A discussion of the pediatric clinical guidelines

Abstract

It is evident from both the AAO and AOA guideline position statements that a visual and eye examination is essential within the first few months of life. Thus, both groups recognize the importance of examining infants within the critical period of visual development. The adequacy of testing performed by lay screeners or primary care physicians to rule out all visual disorders is highly questionable. Photorefraction is a promising screening technique, but as yet needs to be validated by further study. The only adequate means of detecting early vision and eye disorders is through examination by an eye care professional. However, this conclusion immediately underscores the need for eye care professionals prepared to examine very young children. The primary eye care of children should not be considered the responsibility of a minority of ‘pediatric specialists’. Clinical techniques are currently available which would enable all practitioners to evaluate children in the first few months of life, a critical time for an initial evaluation. We believe it is essential for all eye care professionals to be trained in these basics of eye and vision care. The need for widespread pediatric training should be addressed when reviewing the clinical education of interns. Both guidelines yield valuable guidance and background information for the pediatric examination. The AOA guideline is more complete, and includes a useful bibliography. It is well researched, and should be particularly helpful to the newer practitioner. The AAO guideline provides less detailed guidance, and omits some newer and important examination techniques, such as preferential looking for visual acuity and spray application for administering drugs. The AOA and AAO pediatric clinical practice guidelines can serve as helpful examination tutorials for the practitioner. The guidelines do not address the decision making process of diagnosis and treatment options. The references included in the documents can help fill in the gaps, but would require a substantial commitment of time for research and study. We see the need for additional guidelines to help guide the process of difficult decision-making when the patient is ‘in the chair’. The publication of such second generation documents would serve eye care professionals in the total case management of the pediatric patient.