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 comprehensive examination by an ophthalmologist as soon as medically feasible.
2. Children should have an assessment for eye problems in the newborn period and then at all subsequent routine health supervision visits. The elements of the assessment vary with the age of the child. 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 these assessed by a pediatrician or other medical practitioner. Any abnormalities or the inability to test are criteria for referral to an ophthalmologist.
3. School-age children should be evaluated regularly for visual acuity and ocular alignment (approximately every 1 to 2 years) during primary health care visits, and in schools or at public screenings.
4. 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. Women with type 1 or type 2 diabetes should receive a comprehensive eye examination before conception and then early in the first trimester of pregnancy. Recommended intervals for subsequent examinations depend upon the level of retinopathy.
5. Adults with no signs or risk factors for eye disease should receive a baseline comprehensive eye evaluation at age 40. Individuals without risk factors aged 40 to 54 should be examined by an ophthalmologist every 2 to 4 years and individuals without risk factors aged 55 to 64 should be examined by an ophthalmologist every 1 to 3 years.
6. Individuals without risk factors 65 years old or older should have an examination performed by an ophthalmologist every 1 to 2 years.
7. 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 involved, response to treatment, and potential for the disease to progress.
8. 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.
9. 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.