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Table 2 Summary of existing recommendations

From: Vision screening in newborns and early childhood

Source Ref Date General recommendations for vision screening in childrena
Newborns and infants < 6 months Children 6 months to 3 years of age Children 3–5 years of age
USPSTF [4] 2017 “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of vision screening in children younger than 3 years.” (I Statement) “The USPSTF recommends vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors.” (Grade B recommendation)
PrevInfad [5] 2016 “PrevInfad recommends ocular inspection and red reflex test in each well-child visit on the first six months of life, considering that, although the quality of evidence is poor, the expected balance of the intervention is probably positive.
(Grade of recommendation: given that the red reflex test does not meet the necessary conditions to be considered a screening test, it is not possible to establish a grade of recommendation for the newborns and infants’ visual disorders screening.)”
“PrevInfad recommends visual disorders screening (amblyopia, strabismus and refraction errors) at the age of 3 to 5 years old.” (Grade B recommendation)
CDC ‘Prevent blindness’ [8] 2019 Newborns should have their eyes checked while still in the hospital nursery. This examination in the nursery should be for general eye health and include a red reflex test. This examination can help detect several congenital eye problems, some of which can be very serious and permanently threaten vision. During regular well baby exams, from birth to 3 years of age: Pediatricians should use family vision history and a vision assessment to see if vision problems exist. Beginning at well child exams at age 3 and continuing annually through 10 years of age, vision screenings should be performed assessing your child’s visual acuity and ocular alignment
    If a child fails a vision screening or there is any concern of an eye or vision problem: The child should be referred for a comprehensive professional eye examination. This combination of vision screenings with referral for a comprehensive professional eye examination are the recommendations of the American Academy of Pediatrics, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus.
The American Optometric Association supports a comprehensive professional eye examination performed by an eye doctor at age 6 months, 3 years and 5 years for all children.
NICE [9] 2015 “Appropriate recommendations made by the UK National Screening Committee should also be carried out. A physical examination should also be carried out. This should include checking the baby’s: […] eyes; check opacities and red reflex […].”
AAP and AAOb [10, 11] 2016 “Examination of the eyes and visual system should begin in the nursery and continue throughout both childhood and adolescence during routine well-child visits in the medical home.” - At 6 and 12 months: ocular history, external inspection of lids and eyes, red reflex testing, pupil examination, ocular motility assessment (12 months), and visual acuity fixate and follow response.
- From 1 to 3 years of age: all the above and instrument-based screening when available. “Visual acuity screening may be attempted in cooperative 3-year-old child”
- From 4 years of age: visual acuity and all the above (prior age group).
RCPCH [12] 2019 “Examination of all babies’ eyes for the red reflex should take place in the newborn examination.” (Strong evidence)c “Assess visual acuity in all 4–5-year olds as recommended by the UK National Screening Committee.” (Strong evidence)c
“Use evidence-based tests as part of the 4–5-year-old screening programme.” (Strong evidence)c
    “Alert parents to the signs of visual dysfunction, per the Personal Child Health Record.” (Good practice)c
“Carry out specialist eye examinations at appropriate intervals in high-risk groups.” (Strong evidence)c
UK NSC [13] 2013, updated in 2019 “Screening of children’s eyes should continue to be offered to all children aged 4–5 years.”
  1. Abbreviations: AAO American Academy of Ophthalmology, AAP American Academy of Pediatrics, CDC Centers for Disease Control and Prevention, NICE National Institute for Health and Care Excellence, PrevInfad PrevInfad workgroup from the Spanish Association of Primary Care Pediatrics, RCPCH Royal College of Paediatrics and Child Health, UK NSC UK National Screening Committee, USPSTF US Preventive Services Task Force
  2. aThe definitions of the grades to describe the strength of the recommendations are reported in (S2)
  3. bAlthough the AAP and AAO did not report the strength of recommendations, authors specified that the recommendations were based on panel consensus
  4. cThe RCPCH rates the strength of the evidence as ‘strong’, ‘moderately strong’, and ‘emerging’. Strong evidence is defined as evidence that is ‘based on evaluations that are sufficiently rigorous to determine whether an intervention can be causally linked to improvements in outcomes. A reliable comparison group is needed, which is why randomized controlled trials are an important method of estimating impact’