Last updated March 15, 2022

Comprehensive Pediatric Eye and Vision Examination

ACTION STATEMENTS

A comprehensive pediatric eye and vision examination should include, but is not limited to:
• Review of the nature and history of the presenting problem, patient and family eye and medical histories, including visual, ocular, general health, leisure and sports activities, and developmental and school performance history of the child
• Measurement of visual acuity
• Determination of refractive status
• Assessment of binocular vision, ocular motility, and accommodation
• Evaluation of color vision (baseline or periodic, if needed, for qualification purposes or if disease related)
• Assessment of ocular and systemic health, including evaluation of pupillary responses, anterior and posterior segment, peripheral retina, and evaluation/measurement of intraocular pressure and visual field testing.
(, Consensus Statement)
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Cycloplegic retinoscopy is the preferred procedure for the first evaluation of preschoolers. It is necessary to quantify significant refractive error in the presence of visual conditions such as strabismus, amblyopia, and anisometropia. (, Consensus Statement)
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Cycloplegic retinoscopy is the preferred procedure for the first evaluation of school-age children. It is necessary to quantify significant refractive error in the presence of visual conditions such as strabismus, amblyopia, and anisometropia. (, Consensus Statement)
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Abnormal color vision can affect daily performance of activities involving color discrimination and may interfere with or prevent some occupational choices later in life. Children should be tested as soon as possible for color vision deficiency and the parents/caregivers of children identified with color vision deficiency should be counseled. (, Consensus Statement)
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Children at risk for learning-related vision problems should be evaluated by a doctor of optometry. (, Consensus Statement)
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Many children with developmental or intellectual disabilities have undetected and untreated vision problems and should receive a comprehensive pediatric eye and vision examination. (, Consensus Statement)
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At the conclusion of a comprehensive pediatric eye and vision examination, the diagnosis should be explained to the patient/parent/caregiver and related to the patient’s symptoms, and a treatment plan and prognosis discussed. (, Consensus Statement)
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Parents/caregivers and children should be educated about potential risks for eye injuries at home, at school, and during sports and recreational activities, and advised about safety precautions to decrease the risk of ocular injury.193,199 Prevention of eye injuries in children should focus on the use of protective eyewear, parental supervision, and include education about both the risks of eye injury and the benefits of protective eyewear. (B, Strong Recommendation)
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All children and their parents/caregivers should be advised about the benefits of the regular use of sunglasses and/ or clear prescription glasses that effectively block at least 99% of UVA and UVB radiation, the use of hats with brims when outdoors, and the importance of not looking directly at the sun. (, Consensus Statement)
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Patients/parents/caregivers should be counseled about the benefits to children’s vision of spending more time outdoors. (B, Recommendation)
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Infants should receive an in-person comprehensive eye and vision assessment between 6 and 12 months of age for the prevention and/or early diagnosis and treatment of sight-threatening eye conditions and to evaluate visual development. (B, Strong Recommendation)
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Preschool age children should receive an in-person comprehensive eye and vision examination at least once between the ages of 3 and 5 to prevent and/or diagnose and treat any eye or vision conditions that may affect visual development. (B, Strong Recommendation)
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School-age children should receive an in-person comprehensive eye and vision examination before beginning school to diagnose, treat and manage any eye or vision conditions. (B, Strong Recommendation)
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Children with myopia should have an in-person comprehensive eye and vision examination at least annually, or as frequently as recommended (especially until age 12), because of the potential for rapid myopia progression. (B, Strong Recommendation)
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School-age children should receive an in-person comprehensive eye and vision examination annually to diagnose, treat, and manage eye or vision problems. (, Consensus Statement)
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Recommendation Grading

Overview

Title

Comprehensive Pediatric Eye and Vision Examination

Authoring Organization

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Child, Infant

Health Care Settings

Ambulatory, School

Intended Users

Optometrist, optician, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D011315 - Preventive Medicine, D014786 - Vision Disorders, D015351 - Vision Screening, D014787 - Vision Tests

Keywords

preventative care, vision, pediatric vision

Methodology

Number of Source Documents
251
Literature Search Start Date
January 1, 2005
Literature Search End Date
October 1, 2016