Vision Screening In Children

     Medicine usually readily accepts and applies new technological advances. There is, however, one area where this hasn’t been the case and that is visual screening in children. Throughout my entire career when doing a physical exam on a child, we tested vision the same way that it had been done for decades – the wall chart (”E” chart for older kids; picture cards for younger kids). We also looked into the eye with an ophthalmoscope to see that the lens was clear and that there was a red reflection off the retina. Finally, those of us who were thorough would cover one eye while watching the other eye to see if it would “wander”. These tests helped us find cataracts, tumors in the eye, decreased vision and strabismus. Any of these can result in amblyopia – poor vision in an eye that affects 2 – 4% of children and is the most common cause of permanent vision loss in one eye in adults. But visual screening in children is difficult and the results are inconsistent, so, it is often passed over in the physical exam. A study done in 1992 found that vision screening was attempted in only 38% of 3 year-old children and 81% of 5 year-old children. 

     Amblyopia needs to be detected early. The earlier it is discovered, the easier it is to treat. If it is not found until after age five, the treatment is much more difficult and much less effective. But, although young children are the ones who need testing the most, younger children are the most difficult to test and the tests are the least reliable.

     This is where technology offers an advantage over the old methods. There are now many different types of machines called photoscreening devices. By rapidly reflecting a light off the child’s eye or by taking a picture of the eye, these devices can measure the risk factors for amblyopia. They operate much faster than eye charts, are more efficient in finding abnormalities that could lead to amblyopia and they are much more accurate in testing vision.  Many insurance companies are now paying for routine photoscreening because they realize the importance of early and accurate eye exams. The American Academy of Pediatrics has also recommended that photoscreening should be used for pediatric eye exams. There are plans for new photoscreening devices that use laser technology and may be even faster and more efficient.

     Every pediatric caregiver who does routine physical exams should be using photoscreening and every parent coming into a caregiver’s office should insist that their child have this screening.  For more information, parents and caregivers can check the Alaska Blind Child Discovery program that was started by Robert Arnold M.D. in the early 1990’s. The website is: www.abcd-vision.org/