How often are spectacles prescribed to "normal" preschool children?
BACKGROUND
Legislation to require formal eye examination prior to school entry is being considered in several states and is supported by optical trade organizations. Pediatric ophthalmologists cite anecdotal cases that suggest children receive spectacles unnecessarily, but data to support this are lacking.


METHODS
Eye examination results from children referred to local eye doctors following a statewide preschool photoscreening program were reviewed to determine how often glasses were prescribed for children who did not have amblyogenic factors (those with false-positive screenings).


RESULTS
Of 102,508 preschool children screened, 890 children did not have amblyogenic factors (false-positive screenings). Nevertheless, spectacles were prescribed for 174 (19.5%) of these children. Only 5/272 children (1.8%) were prescribed glasses following examination by a pediatric ophthalmologist, while glasses were prescribed for 24/205 children (11.7%) examined by comprehensive ophthalmologists and 145/413 (35.1%) of children seen by optometrists (P < 0.001). Eighty children were prescribed glasses for refractive error ranging from -0.75 sph to +2.00 sph, 32 of whom had spherical equivalent of 1D or less.


CONCLUSIONS
While some preschoolers without amblyogenic factors may require spectacle correction, a significant percentage of children are probably prescribed glasses unnecessarily. Extrapolation of these data to the United States population suggests that a single mandatory eye examination prior to school entry could cost over 200,000,000 US dollars yearly for unnecessary spectacles. Vision screening programs with high referral rates, and health policy proposals supporting comprehensive preschool eye exams, must consider these unnecessary costs.
Donahue
Sean P
SP
Tennessee Lions' Eye Center, Vanderbilt Children's Hospital, Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN 37212, USA. sean.donahue@vanderbilt.edu
D002675:Child, Preschool; D005139:Eyeglasses / Q000706:statistics & numerical data*; D005189:False Positive Reactions; D006801:Humans; D007223:Infant; D007883:Legislation, Medical; D009885:Ophthalmology / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D009907:Optometry / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D055656:Prescriptions / Q000706:statistics & numerical data*; D013714:Tennessee; D014786:Vision Disorders / Q000628:therapy; D015351:Vision Screening / Q000331:legislation & jurisprudence