Vision Screening for Amblyopia Is Recommended in Children Aged 3 to 5 Years

Target Audience: Pediatric primary care providers

Target Population: Children aged 6 months to 5 years

Background and Objective

Amblyopia (also called “lazy eye”) is an alteration in the visual neural pathway estimated to occur in 1% to 6% of children aged <6 years. When left untreated, it can lead to permanent vision loss in the affected eye. The USPSTF has conducted a systematic review of the most recent evidence on screening for amblyopia and its risk factors (strabismus, uncorrected refractive errors, cataracts, and anisometropia) and has updated its 2011 recommendation statement on vision screening in children aged 6 months to 5 years.

What's Changed: Recommendations are unchanged from the 2011 statement.

Key Recommendation

• Screen all children aged 3 to 5 years at least once to identify amblyopia or its risk factors. When abnormalities are identified, refer children for formal visual testing.

Key Points

• Treatment of amblyopia in children aged 3 to 5 years improves visual acuity.

• Risks of screening are outweighed by the benefit.

• Screening test options include the red reflex test, the cover-uncover test, the corneal light reflex test, visual acuity tests, autorefractors, photoscreeners, and stereoacuity tests.

• Treatment should be tailored to the specific condition or risk factor identified but often requires eye patching of the involved eye.

• Other risk factors for amblyopia include having a first-degree relative with amblyopia, prematurity, low birth weight, maternal substance abuse, maternal gestational smoking, and low parental education levels.

• Hispanic children and those whose families earn <200% of the federal poverty level are less likely to receive screening.

• Evidence is insufficient to recommend screening in children aged <3 years.