Pediatric Eye Evaluations

Publication Date: December 19, 2022
Last Updated: January 2, 2023


  • Amblyopia meets the World Health Organization criteria for a disease that benefits from screening because it is an important health problem for which there is an accepted treatment, it has a recognizable latent or early symptomatic stage, and a suitable test or examination is available to diagnose it before permanent vision loss occurs. The U.S. Preventive Services Task Force (USPSTF) recommends vision screening at least once for all children aged 3 to 5 years to detect amblyopia or its risk factors.
  • Vision testing with single optotypes is likely to overestimate visual acuity in a patient who has amblyopia. A more accurate assessment of monocular visual acuity is obtained by presenting a line of optotypes or a single optotype with crowding bars that surround (or crowd) the optotype being identified.
  • The choice and arrangement of optotypes (letters, numbers, symbols) on an eye chart can significantly affect the visual acuity score obtained. The preferred optotypes are LEA symbols, HOTV, and Sloan letters because they are standardized and validated.
  • Instrument-based screening techniques, such as photoscreening and autorefraction, are useful for assessing amblyopia and reduced-vision risk factors for children ages 1 to 5 years, as this is a critical time for visual development. Instrument-based screening can also be used for older children who are unable to participate in optotype-based screening. This type of screening has been shown to be useful in detecting amblyopia risk factors in children with developmental disabilities.
  • Vision screening should be performed at an early age and at regular intervals throughout childhood to detect amblyopia risk factors and refractive errors. The elements of vision screening vary depending on the age and level of cooperation of the child, as shown in Table 1.



Pediatric Eye Evaluations

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