This article is more than 5 years old. Information may no longer be current.
AOA supports annual comprehensive exams for all school-age kids
Click Here to Manage Email Alerts
The American Optometric Association recently released its newly revised Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination for pediatric eye health.
Evidence now supports that children ages 6 to 18 years should receive a comprehensive eye exam before entering the first grade and annually thereafter, according to a press release from the AOA. The revised guideline is based on a 3-year systematic review of the latest research.
AOA President Christopher J. Quinn, OD, FAAO, spoke with Primary Care Optometry News about the new guidelines.
PCON: The guidelines state that one in five preschoolers has a vision problem. Can you elaborate on this?
Quinn: The main problems are refractive error, myopia, hyperopia, nearsighted, farsightedness and astigmatism. These are all conditions that are prevalent and result in kids having blurry vision. Identifying those kids as they are entering school and before they even start is critically important so we can maximize their performance.
There is a whole range of other issues kids have, such as coordinating movement of their eyes when changing focus from distance to near. Those things are equally important in maximizing visual performance. So, while we tend to think of refractive error as the main thing, it is only part of the problem. This is why a comprehensive exam is so important, as screenings only test for one thing.
Your comprehensive eye exam is going to capture every part of the problem and offer a remedy for it. When a kid fails a screening, it's greater than likely that they will not end up getting care, as there is never follow-through. Ultimately, screenings are a really flawed approach to taking care of children’s vision.
Some people say: “Isn’t it better than nothing?” If you are one of the children who fails a screening and doesn’t get care, it’s worse than nothing. If you pass the screening, you’ve been screened for one thing, but there could be a hundred other problems, and none of the other conditions have been tested for. Screenings can deliver a false sense of security.
PCON: Can you explain the rationale for the switch in comprehensive eye exams from every 2 years to every year for children 6 to 18 years old?
Quinn: When our group looked at the evidence and the weight of the evidence, they made the recommendation for the annual eye exam. It’s a critical analysis of the published data, where the older guidelines were consensus-based.
For example, there is an increase in myopia, and this is happening worldwide. We know that it can degrade performance in school. It's important to identify that earlier so it can be treated properly.
The group looked at hundreds and hundreds of studies. The way the process works is, you elevate the studies and you grade the studies based on the quality of the evidence, and then you group the evidence together or the studies together based on certain categories and weigh the evidence based on a recommendation.
This helps answer questions and identify areas where there are gaps in evidence, which is a good way to stimulate research in areas where we have gaps, like in blue light and the effect of excessive screen time on vision, for example.
PCON: Did any surprising or unexpected findings come out of the 3-year systematic review?
Quinn: I don't think anyone will be shocked, but when you read this kind of a comprehensive review of evidence it reinforces what you know already. When it's right there in black and white it is very impactful.
When you read the National Academies of Sciences, Engineering and Medicine (NASEM) report released last year, which identified that up to 16 million people have uncorrected refractive error that is treatable – it just really makes it more apparent that we are not identifying children who have visual problems and getting them treatment.
The NASEM report has helped us identify and focus on the public health problem of vision disability in this country. It has all reinforced that getting kids into care and having care is the only practical solution to this important public health problem.
PCON: How is the InfantSee program performing? What has patient and doctor feedback been like?
Quinn: Over the years, tens of thousands of infant assessments have been done through this program. InfantSee has raised awareness of early identification of those at-risk in this younger age group.
At that age, it is critically important to identify infants that have permanent visual disability, like amblyopia, which is something we can treat when there is still plasticity in the visual system. Once you get into the older age groups it becomes less treatable.
Infants with tumors and high refractive error have also been identified. These are things that would be missed if they didn't get into care.
PCON: What is an eye doctor looking for during an exam with an infant age 6 to 12 months?
Quinn: By 6 to 12 months the eyes are starting to develop, and the visual system is developing
The first thing optometrists look for is alignment to make sure eyes are aligned, large degrees of refractive error and things like a cataract. We check for tracking and focus ability, most of the things that we check in preschoolers, but we simply do it in a different way with infants, as they are nonverbal.
PCON: Why is it important for providers and policymakers to understand these revised guidelines?
Quinn: It’s important for providers to really be familiar with the guidelines so they are practicing with the most up-to-date evidence.
It’s important for policymakers who develop health care policy to understand the importance of eye exams and how they can aid the population and affect the performance of children in school. It's the reason Congress recognized the importance of vision care in the pediatric population by including it as one of the 10 essential health benefits under the Affordable Care Act.
This just further informs policymakers on the importance of pediatric vision and its impact throughout behavior, school performance and special needs. It impacts so much of a kid’s life, and it's such a simple thing to take care of.