Pediatric Ophthalmologists Offer Guidelines on Screening, Treatment

Tinker Ready

October 10, 2013

The American Association for Pediatric Ophthalmology and Strabismus has released a list of "Five Things Physicians and Patients Should Question." The evidence-based recommendations are part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign.

1. "Don't put asymptomatic children in weak reading glasses." Low farsightedness is normal in children, and unless a child has crossed eyes, prescription glasses are not necessary.

2. Children who pass routine vision screening assessments do not need annual eye exams. Routine early childhood screening identifies most children with significant but asymptomatic eye problems. Annual exams, although appropriate for children who do not pass vision screening, can be costly and often require children to miss school and parents to miss work. Timely, recurrent screening is often sufficient to detect problems.

3. "Don't recommend vision therapy for patients with dyslexia." The condition, which results in problems understanding written word, is not a vision disorder. It occurs "because the brain has a problem distinguishing and separating the sounds in spoken words, called a phonological deficit.... Vision therapy does not work for this population because the eyes are not the problem."

4. "Don't routinely order imaging for patients with double vision." Patients often request a computed tomography scan or magnetic resonance imaging to determine whether double vision is caused by a brain tumor or other serious problem. Much of the time, however, an eye exam finds that neither test is necessary. The most common causes of double vision are refractive error (when the shape of the eye impairs focus), dry eyes, cataract, and "non-neurologic eye misalignment." Double vision is rarely linked to the brain.

5. "Don't order retinal imaging tests for children without symptoms or signs of eye disease." Taking a photograph or ordering an ocular coherence tomography scan is not useful in identifying normal ocular anatomy in asymptomatic children. The scans can be useful in cases of retinal or optic nerve conditions, however.

The list was created by the members of the association's board. Each board member offered a list of 10 potential topics, which each member then ranked. The top 5 recommendations were chosen. Each recommendation also was reviewed by a relevant specialist or committee of experts.


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