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Monday, July 23, 2007

Are Preschool Eye Exams Necessary?

It seems that schools open earlier and earlier each year. Many families are already busy with their back-to-school checklists.

Should an eye exam be on your checklist for your young students?

Here is an excerpted Joint Policy Statement from the American Academy of Pediatricians, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus:

Early detection of treatable eye disease in infancy and childhood can have far reaching implications for vision and, in some cases, for general health.

Good vision is essential for proper physical development and educational progress in growing children. 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.

Vision screening programs should provide widespread, effective testing of preschool and early school-age children.

Many school systems have regular vision screening programs that are carried out by volunteer professionals, school nurses, and/or properly trained lay persons. 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 and, in most cases, misalignment of the eyes (called strabismus).

Refractive errors cause decreased vision, visual discomfort (“eye strain”), and/or amblyopia. The most common form, nearsightedness (poor distance vision) is usually seen in school-age children and is treated effectively, in most cases, with glasses. Farsightedness can cause problems with focusing at near and may be treated with glasses. Astigmatism (imperfect curvature of the front surfaces of the eye) also requires corrective lenses if it produces blurred vision or discomfort. Uncorrected refractive errors can cause amblyopia particularly if they are severe or are different between the two eyes.

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.

The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend an ophthalmological examination be performed whenever questions arise about the health of the visual system of a child of any age. They recommend that infants and children be screened for vision problems as follows and any child who does not pass these screening tests have an ophthalmological examination.

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 ½ to 3 ½. It is essential that a formal testing of visual acuity be performed by the age of 5 years.

Further screening examinations should be done at routine school checks or after the appearance of symptoms. Routine comprehensive professional eye examination of the normal asymptomatic child has no proven medical benefit.

School aged children who pass standard vision screening tests but who demonstrate difficulties learning to read, should be referred to reading specialists such as educational psychologists for evaluation for language processing disorders such as dyslexia. There is not adequate scientific evidence to suggest that “defective eye teaming”, and “accommodative disorders” are common causes of educational impairment. Hence, routine screening for these conditions is not recommended.

Here’s a nutshell summary:

  • Every child does not need a preschool eye exam every year
  • Vision should be measured in every child before age 5
  • Properly performed school vision checks are sufficient if good vision is recorded
  • Children with any vision symptoms deserve a prompt, comprehensive eye examination by a qualified eye doctor

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Posted by: Bill Lloyd MD at 8:30 am

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