Pediatric Eye Examination

- Recommendations

♦️ A comprehensive pediatric eye and vision examination should include but is not limited to

            -  review of the nature and history of the presenting problem, patient and family eye and medical histories and school performance history of the child.

          -   Examination should include assessment of visual acuity with a method suitable to age, determination of refractive status, ocular motility assessment, evaluation of pupillary response,

            - Assessment of binocular vision, accommodation, evaluation of color vision can be indicated in selected cases.

           -   Assessment of peripheral retina, measurement of intraocular pressure, and visual field testing can be indicated in selected cases.

 - Good practice statement

          -   Level of evidence: very low (lack of published research to support or refute the use of all of the tests and/or assessments included in this recommendation).

♦️ Cycloplegic retinoscopy is the preferred procedure for the evaluation of refraction in children, both for preschool and school age

 - Good practice statement

          -   Level of evidence: very low (lack of published research to support or refute the use of all of the tests and/or assessments included in this recommendation).

♦️ Infants should receive an in-person comprehensive eye and vision assessment between 6 and 12 months of age for the prevention and/or early diagnosis and treatment of sight-threatening eye conditions and to evaluate visual development.

 - Strong Recommendation

         -  Level of evidence: Medium (Prospective cohort studies, Diagnostic study) (6-8)

♦️ Preterm infants with a history of ROP should be closely monitored for the development of high myopia, astigmatism, and anisometropia

- Strong Recommendation

         -   Level of evidence: Medium (Prospective cohort studies, Diagnostic study) (6)

♦️ Early visual examination in infants for amblyopia and amblyopic risk factors can lower the prevalence and severity of amblyopia in children.

 - Strong Recommendation

        -   Level of evidence: Medium (Prospective cohort studies, Diagnostic study) (7)

♦️  Preschool age children should receive an in-person comprehensive eye and vision examination at least once between the ages of 3 and 5 to prevent and/ or diagnose and treat any eye or vision conditions that may affect visual development.

- Strong Recommendation

         -   Level of evidence: Medium (Systematic Review, Case series, Cross-sectional study) (9-12)

♦️ School-age children should receive an in-person comprehensive eye and vision examination before beginning school to diagnose, treat, and manage any eye or vision conditions.

- Strong Recommendation

          -   Level of evidence: Medium (Systematic Review, Case series, Cross-sectional study) (13-16)

♦️ Children with myopia should have an in-person comprehensive eye and vision examination at least annually.

-   Strong recommendation

           -   Level of evidence: Medium (Randomized clinical trial, Prospective cohort study) (17-18)

➡️Clinical Indicators:

➡️Updates:

To keep these recommendations up to date and  ensure  its validity it will be periodically updated. This will be done whenever new strong evidence is available and necessitates updating.

➡️Research Gaps:

It is recommended to have high quality randomised controlled trials on the frequency of visits needed for hypermetropic and astigmatic children