• Written By:
    Pediatric Ophth/Strabismus

    The U.S. Preventive Services Task Force (USPSTF) has updated its 2011 recommendations on screening for amblyopia in children.

    Key findings

    After reviewing recent evidence on the accuracy of screening tests, and the benefits and harms of vision screening and treatment, the task force recommends the following:

    • Vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors (“B rating”).
    • Current evidence is insufficient to assess the balance of benefits and harms of vision screening in children younger than 3 years (“I rating”).

    Clinical significance

    The 2017 update is essentially unchanged from the previous recommendations for preschool vision screening in a primary care setting.

    Recommendations for vision screening for children aged 3 to 5 years came with a “B rating”, which represents a moderate net benefit. One of the most important causes of vision abnormality in children is amblyopia, which can result in permanent vision loss in the affected eye. USPSTF found adequate evidence that vision screening tools are accurate in detecting vision abnormalities, including refractive errors, strabismus and amblyopia. It also found that treatment of amblyopia or its risk factors in children aged 3 to 5 years leads to improved visual acuity.

    However, an "I rating” was provided for screening children younger than 3 years, as the task force found insufficient evidence to assess the balance of benefits and harms of the service. This recommendation for younger children is disappointing as it excludes the importance of red reflex testing to detect congenital cataract and retinoblastoma. Both conditions can result in severe visual impairment, and the latter can even cause death if it is not detected early.

    USPSTF recognizes amblyopia is an important public health issue and provides key recommendations for preschool vision screening. Hopefully, future studies can provide stronger evidence on importance of red reflex testing in infancy for early detection of congenital cataract and retinoblastoma.