What to Assess
For information on specific tests and procedures see: Vision Screening Tools and Tests section
- History — review risk factors for visual impairment
- All items in the Preschool exam–
- External examination of orbit, eyelids, globe, cornea and iris
- Pupil examination
- Red reflex examination
- Ocular motility assessment
- 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.
- 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)
- 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.