Pediatric guideline receives national recognition

Two days after being submitted, the AOA's newest clinical practice guideline for pediatric eye care has been recognized by acceptance to the National Guideline Clearinghouse (NGC) .

A database of clinical guidelines, the NGC is maintained by the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services. Guidelines accepted there must meet rigorous, evidence-based standards. The Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination will soon be posted on the NGC site, after an abstract is prepared and reviewed.

Posting to the clearinghouse means the guideline for pediatric eye and vision care will publicly be available for patients, health care professionals, institutions and agencies to reference with knowledge and confidence that it has met NGC standards, says Diane Adamczyk, O.D., chair of the AOA's Evidence-Based Optometry (EBO) Committee.

"The guideline itself and this acceptance is an important milestone," Dr. Adamczyk says. "The development of this guideline reflects the Evidence-Based Optometry Committee's dedication, hard work and commitment to the profession and, most importantly, to the care of the pediatric patient."

Adds AOA President Andrea P. Thau, O.D.: "This is fantastic news and a reflection of the outstanding work of the entire EBO team of volunteers and staff."

The speedy NGC acceptance, which previously might have taken months, reflects the EBO Committee's strict adherence to AHRQ and the National Academies of Sciences, Engineering and Medicine's standards.

What the pediatric guideline offers

Declaring eye and vision problems in children as a significant public health concern, the AOA issued the revised, evidence-based clinical pediatric guideline in April for doctors of optometry and other professionals who treat children, and also for their parents and caregivers.

The guideline reflects a systematic review and rigorous assessment by the EBO Committee, along with experts in their fields, including doctors of optometry, a pediatrician, a social worker and a parent.

An estimated 1 in 5 preschool children have vision problems and 1 in 4 school-age children wear corrective eyewear in this country. The guideline makes the argument for in-person, comprehensive eye exams for newborns through 18 years old.

"What becomes critically important in children is the impact eye care and vision health can have on how well they function in their lives," says Dr. Adamczyk. "If this guideline heightens the awareness of getting children's eyes checked, we've accomplished our purpose."

Dr. Thau thanked the committee for its diligence and urges all doctors of optometry and other health care providers to use the guideline to provide exceptional care for their patients.

"Children in America are entitled to the best, evidence-based care we can provide," Dr. Thau says. "These recommendations are the only guideline for providing evidence-based care to help protect the eye care and vision health of the next generation. As America's eye doctors, we are in a unique position to make a difference for these young people."

Rigorous process

The clinical practice guideline represents three years of work by the committee, whose members identified and read 1,475 abstracts and 353 articles. The guideline for pediatric eye and vision care is designed to:

• Recommend optimal intervals for in-person, comprehensive eye and vision examinations for infants and children (newborn through 18 years old).
• Suggest appropriate procedures to effectively examine the eye health, vision status and ocular manifestations of systemic disease in infants and children.
• Reduce the risks and adverse effects of eye and vision problems in infants and children through prevention, education, early diagnosis, treatment and management.
• Inform and educate patients, parents/caregivers and other health care providers about the importance of eye health and good vision, and the need for and frequency of pediatric eye and vision examinations.

The guideline meets the revised standards of the National Academies of Sciences, Engineering and Medicine (formerly the Institute of Medicine). The AOA will submit the guidelines to the National Guideline Clearinghouse, a public resource for evidence-based clinical practice guidelines operated by the Agency for Healthcare Research and Quality.

Far-reaching impact

The guideline extensively covers how to provide a comprehensive pediatric eye and vision examination. Topics include exam procedures; assessment; and diagnosis and management of conditions and diseases. The guideline specifies age-appropriate testing procedures for infants and toddlers (newborn through 2 years of age); preschool children (3 through 5 years old); and school-age children (6 through 18 years old).

The guideline also reflects how far research and best practices in pediatric eye care have come since the last time the AOA revised its Optometric Clinical Practice Guideline for Pediatric Eye and Vision Examination in 2002. New and expanded sections in the guideline include trauma, myopia, ocular manifestations of child abuse/neglect, color vision deficiency, and ultraviolet radiation and blue light protection.

Early detection and prevention is key, because visual systems develop in early childhood, Dr. Adamczyk says. For that, there is no substitute for an in-person, comprehensive eye exam that can lead to prevention or a timely diagnosis and treatment, she says.

"If you can catch certain eye conditions and diseases early in the course of their lives, you can really change children's lives," Dr. Adamczyk says. "If a child isn't functioning well visually, it can impact his or her performance in school. It can impact his or her behavior, future goals and the kind of work he or she will do as an adult.

"The AOA hopes the impact of this guideline will be far-reaching," she adds.