Detection of eye abnormalities is extremely important in infants and children (under age 6) as irreversible vision loss (amblyopia) can be prevented before the visual pathways are fully developed. Myopia (nearsightedness) may not be identified until age 11 and is important to screen for in older children.

Impact of vision problems:

Children with impaired vision have: greater difficulty learning (80% of learning depends on good vision), trouble participating in recreational activities, a future with limited employment options, and difficulty with psychosocial development.

Common Vision Problems:

  • Amblyopia (2-4%)
  • Strabismus (~4%)
  • Refractive Errors (Nearsightedness (~20%), farsightedness and astigmatism

Screening Tools Needed:

  • HOTV/Lea/Snellen/Sloan chart
  • Occluder, pen light, small toy
  • Ophthalmascope
  • Stereopsis (optional)

Screening Tips for charts:

  • Check for 2-line difference, show whole line at a time, DON’T ISOLATE LETTERS (could miss amblyopia), no peeking.

Age related recommendations:

Birth to 2 Months:

  • Red Reflex and External Inspection
  • Eye History/behavior (subjective screen)

2 months:

  • Same as at 0-1 months plus:
  • Corneal light reflection with penlight or ophthalmoscope light

4 months to Age 3 Years

  • Same as at 2 months visit plus:
  • Cover-uncover w/occluder & toy
  • Fix and follow w/each eye (if crossed eye is fixed-refer to Eye professional).

Age 3 years through 8 Years

  • Visual acuity (monocular)
  • Inspection, history update
  • Corneal light reflex & Cover-uncover while fixating on a toy*.
  • Stereopsis (optional)*

Age 9 Years to 20 years

  • Visual acuity charts *if never had