II. Epidemiology
- Only 20% of U.S. Children screened for eye disease
III. Risk Factors: High risk children (may require eye specialist screening)
- Difficulty testing child on 2 separate attempts
- Age 3: Repeat attempt in 6 months
- Age 4 and older: Repeat attempt in 1 month
- Premature Infants
- Developmental Delay or neurologic disorder
- Systemic disease
-
Family History of eye disorder
- Retinoblastoma
- Congenital Cataracts
- Metabolic disorder
- Strabismus
- Amblyopia
- Childhood Glaucoma
IV. Evaluation: Well Child Exam Eye Screening
- Protocol
- AAP/AAOS recommend Vision Screening at ages 4, 5, 6, 8, 10 and 12 years
- Refer if Visual Acuity worse than 20/40
-
Newborn Eye Exam
- Red Reflex (Pupillary Light Reflex, Bruckner Test)
- Pupil Response
- Observe constant Eye Deviation
- Observe for Congenital Cataracts
- Infants at 6 months of age to 3 years
- Newborn Eye Exam (as above) and
- Fixation and Following
- Ocular Alignment (Screen for Strabismus)
- Children 3 to 5 years old
- Visual Acuity (Tumbling-E Test, Allen OR HOTV Chart)
- Ocular Alignment (Screen for Strabismus)
- Children 6 years and older
- Snellen Chart (Letters or Numbers)
V. Evaluation: Abnormal Vision testing
- Criteria for abnormal
- Additional testing: Pinhole Test
- Distinguishes Refractive Error from Amblyopia
- Indicated for failed Vision Screening
VI. Differential Diagnosis: Childhood Eye Disease
- High risk diseases
- Common eye problems
VII. Resources
- AFP: Childhood Eye Exam