American Optometric Association Statement Regarding 2017 USPSTF Children’s Vision Screening Recommendation

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Deirdre Middleton, 703.837.1437

The National Academies of Sciences, Engineering and Medicine (NASEM) report, "Making Eye Health a Population Health Imperative: Vision for Tomorrow," confirmed that undiagnosed and uncorrected eye and vision problems in children are a significant public health concern. The American Optometric Association (AOA), representing more than 33,000 doctors of optometry, is disappointed and concerned that the recently released U.S. Preventive Services Task Force (USPSTF) Children's Vision Screening Recommendation Statement reflects no changes since the last update in 2011 and disregards children's vision and eye health needs.

The USPSTF recommendation acknowledges the importance of detecting vision problems in children and reinforces the value of early treatment that leads to improved outcomes. However, the recommendation fails to bridge the divide between detection and treatment. Screenings miss up to 75% of school children with vision problems. And, of the children found to have vision problems through a screening, 61% do not get treatment. Evidence demonstrates, and the CDC and NEI agree, that the best way to ensure healthy vision is with a comprehensive eye exam by an eye doctor.

"Doctors of optometry are extremely concerned that the USPSTF Children's Vision Screening Recommendation will continue to hamper ongoing efforts to combat unacceptably high rates of preventable and treatable vision loss in children - especially among vulnerable and at-risk children that deserve care in communities across America," said AOA President Christopher Quinn, O.D. "In fact, the new recommendation reiterating 'no change,' appears to overlook the NASEM report which underscored that avoidable vision impairment occurs because of outdated assumptions, missed opportunities, and shortfalls in public health policy and health care delivery. Promoting optimal conditions for vision and health requires changes to our current system of vision health prevention."

High rates of undetected and untreated eye disorders continue to plague the nation's children and impair their ability to learn, grow and function normally; even higher rates of disability exist among disadvantaged populations. An estimated one in five preschool children has a vision problem. Since eye and vision problems can become worse over time, early diagnosis and treatment are essential to optimize children's eye health and vision and to prevent future vision loss. Eye and vision disorders can lead to problems in a child's normal development, school performance, social interactions, and self-esteem.

The new recommendation, which was released by the federally-funded committee, did not adequately address concerns expressed by the NASEM report which was developed by a task force of eye health and vision care experts, including doctors of optometry, ophthalmologists and stakeholders, as well as the direct comments from the AOA, representing doctors of optometry, the primary providers of children's vision and eye health care in the United States.

The AOA explained, and USPSTF did not clarify, that the recommendation is for "amblyopia screening" not "vision screening." The AOA urged the USPSTF to correct the name of the recommendation for accuracy, health literacy, health equity, and consistency with other health risks, to no avail. 

The AOA also asserts that the recommendation misses the true failing of most children's vision screenings: "false negatives." Vision screenings by almost any measure fail to achieve the sensitivity of a valid health screening. By focusing the effectiveness of screenings to detect only one of the most serious visual problems, amblyopia, the task force ignores the multitude of vision problems in children that screenings have repeatedly been demonstrated to not adequately detect. Giving parents and educators a false sense of security, the vast majority of children's vision screenings have high rates of "false negatives," failing to adequately detect signs of significant vision problems in children chronically burdened by these difficulties. During this critical developmental stage, undiagnosed and untreated vision problems can have a massive impact on a child's ability to succeed in school and later in life as fully outlined and evidenced in the NASEM report.

Routine vision screenings cannot be relied on to catch most vision problems. In fact, these tests fail to detect a wide variety of eye and overall health conditions that only a comprehensive eye exam can diagnose. Evidence upholds the importance of a regular comprehensive eye exam schedule for children.

The AOA recently released the 2017 revised, Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination, for pediatric eye health, based on a three-year systematic review by doctors of optometry and other stakeholders in the pediatric health field, such as pediatricians, social workers and parents. The research in the report underscores that comprehensive eye exams should be required, as with other annual health examinations for children. Specifically, the guideline recommends:

• Comprehensive vision assessment by an eye doctor between age 6 months and 12 months.
• An in-person comprehensive eye examination by an eye doctor between the ages of 3 and 5  years.

Screenings may identify some children at risk for vision problems, but an in-person comprehensive eye exam is the only way to make the bridge between an accurate and definitive diagnosis and appropriate treatment.

About the American Optometric Association (AOA):
The American Optometric Association, founded in 1898, is the leading authority on quality care and an advocate for our nation's health, representing more than 44,000 doctors of optometry (O.D.), optometric professionals and optometry students. Doctors of optometry take a leading role in patient care with respect to eye and vision care, as well as general health and well-being. As primary health care providers, doctors of optometry have extensive, ongoing training to examine, diagnose, treat and manage ocular disorders, diseases and injuries and systemic diseases that manifest in the eye. Doctors of optometry provide more than two-thirds of primary eye care in the U.S. For more information on eye health and vision topics, and to find a doctor of optometry near you, visit aoa.org.