A vision screening is a brief eye test that looks for potential vision problems and eye disorders. They are often first performed by the child's pediatrician.Vision screenings do not diagnose vision problems but if a problem is found, your child's provider will refer you to an eye specialist for diagnosis and treatment.
Your child’s vision can be screened by a:
- pediatrician
- family physician
- optometrist
- ophthalmologist
- or other properly trained health care provider
Screenings are also offered at schools, community health centers or community events.
The American Academy of Ophthalmology (AAO) recommends the following schedule:
Newborn
A pediatrician, family physician, or other properly trained health care provider should examine a newborn's eyes for general eye health and perform a red reflex test in the newborn nursery. Any baby with an abnormal red reflex requires urgent consultation. An ophthalmologist should be asked to examine all high-risk infants (i.e., those at risk of developing retinopathy of prematurity (ROP); those with a family history of retinoblastoma, glaucoma, or cataracts in childhood; those with a family history of retinal dystrophy/degeneration; those with systemic diseases or neurodevelopmental delays associated with eye problems; those with any opacity of the ocular media; or those with nystagmus).
1 month to 4 years of age
From 1 month to 4 years of age, infants and toddlers should have their ocular health assessed at each routine well-child visit, including an external inspection, pupillary examination, corneal light reflection and assessment of fixation and following behavior. This assessment should address any concerns raised by the family or noted by the primary care provider.
3 ½ to 4 years of age
Emphasis should be placed on checking visual acuity as soon as a child is cooperative enough to complete the assessment. Generally, this occurs between ages 3 ½ and 4 years. This assessment can be performed by a pediatrician, family practitioner, ophthalmologist, optometrist, orthoptist, nurse, or other appropriately trained individual. Screeners should not have a vested interest in the screening outcome. A child who is referred from a vision screening or is uncooperative at a second attempt at vision testing should be referred for a comprehensive eye evaluation. It is essential that a formal testing of visual acuity be performed by the age of 5 years.
3 to 5 years
Photoscreening and handheld autorefraction may be electively performed in children 12 months to 3 years of age, allowing earlier detection of conditions that may lead to amblyopia. Photoscreening and handheld automated refraction are recommended as an alternative to visual acuity screening with vision charts (typically used for children 3 through 5 years of age) and in children who are unable or unwilling to cooperate with routine acuity screening with vision charts (but are not superior to vision chart testing for children able to participate). The use of vision charts to assess amblyopia in children 3 to 5 years of age remains a viable practice at the present time.
5 years and older
Additional screening on each child should be done at routine school checks or well-child visits every 1-2 years after age 5 years. Routine comprehensive professional eye examinations performed on normal asymptomatic children have no proven medical benefit.
Children with possible or diagnosed learning disabilities, such as dyslexia, should undergo a comprehensive eye examination so that any undiagnosed vision impairment can be identified and treated. Such children should be referred for appropriate medical, psychological, and educational evaluations and treatment of any learning disability. There is inadequate scientific evidence to suggest that “defective eye teaming” and “accommodative disorders” are common causes of educational impairment.2,3 Hence, routine screening for these conditions is not recommended.
What’s the difference between vision screening and a comprehensive eye exam?
A comprehensive eye exam diagnoses eye disease. Eye drops are used to dilate (widen) the pupil during the exam. This gives your ophthalmologist a fuller view inside the eyes. With dilation and other special testing, signs of eye disease are more evident. The American Academy of Ophthalmology advises parents to seek a comprehensive eye exam if:
- their child fails a vision screening
- a vision screening is inconclusive or cannot be done
- referred by a pediatrician or school nurse
- their child has a vision complaint or observed abnormal visual behavior
- is at risk for developing eye problems - children with medical conditions (such as Down syndrome, prematurity, juvenile idiopathic arthritis, neurofibromatosis) or a family history of amblyopia, strabismus, retinoblastoma, congenital cataractsor glaucoma are at higher risk for developing pediatric eye problems
- their child has a learning disability, developmental delay, neuropsychological condition, or behavioral issue
