This series of fact sheets is based on the work of the U.S. Preventive Services Task Force (USPSTF). The USPSTF systematically reviews the evidence of effectiveness of a wide range of clinical preventive services—including screening, counseling, and chemoprevention (the use of medication to prevent diseases)—to develop recommendations for preventive care in the primary care setting.
This fact sheet presents highlights of USPSTF recommendations on this topic and should not be used to make treatment or policy decisions.
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The U.S. Preventive Services Task Force (USPSTF) recommends screening to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5 years.
Early detection and treatment of amblyopia and amblyogenic risk factors can improve visual acuity. Screening tests have reasonable accuracy in identifying strabismus, amblyopia, and refractive error in children with these conditions; more intensive screening compared with usual screening leads to improved visual acuity; and treatment of strabismus and amblyopia can improve visual acuity and reduce long-term amblyopia.
| Early detection and treatment of amblyopia and risk factors for this condition can improve visual acuity. |
The choice of screening tests depends on the child's age. During the first year of life, strabismus can be assessed by the cover test and the Hirschberg light reflex test. Newer automated techniques can be used to test children younger than age 3 years. Photoscreening can detect amblyogenic risk factors such as strabismus, significant refractive error, and media opacities; however, photoscreening cannot detect amblyopia. Screening children younger than age 3 years for visual acuity is more challenging than screening older children and typically requires testing by specially trained personnel.
| Traditional vision testing requires a cooperative, verbal child. |
In children older than age 3 years, stereopsis (the ability of both eyes to function together) can be assessed with the Random Dot E test or Titmus Fly Stereotest; visual acuity can be assessed by tests such as the HOTV chart, Lea symbols, or the tumbling E. Traditional vision testing requires a cooperative, verbal child.
The USPSTF found no studies detailing permanent harms resulting from screening or data on the harms of false-positive screening. Potential harms may include "labeling" and the costs associated with further evaluation of children with false-positive results.
Treatments that can improve visual acuity include:
Potential harms of treatment include disruption of normal eye development and temporary loss of visual acuity of the nonamblyopic eye, which resolves weeks after the completion of therapy.
The most common causes of visual impairment in children are amblyopia and its risk factors, and refractive error not associated with amblyopia. Amblyopia—reduced visual acuity without a detectable organic lesion of the eye—is usually associated with risk factors that interfere with normal binocular vision, such as strabismus (ocular misalignment), anisometropia (a large difference in refractive power between the 2 eyes), cataract (lens opacity), and ptosis (eyelid drooping). Refractive error not associated with amblyopia mainly includes myopia (near-sightedness) and hyperopia (far-sightedness); both are correctable regardless of the age of detection.
Contact the following organizations:
healthfinder®
www.healthfinder.gov
National Eye Institute, National Institutes of Health
www.nei.nih.gov
More detailed information is available in:
All are on the Web sites of the Agency for Healthcare Research and Quality (AHRQ) (www.preventiveservices.ahrq.gov) and the National Guideline Clearinghouse™ (www.guideline.gov). The update of the evidence and the USPSTF recommendation statement are also available in print through the AHRQ Clearinghouse (1-800-358-9295, or ahrqpubs@ahrq.gov).
Members of the USPSTF represent the fields of family medicine, gerontology, obstetrics-gynecology, pediatrics, nursing, prevention research, and psychology. Members of the USPSTF when its recommendation on this topic was finalized:
Alfred O. Berg, M.D., M.P.H., Chair
Janet D. Allan, Ph.D., R.N., C.S., Vice-chair
Ned Calonge, M.D., M.P.H.
Paul S. Frame, M.D.
Joxel Garcia, M.D., M.B.A.
Russell Harris, M.D., M.P.H.
Mark S. Johnson, M.D., M.P.H.
Jonathan D. Klein, M.D., M.P.H.
Carol Loveland-Cherry, Ph.D., R.N.
Virginia A. Moyer, M.D., M.P.H.
C. Tracy Orleans, Ph.D.
Albert L. Siu, M.D., M.S.P.H.
Steven M. Teutsch, M.D., M.P.H.
Carolyn Westhoff, M.D., M.Sc.
Steven H. Woolf, M.D., M.P.H.
For a list of current Task Force members, go to www.ahrq.gov/clinic/uspstfab.htm.
AHRQ Publication No. APPIP04-IP012
Current as of May 2004
Internet Citation:
Screening for Visual Impairment in Children Younger than Age 5 Years: What’s New: Overview of Recommendations. AHRQ Publication No. APPIP04-IP012, May 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/visionscr/vischwh.htm
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