AAPOS backs pediatric screening

July 15, 2005

Orlando—Ongoing efforts to encourage the adoption of mandatory preschool vision screening in every state were the main topic of discussion during a workshop at the annual meeting of the American Academy of Pediatric Ophthalmology and Strabismus (AAPOS).

Orlando-Ongoing efforts to encourage the adoption of mandatory preschool vision screening in every state were the main topic of discussion during a workshop at the annual meeting of the American Academy of Pediatric Ophthalmology and Strabismus (AAPOS).

Impediments to this goal include lack of funding and no strong movement in various states or at the federal level to require this screening, according to Robert W. Arnold, MD, Anchorage, AK, chairman of the AAPOS vision screening committee, which presented the workshop.

"As the vision screening committee, our goal is to make screening valid and valuable and to try to prevent permanent amblyopia at the community level," Dr. Arnold said.

One of the few places where the government can mandate health care measures for children is at the age when they enter school, Dr. Arnold pointed out, and this is why schools require proof of immunizations before enrollment. The vision screening committee is urging states to mandate vision screening for children similarly by the time they enter kindergarten.

If such screening were required, companies that manufacture screening tools would have more investment dollars and a greater incentive to improve their devices and make screening more accurate and cheaper, Dr. Arnold said. Since that money isn't available, companies that have good ideas often cannot afford to translate them into mass-produced devices.

"We're at a critical turning point in terms of development of the equipment that allows a lay screener or non-eye doctor to screen the problem kids from the non-problem kids," he added. "Right now there's a real disconnect between the ongoing development of those devices and whether anybody's ever going to be able to pay for them."

The rationale for more widespread use of childhood vision screening is that amblyopia is the number one cause of monocular vision loss in patients under the age of 70, and that amblyopic risk factors can be easily detected.

However, despite the significance of amblyopia as a significant health problem, fewer than 22% of preschool children receive some type of vision screening, and only 14% of children under the age of 6 receive an eye examination, said David Stager Jr., MD, a pediatric ophthalmologist in Dallas and one of the members of the vision screening committee who spoke at the workshop.

Maya Eibschitz, MD, assistant professor, University of Michigan Department of Ophthalmology and Visual Science, Ann Arbor, MI, cited studies by Kvarnstrom et al.1 and Eibschitz-Tsimhoni et al.,2 demonstrating that preschool vision screening reduced the prevalence of amblyopia.

In the first study, prevalence was reduced from 2.9% to 1% with a screening program. The Eibschitz-Tsimhoni study compared prevalence of amblyopia in 8-year-olds in a city where early vision screening was available with prevalence in a city where it was not and found that the condition occurred in 1% of the screened population and 2.6% of the control group.

Preventing vision loss There is a sensitive period in visual development early in life during which recognition of amblyopia or amblyopic risk factors can result in normal or near-normal vision, Dr. Eibschitz-Tsimhoni said, and mass population screenings would help prevent many cases of vision loss.

"Failure to identify children at risk of preventable vision loss should be held as unacceptable," she added.

The vision screening committee favors any valid screening method conducted in the pediatrician's office or under the coordination of a pediatrician. However, because there are no pediatricians in some communities, others can be trained to perform screening, including family practitioners and their clinical staff members, public health nurses, school nurses or other school employees, optometrists, or volunteers such as Lions Club members.