Preschool Vision Screening: Summary of a Task Force Report

Vision screening to detect eye problems in school-aged children dates back at least a century.¹ Calls to screen specifically for amblyopia, generally defined as monocular decreased acuity, began appearing by the 1950s.² However, it was not until the 1960s, when animal research indicated that cortical plasticity was limited to a period early in life, that emphasis was placed on vision screening in the preschool years. Since that time, a variety of preschool screening programs have been adopted in various countries,³ ranging from the systematic and thorough efforts of Scandinavian countries that evaluate screening methods and outcome from infancy through preschool ages,^3,4 to the diversity of screening standards (Table 1) and screening programs found in different jurisdictions across the United States.^5,6

Recommendations for health-related screening programs, developed by the World Health Organization,⁷ require that a disorder suitable for mass screening should have a high prevalence in the population, should result in significant impairment to the individual, and should be treatable at the time of its detection. Although the Scandinavian experience and other data make clear the effectiveness of preschool screening in reducing visual morbidity from amblyopia,^8–10 fundamental questions remain about specific issues, ranging from screening methodology to quantitative measures of both efficacy and cost-effectiveness of such screening. These questions were recently brought to focus by a report from the United Kingdom questioning the utility of preschool vision screening.^11–13 Although both the data interpretation and conclusions of this report have been questioned,^14–23 it has given impetus to a reexamination of the why and how of preschool vision screening.

Recognizing the growing list of questions about preschool vision screening and the lack of consistency in preschool vision screening recommendations and programs in the United States, Congress urged …