Pediatric Eye Screening or Evaluation

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Professional Academy Recommendations
The American Association for Pediatric Ophthalmology and Strabismus, the American Academy of Ophthalmology, the American Academy of Pediatrics, the American Academy of Family Physicians and the American Association of Certified Orthoptists recommend early vision screening. A pediatrician, family physician, nurse practitioner, or physician assistant should examine a newborn's eyes for general eye health including a red reflex test in the nursery. An ophthalmologist should be asked to examine all high risk infants, i.e., those at risk to develop retinopathy of prematurity (ROP), those with a family history of retinoblastoma, glaucoma, or cataracts in childhood, retinal dystrophy/degeneration or systemic diseases associated with eye problems, or when any opacity of the ocular media or nystagmus (purposeless rhythmic movement of the eyes) is seen. Infants with neuro-developmental delay should also be examined by an ophthalmologist.

All infants should be examined by 6 months of age to evaluate fixation preference, ocular alignment, and the presence of any eye disease. There is some variation in the screening schedule as indicated below. Therefore, the Minnesota Department of Health convened a committee of vision screening experts and key stakeholders to provide specific recommendations to MDH for vision screening in Child & Teen Checkups, Head Start, Early Childhood Screening and school programs.

The following are recommendations for Pediatric eye evaluation screening recommendations when conducted by primary care providers, nurses, nurse practitioners, and physician assistants and trained lay personnel.

Recommended Ages For When To First Administer Tests
Test American Academy of Ophthalmology and AAPOS13 American Academy of Pediatrics14 MDH Recommendations*
Red Reflex Newborn to age 5 Years First 2 months of life + Newborn to Age 3
Corneal Light Reflex 6 months-12 months Newborn-2 months Newborn to Age 8
Inspection Newborn-3 months Newborn-2 months Newborn to Age 21
Binocular Fix and Follow 3-6 months 2 months-3 years 4 months to age 3 years
Monocular Fix and Follow 6-12 months 2-months-3 years 4 months to age 3 years
Cover Uncover 6-12 months to not designated Non specific 4 months to 8 years
Visual Acuity 3 years (approx) 3 years 3 years and older

In addition, a complete professional eye exam should be done at age 6-12 months for those children with a family history of amblyopia or strabismus.


13. American Academy of Ophthalmology. Pediatric Eye Evaluations. Preferred Practice Patterns. 2002.

14. American Academy of Pediatrics. Eye and Vision Screening Recommendations for Primary Care Providers. 2002.