Screenings vs. Exams

The Need for Comprehensive Eye and Vision Examinations for ChildrenVision disorders are a common disability and one of the most prevalent handicapping conditions during childhood. Since the majority of learning in early school-age children is primarily through the visual sense, it is important for all children to receive comprehensive eye examinations prior to entering school. The earlier a vision problem is diagnosed and treated, the less of a negative impact it will have on a child's overall development.  

As many as one in four school-age children have vision problems.  Vision problems not diagnosed and treated have a negative impact on learning. Vision problems with the potential to impact learning include skills related to sustained reading. Problems with eye movement control, eye focusing or accommodation, and eye teaming or binocularity can affect efficiency of learning despite a child having 20/20 vision. Although the most prevalent eye problem in children is refractive errors that affect visual acuity, there are additional skills important for visual information acquisition. The examination of children for eye and vision problems should therefore include all visual functions of acuity, binocularity, eye motility and focusing, and ocular health, including neurodevelopmental and congenital eye abnormalities. The identification of all eye and vision problems a child may have can only be through a comprehensive eye examination, not a vision screening. Due to the importance of early identification and therefore treatment of eye and vision problems, the American Optometric Association recommends all children receive their first eye examination before the age of one year. National estimates suggest a rate of vision screening between a low of 2 percent to a high of 64 percent, and vision screenings are only able to identify 27 percent of the children who actually have vision problems. Furthermore, the data showing the proportion of these children who fail the vision screening and subsequently receive comprehensive vision care and treatment of vision problems is uncertain. 

Vision screenings are not a substitute for a comprehensive eye examination that evaluates not only acuity and eye health, but also focusing, eye teaming, eye tracking, and visual processing skills - skills needed for academic success. Excellent vision starts with seeing clearly but it does not end there; focusing skills and eye teaming skills are important for school readiness and academic success.

Therefore, it is the position of the American Optometric Association that:

• Vision problems left untreated may result in the reduction of the efficiency of the visual system. Timely identification and treatment of visual acuity and visual performance problems will allow a child to perform at his or her full potential.

• An eye/vision assessment conducted as part of a pediatric well child visit or school physical cannot substitute for regular professional eye care. Vision screening is a limited process of surveying certain aspects of vision problem areas. An exam by an eye doctor is essential for the diagnosis and treatment of eye and vision problems prior to entry into school.

• All children should receive a comprehensive eye and vision examination to diagnose and treat any deficiencies in ocular health, visual acuity, refractive status, oculomotility, focusing and binocular vision prior to entering school. The first eye examination should take place by the age of one year. Subsequent examinations should parallel child development of social, motor, and cognitive skills and are recommended to take place at the age of three years, and every two years thereafter. Symptomatic and at risk children such as those struggling in school, may need to have examinations more frequently.

Resources available for download by clicking here.

Updated in August 2015 by the InfantSEE and Children's Vision committee