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What to Assess

For information on specific tests and procedures see: Vision Screening Tools and Tests section

  1. History review risk factors for visual impairment
  2. All items in the Preschool exam–
    • External examination of orbit, eyelids, globe, cornea and iris
    • Pupil examination
    • Red reflex examination
    • Ocular motility assessment
  3. Monocular visual acuity measurement Assess every two years until age 10 and every three years thereafter
    • Usually evaluated with Snellen Letter or Number Chart measuring visual responses at 10 feet from the eye chart with occlusion of the contralateral eye.
    • Eye patches are the only way to be absolutely sure there is no peeking with the other eye!
    • Children who have corrective lenses, should have vision assesment performed while wearing the glasses.  If a child requires reading glasses only, remove them for distant visual acuity assessment.
  4. Binocular Alignment
    • Hirschberg corneal light reflex test
    • Bruckner test
    • Combination of cover-uncover test and alternating cover test (requires more cooperation but may elicit latent deviations)
  5. Ophthalmoscopy/Retinal exam

Who to Refer for Ophthalmologic Assessment

  • Any child who does not pass risk factor screening or observation.
  • Any child with anatomic abnormality, poor visual fixation, eye misalignment, asymmetric or abnormal red reflexes, or nystagmus
  • Traumatic injury to the eye
Results of vision assessments, visual acuity measurements (if performed), eye evaluations and recommendations for follow-up care should be clearly communicated to parents.