Most young children have some degree of myopia (nearsightedness). Other prevalent preschool vision disorders include amblyopia and strabismus. Children with vision problems generally don’t complain because they can’t understand symptoms are abnormal and/or can’t articulate they are having problems. Studies have shown myopia can interfere with learning and development, which implies correction in young children might be beneficial. While most states require vision screening before entrance into kindergarten, only 16 states mandate preschool vision testing. This leaves many parents confused about when preschool children’s vision should be tested.
The American Optometric Association (AOA) recommends scheduling the first eye assessment when a baby is 6-months old or earlier if they are at risk. During the test, an optometrist will look for excessive or unequal amounts of nearsightedness, farsightedness, or astigmatism; eye movement ability; and eye health problems. Launched in 2005, InfantSEE® is a public health program managed by Optometry Cares® – the AOA Foundation. Under this program, participating optometrists provides a no-cost comprehensive infant eye assessment at 6-12 months of age.
After the initial infant exam, the AOA recommends vision testing at age 3, before first grade, and every 2 years thereafter in children ages 6-18 who are not at risk or asymptomatic. For those with problems, exams should also be done at age 3 (or as recommended) and annually or as recommended in children ages 6-18.
AAO and AAPOS Guidelines
The American Academy of Ophthalmology (AAO) and American Association for Pediatric Ophthalmology and Strabismus (AAPOS) recommend the following exams:
Newborns: An ophthalmologist, pediatrician, family doctor or other trained health professional should examine a newborn baby’s eyes and perform a red reflex test (a basic indicator the eyes are normal). If the baby is premature or at high risk for other medical problems, shows signs of abnormalities, or has a family history of serious childhood vision disorders, an ophthalmologist should perform the exam.
Infants: A second screening for eye health should be done by an ophthalmologist, pediatrician, family doctor, or other trained health professional as part of a well-child exam at 6-12 months-old.
Preschool Age: At age 3-3 1/2, vision and eye alignment should be assessed by a pediatrician, family doctor, ophthalmologist, optometrist, orthoptist, or person trained in vision assessment of preschool-age children.
School Age: When entering school (or if a problem is suspected), visual acuity and alignment tests should be administered by a pediatrician, family doctor, ophthalmologist, optometrist, orthoptist, or person trained in vision assessment of school-age children (e.g. school nurse). If an alignment problem or other eye health issues is suspected, it’s important to schedule an appointment with an ophthalmologist.
- Annual photoscreening is now recommended for children starting at ages 1-3
- Visual acuity testing is now recommended for children starting at age 4, when possible
Instrument-based screening devices have been extensively validated through AAP and other studies, therefore they may be electively performed in children ages 6 months to 3 years-old. When performed and interpreted correctly by appropriately trained individuals, these instruments usually identify the presence of common childhood eye conditions such amblyopia, high refractive error, and strabismus.
Research on Preschool Vision Screenings
Preschool vision screenings have been recommended as a cost-effective way to identify children with vision disorders who might benefit from early detection, treatment, or follow-up eye care. In Phase 1 of a large-scale study, 2,588 3-5-year-olds enrolled in Head Start were screened by eye care professionals for potential problems with 11 different preschool vision screening tests. Phase 2 of the study utilized the most accurate screening tests from the prior phase, with trained nurses and lay screeners administering the tests. Researchers compared results from the second phase with those achieved by the eye care professionals. Accuracy and speed were virtually the same for both groups, with small variances attributed to screening equipment rather than personnel.
A recent study published in Pediatrics showed instrument-based vision screening resulted in greater completed screenings among 3-5-year-olds. The rate increased from 54% to 89% in the phase 1 group and from 65% to 92% in the phase 2 group. Improvement was most notable among 3-year-olds, with completed screening increasing from 39% with charts to 87% with instruments.
Testing Your Child’s Vision at Home
If you wish to test your child’s vision more frequently than the aforementioned guidelines, now you can do so in the comfort of your own home, as often as you wish. EyeQue Insight screens vision for 20/20 to 20/400 in less than 3 minutes, providing exact measures of single and dual eye performance. It runs in two modes, simple straightforward “adult” mode, and gamified “kids” mode to make vision testing fun for children. In school-age children, myopia (nearsightedness) is quite prevalent and can occur with rapid onset. Testing your child’s eyes at home is a great way to detect a potential problem early and follow up with a visit to the eye doctor.