OPTOMETRIC CLINICAL PRACTICE GUIDELINE
In 2000 the U.S. Census Bureau reported that there were 72.3 million children under 18 years of age in the United States (26% of the population) and the numbers in this age group, with its growth rate of 13.7 percent, were increasing faster than in any other segment of the population.3 Vision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition during childhood.4 In spite of the high prevalence of vision disorders in this population, studies show that only about 31 percent of children between ages 6 and 16 years are likely to have had a comprehensive eye and vision examination within the past year, while below the age of 6, only about 14 percent are likely to have had an eye and vision examination.
In a study of 5,851 children 9 to 15 years of age, nearly 20 percent needed glasses but only 10 percent of that group already had them.6 Thus, 90 percent of those children requiring prescription eyeglasses were not wearing them. Why so few children receive professional eye care is unknown. Possible explanations include a reliance on pediatricians, other primary care physicians, or school screenings, many uninsured parents’ or caregivers’ inability to pay for the needed services, and parents’ or caregivers’ lack of knowledge that early professional eye care is needed to prevent unnecessary loss of vision as well as to improve educational readiness.
Unfortunately, undue reliance on vision screening by pediatricians or other primary care physicians may result in the late detection of amblyopia and other vision disorders. One study reported that in a sample of 102 private pediatric practices in the United States, vision screening was attempted on only 38 percent of 3-year-old children and 81 percent of 5-year-old children. The study also showed that only 26 percent of children failing the American Academy of Pediatrics vision screening guidelines were referred for a professional eye examination.
The interrelationships between vision problems and learning difficulties and the cost of undetected vision problems to society are of concern. Vision problems generally are not the direct cause of learning disorders; however, they can interfere with children’s abilities to perform to their potential. When children fail to progress in school, the cost to the individual and society can be substantial.
Over the past 30 years, studies have shown the need for earlier eye examination and treatment and have resulted in clinical advances that enable more effective preventive eye care for infants and preschool children. Extensive research has demonstrated the importance of the first few years of life in the development of vision. Within the first 6 months of life, rapid changes occur in most components of the visual system including visual acuity,11,12 accommodation,13,14 and binocular vision. Interference with development during this very critical phase may lead to serious lifelong effects on vision.18 Successful treatment can be obtained more quickly with early intervention.
An outgrowth of this research is the development of new clinical procedures appropriate for the evaluation of vision in infants and toddlers.
Clinicians have gained a better understanding of both the characteristics and processes of vision development in infants and the tools necessary to examine them. As a result, it is now recommended that all children receive regular, professional eye care beginning at 6 months of age after an initial eye screening at birth, typically performed by the pediatrician.
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