Eye Conditions in Infants and Children: Vision Screening and Routine Eye Examinations

Vision problems in children are relatively common, with refractive error, strabismus, and/or amblyopia affecting between 5% to 10% of preschool-age children. Amblyopia is most concerning in the pediatric population because the visual system can develop poorly, potentially causing unilateral or bilateral vision impairment, which may or may not be correctable. Because of this, most pediatric vision screening recommendations focus on screening for amblyopia or the risk factors for amblyopia, including anisometropia, high refractive errors, and strabismus. The U.S. Preventive Services Task Force (USPSTF) recommends screening children for amblyopia and its risk factors at least once between ages 3 and 5 years. However, the joint policies of the American Academy of Pediatrics (AAP), American Academy of Ophthalmology (AAO), American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and American Association of Certified Orthoptists (AACO) recommend screening starting in the newborn period and continuing through adolescence. These groups advocate for instrument screening in younger children and children who are developmentally delayed because the use of eye charts can be difficult in these children. In general, children with abnormal screening results should be referred to an ophthalmology subspecialist for further evaluation.