====== Guidelines for Prescribing Glasses in Children ======

===== Preschool-Aged Children =====


^ Condition                           ^  Refractive Errors                                  |||
|                                     | Age < 1 year        | Age 1-2 Years  | Age 2-3 years  |
^ Isoametropia                                                                             ||||
| Myopia                              | ≥ -5.00             | ≥ -4.00        | ≥ -3.00        |
| Hyperopia (no strabismus) ☆         | ≥ +6.00             | ≥ +5.00        | ≥  +4.50       |
| Hyperopia with esotropia ★          | ≥ +2.50             | ≥ +2.00        | ≥ +1.50        |
| Astigmatism                         | ≥ 3.00              | ≥ 2.50         | ≥ 2.00         |
^ Anisometropia without strabismus ♠                                                       ||||
| Myopia                              | ≥ -4.00             | ≥ -3.00        | ≥ -3.00        |
| Hyperopia                           | ≥ +2.50             | ≥ +2.00        | ≥ +1.50        |
| Astigmatism                         | ≥ 2.50              | ≥ 2.00         | ≥ 2.00         |
| Oblique Astigmatism ♦               |  ≥ 1.00                                             |||
☆ may under-correct by +1.00 to +3.00\\
★ give full plus\\
♠ Threshold for correction of anisometropia should be lower if the child has strabismus\\
♦ Defined as >15 degrees from 90 or 180 meridian\\
 
  * These values are based on consensus of expert opinion (see AAO source below)
  * For children 4 years and older: prescriptions should be based on visual acuity measurements and visual functioning when at all possible 

===== School-Aged Children =====

==== General guidelines: ====

  - Glasses should be prescribed based on visual acuity testing at distance and near. 
  - An appropriate screening history should include questions about difficulty with near reading vision and distance vision 

==== Myopia: ====

Prescribe glasses for children with distance vision worse than 20/30

==== Astigmatism: ====

Prescribe glasses for children with distance or near vision worse than 20/30

==== Hyperopia without Esotropia: ====
 
  - Prescribe glasses for children with vision worse than 20/30 at near or distance
  - Prescribing glasses for children with 20/20 vision may be appropriate if vision is worse at near viewing or significant reading difficulty that appears to be related to poor accommodative effort.  
  - Glasses should have less than the full amount of hyperopia.  
    - The amount of under-correction can be based on the amount of hyperopia that improves vision 
    - The amount of under-correction can be from 1 to 3 diopters to help encourage glasses wear. 

==== Hyperopia with Esotropia: ====

Prescribe full cycloplegic refraction

==== Anisometropia: ====
 
  - Correct the difference between the two eyes to within 1 diopter
  - If one eye is hyperopic and one is myopic it may be appropriate to undercorrect the hyperopic eye by 0.5 to 1 diopter. 
  - When the child has reached visual maturity, glasses may be discontinued if desired by the family.  
 
===== Sources =====
  * Preschool-Aged children information: Adapted from AAO Preferred Practice Pattern 2012, Pediatric Eye Evaluations p. 19 [[http://www.aao.org/Assets/7364f939-97b3-4c2e-948f-e6c3d78cb45d/634965436524370000/pediatric-eye-evaluations-pdf|PDF from AAO Website]]
  * School-Aged Children is consensus from the Pediatric Ophthalmology Section, Department of Ophthalmology and Visual Sciences, University of Iowa

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