From the Guidelines
Instrument-based vision screenings are not leading to excessive ophthalmologic examinations or unnecessary corrective eyeglasses in pediatric patients, as the benefits of early detection and treatment of amblyopia and other vision problems outweigh the potential risks of overdiagnosis. The most recent and highest quality study, published in 2023 in the journal Ophthalmology 1, supports the use of periodic vision screening throughout childhood, including instrument-based screenings, to detect vision problems such as amblyopia and refractive errors. While there is some evidence to suggest that instrument-based screenings may have high sensitivity but lower specificity, potentially leading to false positives and unnecessary referrals 1, the benefits of early detection and treatment of vision problems, including improved visual acuity and reduced risk of long-term vision loss, outweigh the potential risks of overdiagnosis. Some key points to consider include:
- The American Academy of Pediatrics and other organizations recommend periodic vision screening for asymptomatic children, including instrument-based screenings 1.
- Instrument-based screenings can detect amblyogenic risk factors, such as strabismus and refractive errors, and can be especially useful in young children who may not be able to participate in traditional vision testing 1.
- Early detection and treatment of amblyopia and other vision problems can improve visual acuity and reduce the risk of long-term vision loss, and can also have a positive impact on quality of life 1.
- While there is some evidence to suggest that instrument-based screenings may lead to overdiagnosis, the benefits of early detection and treatment of vision problems outweigh the potential risks, and refining referral criteria rather than abandoning instrument-based screening altogether is likely the best approach 1.
From the Research
Instrument-Based Vision Screenings in Pediatric Patients
- The American Academy of Pediatrics recommends screening starting at three years of age and at regular intervals in childhood, and that instrument-based screening is an alternative to vision charts for testing visual acuity in patients three to five years of age 2.
- Instrument-based screening can detect conditions that may lead to amblyopia and vision loss if left untreated, and its implementation in primary care settings can substantially improve completed screening among preschool-aged children 3.
- The deployment of vision screening devices in primary care practices has been shown to increase the percentage of children completing vision screening, with improvement greatest among 3-year-olds 3.
Referrals to Ophthalmology and Corrective Eyeglasses
- Routine eye examinations during childhood can identify abnormalities necessitating referral to ophthalmology, which optimizes children's vision through the early diagnosis and treatment of abnormalities 2.
- Children found to have an ocular abnormality or who fail a vision assessment should be referred to a pediatric ophthalmologist or an eye care specialist appropriately trained to treat pediatric patients 4.
- Approximately 1 in 4 children between two and 17 years of age wears glasses, and early detection and treatment of amblyopia can improve visual acuity and reduce the risk of monocular vision loss 2, 5.
Evidence for Vision Therapy
- The utility of vision therapy to treat various learning disabilities is challenged by the American Academy of Pediatrics, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and the American Association of Certified Orthoptists 6.
- There is insufficient evidence to recommend in-office vision therapy for the management of other types of strabismus, amblyopia, or learning disability in the pediatric population, except for convergence insufficiency 6.