The Guide to Clinical Preventive Services 2008 - part 9 pot

Clinical Considerations ■ The most common causes of visual impairment in children are: (1) amblyopia and its risk factors and (2) refractive error not associated with amblyopia. Amblyopia refers to reduced visual acuity without a detectable organic lesion of the eye and is usually associated with amblyogenic risk factors that interfere with normal binocular vision, such as strabismus (ocular misalignment), anisometropia (a large difference in refractive power between the 2 eyes), cataract (lens opacity), and ptosis (eyelid drooping). Refractive error not associated with amblyopia principally includes myopia (nearsightedness) and hyperopia (farsightedness); both remain correctable regardless of the age at detection. ■ Various tests are used widely in the United States to identify visual defects in children, and the choice of tests is influenced by the child’s age. During the first year of life, strabismus can be assessed by the cover test and the Hirschberg light reflex test. Screening for Visual Impairment in Children Younger Than Age 5 Years 201 Summary of Recommendation The U.S. Preventive Services Task Force (USPSTF) recommends scr eening to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5 years. Grade: B Recommendation. Screening children younger than age 3 years for visual acuity is more challenging than screening older children and typically requires testing by specially trained personnel. Newer automated techniques can be used to test these children. Photoscreening can detect amblyogenic risk factors such as strabismus, significant refractive error, and media opacities; however, photoscreening cannot detect amblyopia. ■ Traditional vision testing requires a cooperative, verbal child and cannot be performed reliably until ages 3 to 4 years. In children older than age 3 years, stereopsis (the ability of both eyes to function together) can be assessed with the Random Dot E test or Titmus Fly Stereotest; visual acuity can be assessed by tests such as the HOTV chart, Lea symbols, or the tumbling E. Some of these tests have better test characteristics than others. ■ Based on their review of current evidence, the USPSTF was unable to determine the optimal screening tests, periodicity of screening, or technical proficiency required of the screening clinician. Based on expert opinion, the American Academy of Pediatrics (AAP) recommends the following vision screening be performed at all well-child visits for children starting in the newborn period to 3 years: ocular history, vision assessment, external inspection of the eyes and lids, ocular motility assessment, pupil examination, and red reflex examination. For children aged 3 to 5 years, the AAP recommends the aforementioned screening in addition to age- 202 Visual Impairment in Children Younger Than Age 5 Years appropriate visual acuity measurement (using HOTV or tumbling E tests) and ophthalmoscopy. 1 ■ The USPSTF found that early detection and treatment of amblyopia and amblyogenic risk factors can improve visual acuity. These treatments include surgery for strabismus and cataracts; use of glasses, contact lenses, or refractive surgery treatments to correct refractive error; and visual training, patching, or atropine therapy of the nonamblyopic eye to treat amblyopia. ■ These recommendations do not address screening for other anatomic or pathologic entities, such as macro cornea, cataracts, retinal abnormalities, or neonatal neuroblastoma, nor do they address newer screening technologies currently under investigation. Reference 1. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine and Section on Ophthalmology, American Association of Certified Orthoptists, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Eye examination in infants, children, and young adults by pediatricians: policy statement. Pediatrics. 2003;111(4):902-907. This USPSTF recommendation was first published in: Ann Fam Med. 2004;2:263-266. 203 Visual Impairment in Children Younger Than Age 5 Years [...]... 1 week) • If mother is HBsAg negative, the birth dose can be delayed, in rare cases, with a provider’s order and a copy of the mother’s negative HBsAg laboratory report in the infant’s medical record After the birth dose: • The HepB series should be completed with either monovalent HepB or a combination vaccine containing HepB The second dose should be administered at age 1-2 months The final dose... weeks Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg after completion of at least 3 doses of a licensed HepB series, at age 9- 1 8 months (generally at the next well-child visit) 4-month dose: • It is permissible to administer 4 doses of HepB when combination vaccines are administered after the birth dose If monovalent HepB is used for doses after the birth dose,... aged 0-5 9 months • Administer annually to children 5 years of age and older with certain risk factors, to other persons (including household members) in close contact with persons in groups at higher risk, and to any child whose parents request vaccination • For healthy persons (those who do not have underlying medical conditions that predispose them to influenza complications) ages 2-4 9 years, either... Bill Sowers Marion Torchia Tricia Trinité, M.S.P.H., A.P.R.N Gloria Washington Tracy Wolff, M.D., M.P.H Evidence-Based Practice Centers Supporting the USPSTF 2001 -2 008 The following researchers working through three AHRQ Evidence-Based Practice Centers prepared systematic evidence reviews and evidence summaries as resources on topics under consideration by the USPSTF Oregon Evidence-Based Practice Center... Evidence The USPSTF grades the quality of the overall evidence for a service on a 3-point scale (good, fair, poor): Good: Evidence includes consistent results from welldesigned, well-conducted studies in representative populations that directly assess effects on health outcomes Fair: Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number,... weeks) • Administer the first dose at age 6-1 2 weeks • Do not start the series later than age 12 weeks • Administer the final dose in the series by age 32 weeks Do not administer any dose later than age 32 weeks • Data on safety and efficacy outside of these age ranges are insufficient 3 Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) (Minimum age: 6 weeks) • The fourth dose of... of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes Poor: Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes 211 Appendix B Members of the U.S Preventive. .. dose of PCV to all healthy children aged 2 4-5 9 months having any incomplete schedule • Administer PPV to children aged 2 years and older with underlying medical conditions 6 Influenza vaccine (Minimum age: 6 months for trivalent inactivated influenza vaccine [TIV]; 2 years for live, attenuated influenza vaccine [LAIV]) Appendix D 225 • Administer annually to children aged 6-5 9 months and to all eligible... primary disease prevention The Task Force refers to recommendations made by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) for immunization of children and adults The methods used by ACIP to review evidence on immunizations may differ from the methods used by the USPSTF 221 222 Footnotes begin on page 224 This schedule indicates the recommended ages... administered at the recommended age should be administered at any subsequent visit, when indicated and feasible Additional vaccines may be licensed and recommended during the year Licensed combination vaccines may be used whenever any components of the combination are indicated and other components of the vaccine are not contraindicated and if approved by the Food and Drug Administration for that dose of the series . This conclusion is therefore unlikely to be strongly affected by the results of future studies. Moderate The available evidence is sufficient to determine the effects of the preventive service on. surgery treatments to correct refractive error; and visual training, patching, or atropine therapy of the nonamblyopic eye to treat amblyopia. ■ These recommendations do not address screening for other anatomic. Suggestions for Practice A The USPSTF recommends the service. There is Offer or provide this service. high certainty that the net benefit is substantial. How the U.S. Preventive Services Task Force