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Comprehensive Pediatric Eye and Vision Examination

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Comprehensive Pediatric Eye and Vision Examination American Optometric Association – Peer/Public Review Document 1 2 3 EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Comprehensive 18 Pediatric Eye 19 and Vision 20 Examination 21 22 For Peer/Public Review May 16, 2016 23 American Optometric Association – Peer/Public Review Document 24 OPTOMETRY: THE PRIMARY EYE CARE PROFESSION 25 26 The American Optometric Association represents the thousands of doctors of optometry 27 throughout the United States who in a majority of communities are the only eye doctors. 28 Doctors of optometry provide primary eye care to tens of millions of Americans annually. 29 30 Doctors of optometry (O.D.s/optometrists) are the independent primary health care professionals for 31 the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the 32 visual system, the eye, and associated structures, as well as identify related systemic conditions 33 affecting the eye. Doctors of optometry prescribe medications, low vision rehabilitation, vision 34 therapy, spectacle lenses, contact lenses, and perform certain surgical procedures. 35 36 The mission of the profession of optometry is to fulfill the vision and eye care needs of the 37 public through clinical care, research, and education, all of which enhance quality of life. 38 39 40 Disclosure Statement 41 42 This Clinical Practice Guideline was funded by the American Optometric Association (AOA), 43 without financial support from any commercial sources. The Evidence-Based Optometry 44 Guideline Development Group and other guideline participants provided full written disclosure 45 of conflicts of interest prior to each meeting and prior to voting on the strength of evidence or 46 clinical recommendations contained within this guideline. 47 Disclaimer 48 49 Recommendations made in this guideline do not represent a standard of care. Instead, the 50 recommendations are intended to assist the clinician in the decision-making process. Patient 51 care and treatment should always be based on a clinician’s independent professional 52 judgment, given the patient’s circumstances, and in compliance with state laws and 53 regulations. 54 The information in this guideline is current to the extent possible as of the date of publication. 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 American Optometric Association – Peer/Public Review Document 70 EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE 71 72 73 74 75 76 77 Comprehensive Pediatric Eye and Vision Examination 78 79 80 Developed by the AOA Evidence-Based Optometry Guideline 81 Development Group 82 83 84 85 86 87 88 89 90 91 92 93 Approved by the AOA Board of Trustees insert date 94 95 96 © AMERICAN OPTOMETRIC ASSOCIATION 97 243 N. Lindbergh Blvd., St. Louis, MO 63141-7881 98 99 American Optometric Association – Peer/Public Review Document 100 TABLE OF CONTENTS 101 102 EVIDENCE-BASED CLINICAL GUIDELINES 103 104 A. What is the Evidence-Based Process? ……………………………………………………. 105 106 B. How to Use This Guideline …………………………………………………………………… 107 108 I. INTRODUCTION …………………………………………………………………………………. 109 110 A. Guideline Objectives ………………………………………………………………………….. 111 112 II. BACKGROUND …………………………………………………………………………………. 113 114 A. Visual Development …………………………………………………………………………… 115 116 B. Epidemiology of Eye and Vision Disorders in Children ………………………………… 117 118 C. Access to Care …………………………………………………………………………………. 119 120 D. Costs of Eye and Vision Disorders in Children …………………………………………… 121 122 E. Early Detection and Prevention of Eye and Vision Disorders ………………………….. 123 124 III. CARE PROCESS ………………………………………………………………………………… 125 126 A. Comprehensive Pediatric Eye and Vision Examination 127 128 1. General Considerations ……………………………………………………………………… 129 130 a. Infants and Toddlers …………………………………………………………………….. 131 132 b. Preschool Children ……………………………………………………………………….. 133 134 c. School-age Children …………………………………………………………………….. 135 136 d. Examination Procedures …………………………………………………………………. 137 138 2. Patient History ………………………………………………………………………………….. 139 140 3. Testing of Infants and Toddlers ………………………………………………………………. 141 142 a. Visual Acuity ............................................................................................................... 143 144 b. Refraction ................................................................................................................... 145 146 c. Binocular Vision and Ocular Motility ........................................................................... 147 148 4. Testing of Preschool Children ........................................................................................... 149 150 a. Visual Acuity ............................................................................................................... 151 152 b. Refraction ................................................................................................................... 153 American Optometric Association – Peer/Public Review Document 154 c. Binocular Vision, Ocular Motility, and Accommodation …………………………….. 155 156 d. Color Vision …………………………………………………………………………….. 157 158 5. Testing of School-age Children ……………………………………………………………… 159 160 a. Visual Acuity ............................................................................................................... 161 162 b. Refraction ................................................................................................................... 163 164 c. Binocular Vision, Ocular Motility, and Accommodation…………………………….. 165 166 d. Color Vision.…………………………………………………………………………….. 167 168 6. Ocular and Systemic Health Assessment ........................................................................ 169 170 a. Assessment of Pupillary Responses …………………………………………………… 171 172 b. Visual Field Evaluation (Confrontation) ………………………………………………… 173 174 c. Evaluation of the Ocular Anterior Segment and Adnexa ……………………………. 175 176 d. Evaluation of the Ocular Posterior Segment ………………………………………….. 177 178 e. Measurement of Intraocular Pressure …………………………………………………. 179 180 7. Supplemental Testing ...................................................................................................... 181 182 a. Electrodiagnostic Testing…………………………………………………………………. 183 184 b. Ocular Imaging…………………………………………………………………………….. 185 186 c. Testing for Learning-related or Visual Information Processing Problems…………… 187 188 d. Examination of Children with Special Needs…………………………………………… 189 190 e. Evaluation of Ocular Manifestations of Child Abuse…………………………………… 191 192 8. Assessment and Diagnosis…………………………………………………………………… 193 194 9. Potential Benefits and Harms of Testing .......................................................................... 195 196 B. Management ....................................................................................................................... 197 198 1. Counseling and Education ........................................................................................ 199 200 a. Eye Safety and Protection………………………………………………………………… 201 202 b. Ultraviolet Radiation and Blue Light Protection………………………………………… 203 204 c. Impact of Near Work and Reduced Time Outdoors on Vision………………………… 205 206 2. Coordination and Frequency of Care ............................................................................... 207 208 a. Coordination of Care ……………………………………………………………………… American Optometric Association – Peer/Public Review Document 209 210 b. Frequency of Care ………………………………………………………………………… 211 212 c. At-risk Children …………………………………………………………………………….. 213 214 C. Conclusion ............................................................................................................................ 215 216 IV. REFERENCES .................................................................................................. 217 218 V. APPENDIX ......................................................................................................... 219 A. Appendix Figure 1: Comprehensive Pediatric Eye and Vision Examination: A 220 Flowchart .................................................................................................................................. 221 222 B. Appendix Table 1: Potential Components of the Comprehensive Eye and Vision 223 Examination for Infants and Toddlers .................................................................................... 224 225 C. Appendix Table 2: Potential Components of the Comprehensive Eye and Vision 226 Examination for Preschool Children ...................................................................................... 227 228 D. Appendix Table 3: Potential Components of the Comprehensive Eye and Vision 229 Examination for School-age Children .................................................................................... 230 231 E. Appendix Table 4: Partial Listing of Ocular Manifestations of Neurodevelopmental 232 Disorders and Other Syndromes ………………………………………………………………… 233 234 F. Abbreviations ............................................................................................................................ 235 236 G. Summary of Action Statements …………………………………………………………………. 237 238 H. Gaps in Research Evidence……………………………………………………………………… 239 240 VI. METHODOLOGY FOR GUIDELINE DEVELOPMENT………………………… 241 242 VII. EVIDENCE-BASED OPTOMETRY GUIDELINE DEVELOPMENT GROUP… American Optometric Association – Peer/Public Review Document 243 244 A. What is the Evidence-Based Process? 245 246 As a result of the Medicare Improvement for Patients
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