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Vision Screening Recommendations

Most effective when performed periodically throughout childhood, the main goal of vision screening is to identify children who have or are at risk of developing amblyopia (“lazy eye”), a condition that can lead to permanent visual impairment unless treated in early childhood.

Other problems that can be detected by vision screening include:

  • Strabismus
  • Cataracts
  • Glaucoma
  • Refractive errors such as myopia ("nearsightedness")
  • Hyperopia ("farsightedness")
  • Astigmatism
  • Ptosis
  • More serious conditions such as tumors or neurological diseases

Vision Screening Recommendations (provided by the Vision Screening Committee of American Association for Pediatric Ophthalmology and Strabismus):

 

Age: Newborn to 12 months

Tests:

  • Ocular history
  • Vision assessment
  • External inspection of the eyes and lids
  • Ocular motility assessment
  • Testing for any eye disorder that involves problems with moving the eyes
  • Pupil examination
  • Red reflex examination
  • The red reflex is a reflection from the lining of the inside of the eye that causes the pupil to look red in photographs. The red reflex should be bright in both eyes and equal.

Referral criteria:

  • Refer infants who do not track well after 3 months of age
  • Refer infants with an abnormal red reflex or history of retinoblastoma in a parent or sibling

 

Age: 12 to 36 months

Tests:

  • Ocular history
  • Vision assessment
  • External inspection of the eyes and lids
  • Ocular motility assessment
  • Pupil examination
  • Red reflex examination
  • Visual acuity testing
    • The use of an eye chart requires a cooperative child, so successful testing       is greatest with children 3 years and older. Since this is the only screening method that directly measures visual acuity, it is the preferred exam for older children.
  • Photoscreening
    • An automated technique that uses the red reflex to identify many types of eye problems
  • Ophthalmoscopy
    • A test that allows a health professional to see inside the fundus (back of the eye) and other structures using an ophthalmoscope

Referral criteria:

  • Refer infants with strabismus
  • Refer infants with chronic tearing or discharge
  • Refer children who fail photoscreening

 

Age: 36 months to 5 years

Tests:

  • Ocular History
  • Vision assessment
  • External inspection of the eyes and lids
  • Ocular motility assessment
  • Pupil examination
  • Red reflex examination
  • Visual acuity testing (preferred) or photoscreening
  • Ophthalmoscopy

 

Visual acuity thresholds

  • Ages 36-47 months Must correctly identify the majority of the optotypes on the 20/50 line to pass.
  • Ages 48-59 months Must correctly identify the majority of the optotypes on the 20/40 line to pass.
  • Refer children who fail photoscreening

Age: 5 years and older (Repeat screening every 1-2 years after age 5)

Tests:

 

  • Ocular history
  • Vision assessment
  • External inspection of the eyes and lids
  • Ocular motility assessment
  • Pupil examination
  • Red reflex examination
  • Visual acuity testing
  • Ophthalmoscopy

Referral criteria:

  • Refer children who cannot read at least 20/32 with either eye. (Must be able to identify the majority of the optotypes on the 20/32 line)
  • Refer children not reading at grade level

 

Source: AAPOS.org