Related Experiment Video
Updated: Apr 18, 2026
Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
Published on: March 24, 2020
Vision screening for children 36 to <72 months: recommended practices
Susan A Cotter1, Lynn A Cyert, Joseph M Miller
1*OD, MS, FAAO †PhD, OD, FAAO ‡MD, MPH §MD, MSCE Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California (SAC); Northeastern State University Oklahoma College of Optometry, Tahlequah, Oklahoma (LAC); University of Arizona College of Medicine, Tucson, Arizona (JMM); and Department of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (GEQ).
Insights
Annual vision screening for children aged 3 to 6 years is recommended to detect amblyopia and other visual disorders. Best practices include visual acuity testing or instrument-based screening for early intervention.
Area of Science:
- Pediatric Ophthalmology
- Public Health
- Vision Science
Background:
- Early detection of vision disorders in children is crucial for preventing long-term visual impairment.
- The National Center for Children's Vision and Eye Health developed guidelines for vision screening in preschool-aged children.
Purpose of the Study:
- To provide recommendations for screening children aged 36 to younger than 72 months for eye and visual system disorders.
- To define best and acceptable practice standards for vision screening.
- To identify targeted vision disorders including amblyopia, strabismus, and refractive errors.
Main Methods:
- Two best practice vision screening methods are described: monocular visual acuity testing and instrument-based testing.
- Recommended screening tests are suitable for lay screeners, nurses, and healthcare professionals.
- Characteristics of children requiring professional examination by an optometrist or ophthalmologist are outlined.
Main Results:
- Best practice methods include HOTV or LEA Symbols visual acuity testing and instrument-based testing with specific devices (Retinomax, SureSight).
- Acceptable practice includes using the Plusoptix Photoscreener.
- Supplemental stereoacuity testing with the PASS stereotest is also acceptable.
Conclusions:
- Annual vision screening is recommended as best practice for children aged 36 to younger than 72 months.
- A minimum standard of at least one screening is accepted.
- Technological updates will be available online.
Purpose:
This article provides recommendations for screening children aged 36 to younger than 72 months for eye and visual system disorders. The recommendations were developed by the National Expert Panel to the National Center for Children's Vision and Eye Health, sponsored by Prevent Blindness, and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, United States Department of Health and Human Services. The recommendations describe both best and acceptable practice standards. Targeted vision disorders for screening are primarily amblyopia, strabismus, significant refractive error, and associated risk factors. The recommended screening tests are intended for use by lay screeners, nurses, and other personnel who screen children in educational, community, public health, or primary health care settings. Characteristics of children who should be examined by an optometrist or ophthalmologist rather than undergo vision screening are also described.
Results:
There are two current best practice vision screening methods for children aged 36 to younger than 72 months: (1) monocular visual acuity testing using single HOTV letters or LEA Symbols surrounded by crowding bars at a 5-ft (1.5 m) test distance, with the child responding by either matching or naming, or (2) instrument-based testing using the Retinomax autorefractor or the SureSight Vision Screener with the Vision in Preschoolers Study data software installed (version 2.24 or 2.25 set to minus cylinder form). Using the Plusoptix Photoscreener is acceptable practice, as is adding stereoacuity testing using the PASS (Preschool Assessment of Stereopsis with a Smile) stereotest as a supplemental procedure to visual acuity testing or autorefraction.
Conclusions:
The National Expert Panel recommends that children aged 36 to younger than 72 months be screened annually (best practice) or at least once (accepted minimum standard) using one of the best practice approaches. Technological updates will be maintained at http://nationalcenter.preventblindness.org.
