A survey of hospital Optometrists’ perceptions to assessment and management of accommodation in a low vision clinical setting

Background: The study aimed to survey hospital Optometrists to investigate accommodative function assessments employed in low vision clinics (LVCs). The research also aimed to explore the management methods used in cases of accommodative dysfunction.
Methods: Data were collected from delegates attending the 40th Annual Hospital Optometry Conference. All delegates (n=200) were provided with a hard copy of the survey to complete, investigating their practice with regards to assessment of accommodative function in low vision clinics (LVCs). The survey comprised 15 questions using 5-point Likert scales to grade responses.
Results: Questionnaires were returned from n=26 delegates. Over 50% of respondents reported that they measured amplitude of accommodation ‘never’ or a little of the time’ (adult low vision clinic 60%, paediatric low vision clinic 53%). In adult LVCs, accommodative responses (to assess for a lag or lead of accommodation) were examined ‘never’ or ‘a little of the time’ in 93% of respondents. In paediatric LVCs, accommodative responses were assessed ‘all of the time’ or ‘most of the time’ in only 43% of respondents. Reasons for this included; not relevant to measure (43%), prior cycloplegic refraction (17.4%), inappropriate equipment (8.7%) or time constraints (17.4%). 53% of respondents reported that assessment of accommodation influenced prescribing decisions for hyperopic patients only, with 20% reporting that measurement of accommodation influenced prescribing for all patients.
Conclusions: This study highlights the low proportion of hospital Optometrists working in LVCs who routinely consider accommodative function during clinical assessment. This has implications for training and service provision.

Acknowledgements: The authors wish to acknowledge the support of the Vision Translational Research Group (TRG) who funded travel to the Hospital Optometry Conference.