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Task force updates vision screening recommendations
Chou R. Pediatrics 2011;127:e442-e479.
USPSTF.
Pediatrics. 2011;127:340-346.
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In a paper recently published online, The US Preventive Services Task Force recommended screening to detect amblyopia at least once for those aged 3 to 5 years, but panel members said they could not find enough evidence to support or deny the screening of children younger than 3 years.
The paper provided some clarity on vision screening, which has been debated between medical organizations for some time. Previously, the Task Force recommended vision screening for all children younger than 5 years. However, the AAP differed in its recommendations, noting universal screening for distance visual acuity, ocular alignment and ocular media clarity at ages 3, 4, 5, 6, 8 and 10 years, and once during the early-, middle- and late-adolescent phases. The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend vision screening during the preschool years, and the American Optometric Association recommends a comprehensive examination at age 3 years, according to the panel.
A study published in the same issue of Pediatrics, alongside the panel’s paper by Roger Chou, MD, and colleagues from the Oregon Evidence-based Practice Center and the Oregon Health and Science University, said, “Diagnostic accuracy did not clearly differ for children stratified according to age, although testability rates were generally lower in children 1 to 3 years of age.” The researchers on that study, which involved searches of Medline and the Cochrane Library and randomized trials, said treatments for amblyopia or unilateral refractive error were associated with mild improvements in visual acuity compared with no treatment.
“It should be emphasized that the ‘I’ (inconclusive) rating given by the USPSTF for screening children younger than 3 years should not be misinterpreted as ‘ineffective,’” wrote Sean P. Donahue, MD, and James B. Ruben, MD, in an commentary accompanying both papers. “We welcome the USPSTF level B recommendation for at least one vision screening in the child aged 3 to 5 years and believe that there is now adequate evidence to support an earlier screening using photorefraction or autorefraction in younger children.”
Disclosures: Dr. Donahue reported research and travel support from Plusoptix and Welch Allyn, and that he is a consultant for Diopsys. Dr. Ruben reported no relevant financial disclosures.
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