It is essential that a formal testing of visual acuity be performed by the age of 5 years.

POLICY STATEMENT

Excerpts from Vision Screening for Infants and Children Policy

The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend timely screening for the early detection and treatment of eye and vision problems in America's children. This includes institution of rigorous vision screening during the preschool years. Early detection of treatable eye disease in infancy and childhood can have far reaching implications for vision and, in some cases, for general health.

Background

Good vision is essential for proper physical development and educational progress in growing children. The visual system in the young child is not fully mature. Equal input from both eyes is required for proper development of the visual centers in the brain. If a growing childís eye does not provide a clear focused image to the developing brain, then permanent irreversible loss of vision may result. Early detection provides the best opportunity for effective, inexpensive treatment. The American Association for Pediatric Ophthalmology and Strabismus, the American Academy of Ophthalmology, the American Academy of Pediatrics, the American Academy of Family Physicians and the American Association of Certified Orthoptists recommend early vision screening.

Amblyopia is poor vision in an otherwise normal appearing eye, which occurs when the brain does not recognize the sight from that eye. Two common causes are strabismus (misaligned eyes) and a difference in the refractive error (need for glasses) between the two eyes. If untreated, amblyopia can cause irreversible visual loss. The best time for treatment is in the preschool years. Improvement of vision after the child is 8 or 9 years of age is rarely achieved.

Vision screening programs should provide widespread, effective testing of preschool and early school-age children. Screening can be done quickly, accurately, and with minimum expense by one of these individuals. The screener should not have a vested interest in the screening outcome. As with all screening programs, vision screening should be performed in a fashion that maximizes the rate of problem detection while minimizing unnecessary referrals and cost. Beginning in the preschool years, those conditions which can be detected by vision screening using an acuity chart are: reduced vision in one or both eyes from amblyopia, uncorrected refractive errors or other eye defects. In addition to detection of vision problems, effective screening programs should also place emphasis on a mechanism to inform parents of screening failures and attempt to ensure that proper follow-up care is received.

Recommendations

Vision screening should also be performed between 3 and 3 1/2 years of age. Vision and alignment should be assessed by a pediatrician, family practitioner, ophthalmologist, optometrist, orthoptist, or individual trained in vision assessment of preschool children. Emphasis should be placed on checking visual acuity. as soon as a child is cooperative enough to complete the examination. Generally, this occurs between ages 2 Ω to 3 Ω. It is essential that a formal testing of visual acuity be performed by the age of 5 years.

Revised and Approved by: The American Association for Pediatric Ophthalmology and Strabismus, August 2001. The American Academy of Ophthalmology, Board of Trustees, October 2001.