Don’t put asymptomatic children in weak reading glasses.
Low “farsightedness” is a normal finding in children. Children can easily focus to see at near, with their large accommodative reserve. If the reading glasses prescription is low (less than +2.00 diopters), their innate ability to focus can be used to see clearly at both distance and near. If the eyes are not crossed, prescription of weak glasses is generally not necessary.
Annual comprehensive eye exams are unnecessary for children who pass routine vision screening assessments.
Early childhood vision screening done as part of routine well-child care accurately identifies most children with significant eye problems that are otherwise asymptomatic. Annual comprehensive eye examinations increase financial costs, a child’s absence from school and parental time away from work, with no evidence that the comprehensive exam detects asymptomatic vision problems better than timely, methodical and recurrent screening efforts. Comprehensive eye exams are appropriate for children who do not pass a vision screening.
Don’t recommend vision therapy for patients with dyslexia.
Dyslexia is a language-based learning disorder in which a person has trouble understanding written words. This occurs because the brain has a problem distinguishing and separating the sounds in spoken words, called a phonological deficit. Dyslexia is not due to a vision disorder. Children with dyslexia do not have any more visual problems than children without dyslexia. Vision therapy does not work for this population because the eyes are not the problem.
Don’t routinely order imaging for all patients with double vision.
Many people with double vision, or diplopia, want a CT scan or MRI to see if it is caused by a brain tumor or other serious problem. Much of the time, following a comprehensive eye evaluation, neither test is necessary. Other common causes of double vision are refractive error, dry eyes, cataract, and non-neurologic eye misalignment, all readily diagnosed by a complete exam, precluding the need for brain scans. Only a minority of cases of diplopia result from problems within the brain.
Don’t order retinal imaging tests for children without symptoms or signs of eye disease.
Retinal imaging, such as taking a photograph or obtaining an Ocular Coherence Tomography (OCT) image of the back of a child’s eye, can be useful for documenting or following known retinal or optic nerve pathology. These imaging studies should not be obtained routinely for documentation of normal ocular anatomy in asymptomatic children.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) is the flagship specialty organization for pediatric ophthalmologists in the U.S. with more than 1,500 U.S. and international members. AAPOS’s mission is to enhance the quality of health care by fostering excellence and professionalism in pediatric ophthalmology and adult strabismus. AAPOS provides information and advocacy for its members in ophthalmology, pediatrics and related subspecialties.
For more information or questions, please visit www.aapos.org.
The President and the Executive Vice President of the American Association for Pediatric Ophthalmology and Strabismus met with its Board of Directors. These 10 pediatric ophthalmologists leading the American Association for Pediatric Ophthalmology and Strabismus then generated a list of 10 potential topics. Each individual ranked the topics and the top five recommendations were chosen. Each recommendation was sent to a recognized expert in that specific area or to a committee of experts to complete the template. The American Association for Pediatric Ophthalmology and Strabismus disclosure and conflict of interest policies can be found at www.aapos.org.
Donahue SP. How often are spectacles prescribed to “normal” preschool children? J AAPOS. 2004;8:224–9.
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