Pediatric Eye Evaluations Preferred Practice Pattern®

中文摘要

視力篩查通常在兒科診所由護士或其他受過培訓的醫護人員進行。兒童視力障礙和失明的原因在全球各地差異很大。在低收入國家，白內障和由傳染病或維生素A缺乏引起的角膜病變是導致嚴重視力障礙和失明的常見原因。

兒童應在整個童年和青少年時期接受定期視力篩查，因為隨著孩子的成長，可能會出現視力問題。大多數基於儀器的視力篩查方法可以檢測弱視的風險因素，如斜視、高度或不對稱的屈光不正、晶體混濁（如白內障）、視網膜異常（如視網膜母細胞瘤）和眼瞼下垂。在社區中，照相篩檢設備對弱視風險因素評估有高的敏感性和特異性。

執行視力篩查的醫生、護士、眼科醫生、驗光師、視光師、教師和其他執業人員應接受培訓，以便評估視力問題的風險因素、檢測眼睛結構性的問題、評估不同年齡兒童的視力，並/或進行儀器篩查。對於無法進行常規視力測試的兒童，應在6個月內（如有可能，更早）重新篩查或接受全面眼科檢查。

總之，對兒童和青少年進行定期視力篩查非常重要。

English Abstract

Vision screening is typically conducted in pediatric clinics by nurses or other trained healthcare professionals. The causes of severe vision impairment and blindness in children vary considerably worldwide, with cataracts and corneal conditions due to infectious diseases or vitamin A deficiency being common causes in low-income countries.

Children should undergo periodic vision screenings throughout childhood and adolescence, as vision problems may arise as they grow. Most instrument-based vision screening methods detect risk factors for amblyopia, such as strabismus, high or asymmetric refractive errors, media opacities (e.g., cataract), retinal abnormalities (e.g., retinoblastoma), and ptosis. In community settings, photoscreening devices demonstrate reasonably high sensitivity and specificity for amblyopia risk factors.

Physicians, nurses, ophthalmologists, optometrists, orthoptists, teachers, and other professionals performing vision screening should be trained to assess risk factors for vision problems, detect structural eye issues, evaluate visual abilities in children of different ages, and/or conduct instrument-based screenings. Children who are untestable should be rescreened within six months (preferably sooner) or referred for a comprehensive eye examination.

In summary, regular vision screenings for children and adolescents are essential in identifying and addressing potential vision problems to ensure healthy visual development.

HIGHLIGHTED RECOMMENDATIONS FOR CARE

Amblyopia meets the World Health Organization criteria for a disease that benefits from screening because it is an important health problem for which there is an accepted treatment, it has a recognizable latent or early symptomatic stage, and a suitable test or examination is available to diagnose it before permanent vision loss
occurs. The U.S. Preventive Services Task Force (USPSTF) recommends vision screening at least once for all children aged 3 to 5 years to detect amblyopia or its risk factors.

4 Vision testing with single optotypes is likely to overestimate visual acuity in a patient who has amblyopia. A more accurate assessment of monocular visual acuity is obtained by presenting a line of optotypes or a single optotype with crowding bars that surround (or crowd) the optotype being identified.
The choice and arrangement of optotypes (letters, numbers, symbols) on an eye chart can significantly affect the visual acuity score obtained. The preferred optotypes are LEA symbols, HOTV, and Sloan letters because they are standardized and validated.5, 6 Instrument-based screening techniques, such as photo screening and autorefraction, are useful for assessing amblyopia and reduced-vision risk factors for children ages 1 to 5 years, as this is a critical time for visual development.7 Instrument-based screening can also be used for older children who are unable to participate
in optotype-based screening. This type of screening has been shown to be useful in detecting amblyopia risk factors in children with developmental disabilities.8
Vision screening should be performed at an early age and at regular intervals throughout childhood to detect amblyopia risk factors and refractive errors. The elements of vision screening vary depending on the age and level of cooperation of the child, as shown in Table 1.