Thank you American Optometric Association (AOA). The AOA has expressed “deep disappointment and concern” about the US Preventative Services Task Force’s (USPSTF) plan to proceed with misguided recommendations on children’s vision screenings. These recommendations, which support vision screenings as the preferred method of identifying visual impairment in children aged 1 to 5, would negate the efforts of eye doctors to reverse the rates of preventable vision loss in children.
The AOA points to the many flaws in a reliance on vision screenings to identify children with visual problems. First, there is the issue of false negatives. Many children with vision problems, such as amblyopia, are not identified by the vision screening. They are categorized as a negative result, meaning that no positive findings were noted. If they had received a comprehensive eye examination, the vision problem would have been identified. Therefore, the negative result is a false result. Many vision screenings result in a very high rate of false negatives. It might be years before their vision problems are identified and treatment is initiated. Some of these children are NEVER identified.
Even if a child is identified with a problem at a vision screening, the screening does not provide either a diagnosis or a direct path to treatment. Research has shown that between 40 and 80 percent of children who fail a vision screening do not receive appropriate follow-up care. Although the screening has identified the problem and treatment exists, there is a missing link–the diagnostic examination. It is the treatment that is effective at improving visual outcomes for children, and treatment follows the examination, not the screening. The USPSTF should support a recommendation that “children receive care and treatment” not that “children should be screened.”
The USPSTF seemed overly concerned that the child’s inability to cooperate would render comprehensive examinations impossible to perform on young children. Optometrists and pediatric ophthalmologists are well-trained in procedures that enable comprehensive evaluations of very young children. These procedures may require special equipment not typically available to doctors during vision screenings, which only increases the rate of false negatives. Comprehensive examinations should be the preferred recommendation.
In summary, the evidence of the benefits of treatment should be used to support comprehensive eye examinations for all children, because early detection and timely treatment are essential in addressing the public health crisis of high rates of preventable vision loss in children. Earlier identification and treatment will result in an enhanced quality of life and improved academic performance among children with vision problems.