II. Epidemiology
- One quarter of children wear glasses in the U.S.
- Eye disease is identified in 7% of children under age 18 years old
- Yet only 20% of U.S. Children screened for eye disease in U.S.
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 birth history
- Developmental Delay or neurologic disorder
- Systemic disease
-
Family History of eye disorder
- Retinoblastoma
- Congenital Cataracts
- Metabolic disorder
- Strabismus
- Amblyopia
- Childhood Glaucoma
- First degree relatives requiring Vision correction as a child
IV. History: Well Child Visit - Eye Related
- Has your child injured their eye at any time?
- Have you noticed your child having difficulty seeing close objects or far objects?
- Do your child's eyes appear straight, or do they appear to cross (esp. when tired)?
- Does your child tilt their head or squint with one eye when trying to see a distant object?
V. Exam: Well Child Exam Eye Screening
- Protocol
- AAP/AAOS recommend Vision Screening at ages 4, 5, 6, 8, 10 and 12 years
- Referral indications
- Visual Acuity worse than 20/40 (age <=6 years) or 20/30 (age >=6 years) OR
- Two-line difference between eyes
-
Newborn Eye Exam
- Red Reflex (Pupillary Light Reflex, Bruckner Test)
- Pupil Response (observe for Anisocoria)
- 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)
VI. Exam: Abnormal Vision testing
- Criteria for abnormal
- Age 3 to 4 years
- Either eye Vision <20/50
- Two-line difference between eyes
- Age 4 to 5 years
- Either eye Vision <10/20 or 20/40 (<3 of 5 correct)
- Two-line difference between eyes (e.g. 20/25 and 20/40)
- Age 6 and up
- Either eye Vision <10/15 or 20/30 (<3 of 5 correct)
- Two-line difference between eyes (e.g. 20/20 and 20/30)
- Age 3 to 4 years
- Additional testing: Pinhole Test
- Distinguishes Refractive Error from Amblyopia
- Indicated for failed Vision Screening
VII. Differential Diagnosis: Childhood Eye Disease
- High risk diseases
- Common eye problems