Authors: (including presenting author): :
Chan M S
Keyword 1: :
Paediatric Optometry clinic
Introduction: :
Paediatric optometry clinic (POC) was started in December 2022, the targeted patients are mainly amblyopic children affected by refractive errors. The optometrist will enhance their vision through spectacles correction and visual training. Amblyopia is a reversible neurodevelopment problem, and visual acuity worse than 6/9 is treated as amblyopia (Sit et. Al., 2023). Vision development is sensitive before the age of 8 (Williams, 2009). For this reason, our clinic’s goal is to correct the patient’s vision to normal (Visual acuity 6/6) during this sensitive period. The patients in this clinic are referred by ophthalmologist or paediatric ophthalmologist. The patient’s vision performance will be assessed, and home training may be instructed according to their needs.
Objectives: :
The objective of this study is to review the improvement of VA after patient visit the POC, and to identify the methods to enhance the visual improvement.
Methodology: :
This clinical audit reviewed the patients who attended POC from May of 2024 to April of 2025. There were 100 patients, the average age of patients was 7.6 years old, the youngest patient was 4 years old and the oldest patient was 22 years old and had an accommodation problem. 48 patients were male and 52 patients were female.
95% of patient was below 11 years old, and 73% was 8 or below 8 years old. For those 100 patients, 52 patients attended one time within the review period, and 48 patients had follow-up during this period. Both of their eyes will be analyzed independently according to the power of refractive error, Visual Acuity (VA) and the VA changes among the visits.
Result & Outcome: :
There was a total of 200 eyes in this study.Most of the improvement was revealed in the second visit after prescription and home treatment. The change of VA in first and second visit is statistically significant (P value: less than 0.0001; 95% confidence interval if the difference from -0.293 to -0.143, t=5.8695, df=44, standard error of difference = 0.037). There were 98 eyes in the follow up group, 54% of eye showed 6/6 in the first visit, and the VA was remained stable in the second visit. If we excluded the 54% of normal VA eyes (VA 6/6) in the first two visits, there were 45 eyes with VA worse than 6/6 in the second visit. 9.2% remained stable VA, 13.3% showed 1 line improvement of VA, 6.1% showed 2 lines improvement, 10.2% showed 3 lines improvement, there was no 4 lines improvement and 3.1% showed 5 lines improvement. Finally, there was 2% with 1 line and 2 lines worse in VA respectively. The eye with high hyperopia and high astigmatism showed poor VA (6/18 and 6/24).
High reflective error was correlated to amblyopia because poorly uncorrected vision alters vision development. For this reason, we focus on analyzing the group of very high myopia (>-6.00D), very high hyperopia (>+5.00D) and very high astigmatism power (cyl >-3.00) and the changes of VA among the groups. Most of the patients with high refractive error showed normal VA after the second visit of POC. According to the analysis of refractive errors and VA in POC, early detection and management were important to retain the normal vision in amblyopic patients. Most of the patients with different refractive error had normal VA after spectacles correction and visual training within one year. Also, compliance is crucial for the success of the vision improvement in POC. Therefore, POC in Tuen Mun Eye Center is investigating some web-based visual trainings in order to increase the patient interests. Also, Optometrist can assess the progress of the training through the internet. And the training progress can be made more quantitative by the result of the web-based training.
