7 Minutes
19 millions children under the age of 14 are living with a vision disorder.1 Fortunately, with early detection and treatment, 80% of vision disorders can be prevented or cured.2 However, only 1 in 3 American children has had a vision screening before kindergarten.3
Vision loss can be caused by a wide range of factors including damage to the eye, incorrect eye shape, or from a problem within the brain.4 Equal input from both eyes is vital for normal development of the vision system in babies and young children.5 A child's vision may be permanently impaired if eyes are unable to send clear image signals to the brain.5
Up to 10% of preschoolers and 25% of school-age children have a vision disorder that can impact learning and quality of life.6 Here are some of the most common disabling vision disorders among U.S. children:7
Oftentimes, vision disorders have no noticeable symptoms.8 Signs that may indicate a potential vision problem include:9
Among preschool children, less than 15% receive comprehensive eye examinations and less than 25% undergo vision screenings.10 The evaluation of the visual system is vital as it can help detect conditions like strabismus and amblyopia that distort or suppress normal visual images and may lead to vision loss.11
Pediatric vision screening is the first line of defense for detecting potential vision problems early on when treatment is more likely to be effective.12 Vision screening is an efficient and cost-effective method5 that can be conducted by primary care providers, eye care professionals, school nurses and other trained laypersons. Vision screening can help identify children who have or are at risk for developing vision disorders such as amblyopia, strabismus 13, and various refractive errors (e.g., myopia, hyperopia).5 A child should be referred to an eye care professional if they fail a vision screening test.13
A comprehensive eye exam by an eye doctor (optometrist or ophthalmologist) is required to formally diagnose and treat vision disorders. During the exam, various tests are performed to evaluate visual acuity, depth perception, eye alignment, and eye movement.14 Eye drops are used to dilate the pupil, enabling a more thorough investigation of the eye.15
An instrument-based vision screener is a device that can help detect vision disorders that may cause visual impairment. An instrument-based vision screener takes an image of the eyes to measure refractive error and ocular misalignments16 and easy as having a photo taken with a digital camera.6 An instrument-based vision screener is recommended for children who are unable to perform a visual acuity chart test.17
80% of all learning happens visually.18 Therefore, uncorrected vision disorders may result in impaired development, behavior problems, interference with early literacy and learning, and even permanent vision loss.19
To help facilitate early detection and treatment, the U.S. Preventative Services Task Force (USPSTF) recommends all children between the ages of three and five years receive at least one vision screening to help detect vision problems.20
The American Optometric Association recommends infants should receive their first comprehensive eye exam as soon as six months old. Another eye exam should occur at three years old and again before they enter kindergarten.21
High-risk children (e.g., born prematurely, family history of vision problems or eye disease, noticeable abnormalities or symptoms of decreased vision, etc.) should bypass a vision screening and be directly referred to an eye care professional.15
1. Children’s Eye Foundation. https://www.childrenseyefoundation.org. Accessed July 12, 2023.
2. “80% of Visual Impairment Can Be Avoided or Cured.” Central European Journal of Public Health 12, no. 1 (March 2004): 31.
3. Zabba, Joel N. “Children’s Vision Care in The 21st Century & Its Impact on Education, Literacy, Social Issues & the Workplace: A Call to Action.” Journal of Behavioral Optometry (2011)
4. Centers for Disease Control and Prevention. Facts About Vision Loss. https://www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/VisionLossFactSheet.pdf. Accessed July 18, 2024.
5. Joint Policy Statement - Vision Screening For Infants and Children. American Academy of Ophthalmology. Revised and Approved by the American Association for Pediatric Ophthalmology and Strabismus, October 2022 American Academy of Ophthalmology, Board of Trustees, September 2022.
6. American Academy of Pediatrics. Children’s Eye Foundation. A Practical Guide for Primary Care Physicians: Instrument-Based Vision Screening in Children. American Academy of Ophthalmology. Eye Screening for Children.
7. Ambrosino C, Dai X, Antonio Aguirre B, Collins ME. Pediatric and School-Age Vision Screening in the United States: Rationale, Components, and Future Directions. Children (Basel). 2023 Mar 2;10(3):490. doi: 10.3390/children10030490. PMID: 36980048; PMCID: PMC10047420.
8. “Vision Photoscreening of Infants and Young Children in a Primary Care Pediatric Office: Can It Identify Asymptomatic Treatable Amblyopic Risk Factors? - PubMed.” Accessed August 9, 2023. https://pubmed.ncbi.nlm.nih.gov/25009113/.
9. Prevent Blindness. Your Child's Sight - Signs of Possible Eye Problems in Children. https://preventblindness.org/signs-of-possible-eye-problems-in-children/ Accessed May 21, 2024.
10. American Optometric Association. Championing Children's Eye Care. https://www.aoa.org/news/inside-optometry/aoa-news/championing-childrens-eye-care?sso=y Accessed July 18, 2024.
11. Prevent Blindness. Children’s Vision Screening and Intervention. https://preventblindness.org/childrens-vision-screening-and-intervention/. Accessed July 6, 2023.
12. Blair K, Cibis G, Zeppieri M, et al. Amblyopia. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430890/
13. American Academy of Ophthalmology. Eye Screening for Children. https://www.aao.org/eye-health/tips-prevention/children-eye-screening. Accessed May 21, 2024.
14. Childhood Eye Examination AMANDA L. BELL, MD; MARY ELIZABETH RODES, MD, MEd; and LISA COLLIER KELLAR, MD, MSCE Wright State University Boonshoft School of Medicine, Dayton, Ohio. https://www.aafp.org/pubs/afp/issues/2013/0815/p241.pdf
15. Comprehensive eye exams. (n.d.). AOA. https://www.aoa.org/healthy-eyes/caring-for-your-eyes/eye-exams?sso=y. Accessed June 15, 2024.
16. American Association for Pediatric Ophthalmology and Strabismus. Photoscreening. https://aapos.org/glossary/photoscreening. Accessed July 6, 2023.
17. Instrument-Based Pediatric Vision Screening Policy Statement. American Academy of Pediatrics. www.pediatrics.org/cgi/doi/10.1542/peds.2012-2548
18. Optometrists Network. Guide to Vision and Learning Difficulties. https://www.optometrists.org/vision-therapy/guide-vision-and-learning-difficulties. Accessed August 7, 2024.
19. National Association of School Nurses. Vision and Eye Health. https://www.nasn.org/nasn-resources/practice-topics/vision-health. Accessed March 6, 2024.
20. Vision Screening in Children Aged 6 Months to 5 Years: Recommendation Statement U.S Preventive Services Task Force. American Family Physician.Volume 96, Number 12, December 15, 2017.
21. American Academy of Ophthalmology. Eye Screening for Children. https://www.aao.org/eye-health/tips-prevention/children-eye-screening. Accessed May 21, 2024.
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