Doctors of Optometry troubled by disregard for vision and eye health needs of children

American Optometric AssociationFeb 5 2011

Doctors of Optometry Troubled by Disregard for Vision and Eye Health Needs of Children under 3 and Reliance on Failed Vision Screening System for Preschoolers

The American Optometric Association (AOA), the voice of America's family eye doctors, today warned that if a set of U.S. Preventive Services Task Force (USPSTF) recommendations are adopted as policy, significant harm will be caused to the ongoing efforts of eye doctors nationwide to reverse the high rates of preventable vision loss in children across America, from the first year of life through age 5. Recognized as a public health emergency, high rates of undetected and untreated eye disorders continue to plague the nation's children and impair their ability to learn, grow and function normally; and even higher rates of disability exist among disadvantaged populations.

"This nation's Doctors of Optometry are extremely concerned that the USPSTF Children's Vision Screening Recommendations will hamper ongoing efforts to combat unacceptably high rates of preventable vision loss in children - especially among vulnerable and at-risk children in communities across America," said AOA President Joe E. Ellis, O.D. "With nearly one in four school-aged children now suffering from preventable vision loss which directly impacts their ability to learn, grow and function normally; ensuring that our children receive early and periodic comprehensive vision and eye health examinations will prove both cost-effective for our country and the key to fully confronting and potentially solving this continuing crisis."

The recommendations, which were recently updated and released by the federally-funded committee without adequately consulting with optometrists, who provide the majority of children's vision and eye health care in the United States, disregard the vision and eye health needs of America's children under the age of 3 – the most critical stage of visual development - apparently "due to the child's inability to cooperate." AOA believes that this approach is flawed and questions if cooperation were the criteria by which to determine the benefits of intervention, whether the USPSTF should recommend against immunizations by needles since children are loathe cooperating with shots. Despite this misconception, optometrists and pediatric ophthalmologists alike are well trained and have access to specialized equipment and procedures that enable comprehensive and cooperative evaluation of children's vision and eye health at less than 3 years of age.

For children ages 3 to 5, the USPSTF recommends continued reliance on a failed vision screening methodology and a broken screening system as a means of identifying visual impairment in preschool-age children, a critical developmental stage during which undiagnosed and untreated vision problems can have a massive impact on a child's ability to succeed in school and later in life. The USPSTF claims "false positives" are a drawback to vision screening asserting that "false positive screening results may lead to over prescribing corrective lenses." The AOA feels that the panel misses the true failing of most children's vision screenings: "false negatives." Giving parents and educators a false sense of security, the vast majority of children's vision screenings have high rates of "false negatives" (telling the child that no problem exists), failing to adequately detect signs of significant vision problems in children chronically burdened by these difficulties.

"These ill-advised USPSTF recommendations seem to ignore mountains of scientific data showing that the vast majority of vision screenings for children demonstrate an unacceptably high rate of error," said AOA President-Elect Dori Carlson, O.D. "To make matters worse, for those children lucky enough to have been told they have failed a screening, numerous studies have also clearly shown that the overwhelming majority of those kids do not receive proper diagnosis and follow-up care. High error rates found in most children's vision screening programs coupled with little or no assurances of proper diagnosis or follow-up care are the very reasons we find ourselves facing this crisis today. We simply can't expect to repeat the mistakes of the past and somehow produce any level of improved results for our children's future."

Doctors of Optometry are now urging the Task Force to join the AOA in calling for the flawed screening recommendations to be immediately withdrawn and for the convening, on an emergency basis, a collaborative inter-professional dialog aimed at strengthening, rather than undermining, the most effective risk reduction and health promotion policies and recommendations on eye disease and vision.