In response to the growing concerns about children’s vision health and the effectiveness of current vision screening programs, the Canadian Association of Optometrists (CAO) released a updated position paper on July 18 to address the need for standardized and comprehensive pediatric eye care.

This paper underscores the significance of early detection and treatment of vision issues such as refractive errors, amblyopia, and strabismus, which, if left unaddressed, can profoundly impact children’s academic performance, social interactions, and overall quality of life. The CAO aims to highlight the shortcomings of existing vision screening programs and advocate for an integrated approach that ensures all children have access to thorough and effective eye care.

Limited evidence from small Canadian studies aligns with international research, showing that 10-14% of young children have vision impairment, mainly due to refractive errors like astigmatism and hyperopia, followed by amblyopia and strabismus. Additionally, myopia, another common refractive error, is increasing rapidly among children. A 2018 study in Ontario revealed that 6% of children aged six to eight years and 30% of children aged 11 to 13 years were myopic.

Vision impairment can negatively impact children’s academic performance, social interactions, self-esteem, and overall quality of life. Early childhood is crucial for visual development, making timely and appropriate vision and eye care essential.

Children’s vision screening programs in Canada need improvements

Public and school screening programs lack standardization, and there is limited empirical evidence to support their efficacy and cost-effectiveness. Vision screening aims to identify children with risk factors for vision problems and refer them to eye care professionals for further examination and treatment. Early detection, particularly for conditions like amblyopia, is crucial for better outcomes.

Primary care providers conduct well-baby and child visits for children up to five years of age, incorporating vision screening into these check-ups. Tests like the red reflex test for ocular diseases, the cover/uncover test for strabismus, and visual acuity tests are conducted between ages three to five.

Limitations of Vision Screening Programs

Several limitations hinder the effectiveness of children’s vision screening programs:

• Limited Efficacy Evidence: Although programs like Quebec’s École de la Vue have shown success, there is insufficient evidence to conclusively prove the efficacy of vision screening in improving outcomes.
• Accuracy of Screening Tools: The accuracy of screening tools varies, leading to false positives and unnecessary referrals. There is also insufficient evidence to demonstrate the accuracy of community screenings conducted by non-experts.
• Compliance Issues: Vision screening programs often face challenges with compliance, as not all eligible children participate or receive follow-up care. Studies show that many children identified for follow-up do not receive the necessary care, indicating a need for improved compliance measures.
• Socioeconomic Disparities: Vision screening programs may exacerbate social disparities, as children from deprived areas may be at higher risk of vision problems but face barriers to accessing care. Lower follow-up rates in school districts with high concentrations of Black students and students living in poverty highlight this issue.
• Misunderstanding Screening vs. Comprehensive Exams: Parents may confuse vision screening with comprehensive eye examinations, potentially leading to inadequate follow-up care.

Comprehensive Eye Exams

Comprehensive eye exams conducted by optometrists provide a full assessment of a child’s vision and eye health. Unlike vision screenings, these exams diagnose conditions like amblyopia, strabismus, uncorrected refractive errors, and more serious conditions such as cataracts and retinoblastoma. Optometrists can also refer children to specialists if needed.

Despite their importance, many children do not receive comprehensive eye exams according to Canadian guidelines. A 2018 Ontario study found that 35% of children with myopia were uncorrected. Effective communication of exam results and educating caregivers about visual health are essential components of the comprehensive eye examination process.

Policy Position and Recommendations

Vision issues significantly affect children’s health and development. The Canadian Association of Optometrists emphasizes the need for effective vision care strategies that ensure prevention, early detection, and treatment.

The Association calls for a comprehensive approach to pediatric vision care that integrates vision screening with comprehensive eye care. This approach should include:

• Integration of Vision Screening and Comprehensive Eye Care: Develop a model that seamlessly integrates vision screening within a broader pediatric eye care framework, ensuring prompt referrals and comprehensive care.
• Engagement of Trained Professionals: Involve trained professionals, especially optometrists, in planning and executing screening programs to ensure appropriate care and referrals.
• Parental and Community Education: Increase awareness among parents, caregivers, and communities about the importance of early detection and treatment of vision issues, and clarify the difference between vision screening and comprehensive eye exams.
• Standardization of Protocols: Develop and implement national screening protocols to address variability and lack of standardization in current practices, ensuring evidence-based and adaptable protocols.

The Canadian Association of Optometrists cautions against conflating vision screening with comprehensive eye exams. Every child must undergo comprehensive eye exams according to current frequency guidelines, regardless of whether they have been screened at school or in the community.

Visit the Canadian Association of Optometrists’ website to view the full Position Paper