{"id":1815,"date":"2026-03-09T14:34:14","date_gmt":"2026-03-09T17:34:14","guid":{"rendered":"https:\/\/sbop.com.br\/medico\/?post_type=consensos&p=1815"},"modified":"2026-03-10T13:09:38","modified_gmt":"2026-03-10T16:09:38","slug":"diretrizes-a-perspective-of-global-interest","status":"publish","type":"consensos","link":"https:\/\/sbop.com.br\/medico\/consensos\/diretrizes-a-perspective-of-global-interest\/","title":{"rendered":"Diretrizes – Pediatric vision screening in Brazil"},"content":{"rendered":"\n

Download the guideline in PDF format<\/a><\/p>\n\n\n\n

Authors:<\/strong>\u00a0ACSB Carneiro, JM Furtado, AL Silva, ALF Darcie, AC Ribeiro, LM Hopker, C Nakanami, SP Donahue, JD Rossetto<\/p>\n\n\n\n

Abstract<\/h3>\n\n\n\n

Purpose: This perspective presents evidence-based guidelines developed by a representative expert group from Brazil. The guidelines aim to enhance pediatric eye care through structured screening protocols, comprehensive eye examinations, and effective eyeglass prescriptions tailored to local contexts. <\/p>\n\n\n\n

Methods: The guidelines were developed through a narrative literature review and expert consensus among Brazilian Society of Pediatric Ophthalmology members, utilizing a comprehensive search strategy on PubMed from September 2022 to July 2024.<\/p>\n\n\n\n

Results: Key recommendations include performing the red reflex test (RRT) before neonatal discharge and
repeating it at least three times per year during the first three years of life. Additional recommendations include initiating photoscreening at one year of age and conducting visual acuity screening between ages 3 and 5\u2014prioritizing age 5 for amblyopia detection\u2014and again at ages 10\u201311. Follow-up screenings are advised at critical developmental stages. To expand access, trained non-ophthalmology professionals should participate in screening efforts within existing healthcare frameworks. Scaling secondary and tertiary care and aligning the program with other governmental initiatives are essential for sustainability and impact. Additionally, structuring the health program to align with other government initiatives will help ensure its sustainability and long-term impact.<\/p>\n\n\n\n

Conclusion: These guidelines provide a solid foundation for effective pediatric eye health programs, contributing to broader public health and sustainable development goals<\/p>\n\n\n\n

Instroduction<\/h3>\n\n\n\n

Visual impairment is estimated at 0.3 to 1.0 per thousand children in high and low-income countries, respectively. For 2020, 1.44 million children aged 0\u201314 years were estimated to be blind, and 46.60 million had mild vision impairment. However, most cases of childhood visual impairment are considered preventable or treatable with adequate ophthalmological care.<\/p>\n\n\n\n

Uncorrected refractive error is the primary cause of childhood visual impairment in most countries, including Brazil. An Indian study using The Refractive Error Study in Children (RESC) protocols has
shown that refractive error accounts for over 80 % (prevalence of 7.26%) of visual impairment and amblyopia for another 6.4 % (prevalence 0.57 %). In a low\u2013middle-income urban school project in S\u02dc
ao Paulo, Brazil, using the same protocol, refractive error was also the main cause (76.8 %; prevalence of 6.93 %) of visual impairment, followed by amblyopia (11.4 %; prevalence of 1.02 %). Other causes in Brazilian municipalities include retinopathy of prematurity (ROP), congenital cataracts, and glaucoma. A recent study from a Brazilian rehabilitation facility found cerebral visual impairment to be the main cause (27.9 %) of functional low vision (vision effectively used in daily activities), followed by ocular toxoplasmosis (8.2 %), ROP (7.8 %), and congenital cataracts (7.2 %).<\/p>\n\n\n\n

Compared to adults, children have longer \u2019blind person years\u2019 due to extended life expectancy, which imposes significant social and economic burdens. Visual impairment in childhood profoundly affects education, personality development, and career prospects, further straining societal resources. Early intervention is crucial for prevention, prompt diagnosis, and effective treatment. In the context of Brazil, where healthcare resources are unevenly distributed, establishing comprehensive eye health programs for all children is not only logistically complex but also financially unfeasible. Moreover, evidence does not
support their superiority over widespread vision screening programs in terms of effectiveness in amblyopia screening. Disparities in methods, starting ages, and examiner profiles in existing visual screening programs across 18 countries highlight the hurdle.<\/p>\n\n\n\n

In Brazil, regional disparities and socioeconomic inequalities present significant challenges to achieving universal eye health coverage. This issue is particularly pronounced within the framework of the Unified
Health System (Sistema \u00danico de Sa\u00fade, SUS), the government-funded healthcare system that provides free medical services nationwide and serves as the primary healthcare provider for approximately 75 % of the population. Effective pediatric eye health programs necessitate integrated approaches spanning Primary (screening and promotion and prevention actions), Secondary, and Tertiary Care levels (ophthalmologist assistance, diagnosis, and treatment of eye conditions) to ensure screening, prevention, diagnosis, and treatment are accessible to all. Moreover, programs for diagnosing and correcting refractive errors in school-aged children have demonstrated high cost-effectiveness globally.<\/p>\n\n\n\n

This manuscript, authored by a nationally representative expert group from Brazil, presents evidence-based guidelines for screening, comprehensive eye care, and eyeglass prescriptions for pediatric populations in Brazil. The recommendations consider optimal ages for testing, essential examinations, and adaptations for various contexts. These guidelines aim to facilitate application across diverse settings
globally, enhancing visual health initiatives\u2019 efficiency and effectiveness.<\/p>\n","protected":false},"author":1,"featured_media":1667,"parent":0,"menu_order":0,"template":"","class_list":["post-1815","consensos","type-consensos","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/sbop.com.br\/medico\/wp-json\/wp\/v2\/consensos\/1815","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sbop.com.br\/medico\/wp-json\/wp\/v2\/consensos"}],"about":[{"href":"https:\/\/sbop.com.br\/medico\/wp-json\/wp\/v2\/types\/consensos"}],"author":[{"embeddable":true,"href":"https:\/\/sbop.com.br\/medico\/wp-json\/wp\/v2\/users\/1"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sbop.com.br\/medico\/wp-json\/wp\/v2\/media\/1667"}],"wp:attachment":[{"href":"https:\/\/sbop.com.br\/medico\/wp-json\/wp\/v2\/media?parent=1815"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}