The USPSTF now recommends vision screening for all children at least once between the ages of 3 and 5 years, to detect the presence of amblyopia ("lazy eye") or its risk factors. The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of vision screening for children less than 3 years of age.
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In developing its updated recommendations, the USPSTF considered evidence from a review of the association of screening for visual impairment in children 1 to 5 years old with improved health outcomes, the accuracy of risk factor evaluation and screening tests, the efficacy of early detection and intervention, the potential harms of screening and treatment, and the net benefit of screening in this population. The USPSTF also realized the need for clinical or policy decisions to be based on additional considerations. Therefore, they recommend that clinicians and policy makers tailor their decisions to the specific patient or situation.
The authors noted that approximately 2% to 4% of preschool-aged children have amblyopia, an alteration in the visual neural pathway in the developing brain that can lead to permanent vision loss in the affected eye. Amblyopia usually occurs unilaterally but can occur bilaterally. Identification of vision impairment before school entry could help identify children who may benefit from early interventions to correct or to improve vision.
On the basis of the evidence, the USPSTF concluded with moderate certainty that screening for visual impairment in children ages 3 to 5 years had a moderate net benefit.
Screening tests that can be used in primary care to identify visual impairment in children include visual acuity tests, stereoacuity tests (depth perception), and ocular alignment tests. Also potentially useful are autorefractors, or automated optical instruments that detect refractive errors and photoscreeners, or instruments that detect risk factors for amblyopia and refractive errors (the need for a glasses prescription).
Evidence was adequate that vision screening tools are reasonably accurate in the detection of visual impairment, including refractive errors, strabismus (ocular misalignment), and amblyopia, and that early treatment for amblyopia for children 3 to 5 years old is associated with improved visual outcomes. Treatment for amblyopia includes patching the better eye and the use of dilating eye drops. For children younger than 3 years, however, evidence was inadequate that early treatment of amblyopia results in better visual outcomes.
Newer technologies now allow the identification of amblyopia risk factors before strabismus and amblyopia develop and become entrenched, and evidence supports the effectiveness of treatment of children so identified.
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