Pediatric Vision Screening

Noelle S. Matta, CO, CRC, COT; David I. Silbert, MD, FAAP

Disclosures

Int Ophthalmol Clin. 2014;54(3):41-53. 

In This Article

Subjective Pediatric Vision Screening

Subjective pediatric vision screening utilizing recognition acuity is the most widely used method. This method is inexpensive to perform, but can be difficult to execute properly. Over-referral or under-referral can have real economic costs. Subjective screening requires significant participation from a child. Subjective pediatric vision screening includes recognition acuity and stereoacuity. The testing distance can vary from 3 to 20 feet and it is critical that the child be tested at an appropriate distance from the chart. It is also important that an appropriate eye chart be selected. Appropriate optotypes for children include: Sloan (Fig. 1), HOTV (Fig. 2), Lea symbols (Fig. 3), and Patti Pics. The optotypes should be presented in a line or singly with crowding bars, as isolated optotypes may overestimate vision.[8] The child should be seated comfortably in a chair or on their parents lap and encouraged not to lean forward. The testing distance needs to be measured from the child's face to the eye chart, and if sitting on a parents lap this may alter the testing distance. A hand should never be used to cover the eye. It is best to use a stick on eye patch, which can be purchased or can be fashioned out of fabric tape and a tissue. It is important that the examiner pay close attention so that the child is not peaking from the side of the patch or holding their head sideways. Another alternative is pediatric occlusion glasses (Fig. 4), which have black plastic over the occluded eye and large foam animal shapes around the edges, making peaking nearly impossible. Children aged 3 to 5 years old should be considered if they do not correctly identify 4 of 6 optotypes on the 20/40 line with either eye or have a 2-line difference between the eyes (example 20/20 with the right eye and 20/30 with the left eye). Children aged 6+ years old should be considered if they do not correctly identify 4 of 6 optotypes on the 20/30 line with either eye or have a 2-line difference between the eyes.[9]

Figure 1.

Sloan acuity chart (photograph courtesy of Good-Lite, Elgin, IL). Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.

Figure 2.

HOTV acuity chart (photograph courtesy of Good-Lite, Elgin IL). Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.

Figure 3.

Lea acuity chart (photograph courtesy of Good-Lite, Elgin IL). Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.

Figure 4.

Occlusion glasses (photograph courtesy of Good-Lite, Elgin IL). Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.

Computerized visual acuity testers are also available including: Vision Quest 20/20, Innova, and M&S. These devices automate the testing protocol and are performed utilizing a computer monitor. Vision Quest is fully automated and uses crowded HOTV letters in a matching game disguised as a video game.

Stereoacuity is often combined with recognition acuity to assess binocularity, although there is no good validation that it is an effective screening tool. An abnormal response might suggest strabismus, which would require a referral to a pediatric ophthalmologist. These forms of subjective pediatric vision screening tend to be most effective in verbal children aged 5 years and older, but may be attempted in younger verbal children.

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