Academy of Ophthalmology reacts to recent study on eye exams for children

Sean Donahue, M.D., Ph.D., a pediatric ophthalmologist at Vanderbilt Medical Center in Nashville Tenn., agrees. "The data used in this paper unfortunately mixes well-conducted clinical trials and weak, poorly conducted and non-controlled studies."

The study doesn't provide any new information, according to Dr. Donahue, and is silent on the "costs" of an eye exam mandate. Dr. Donahue authored a recent study that estimated a nation-wide mandatory preschool vision exam program could cost more than $200 million annually simply for unnecessary eyeglasses.

The study goes further, concluding that, "policymakers should consider programs that would increase the proportion of preschool children who receive a comprehensive exam, potentially including an exam requirement."

Drs. Donahue and Beauchamp contend that using this study as a rationale to promote universal preschool eye exams is inappropriate. That was beyond the scope of this study, they said. Even the study admits that the data is insufficient to support that conclusion.

According to the study, "little data has been published on the relative performance of comprehensive exams and vision screenings, the costs and outcomes associated with treating amblyopia, or the impact of untreated amblyopia on quality of life."

Moreover, Dr. Beauchamp stressed, the results of this study conflict with recent recommendations from the U.S. Preventive Services Task Force (USPSTF), a well-respected, unaffiliated organization.

"The Task Force announced just this spring (May 2004) its support of vision screening for children under the age of five," said Dr. Beauchamp. The USPSTF found vision screening tests "have reasonable accuracy in identifying strabismus, amblyopia and refractive errors in children."

The Academy shares this position. The Academy has long advocated vision screening to identify children who may need further examination and follow-up treatment. Vision screening serves more children for less cost and is highly effective in picking up vision loss in younger children. Mandating complete eye exams for all preschool children is medically unnecessary and wasteful of limited resources.

States that have active screening programs in place, such as North Carolina, have proven screening to be highly effective in detecting children with vision problems.

Jennifer Talbot, president and chief operating officer for Prevent Blindness, North Carolina, said, "surveys of optometrists and ophthalmologists in our state indicate they believe that the screenings are effective in correctly identifying children with eye problems."

One of the main keys to North Carolina's success is adequate resources to fund follow-up care for children identified as having potential problems. No one disagrees with the benefit of checking children's vision, added Ms. Talbot. "From a public health perspective, however, effective vision screenings help better utilize limited health care resources."

In North Carolina, Prevent Blindness annually screens more than 500,000 children using certified vision screeners. In the current year, more than 30,000 of these children will be preschoolers.

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