Guidelines for vision screening revised

New evidence-based guidelines update recommendations for automated vision screening to detect amblyopia and other eye abnormalities in children before they can read traditional eye charts.

The Vision Screening Committee of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) examined new data on automated vision screening technologies developed since its original guidelines were released in 2003. The updated guidelines help to differentiate very young children who are most at risk for amblyopia from those who are not.

Recommendations include separate screening criteria for toddlers aged 12 to 20 months, early preschool children aged 31 to 48 months, late preschool and kindergarten children aged 49 to 72 months, and those aged older than 72 months. Children who can read linear letters have the option of traditional optotype recognition for screening.

The guidelines also establish a lower referral rate for amblyopia by raising threshold values and include detection of significant media opacities and manifest (not intermittent) strabismus at all ages. Instruments that detect amblyopia should report results using the presence of amblyopia as the gold standard.

The committee notes that prevalence of amblyopia risk factors in preschool children is greater than previously suspected, and early detection is critical. The disease is treatable until the child is aged 60 months, although effectiveness of treatment declines.

The US Preventive Services Task Force has endorsed photoscreening for detecting amblyopia risk factors in children aged older than 36 months, however the American Academy of Pediatrics recently recommended photoscreening children beginning at age 1 year.