Authors' objectives:

Visual impairment is common in children younger than age 5 years. Early detection of visual impairment is thought to lead to better outcomes. New screening technologies, such as photorefractive screening, allow for the screening of very young children.

Authors' results and conclusions: The prevalence of visual impairment in children 5 years of age and younger is between 7% and 8%. Three percent of children have amblyopia. Few data are available regarding the long-term consequences of untreated amblyopia. We found no randomized trials of screening. Treating children younger than age years who have cataracts or strabismus may prevent the development of amblyopia. It is unclear whether treating young children with refractive errors associated with amblyopia would prevent the development of amblyopia. Furthermore, a theoretical risk exists that treating refractive errors in children younger than age 3 years may interfere with the normal development of the eye. Indirect evidence supports the effectiveness of treatment for amblyopia and indicates treatment becomes more difficult with age. The cut-off age at which treatment is no longer effective depends on many factors, including the cause of the amblyopia. In general, treatment seems most effective when initiated before the grade-school years. Treatment for amblyopia may transiently decrease acuity in the nonamblyopic eye. Treatment of refractive errors not associated with amblyopia is nearly always successful and does not depend upon the age of the child. As with the treatment of refractive errors associated with amblyopia, treating children younger than age 3 years in this circumstance may, at least theoretically, interfere with the normal development of the eye. Few high-quality data are available regarding the performance of current screening tests. None of these studies was performed in the primary care practice setting by usual caregivers. Few data are available about the long-term consequences of visual impairment in children.

Authors' recommendations: Visual impairment is common in childhood. Although early intervention is important for the prevention or treatment of visual impairment, treatment of certain refractive errors in children younger than age 3 years may interfere with the development of the eye. Few data are available regarding the performance of screening tests in the primary care practice setting.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspsvsch.htm

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)