USPSTF, AAFP: Perform Vision Screening in Children Ages 3-5

Groups Find Insufficient Evidence on Screening Younger Kids

September 06, 2017 12:16 pm News Staff

On Sept. 5, the U.S. Preventive Services Task Force (USPSTF) published its final recommendation statement(www.uspreventiveservicestaskforce.org) and evidence summary(www.uspreventiveservicestaskforce.org) on vision screening in children ages 6 months to 5 years.  

[Young girl with glasses in front of Snellen chart]

Based on its review of the evidence, the USPSTF recommended vision screening at least once in all children ages 3-5 -- a "B" recommendation(www.uspreventiveservicestaskforce.org).

The task force also found that there wasn't enough evidence to support vision screening to detect amblyopia or its risk factors (strabismus, anisometropia, or both) in children younger than 3 -- an "I" recommendation.

Research has shown that amblyopia or its risk factors may be present in 1 percent to 6 percent of preschool-age children. If this condition goes untreated during childhood, it can lead to permanent vision loss or impairment. In fact, the group noted, treating eye disorders overall becomes less effective with age. On the extreme end of the spectrum, amblyopia typically becomes irreversible if not treated by ages 6-10.

Story highlights
  • The U.S. Preventive Services Task Force (USPSTF) posted a final recommendation statement and evidence summary on Sept. 5 that call for clinicians to conduct vision screening at least once in children ages 3-5 years.
  • The USPSTF found that current evidence is insufficient to assess the balance of benefits and harms of vision screening in children younger than 3.
  • The task force determined that a variety of vision screening tools accurately detected visual abnormalities such as amblyopia, strabismus and refractive errors.  

"Screening for vision problems in children 3 to 5 years old can catch issues early and allow for them to be corrected," said USPSTF member Alex Kemper, M.D., M.P.H., M.S., in a news release(www.uspreventiveservicestaskforce.org). "Often, this can prevent permanent vision loss."

This final recommendation statement reaffirms the USPSTF's 2017 draft and 2011 final recommendations.

The AAFP has released its own final recommendation on vision screening in children that mirrors the USPSTF's guidance.

Screening Tests

The task force found that a variety of vision screening tools accurately detected visual abnormalities such as amblyopia, strabismus and refractive errors, including visual acuity tests to screen for visual deficits associated with amblyopia and refractive error and ocular alignment tests for strabismus. Children who have a positive screening result should be referred for a complete eye examination to confirm the presence of vision abnormalities and receive treatment.

Additionally, the final recommendation said the corneal light reflex test (for strabismus) can be performed at any age, including in preverbal children, and instrument-based vision screening (i.e., autorefractors and photoscreeners) may be used in very young children, including infants.

Other options for vision screening in children older than 3 can include external inspection of the eyes, the red reflex test, the cover-uncover test (strabismus) and evaluation of visual acuity with charts.

As noted in the previously released draft statement on this topic, stereoacuity testing often is omitted because it may be incorrectly performed in a primary care office.

The USPSTF found inadequate evidence to determine the optimal screening interval for children ages 3-5.

If testing is performed in a child younger than age 3, "screening may include the fixation and follow test (for visual acuity), the red reflex test (for media opacity) and the corneal light reflex test (for strabismus)," said the recommendation statement.

"Though screening early is important, we found that there is not enough evidence to determine if screening children younger than age 3 is beneficial," said USPSTF Chair David Grossman, M.D., M.P.H., in the news release. "The task force is calling for more research to better understand the balance of benefits and harms of screening in this age group."

Response to Public Comment

A draft version of the final recommendation statement was posted for public comment on the USPSTF website from Feb. 28 to March 27.

Some commenters expressed concerns about the scope of review for this vision screening recommendation. In response, the task force added language to clarify that the general eye examination to detect ocular abnormalities was not within the scope of this review, and it further clarified language about screening tests in the Clinical Considerations section(www.uspreventiveservicestaskforce.org) of the recommendation.

Other commenters disagreed with delaying screening until patients were age 3 or older, prompting the task force to add language about the dearth of evidence on screening and treatment in children younger than 3 to the recommendation statement's Discussion section(www.uspreventiveservicestaskforce.org)

Finally, the USPSTF revised its Other Considerations(www.uspreventiveservicestaskforce.org) section in response to a number of comments seeking information about the effects of screening on learning and quality-of-life outcomes, noting that there was a gap in evidence on such outcomes.

Related AAFP News Coverage
USPSTF Draft Recommendation
Screen Vision in Children Ages 3-5; Evidence Lacking for Younger Kids
(3/1/2017)

Evidence Insufficient to Screen Seniors for Impaired Visual Acuity
USPSTF Final Recommendation Matches AAFP's
(3/7/2016)

More From AAFP
American Family Physician: AFP By Topic: Eye and Vision Disorders