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The Following Policy Statement
is from the
American
Academy of Ophthalmology
Frequency of Ocular Examinations
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Policy
The frequency of ocular examinations
should be based on the presence of visual
abnormalities and/or the probability
of visual abnormalities developing.
Individuals who have ocular symptoms
require prompt examinations. Individuals
who do not have symptoms but who are
at high risk of developing ocular abnormalities
related to systemic diseases such as
diabetes mellitus and hypertension or
who have a family history of eye disease
require periodic eye examinations. The
frequency of these examinations depends
on the age of the individual, the specific
condition, and the likelihood of finding
abnormalities on examination. Patients
who have no symptoms and who are at
low risk should receive an initial comprehensive
eye examination, and they should then
follow a schedule of periodic assessment
designed to detect ocular disease.
Background
There are several times in an individual's
lifetime when an ocular examination
is extremely important. Certain infectious,
congenital, and hereditary eye diseases
may be manifest at birth, and since
they create a risk to vision if undetected,
an examination in the newborn is justified.
Preschool-age children should receive
an ocular examination because amblyopia
is estimated to occur at a rate of two
to four percent and may lead to functional
blindness if undetected. The major abnormality
among school-age children is the unrecognized
development and progression of myopic
refractive error, and individuals in
this age group should be examined. Myopia
can develop in individuals in their
20s, and it can progress in those whose
refractive error did not stabilize in
the teenage years. In the young adult
the rate of development of other significant
eye disease is low, but it increases
steadily after the age of 40.
Routine or yearly eye examinations have
been recommended as a standard for good
health maintenance. However, population-based
data confirm a low frequency of eye
disease in adults below the age of 40
in the United States and suggest that
less frequent examinations are appropriate
for most patients.
Evaluation
If a comprehensive medical eye examination
in the third decade of life reveals
that no ocular disease is present, routine
ocular examinations every 2 to 3 years
for young adults with no ocular complaints
serve little practical purpose. Prior
to the onset of presbyopia (at approximately
age 40), the majority of Americans experience
no changing refractive error or significant
ocular disease. However, an interim
evaluation is warranted if ocular symptoms,
visual changes, or injury are encountered.
For young individuals at higher risk
for certain diseases, such as African-Americans
who are at higher risk for glaucoma,
examinations should be considered every
2 to 4 years for adults under age 40,
every 1 to 3 years for those aged 40
to 54, and every 1 to 2 years for those
aged 55 to 64, even in the absence of
visual or ocular symptoms.
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For asymptomatic
individuals or individuals without
risk factors who are 40 to 54
years old and who have had a comprehensive
examination, the recommended interval
for interim evaluations is 2 to
4 years. For individuals who are
55 to 64 years old, the recommended
interval for interim evaluations
is 1 to 3 years. |
For individuals 65 years old or older,
the American Academy of Ophthalmology
recommends an examination every 1 to
2 years, even in the absence of symptoms.
In summary, the frequency of ocular
examinations should depend on the individual's
age, race, past ocular history, medical
history, family history of eye disease,
and the types of symptoms or ocular
findings encountered. If significant
ocular disease is detected, the frequency
of examination will depend on the severity
of the condition, the response to therapy
(or surgery), and the potential for
detecting progression of the abnormality.
Recommendations
1. Infants at high risk, such as those
with the potential for retinopathy of
prematurity and those with a family
history of retinoblastoma, childhood
cataracts, childhood glaucoma, or metabolic
and genetic disease, should have a medical
examination by an ophthalmologist as
soon as medically feasible.
2. All children should undergo an evaluation
to detect eye and vision abnormalities
during the first few months of life,
at 6 months to 1 year, at 3 years (approximately),
and at 5 years (approximately). Abnormalities
present at birth, such as opacities
of the ocular media (e.g., congenital
cataract) or ptosis, may have profound
effects on the development of the normal
vision in the infant. By age 3 to 3
1/2 years, the child will generally
cooperate enough for fairly accurate
assessment of visual acuity and ocular
alignment, and he or she should have
this assessed by a pediatrician or other
medical practitioner. Any abnormalities
or inability to test are criteria for
referral to an ophthalmologist.
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3. School-age children should
be evaluated regularly (approximately
every 1 to 2 years) during primary
health care visits, in schools,
or at public screenings for visual
acuity and ocular alignment. |
4. After an initial comprehensive eye
examination is performed by an ophthalmologist,
individuals from the age of puberty
to age 40 should be examined every 5
to 10 years unless ocular symptoms,
visual changes, or injury occur. The
exception is for young adults who are
at risk of developing significant ocular
disease in this interval because of
risk factors; these individuals should
be examined every 2 to 4 years.
5. Individuals who develop diabetes
mellitus type 1 should be examined by
an ophthalmologist 5 years after disease
onset and at least yearly thereafter.
Individuals who develop diabetes mellitus
type 2 should be examined at the time
of diagnosis and at least yearly thereafter.
6. Individuals without risk factors
from age 40 to 54 should be examined
by an ophthalmologist every 2 to 4 years.
Individuals without risk factors from
age 55 to 64 should be examined every
1 to 3 years.
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7. Individuals without risk
factors 65 years old or older
should have an examination performed
by an ophthalmologist every 1
to 2 years. |
8. The frequency of ocular examinations
in the presence of acute or chronic
disease will vary widely, with intervals
ranging from hours to several months,
depending on the risks encountered,
response to treatment, and potential
for the disease to progress.
9. Any individual at higher risk for
developing disease, based on ocular
and medical history, family history,
age, or race should have periodic examinations
determined by the particular risks,
even if no symptoms are present.
10. A routine comprehensive annual adult
eye examination in individuals under
the age of 40 unnecessarily escalates
the cost of eye care and is not indicated
except as described above.
Approved by: Board of Directors, February
1983
Revised and Approved by: Board of Directors.
September 1990
Revised and Approved by: Board of Trustees,
February 2000
Revised and Approved by: Board of Trustees,
February 2005
Revised and Approved by: Board of Trustees,
August 2006
©2006 American Academy of Ophthalmology®
P.O. Box 7424 / San Francisco, CA 94102
/ 415.561.8500
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