Pediatric Vision Screening

Vision screening is essential for early detection and prevention of vision loss in young children. In the primary care setting, routine vision screening and eye examinations offer opportunities to diagnose a myriad of conditions.

Here’s a summary table from Pediatrics in Review based on vision screening recommendations from the AAP and the American Association for Pediatric Ophthalmology and Strabismus: 

Source: Loh et al. Pediatric Vision Screening. Pediatr Rev. 2018
  • Note that instrument-based screening refers to photoscreeners or autorefractors, which assess risk factors for vision loss, including myopia, hyperopia, astigmatism, and strabismus. 

Regarding visual acuity, it’s important to recognize that normal acuity changes with age because visual acuity gradually improves as children grow over the first years of life. Children ≥3yo typically can participate in provider-based subjective visual acuity testing. The “rule of 8” is a helpful mnemonic for determining the need for ophthalmology referral in children ≤6yo: 

Source: UpToDate

One important caveat to this rule is to refer any child with significant visual acuity asymmetry. For example, according to the rule, a 3yo child with visual acuity of 20/20 in the right eye and 20/50 in the left eye would not meet the threshold for referral; however, the presence of significant asymmetry in acuity mandates an ophthalmology referral for further evaluation.

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