By the American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel: Amy K. Hutchinson, MD,1
Christie L. Morse, MD,2
Amra Hercinovic, MPH, Methodologist,3
Oscar A. Cruz, MD,4
Derek T. Sprunger, MD,5
Michael X. Repka, MD, MBA, Consultant6
Scott R. Lambert, MD,7
David K. Wallace, MD, MPH, Chair8
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Professor of Ophthalmology, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia2
Concord Eye Center, Concord, New Hampshire3
Jaeb Center for Health Research, Tampa, Florida4
Anwar Shah Endowed Chair and Professor, Department of Ophthalmology and Department of Pediatrics, Saint Louis University Medical Center, Saint Louis, Missouri5
Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana6
David L. Guyton, MD and Fednuniak Family Professor of Ophthalmology, Professor of Pediatrics, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland7
Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California8
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
Highlighted Findings and Recommendations for Care
Amblyopia meets the World Health Organization criteria 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 it before permanent vision loss occurs. The U.S. Preventive Services Task Force (USPSTF) recommends vision screening at least once for all children aged 3 to 5 years to detect amblyopia or its risk factors.
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.
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, HOTV, and Sloan letters because they are standardized and validated.
Instrument-based screening techniques, such as photoscreening and autorefraction, are useful for assessing amblyopia and reduced-vision risk factors for children ages 1 to 5 years, as this is a critical time for visual development. Instrument-based screening can also be used for older children who are unable to participate in optotype-based screening. This type of screening has been shown to be useful in detecting amblyopia risk factors in children with developmental disabilities.
Vision screening should be performed at an early age and at regular intervals throughout childhood to detect amblyopia risk factors and refractive errors. The elements of vision screening vary depending on the age and level of cooperation of the child, as shown in Table 1.
TABLE 1 - Age-Appropriate Methods for Pediatric Vision Screening and Criteria For Referral
Refractive correction should be prescribed for children according to the guidelines in Table 2.TABLE 2 - Guidelines for Refractive Correction in Infants and Young Children
Pediatric Eye Evaluations PPP - 2022 - Literature Search