PRESCRIPTION PRACTICES FOR BORDERLINE HYPEROPIA AMONG OPTOMETRISTS IN LAHORE.

Abstract

Background: Borderline hyperopia is frequently encountered in optometric practice, yet its management remains uncertain because refractive magnitude alone does not determine the need for correction. Symptoms, accommodative capacity, binocular vision, age, and visual demands may influence prescribing decisions. In settings where formal guidance is limited, practitioners may rely on personal experience and individual clinical judgement, producing inconsistent care. Evidence regarding these practices in Pakistan remains scarce, despite their relevance to patient comfort, visual performance, and outcomes.

Objective: To investigate prescribing practices for borderline hyperopia and identify factors influencing clinical decision-making among optometrists practising in Lahore, Pakistan.

Methods: A descriptive cross-sectional survey included 150 qualified optometrists recruited through convenience sampling from government hospitals, private eye clinics, ophthalmology departments, and optical centres in Lahore. A pre-tested structured questionnaire assessed demographic characteristics, clinical experience, refractive techniques, prescribing approaches, influential factors, management of asymptomatic patients, and views regarding clinical guidelines. Data were analysed in SPSS using frequencies, percentages, and chi-square tests, with statistical significance set at p<0.05. Ethical approval and informed consent were obtained.

Results: The mean participant age was 28.28 years; 51.3% were female, and 65.3% had 1–3 years of clinical experience. Borderline hyperopia was encountered frequently by 56.7% and regularly by 18.0%. Combined objective and subjective refraction was used by 56.0%. An integrated approach based on symptoms and refractive findings was reported by 42.0%. Symptoms were the leading prescribing determinant for 47.3%, followed by age for 28.7%, refractive magnitude for 17.3%, and occupational visual demands for 6.7%. For asymptomatic patients, 63.3% prescribed full correction, 20.0% partial correction, and 16.7% observation. Inconsistent guidance was reported by 86.7%, while 89.3% strongly supported standardized guidelines.

Conclusion: Prescribing practices varied substantially, particularly for asymptomatic patients. Evidence-based guidance incorporating symptoms, refractive findings, accommodation, binocular vision, age, and functional demands may improve consistency while preserving individualized clinical judgement.

Keywords: Clinical Decision-Making; Cross-Sectional Studies; Hyperopia; Optometrists; Pakistan; Refraction, Ocular; Surveys and Questionnaires