USPSTF Recommends Screening for Amblyopia in All Children Aged 3 to 5 Years

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The US Preventive Services Task Force (USPSTF) has updated its 2011 recommendations on screening for amblyopia and its risk factors in children, as published in JAMA. Included in this update is the recommendation that all children aged 3 to 5 years undergo vision screening at least once to detect amblyopia or its risk factors.

The task force, led by David C. Grossman, MD, MPH, found adequate evidence that vision screening tools are accurate in detecting vision abnormalities, including refractive errors, strabismus, and amblyopia and that treatment of amblyopia or its risk factors in children aged 3 to 5 years leads to improved visual acuity.

Vision screening in children older than 3 years may include the red reflex test, the cover-uncover test (for strabismus), the corneal light reflex test, visual acuity tests (ie, Snellen, Lea Symbols [Lea-Test], and HOTV [Precision Vision] charts), autorefractors and photoscreeners, and stereoacuity tests. Children with positive findings should be referred for a complete eye examination to confirm the presence of vision problems and for further treatment, which may include the use of corrective lenses, occlusion therapy for amblyopia, or surgical interventions for some causes of refractory strabismus.

The USPSTF concluded with moderate certainty that vision screening to detect amblyopia or its risk factors in children aged 3 to 5 years has a moderate net benefit because untreated amblyopia results in permanent, uncorrectable vision loss, and the benefits of screening and treatment potentially can be experienced over a child's lifetime. The USPSTF concludes that the benefits of vision screening to detect amblyopia or its risk factors in children younger than 3 years are uncertain, and that the balance of benefits and harms cannot be determined for this age group.

Limitations were found in the research, including the need for well-designed trials to better understand the effects of screening vs no screening, the optimal age for initiation of screening, and appropriate screening intervals. Additional studies are needed to determine the best screening approach and most favorable combinations of screening tests in primary care.

Reference

  1. US Preventive Services Task Force (Grossman DC, Curry SJ, Owens DK, et al). Vision screening in children aged 6 months to 5 years: US Preventive Services Task Force recommendation statement. JAMA. 2017;318(9). doi:10.1001/jama.2017.11260
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