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ABSTRACT: Amblyopia is the leading cause of vision loss in children. It is treatable if diagnosed early, making identification of affected children critical. The American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics recommend that clinicians routinely perform age-appropriate vision chart testing, red reflex testing, and examination for signs of strabismus. The U.S. Preventive Services Task Force recommends vision screening for all children at least once between three and five years of age to detect the presence of amblyopia or its risk factors. Photoscreening may be a useful adjunct to traditional vision screening, but there is limited evidence that it improves visual outcomes. Treatments for amblyopia include patching, atropine eye drops, and optical penalization of the nonamblyopic eye. In children with moderate amblyopia, patching for two hours daily is as effective as patching for six hours daily, and daily atropine is as effective as daily patching. Children older than seven years may still benefit from patching or atropine, particularly if they have not previously received amblyopia treatment. Amblyopia recurs in 25 percent of children after patching is discontinued. Tapering the amount of time a patch is worn each day at the end of treatment reduces the risk of recurrence.
Childhood Eye Examination - Article
ABSTRACT: Vision screening in children is an ongoing process, with components that should occur at each well-child visit. The purpose is to detect risk factors and visual abnormalities that necessitate treatment and to identify those patients who require referral to an ophthalmologist skilled in examining children. Screening can reveal conditions commonly treated in primary care and can aid in discussion of visual concerns with parents or caregivers. Vision screening begins with a review of family and personal vision history to identify risk factors requiring referral, including premature birth, Down syndrome, cerebral palsy, and a family history of strabismus, amblyopia, retinoblastoma, childhood glaucoma, childhood cataracts, or ocular or genetic systemic disease. Visual acuity measurement and external ocular examination are performed to recognize refractive error, childhood glaucoma, and various ocular conditions. Evaluation of fixation and alignment can identify amblyopia or strabismus. Red reflex examination is used to diagnose retinoblastoma, childhood cataracts, and other ocular abnormalities.