Vision and eye health: moving into the digital age with instrument-based vision screening

Significant advancements in vision screening research are leading to improved design, functionality, and reliability of screening tools. Presently, two vision screening approaches are available to school nurses for children ages 3 years and older: optotype-based screening and instrument-based screening. Optotype-based screening pertains to tests of visual acuity using optotypes (e.g., pictures, letters, and numbers), which children identify to determine visual acuity. Instrument-based screening pertains to automated devices that measure amblyogenic risk factors, such as refractive error, media opacities, and eye misalignment. Differences between the two approaches; best and acceptable practice recommendations for both approaches; unacceptable tests of visual acuity; and best, acceptable, and unacceptable occluders are described.