This statement summarizes the U Pre...

This statement summarizes the U Preventive Services Task Force (USPSTF) recommendation upon screening for visual impairment in children younger than five years and the supporting evidence and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, other edition. (1) In 1996, the USPSTF attract favor toed vision screening for amblyopia and strabismus in all children before they take down school (B recommendation). 1 Since then, the USPSTF criteria to rate the might of the evidence have changed. (2) Therefore, this recommendation statement has been updated and revised based onward the current USPSTF methodology and rating of the vigor of the evidence. Explanations of the ratings and of the nerve of overall evidence are given in Tables 1 and 2 respectively. The integral information on which this statement is based, including evidence tables and relations is available in the systematic evidence review (3) review and in the update of the evidence (4) in succession this topic, available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov). The recommendation statement and update of the evidence also are available in print from the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone 800-358-9295; e-mail, ahrqpubs@ahrq.gov). The recommendation also is columned on the Web site of the National Guideline Clearinghouse (http://www.guideline.gov).

This recommendation statement was first published in Ann Fam M 2004;2:263-6

Summary of Recommendation

* The USPSTF make acceptables screening to detect amblyopia, strabismus, and wants in visual acuity in children younger than five years. B recommendation.

The USPSTF raise no direct evidence that screening for visual impairment in children leads to improved visual acuity. However, the USPSTF raise fair evidence that screening touchstones have reasonable accuracy in identifying strabismus, amblyopia, and refractive error in children with these conditions; that more intensive screening compared with usual screening leads to improved visual acuity; and that treatment of strabismus and amblyopia can improve visual acuity and mould long-term amblyopia. The USPSTF originate no evidence of harms for screening, judg the potential for harms to be small, and conclud that the benefits of screening are likely to outweigh any potential harms.

Clinical Considerations

* The greatest in number common causes of visual impairment in children are amblyopia and its risk factors, and refractive error not associated with amblyopia. Amblyopia imputes to reduced visual acuity without a detectable organic lesion of the view and is usually associated with amblyogenic risk factors that interfere with normal binocular vision, of that kind as strabismus (ocular misalignment), anisometropia (a large difference in refractive power between the eyes) cataract (len opacity), and ptosis (eyelid drooping). Refractive error not associated with amblyopia principally includes myopia (nearsightedness) and hyperopia (farsightedness); the two remain correctable regardless of the age at detection.

* Various trials are used widely in the United States to identify visual faults in children, and the choice of trials is influenced by the child's age. During the first year of life, strabismus can be assessed through the cover test and the Hirschberg light introspective test. Screening children younger than three years for visual acuity is more challenging than screening older children and typically requires testing by means of specially trained personnel. Newer automated techniques can be used to proof these children. Photoscreening can ascertain amblyogenic risk factors such as strabismus, significant refractive error, and media opacities; however, photoscreening cannot lay open amblyopia.

* Traditional vision testing requires a cooperative, verbal child and cannot be performed reliably until ages three to four years. In children older than three years, stereopsis (the ability of the two eyes to function together) can be assessed with the Random Dot E trial or Titmus Fly Stereotest; visual acuity can be assessed from tests such as the HOTV chart, Lea signs or the tumbling E. a certain of these tests have better proof characteristics than others.

* Based upon a review of current evidence, the USPSTF was unable to determine the optimal screening trials periodicity of screening, or technical proficiency required of the screening physician. Based forward expert opinion, the American Academy of Pediatrics (AAP) praises the following vision screening be performed at all well-child visits starting in the newborn period to three years: ocular history, vision assessment, external inspection of the notices and lids, ocular motility assessment, pupil examination, and r reflected examination. For children aged three to five years, the AAP commits the aforementioned screening in addition to age-appropriate visual acuity measurement (using HOTV or tumbling E tests) and ophthalmoscopy. (5)

* The USPSTF ground that early detection and treatment of amblyopia and amblyogenic risk factors can improve visual acuity. These treatments include surgery for strabismus and cataracts; use of glasses, contact lense or refractive surgery treatments to correct refractive error; and visual training, patching, or atropine therapy of the nonamblyopic organ of vision to treat amblyopia.