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Task force reaffirms recommendation for at least one vision screening in children
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The U.S. Preventive Services Task Force updated its 2011 recommendations for children aged 3 to 5 years and reaffirmed that children in this age range receive at least one vision screening to detect amblyopia or its risk factors.
The 2011 USPSTF recommendation suggested children aged 3 to 5 years receive at least one vision screening to detect amblyopia. This update confirmed the need for a screening and also noted that current evidence shows the benefits of screenings to detect amblyopia or its risk factors below the age of 3 years are uncertain.
According to the report, treatment of amblyopia in children aged 3 to 5 years can result in permanent vision improvements for the rest of their lifetime. The USPSTF evaluated several studies to gauge rates of pediatric amblyopia, potential harms of screening and treatment, and effect of amblyopia treatment in this age group.
“Treatment of amblyopia is associated with moderate improvements in visual acuity in children aged 3 to 5 years, which are likely to result in permanent improvements throughout life. The USPSTF concluded that the benefits are moderate because untreated amblyopia results in permanent, uncorrectable vision loss, and the benefits of screening and treatment potentially can be experienced over a child’s lifetime,” the task force wrote.
The task force found the potential harms of screenings, such as false positives in low-prevalence populations, and resulting treatment in this pediatric age group are small.
In a related editorial in JAMA Ophthalmology, Sean P. Donahue, MD, PhD, wrote that the new recommendation is “essentially unchanged from the 2011 recommendation” and is “disappointing” for children younger than 3 years. However, the USPSTF should be commended for identifying the importance of vision screening for all children aged 3 to 5 years, he said, adding that evidence from future studies “hopefully” would support replacement of the I rating “with a stronger one for the screening of younger children.”
The American Optometric Association also addressed the new recommendations and said they were “disappointed” with USPSTF’s findings.– by Robert Linnehan
Disclosures: Donahue reports he has been a consultant for Welch-Allyn and Gobiquity during the past 3 years. The other authors report no relevant financial disclosures.
Editor’s note: This article has been updated to add perspective published in JAMA Ophthalmology and reaction from the American Optometric Association.
Perspective
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Robert S. Gold, MD
As the OSN Pediatrics/Strabismus Section Editor, I have been asked to write a perspective on the United States Preventive Services Task Force study that concluded it recommended “vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harm of vision screening in children younger than 3 years.”
I write this opinion based on 30 years in the private practice of pediatric ophthalmology in the Orlando, Florida, area and my clinical experience in the evaluation of children of all ages to rule out and treat amblyopia. I am glad that the task force agrees that a screening between the ages of 3 to 5 years old is recommended. But while the task force has concluded that there is not enough evidence to include the screening of children younger than age 3 years, in the everyday world of a pediatric ophthalmologist, I would disagree as I see the evidence each and every day. I credit my referring pediatricians and family physicians who screen these youngest children with multiple different credible methods, including newer technologies to identify refractive error concerns, strabismus or ocular media issues, and refer these patients to us at any age for a comprehensive ophthalmic examination. While some of these screenings result in false positives, many identify patients who indeed have amblyopia, and early treatment with glasses and/or patching can be vision saving if instituted early in these preverbal children. Parents are so thankful for this early intervention and diagnosis of amblyopia and the ability to preserve vision in these young patients. I encourage our primary doctors to continue to be diligent to screen children of any age before age 5 years, and I would encourage the USPSTF to relook at this younger age group during their next study.
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