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Recommendations Changed For Vision Screening Of Children

January 31, 2011

On Monday, a federal expert panel backtracked on its 2004 recommendation to screen all kids younger than five years for poor vision, lazy eye and other eye conditions.

According to the U.S. Preventive Services Task Force (USPSTF), healthy children between three and five years should still be tested at least once, but there is not enough evidence to recommend screening of all young toddlers.

“There are harms associated with all screening tests,” said Dr. Ned Calonge, chair of the USPSTF and past president of the Colorado Board of Medical Examiners. “We don’t have good evidence of the harms, but we do know that at least some of these tests can generate a lot of false positives.”

A misdiagnosed child could end up with a bothersome eye patch or corrective lenses for no good reason.

Lazy eye affects between 2 and 4 percent of preschoolers.  It is the leading cause of poor vision in children and can lead to permanent vision loss on one eye if left untreated.

However, according to the USPSTF, screening young toddlers is hard because they tend to not cooperate well with the eye professionals.  Also, waiting for a few years before screening seems to be just as effective.

The new recommendations only cover those children without signs of vision problems.  They do not mean that parents with kids younger than three years should avoid making an appointment with the eye doctor if they are concerned.

“You may want to discuss screening with your healthcare provider, understanding that the evidence is insufficient at this point,” said Calonge, adding that some of the newer screening devices are expensive.

According to a new review of the medical literature published in the journal Pediatrics, there is only limited direct evidence that screening leads to improved vision, and there are no data on how it affects school performance.

The task force found that in kids between three and five years old, the benefits of screening would likely outweigh the harms.

Patching the good eye to allow sight in the lazy eye to develop led to a small increase in visual acuity over the short term.

The difference could be considerable for a kid and might translate into much greater benefits in the long run because lazy eye causes more and more vision loss if untreated, according to Calonge.

Patching the good eye or using eye drops led to only a small and reversible loss of visual acuity on that eye.

The American Academy of Ophthalmologists and other groups representing eye professionals said in a commentary in the same issue of the journal that they were “concerned” about the USPSTF’s new move.

They said eye examinations with an ophthalmoscope or newer technologies should be used regularly in infants to rule out serious eye diseases like cataracts that might lead to lazy eye.

Calonge said that he had not seen the commentary, but noted that “we deal in the realm of being able to say with moderate certainty that screening provides more benefits than harms.”

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