From the Guidelines
Over-referring children with high astigmatism detected by Spot vision screeners can lead to unnecessary healthcare utilization and parental anxiety, and clinicians should consider implementing higher referral thresholds for astigmatism (>2.50 or 3.00 diopters) to reduce false positive referrals while still identifying clinically significant refractive errors. According to the most recent evidence from 1, early detection and treatment of amblyopia and amblyogenic risk factors, including significant refractive error, can improve visual acuity. However, the tendency of automated screeners to overestimate astigmatism, particularly in young children, should be taken into account when interpreting screening results.
When astigmatism is the only abnormality detected, and especially if it's between 1.50-2.50 diopters, consider repeating the screening or implementing a monitoring approach rather than immediate referral, as suggested by expert opinion and guidelines from the American Academy of Pediatrics, as mentioned in 1. This balanced approach ensures children with truly significant refractive errors receive timely care while preventing unnecessary specialist visits for those with mild astigmatism that may not impact visual development or require correction. Key considerations include:
- The potential for successful treatment of amblyopia is greatest in young children, although improvement in visual acuity can reasonably be expected in older children and teenagers, as noted in 1
- Children with risk factors for amblyopia should have at least one comprehensive ophthalmic examination, generally when the risk factor is identified, as recommended in 1
- The goal is to optimize vision screening efficiency while maintaining sensitivity for detecting amblyogenic risk factors, and clinicians should prioritize referral thresholds that balance these competing demands, based on the latest evidence from 1.
From the Research
Clinical Implications of Over-Referring Children with High Astigmatism
- The clinical implications of over-referring children with high astigmatism detected by Spot are not directly addressed in the provided studies 2, 3.
- However, it is known that astigmatism can cause deterioration of the retinal image and affect vision quality 2.
- High degrees of astigmatism in childhood typically decrease with emmetropization, but the prevalence of astigmatism increases with age 2.
- Uncorrected astigmatism can decrease patients' vision-related quality of life, decrease productivity among working-age adults, and pose an economic burden on patients and their families 3.
- Astigmatic patients may experience decreased vision quality, increased glare, haloes, night-time driving difficulties, falls, and spectacle dependence 3.
- The provided studies do not specifically discuss the implications of over-referring children with high astigmatism, but they highlight the importance of understanding and addressing astigmatism to maintain and improve visual function 2, 3.