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Task Force recommends vision screening for children younger than age 5

Children who are younger than 5 years of age should be screened in the primary care setting for vision problems, including lazy eye, crossed eyes, and near- and far-sightedness, according to a new recommendation from the U.S. Preventive Services Task Force. The finding is published in the May/June issue of the Annals of Family Medicine.

The Task Force, an independent panel of experts sponsored by the Agency for Healthcare Research and Quality, found fair evidence that screening tests can lead to detection of lazy eye (known by the clinical term "amblyopia"), crossed eyes (known as "strabismus"), and near- and far-sightedness. Children found to have one of these conditions should be referred to a specialized eye care professional for further testing. Left untreated, amblyopia may lead to visual impairment and may harm a child's ability to learn or affect his or her performance in school.

Visual impairment is a common condition that affects 5 percent to 10 percent of preschool age children. Between 1 percent and 4 percent of preschool age children have amblyopia, and an estimated 5 percent to 7 percent have refractive errors.

Typically, children who are 3 or older are tested in the primary care setting using wall charts that ask the child to identify specific letters or symbols. For younger children who may have difficulty communicating verbally, new methods of photoscreening using specially equipped cameras to capture a picture of the child's pupil have been developed for use by trained eye care professionals. Because photoscreening requires only minimal cooperation from the child, this method has the potential to increase vision screening rates among children.

Other methods used by primary care physicians for screening children under age 1 include the cover test and the Hirschberg light reflex test. The cover test is performed by covering one eye and observing the other eye for movement. The Hirschberg light reflex test is performed by shining a light and observing the reflection of light from the patient's cornea.

The Task Force is the leading independent panel of private-sector experts in prevention and primary care and conducts rigorous, impartial assessments of the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on reports from research teams led by AHRQ's Evidence-based Practice Centers at RTI-International-University of North Carolina at Chapel Hill and the Oregon Evidence-based Practice Center in Portland.

The screening for visual impairment in children younger than 5 years of age recommendations and materials for clinicians are available online, along with previous Task Force recommendations on other topics.

Summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse.

Clinical information also is available from AHRQ's National Guideline Clearinghouse™ at www.guideline.gov.

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