Vision Screening Frequently Asked Questions

Vision Screening vs. Vision Examination

Question 1. When is a newborn or other child considered high risk for potential vision problems?

A. Newborns or children considered high risk include:

• Premature infants.
• Those with a family history of retinoblastoma, glaucoma, or cataracts in childhood, retinal dystrophy/degeneration, or systemic diseases associated with eye problems.
• When any opacity of the ocular media is seen.
• If nystagmus is seen.
• Infants and children with neuro-developmental delay.
• Other children who should have an eye examination by an eye professional are those with a family history of strabismus, amblyopia or sensorineural hearing loss or a family member needing glasses before age 6 years.
• Refer to Child and Family Vision History and Risk Assessment Questionnaire (PDF)

Visual Acuity Screening

Question 2. When charts have the bottom lines split into two columns, which column do you use for which eye?

A. It is recommended that you use the right column for screening the right eye and the left column for screening the left eye.

Question 3. If you are screening a child who does not speak English, regardless of age, can you use the LEA SYMBOLS ® or HOTV charts?

A. Yes, as long as you keep it a matching symbol test and do not ask the child to name the letter or symbol.

Other Visual Screening Instruments

Question 4. Are there any special hints to help with screening kindergarten children for color vision problems?

A. If you are using the Ishihara book, have them trace the lines (with a clean watercolor paint brush) in the back of the book. The instructions for pass/re-screen are found in the back of the book. If they have normal color vision, they will see the same lines as you do, provided you have normal color vision. Some of you have asked about having the child trace the numbers. This is okay, but if they only see one of the numbers, e.g., 7 on the page with the number 74, the question of pass or re-screen is unclear. You may want to invest in one of the books made for unlettered persons or the Waggoner color vision book which is specifically designed to screen young children.

Question 5. Our program would like to order vision screening equipment, what is recommended and for what ages?

A. Refer to Equipment for Visual Acuity Screening (PDF). For younger children, ages 3 through 5 years, vision screening equipment, also called instrument-based vision screening, is considered an acceptable alternative. Instrument based vision screening is not recommended for children 6 years and older. There are no recommendations for using instrument-based vision screening equipment in the mass screening environment. MDH does not recommend specific brands of equipment. It is recommended that programs review the most current evidence based studies on the instruments prior to purchasing equipment.

Age-Appropriate Screening

Question 6. What kind of problems can I anticipate finding at different ages?

A. Infants to age 4 months: It is not uncommon to have an occasional eye that crosses at this age. An eye professional should evaluate a child if the eye is fixed in a crossed position. An immediate referral to an eye professional should be made for any red reflex abnormalities.

Infants aged 6 to 12 months: Can have a high incidence of hyperopia and astigmatism that usually resolves without treatment. However, any concerns by parents and caregivers should warrant a referral.

Children aged 4 months to 3 years: It is important to screen for problems such as strabismus (crossed eyes) in very young children. Forty percent of children with strabismus are at high risk for developing amblyopia.

For children aged 8 and older: During the school-age years, it is important to screen for myopia, as 20% of these children are so nearsighted that they will require corrective glasses. Generally, school-age students do not report visual problems, as they may have grown accustomed to blurred vision.