Prescribing eyeglass correction for astigmatism in infancy and early childhood: A survey of AAPOS members

Purpose: To determine prescribing practices of pediatric ophthalmologists for astigmatism and astigmatic anisometropia in infants and young children. Methods: A survey was sent to the 700 North American AAPOS members listed in the 2004 web site directory. Results: A total of 412/700 surveys (59%) were returned. The level of astigmatism at which pediatric ophthalmologists prescribe eyeglasses for astigmatism varies considerably across the age range from birth to 3 years. The level at which 50% would prescribe glasses was <4.00 D from 0 to <6 months and decreased to <2.00 D by 2 to <3 years. Furthermore, one-fifth indicated that they would not prescribe eyeglasses for astigmatism in infants <6 months of age. Prescribing practices for astigmatic anisometropia were slightly less variable across age, with 50% of respondents indicating that they would prescribe eyeglasses for astigmatic anisometropia <3.00 D from 0 to <6 months, decreasing to <1.50 D by 2 to <3 years. Conclusions: The American Academy of Ophthalmology Preferred Practice Patterns guidelines accurately reflect prescribing practices of pediatric ophthalmologists for 1- and 2-year-old children for bilateral astigmatism and astigmatic anisometropia. However, the AAO guidelines do not accurately reflect the prescribing practices for children in the 0 to <1-year age range. For children 0 to <6 months of age, pediatric ophthalmologists indicate that they typically require a higher amount of astigmatism or astigmatic anisometropia than that recommended by the AAO guidelines, or they do not prescribe glasses at all.