Short Commentary

New Release of Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination

Tamara V Petrosyan^*

Department of Optometry, SUNY College of Optometry, New York, USA

^*Corresponding author: Tamara V Petrosyan, Department of Optometry, SUNY College of Optometry, New York, USA, Tel: +1 6317932386; E-mail: tvpetrosyan@gmail.com

Citation: Petrosyan TV (2017) New Release of Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination. Curr Adv Ophthalmol 2017: 5-6. doi: https://doi.org/10.29199/2638-9940/CAOP-101014

Received: 11 October, 2017; Accepted: 18 October, 2017; Published: 26 October, 2017

In the United States, an estimated 20% of preschoolers have a vision problem [1] and 25% of school-age children wear some form of vision correcting lenses [2]. An ocular or vision disorder in childhood can manifest and negatively impact a person throughout his or her entire life. Eye and vision disorders have been linked to abnormal development [3], poor school performance [4] and level of education [5], as well as affecting employment and social interactions [6,7]. The American Optometric Association (AOA) recognizes the importance of early diagnosis and intervention of eye and vision disorders and has released a new evidence-based Clinical Practice Guideline (CPG) for the comprehensive pediatric eye and vision examination. CPGs contain recommendations “intended to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options [8].” The new guidelines describe procedures to evaluate the ocular and visual health of infants and children and recommends timely diagnosis, treatment, and inter professional care of the pediatric patient. The “clinical recommendations in this guideline are evidence-based statements regarding patient care that are supported by the scientific literature or consensus of professional opinion when no quality evidence was discovered [9].”

In 2012, the total cost of vision loss and eye disorders in children less than 18 years was an estimated $5.9 billion [10]. The most common cause of correctable reduced vision in children is refractive error [11,12], up to the age of 6, the visual system is sensitive to visual conditions which may blur vision or interfere with binocularity. This interference, if left without intervention, may lead to amblyopia, the leading cause of monocular vision loss in children. While amblyopia may be treated in both adults and children, early diagnosis and treatment yields a more favorable outcome [13]. The second most prevalent vision conditions in children are accommodative and binocular in nature. 8.3% of school-age [14] and 13% of fifth and sixth grade children [15] are affected by convergence insufficiency and 5% of school age children have accommodative disorders [16]. Pediatric ocular disease and systemic disease which may affect the ocular and visual system, while rare, can be vision threatening and timely diagnosis and treatment is key.

Clinical experience and research have shown that at 6 months, the average child has reached a number of critical developmental milestones, making this an appropriate age for the first comprehensive eye and vision examination. The AOA recommends that children be seen at 6 months, at least once between the ages of 3 and 5, at the beginning of primary school, and then annually or as recommended by their doctor [9]. Each state has individual requirement relating to vision evaluation for children attending school. These requirements range from no guidelines, to requiring a vision screening, to requiring a comprehensive evaluation [17]. Less than 22% of preschoolers receive some type of vision screening and less than 15% receive an examination by an eye care professional [18]. The access to pediatric comprehensive eye and vision examinations has increased in the past decade with the development of such resources as the Infant SEE program and the Affordable Care Act (ACA). The Infant SEE program provides a one time, no cost comprehensive evaluation to infants 6-12 months of age, irrespective of their insurance status. Participating providers can be found through the find-a-doc application on www.infantsee.org. The ACA has listed pediatric comprehensive eye and vision examinations by a doctor of optometry or ophthalmologist as one of the ten essential health benefits, making them a covered service through insurance programs [19].

Disorders such as significant refractive error, amblyopia, strabismus, and other binocular vision disorders can have significant long-term consequences for a child if undetected and untreated. The cost of treating a longstanding eye and vision disorder may be significantly higher than the cost of early diagnosis and treatment. Because the visual system develops rapidly and is sensitive to interference, a comprehensive eye and vision examination in infants and children by a doctor of optometry or ophthalmologist is imperative for timely diagnosis and treatment of these potential problems. The full guidelines to the new evidence-based clinical practice guideline for the comprehensive pediatric eye and vision examination can be freely accessed at: http://aoa.uberflip.com/i/807465-cpg-pediatric-eye-and-vision-examination

References

NORCAL Publications