who reported they: (1) wore spectacle correction for distance vision (single vision, bifocal or progressive lenses); (2) had struggled to get used to a new pair of glasses and (3) sometimes chose not to wear their distance correction. Focus groups were audio recorded, transcribed verbatim and analysed thematically.

RESULTS

We identified three themes. Trust is about how participants' trust in their optometrist and themselves influences the likelihood of them adapting successfully to new glasses. Conflict describes how the advice patients have received about adapting to glasses can conflict with what they have experienced and how this conflict influences their expectations. Part of Me explores how participants' experiences and feelings about their glasses are important to adaptation and this includes physical, visual, emotional and behavioural aspects.

CONCLUSIONS

The traditional optometric perspective of adaptation to glasses is much narrower than that held by patients, and significantly underestimates the physical, behavioural and emotional adaptation that patients must go through in order to feel fully comfortable wearing their glasses. Patients should receive significantly more information about adaptation, including symptoms that may be experienced and why these happen, practical tips to aid adaptation, and when and how to raise concerns. Patients should also receive information about the day-to-day effects of blur adaptation to avoid them not wearing their glasses, including for vision-critical tasks such as driving.

Spectacle non-tolerance in clinical practice - a systematic review with meta-analysis

PURPOSE

Spectacle non-tolerance or adverse events to spectacle wear are serious concerns for both patients and practitioners. Non-tolerance may contribute to a negative impact on the practitioner's ability and practice. Therefore, a detailed understanding of frequency and causes of spectacle non-tolerance in clinical ophthalmic practice is essential. This review aimed to determine the prevalence and causes of non-tolerance to spectacles prescribed and dispensed in clinical practice.

METHOD

The current systematic review included quantitative studies published in the English language that reported spectacle non-tolerance in clinical practice. A comprehensive search was conducted in PubMed, Scopus and the Web of Science database for studies published until 13 July 2020. An adapted version of the Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies was used to assess the quality of each included study. Five investigations with 205,478 study participants were included in the review. The prevalence of spectacle non-tolerance from individual studies was pooled using MetaXL software. The pooled prevalence of spectacle non-tolerance was 2.1% (95% CI: 1.6-2.7) ranging from 1.6% to 3.0%. The papers were also reviewed to identify the potential causes of non-tolerances. Nearly half reported that non-tolerance (47.4%) was due to an error in refraction. Other causes identified were errors related to communication (16.3%), dispensing (13.5%), non-adaptation (9.7%), data entry (8.7%), binocular vision (7.4%) and ocular pathology (6.4%).

SUMMARY

This review improves our understanding of spectacle non-tolerance in clinical practice. This is important because non-tolerance may lead to spectacle wear discontinuation, which may deprive patients of optimal vision. Increased non-tolerance in clinical practice may affect a clinician's reputation and incur additional costs associated with reassessments and replacements. Spectacle non-tolerance occurred due to a multitude of factors related to optical dispensing and wearer adaptation. Therefore, there is a need for vigilance while prescribing spectacles. The limited evidence highlights the need for more studies, especially in limited-resource settings, to improve the quality of refractive error services.

Motivators and deterrents for seeking eye care in a Canadian region

BACKGROUND

Motivators and deterrents for seeking eye care in a Canadian setting were sought using a qualitative study. Provincial deregulation of eyewear dispensing in 2010 allows consumers to order eyewear without an optical prescription, thus eliminating a potential motivator for obtaining an eye examination.

METHODS

Convenience sampling was used to obtain 25 members of the public who contributed to one of seven focus groups that were facilitated, audiotaped, anonymised and transcribed. Participants completed a demographic questionnaire. Focus group data analysis employed grounded theory and theme saturation determined the number of focus groups.

RESULTS

Nine men and 16 women participated, ranging in age from 18 to 71 years (mean 41.5; median 40.0). Three main themes were identified as influencers for seeking eye care: priority; advice; and capacity. Priority served as a motivator ('lived experience', 'symptoms', and 'habit') and deterrent ('test distress', 'asymptomatic', 'don't know' and 'other priorities'). Advice was a motivator ('professional' and 'family/friends'), while capacity was a motivator ('insurance') and deterrent ('cost').

CONCLUSION

The motivators and deterrents of seeking eye care in these focus groups were framed by three themes. Key findings not reported previously included the motivators of 'habit', 'advice' and 'insurance' and the potential deterrent of 'test distress'. These factors should be added to other previously reported motivators and deterrents in further exploration of Canadian eye-care seeking behaviours. Such knowledge is needed to develop strategies for improving eye-care literacy in Canada. This is particularly important because eyewear deregulation and/or online eye examinations may encourage members of the public to bypass comprehensive eye care without fully understanding the implications of this decision for their health and wellness.