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The Basics: Vision Screening with Kids

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The Basics: Vision Screening with Kids

Dec 05, 2022

A majority of children will not develop 20/20 vision until they are four to six years old. During those first few years, what should parents do to make sure their kids maintain healthy vision? Pediatrician Cindy Gellner, MD, explains vision screening expectations during the first years of your child’s life, how to navigate school vision screening requirements, and when your child may need to see an optometrist.

Episode Transcript

Parents often ask me when I will be able to tell if their baby can see normally. That's hard. But vision screening is something that we do at well-child visits if your child does not already see an eye doctor. Today, I'll discuss the basics of vision screening in kids.

Vision Screening for Children Under Age 3

For children under age 3, any vision concerns need to be referred to a pediatric ophthalmologist, who is a medical doctor who treats eye issues. Some optometrists, who are doctors of optometry, or ODs, will see kids as young as 6 months old, but not usually.

Now, as pediatricians, we look at the eyes of kids starting at birth. We look to see if they have congenital cataracts, if their red reflexes are good. You know, when you take a picture of your kid and they have really bright red pupils, that's actually a good thing. We'll see if they have lazy eye or any other eye concern for which we need to have them see a specialist. But it's hard to check in the office to see if they need glasses at that age.

The American Academy of Pediatrics last updated their vision screening guidelines in 2021. We start doing vision exams at well-child visits starting at the age of 3. I usually tell kids at their 2.5-year well-child visit that when they come back to see me at 3, we'll have them play a picture game with my medical assistants.

It's actually the screening for visual acuity, which is to evaluate to see if they need to see an eye doctor for possible glasses. But a picture game sounds a whole lot more fun.

Vision Screening for School-age Children

Kids up until age 4 normally have 20/40 vision, and by age 5, they will have 20/30 vision. After that, their vision should be 20/25 or better. 20/20 is what most people know as normal vision, and that's what they should ideally have by age 6.

Often, the schools will want a child's vision screened before kindergarten. They will also do vision screening in the schools periodically. The parents will be notified if their child fails their vision screen, and we can repeat the vision exam here to make sure of the results, especially if the screener at school did not document on the letter what the child's visual acuity was.

Then we can help the family find an optometrist that can do a more in-depth vision evaluation and see what kind of glasses the child may need.

The forms that the schools send home usually require a signature from an actual optometrist to prove that the child saw an eye doctor. As pediatricians, we are not qualified to complete those forms and they will be returned to the parents if we fill them out. So if your child gets one of those forms, they do need to see an actual eye doctor.

How Often Should Your Child Have Their Vision Screened?

We recommend that a child has their vision screened at least once a year. That's why we do them at the well-child visits, which also happen once a year.

If your child wears glasses or contacts, the optometrist will let them know how often they need to be seen. Normally, it's still every year to make sure their prescription has not changed.

If you have any questions about your child's vision, talk to your child's pediatrician and we will evaluate what we can and let you know if your child needs to see an optometrist or an ophthalmologist for further testing.