Tuesday, October 7, 2014

Spectacle correction versus no spectacles for prevention of strabismus in hyperopic children.

Spectacle correction versus no spectacles for prevention of strabismus in hyperopic children.

"....Hyperopia (farsightedness) in infancy requires accommodative effort to bring images into focus. Prolonged accommodative effort has been associated with an increased risk of strabismus (eye misalignment). Strabismus makes it difficult for the eyes to work together and may result in symptoms of asthenopia (eye strain) and intermittent diplopia (double vision), and makes near work tasks difficult to complete. Untreated strabismus may result in the development of amblyopia (lazy eye). The prescription of spectacles to correct hyperopic refractive error is believed to prevent the development of strabismus........Although children who were allocated to the spectacle group were less likely to develop strabismus and less likely to have visual acuity worse than 20/30 children allocated to no spectacles, these effects may have been chance findings, or due to bias. Due to the high risk of bias and poor reporting of included trials, the true effect of spectacle correction for hyperopia on strabismus is still uncertain....."

Comments: This was an assessment by Cochrane Reviews. Cochrane takes a very detailed assessment of current evidence that supports the diagnosis and treatment of numerous disorders. They use extensive statistics to assess the research and to determine the validity of its conclusions. Because there is seldom a perfect research project that results in a perfect research publication, you often get the impression that Cochrane dislikes 99.99% of all research published. 

What I usually recommend is to evaluated the research, the assessment of that research and what my patients need to solve their problems. This paper starts out noting that uncorrected hyperopia can lead to strabismus, amblyopia and a whole host of other symptoms that interfere with ones quality of life.

Although you should always use the best available evidence based clinical approach, you should not be bound by this research, it's often restrictive results and its possible non-appropriate application for any one individual patient. 

As always use this research and your own clinical experience to determine what is best for each individual you see. A great example of this was those who stated that amblyopia could not be treated after a certain age because of a misunderstanding of the available research in this area. Functional optometrists had many clinical experiences and published numerous papers from case reports to multipatient studies at different evidence levels that supported treating those with amblyopia at any age. Unlike many of our medical colleagues we actually helped these patients as opposed to those who told their patients that "nothing could be done".

Use research as a guide in patient care and not as a pair of handcuffs binding your approach to improve your patients' quality of life. DM

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