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Vision screenings are a crucial tool to track your child’s eye health.

Beginning soon after birth and continuing at regular intervals throughout childhood, vision screenings can detect potential eye problems that can then be treated.

“Vision screenings are very important,” says Ken Nischal, MD, chief, Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, and director, pediatric program development, UPMC Eye Center.

“When a child is born, they don’t know what they’re supposed to see. The brain learns to see. So, if there’s any impediment to vision getting to the back of the eye, you want to know about it as quickly as possible.”

Several different tools are used for pediatric vision screening. Learn more about eye exams for children, including when they’re done, vision tests by age, and why screening is so important.

What Is Vision Screening?

Vision screenings are tests to detect potential eye problems in children. They are typically performed in the hospital shortly after birth, in pediatrician or primary care offices, and in schools.

Through the use of different tests, vision screenings can identify potential eye problems, including, but not limited to:

• Amblyopia (lazy eye).
• Astigmatism.
• Color vision deficiency (color blindness).
• Congenital cataracts.
• Congenital glaucoma.
• Eye misalignment.
• Hyperopia (farsightedness).
• Myopia (nearsightedness).
• Retinoblastoma (a rare eye cancer).
• Strabismus (crossed eyes).

What’s the difference between a vision screening and a comprehensive eye exam?

While these terms seem interchangeable, they’re really not.

• Vision screenings can detect potential problems with the eyes and are typically performed by providers like pediatricians, family doctors, or school nurses.
• Comprehensive eye exams are performed by eye specialists like optometrists or ophthalmologists. These specialists provide more thorough evaluations and can prescribe treatment, such as glasses.

If a vision screening raises a red flag about your child’s vision, they will be referred to a pediatric optometrist or ophthalmologist for a more comprehensive eye exam.

At What Age Should Kids Get Vision Screenings?

The American Academy of Pediatrics (AAP) recommends vision screenings for children beginning at birth and continuing at every well-child visit.

The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend screenings at the following ages:

• Newborn.
• Between 6 and 12 months of age.
• Between 1 and 3 years of age.
• Between 3 and 5 years of age.
• 5 years and up.

Regular vision screenings can help ensure your child has no vision problems. If a problem is found, they can be referred to a pediatric optometrist or ophthalmologist for further evaluation and treatment.

What Are Common Visual Screening Tests?

The provider will often perform an external examination of the eyes and eyelids. They will also take a medical history, asking you and your child about any noticed vision problems.

However, you may not be aware of any visual problems, and your child may not be able to verbalize any issues. As a result, the provider will conduct visual screening tests to identify any potential issues. There are different types of eye tests for infants, toddlers, and school-age children.

Red reflex test

Also known as the fundus reflex test, the red reflex test is performed at birth and at well-child visits throughout your child’s life.

During the test, the provider uses a tool called an ophthalmoscope to shine a light into the eyes. The light passes through to the retina in the back of the eye and is reflected back to the pupils. The reflected light should appear symmetrical in both eyes.

Abnormal results include:

• If the color of the reflected light is abnormal.
• If the reflection isn’t symmetrical in both eyes.
• If the reflex is absent.

Those abnormal results indicate a problem, such as a cataract or retinoblastoma.

“If the image is not getting to the retina, which is the photosensitive layer in the back of the eye, it’s not going to go along the optic nerve to the brain, and the brain is not going to see it,” Dr. Nischal says. “And if the brain doesn’t see it, it begins to ignore that eye altogether — or both eyes if both eyes are affected and it’s not picked up.”

Pupil examination

The provider uses a light to examine the pupils for their size and symmetry.

Corneal light reflex

During this test, a provider shines a light on the pupils. If the light is visible in the center of both pupils, it’s a normal response. If the light isn’t centered in one or both eyes, it indicates a problem, such as strabismus.

Fix and follow

This test measures your child’s ability to fixate on an object and follow it with their eyes.

Cover-uncover test

In the cover-uncover test, a cover is placed over each eye and then removed. It tests eye alignment and can be used to detect strabismus.

Autorefractor

An autorefractor is a binocular-like instrument. It tests for refractive errors, such as astigmatism, nearsightedness, and farsightedness.

“Refractive error is when the shape of the eye is abnormal, so you’re either too long-sighted, too near-sighted, or both in terms of having astigmatism,” Dr. Nischal says. “Astigmatism is when the shape of the eye, instead of being like a soccer ball, is like an American football. So the image that falls in your retina is skewed.”

“The (autorefractor) machine calculates what the power of the eyes is,” Dr. Nischal adds. “And there are certain thresholds that trigger an automatic referral to a pediatric ophthalmologist or a pediatric optometrist to ensure that the child gets glasses if they need them.”

Autorefractors can detect refractive problems in children who are too young to read letters on an eye chart, such as 2- and 3-year-olds.

Visual acuity screening

Visual acuity screening uses charts with letters or symbols. The child stands or sits a certain distance from the chart and reads the lines of letters or symbols on the chart. They will have one eye covered at a time to test their vision in each eye.

Providers may begin using visual acuity screening on children as soon as they’re able to discern the letters and symbols. The AAP says visual acuity screening can begin as early as 3 years of age. It becomes more common at 4 and 5 years of age and thereafter.

Why Is Vision Screening Important?

It’s important for your child to get regular vision screenings to stay on top of their eye health. According to Pediatrics in Review, identifying vision problems through screening can reduce some causes of blindness by up to half.

The different layers of the eye convert light into electrical signals that your brain receives and turns into images. Eye problems affect the signals your brain receives, which in turn affects your vision. If problems aren’t detected before children are around 8 years old, they often aren’t fixable.

“If you think about neurological development (and) neurovisual development, the plasticity of that part of the brain ceases to be plastic around the age of 8,” Dr. Nischal says. “As a rule, if your vision is not the best it can be by the time you’re 8, then there’s nothing you can do after that — (or) very little, anyway.”

Some children and parents may not be aware of problems, he adds. That’s why routine eye exams matter even without symptoms.

“A child might behave like they’re seeing really well, but actually, when they try to read, they can’t read because they’re either too long-sighted, or have astigmatism, or they’re very nearsighted,” Dr. Nischal says. “Then the brain is getting a blurred image now.

“If by the time a child is 8, the only image the brain sees is a blurred image, it doesn’t matter what you do after that. You can’t make the brain see a better image.”

Vision screenings, on the other hand, can detect potential problems. Children with potential vision issues can get referred to an ophthalmologist or optometrist for a comprehensive eye exam.

How Can I Prepare My Child for a Vision Screening?

Many vision screenings take place at well-child visits with your child’s pediatrician or family doctor. When you’re preparing for a visit, it’s best to keep them calm.

If your child is old enough to understand, you can explain to them what will happen during the screening. Reassure them that it won’t hurt. Bring a toy or stuffed animal to help them stay calm.

Depending on your child’s age, you may have to hold them for part of the screening. You may need to keep them still for parts of the screening that they may find uncomfortable, such as having a light shone in their eyes.

You should bring a notebook with you or use a note-taking app to take down anything your child’s doctor says. Be prepared to discuss any vision problems you’ve noticed in your child. Make sure to ask any questions you have about your child’s vision.