THE NEED FOR COMPREHENSIVE VISION EXAMINATION OF PRESCHOOL AND SCHOOL-AGE CHILDREN

Vision disorders are a common pediatric health problem in the United States.  It is estimated that nearly 25% of school-age children have vision problems.  Despite the economic, social and health care advances which have occurred in our society, many preschool and school-age children are not receiving adequate professional eye and vision care.  Only about one third of all children have had an eye examination or vision screening prior to entering school.  Also, a recent study found that 11.5% of teenagers have undetected or untreated vision problems.  The early detection and treatment of eye and vision problems for children needs to be a major public health goal.  This is made increasingly important by the enhanced understanding of critical periods in human visual development.  The earlier a vision problem is diagnosed and treated, the less the potential negative impact it may have on the child's development.

The American Optometric Association believes that an eye/vision assessment conducted as part of a preschool or school physical or a vision screening in the public or private schools cannot substitute for regular professional care.  Vision screening is a limited process of surveying certain aspects of vision problem areas.  A professional vision examination is essential for the diagnosis and treatment of eye and vision problems prior to entry into school.

The need for vision examinations of school-aged children is supported by a review of various studies, which find that:

	Vision screening programs for school children are intended to help identify those children who have or may potentially have a vision problem that may affect physiological or perceptual processes of vision or that could interfere with school performance.  Vision screenings are not diagnostic nor do they lead to treatment, but rather only indicate a potential need for further care.
	Only 33 states and the District of Columbia have requirements for vision screening in public or private schools.  The scope and frequency of school vision screenings vary considerably from state to state.
	The need for a comprehensive vision examination should not be confused with the need for quality vision screening programs.  Each has a different purpose and generates different results.
	The fact that vision screening is a limited, non-diagnostic process if often not communicated effectively to the public.  This creates the illusion that "passing" the screening means that there is no vision problem.
	The greatest concern in vision screening is under referrals.  Failure to identify children who need further attention jeopardizes the effectiveness and credibility of well-designed and administered screening endeavors.  This is especially evident when only visual acuity is used as the standard in the screening program.  There is also the unmeasurable hidden costs and impact of the untreated vision problem on the child's quality of life.
	Mentally and multiply handicapped children (e.g., children with such conditions as mental retardation, cerebral palsy, hearing impairment, and low birth weight syndrome) exhibit an incidence rate of vision anomalies at least twice as high as normally developed children.  Due to their handicaps, many of these children do not respond appropriately to standard vision screening procedures.  Unidentified vision problems in this special population can further impair their growth and development.  These special children have the greatest need for comprehensive clinical vision examinations well before entering a public or private school system

Therefore, it is the position of the American Optometric Association that:

	Any undetected vision problem may result in the reduction of the efficiency of the visual system.  This may further result in the inability of children to achieve their full potential.
	All children should receive a comprehensive eye and vision examination assessing and treating any deficiencies in ocular health, visual acuity, refractive status, oculomotility and binocular vision prior to entering school.  Asymptomatic/risk free pediatric patients should have a comprehensive examination at age six months, again at age 3 and followed by another examination before first grade.  The asymptomatic/risk free child should continue to have comprehensive eye and vision examinations every 2 years thereafter.  Symptomatic/at risk children may need to have examinations more frequently at the discretion of their doctor of optometry.
	Vision screening programs that are well designed and properly administered in public or private schools should be utilized to assist in the identification of children in need of care who have not had access to comprehensive examination services.

- Information provided by the American Optometric Association -

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