AAP updates guides for pediatric vision screening

Instrument-based vision screening for amblyogenic refractive error is recommended for children aged younger than 4 years, according to updated guidelines from the American Academy of Pediatrics (AAP).

In a new policy statement, the AAP says that automated vision screening, including photoscreening and autorefraction, is preferred for children aged 6 months to 3 years because the procedure is quick and requires little cooperation from the patient. Visual acuity charts continue to be the reliable method of screening for children aged 4 to 5 years.

Vision screening detects amblyopia (lazy eye) and its risk factors, which affect 1% to 4% of children. The neural condition causes obscured or misaligned imaging primarily in 1 eye. The earlier the diagnosis, the higher the benefit from treatment. However, standard screening with vision charts can be difficult for very young children or for those with developmental delays.

Photoscreening examines optical images of the eye’s red reflex to estimate refractive error, alignment, and opacity as well as ocular adnexal deformities that put a child at risk for amblyopia. It assesses both eyes simultaneously and output is interpreted by a trained operator or by computer.

Autorefraction uses automated skiascopy or wave-front technology to evaluate the refractive error of each eye individually. The data determine if the child passes or fails the screening.

Vision screening in children should be performed at the earliest possible age and at regular intervals. Children aged older than 5 years should be screened every 1 to 2 years.

Although instrument-based screening is preferred for preverbal children, the technology is expensive for primary care practices, and currently there is no guarantee of reimbursement from third-party payers.

The new policy statement is cosponsored by the AAP, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, and the American Association of Certified Orthoptists.

source: Contemporary Pediatrics