Guidelines for vision screening in preschoolers revised

Preschool-aged children should receive a vision screening to detect amblyopia or its risk factors at least once between the ages of 3 and 5 years, according to recommendations from the US Preventive Services Task Force (USPSTF).

Amblyopia with its associated risk factors (strabismus, anisometropia, astigmatism, and hyperopia) is the most common cause of vision impairment in children younger than 5 years, affecting 2% to 4% of this age group. It is a functional impairment that alters the normal processing of visual images by the brain. If not treated by 6 to 10 years of age, amblyopia can become irreversible and lead to monocular vision loss in adulthood.

The USPSTF found adequate evidence that early detection and treatment for amblyopia, including the use of cycloplegic agents, eye patching, and eyeglasses, yields moderate improvements in visual acuity for children aged 3 to 5 years, but concluded that the current evidence was insufficient to determine the benefits and harms of vision screening for children younger than 3 years.

The USPSTF did not find adequate evidence that would determine the most beneficial screening interval, saying that “well-designed studies are needed to identify the optimal age for initiation of screening, optimal screening methods, and optimal screening frequency.”

The new recommendation replaces a position statement about screening for visual impairment among children younger than 5 years published by the task force in 2004.

US Preventive Services Task Force. Vision screening for children 1 to 5 years of age: US Preventive Services Task Force recommendation statement. Pediatrics. January 31, 2011. Epub ahead of print.