Automated (instrument-based) vision screening, which is not dependent on behavioral responses from a child, is beneficial and preferred for assessing visual health in children under age 4, and in preverbal, preliterate, or developmentally delayed children, according to a revised AAP policy statement published in the November 2012 issue of Pediatrics (published online Oct. 29).
The statement, “Instrument-Based Pediatric Vision Screening Policy Statement” outlines the role of vision screening in detecting abnormal vision and risk factors that may threaten visual development, such as amblyopia, a neural deficit that limits the ability to see details in an estimated 1 to 4 percent of children. While physicians can reliably determine vision acuity in older children by using a vision chart, it is nearly impossible to do so adequately in a child under age 3, or in an older child who cannot sufficiently communicate what he or she is seeing on the chart. Instrument-based vision screening – photoscreening or hand-held autorefraction – may be electively performed in children ages 6 months to 3 years to allow for early detection of conditions that may lead to amblyopia, as well as in older children who are unable or unwilling to cooperate with routine acuity screening. Clinicians must know how to adequately apply the automated vision screening technology, which is expensive and not always adequately reimbursed.