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In the U.S., vision disorders are the most prevalent disabling condition in children.¹ This is partly due to the fact that only 30% of children receive adequate vision screening.²

These statistics should speak loudly, but for many pediatricians, assumptions about vision care cloud their judgment.

Here are the most common vision care assumptions (myths) we hear from pediatricians.

As you are reading, ask yourself: is your vision screening protocol efficient or are your judgments being clouded by myths?

Myth #1: A snellen chart exam has clinical value for children under the age of 5.

We often hear pediatricians say that they begin vision screening at the age of 3 or 4 using a Snellen chart.

However, recent studies suggest that a child cannot fully comprehend a visual acuity test until they are 5 or 6 years old.

In a 2008 study, April Salcido found a 0% positive predictive value for traditional screening methods like a Snellen chart exam.³

In comparison, photoscreening, an annual test recommended by the AAP starting at age 1, had a 73% positive predictive value for the same age.

Myth #2: A pediatrician can most accurately detect refractive errors with an ophthalmoscope.

Although red reflex testing with an ophthalmoscope can detect high refractive errors, photoscreeners are designed with the referral criteria mandated by the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). This referral criteria is specific for refractive errors that indicate a risk for amblyopia, the #1 cause of preventable vision loss in children.4 This leads to improved referral quality.

A 2001 study by Evelyn Passe found a significant difference in the accuracy of detection of amblyopia using the Bruckner red reflex test (65%) and a photoscreener (82%).5 Since then, photoscreening technology has only improved.

The AAP does recommend red reflex testing with an ophthalmoscope. But it recommends it specifically for the detection of “cataracts, glaucoma, retinoblastoma, retinal abnormalities, systemic diseases with ocular manifestations, and high refractive errors.”6

The AAP does not recommend it for the detection of risk factors for amblyopia.  Instead, they recommend instrument-based screening beginning at age 1.7 The aforementioned photoscreening test using a photoscreener is the best and recommended way to perform instrument-based screening.

Dr. Kody Finstad at Mercy Health System, a medical group with more than 2000 providers, says this about one of his young patients: “with an ophthalmoscope, the ‘red reflex’ was equal bilaterally and normal. So without the GoCheck Kids photoscreener – even with my exam – I would have never considered sending this kid for referral.”

Myth #3: Parents will notice if their children have amblyopia.

In strabismic amblyopia, “one eye may turn in, out, up or down”.8 This type of amblyopia can often be detected by the naked eye.

However, strabismic amblyopia is only one kind of amblyopia. Other types include refractive and deprivation amblyopia. AAPOS’s position is that “other forms of amblyopia may NOT be obvious to parents and therefore must be detected by Vision Screening.”

As Stephanie Messercola, a PA at Glen Falls Pediatrics in New York,  relays, “Using the GoCheck Kids photoscreener, we detected risk factors in an 18-month-old with severe bilateral amblyopia. Her parents had no idea and we wouldn’t have caught her with traditional techniques.”

Myth #4: Amblyopia will not get worse before it is detected using a visual acuity test.

Remember, amblyopia is the #1 cause of preventable vision loss in children, and it generally continues to develop and deepen if it goes untreated.

As Dr. Sean Donahue states in the most recent AAP vision policy update, “refractive adaptation is less likely to occur (or be complete) in children with deeper amblyopia; thus these children must be identified at a younger age.”7

When it comes to amblyopia detection, the earlier it occurs, the more effective the treatment and the more cost-effective it is.9

In fact, “If amblyopia is not treated, the vision in the affected eye will be permanently decreased, causing deficits in depth perception and peripheral vision. Moreover, if the good eye becomes injured or affected by a disease, significant lifetime disability may result.”8

Amblyopia Treatment Outcomes by Age
Amblyopia Treatment Outcomes by Age

Myth #5: Photoscreening is too expensive to be practical.

Initial photoscreeners were accompanied with burdensome costs, but GoCheck Kids is clinically-validated and accessible for small practices to large health systems. It is offered with no upfront costs and a free trial, which allows pediatricians to evaluate reimbursement and workflow before committing. And even then, the commitment is month-to-month.

Most pediatric practices find that they can break even when using GoCheck Kids after only 5-6 reimbursable tests.

Conclusion

The most effective and clinically validated vision screening technique for the detection of amblyopia from ages 1-5 is not visual acuity, red reflex testing with an ophthalmoscope, or relying on a parents’ judgment.

The best way to ensure that your young patients are not at risk is to implement photoscreening in your practice. With GoCheck Kids, photoscreening is now accessible.

Photoscreening is catching on. We now have thousands of providers using our technology to better serve their young patients. But we need your help to advance our mission to screen 20 million children by 2020.

We think every child deserves a chance to fulfill their potential. Don’t you?


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