Prescribing patterns for paediatric hyperopia among paediatric eye care providers.

PURPOSE: To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. METHODS: Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test. RESULTS: Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. CONCLUSION: Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

The evolution of learning.

Most processes or forms of learning have been treated almost as special creations, each as an independent process unrelated to others. This review offers an evolutionary cladogram linking nearly one hundred forms of learning and showing the paths through which they evolved. Many processes have multiple forms. There are at least five imprinting processes, eleven varieties of Pavlovian conditioning, ten of instrumental conditioning, and eight forms of mimicry and imitation. Song learning evolved independently in at least six groups of animals, and movement imitation in three (great apes, cetaceans and psittacine birds). The cladogram also involves at least eight new processes: abstract concept formation, percussive mimicry, cross-modal imitation, apo-conditioning, hybrid conditioning, proto-pantomime, prosodic mimicry, and image-mediated learning. At least eight of the processes evolved from more than one source. Multiple sources are of course consistent with modern evolutionary theory, as seen in some obligate symbionts, and gene-swapping organisms. Song learning is believed to have evolved from two processes: auditory imprinting and skill learning. Many single words evolved from three sources: vocal mimicry, discrimination learning, and abstract concept formation.