By the American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel: David K. Wallace, MD, MPH,1 Stephen P. Christiansen, MD,2 Derek T. Sprunger, MD,3 Michele Melia, ScM,4 Katherine A. Lee, MD, PhD,5 Christie L. Morse, MD,6 Michael X. Repka, MD, MBA7
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1 Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
2 Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
3 Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana
4 Jaeb Center for Health Research, Tampa, Florida
5 Pediatric Ophthalmology, St. Luke’s Health System, Boise, Idaho
6 Concord Eye Center, Concord, New Hampshire
7 Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
Amblyopia meets the World Health Organization guidelines for a disease that benefits from screening because it is an important health problem for which there is an accepted treatment, it has a recognizable latent or early symptomatic stage, and a suitable test or examination is available to diagnose the condition before permanent vision loss occurs.
Vision screening should be performed at an early age and at regular intervals throughout childhood. The elements of vision screening vary depending on the age and level of cooperation of the child.
TABLE 2 Age-Appropriate Methods for Pediatric Vision Screening and Criteria for Referral
The choice and arrangement of optotypes (letters, numbers, symbols) on an eye chart can significantly affect the visual acuity score obtained. The preferred optotypes are LEA symbols, Sloan letters, and HOTV, because they are standardized and validated.
Vision testing with single optotypes is likely to overestimate visual acuity in a patient who has amblyopia. A more accurate assessment of monocular visual acuity is obtained by presenting a line of optotypes or a single optotype with crowding bars that surround (or crowd) the optotype being identified.
Refractive correction should be prescribed for children according to the following guidelines.
TABLE 3 Guidelines for Refractive Correction in Infants and Young Children
Instrument-based screening techniques, such as photoscreening and autorefraction, are useful for assessing amblyopia and reduced-vision risk factors for children ages 1, 2, 3, 4, and 5 years, as this is a critical time for visual development. Instrument-based screening can occur for children at age 6 years and older when children cannot participate in optotype-based screening.