Vision Screening
CHILD AND TEEN CHECKUPS (C&TC) FACT SHEET FOR PRIMARY CARE PROVIDERS
C&TC Requirements
General
All children should receive a risk assessment.
Refer to the Vision Screening Procedures
section for specific requirements.
▪ Children age 3 years and older, in addition
to a risk assessment: Must be screened for
visual acuity using current recommended
standardized instruments, refer to Vision
Screening Procedures section for specific
requirements.
▪ At the 16 and 20-year checkups, perform a
risk assessment, perform visual acuity
screening if no standardized screening was
done at the previous checkup.
Refer to Vision Screening Procedures for
Infancy, Childhood and School Age Children
(www.health.state.mn.us).
Personnel
Physician, Nurse Practitioner, Physician’s
Assistant, or RN with training*, or
Paraprofessional* may perform vision
screening.
*It is recommended that screeners attend the
MDH vision screening training, for a list of
trainings, refer to Child and Teen Checkups
Training Information (www.health.state.mn.us).
Documentation
Document normal/abnormal vision findings,
results of visual acuity screening, and a reason if
visual acuity testing is not completed. For
documentation examples, refer to the C&TC
Documentation Forms for Providers and Clinics
(www.dhs.state.mn.us).
Screening Procedure
Risk Assessment
For all ages, review the following at the first
visit:
▪
▪
▪
Family and child’s history including familial
ocular and vision abnormalities,
Pre- and postnatal infections and conditions
such as prematurity, syndromes and
parental concerns.
For subsequent visits, review and update
the history and risk factors to reflect new
conditions or concerns.
Vision Screening Procedure
For ages 0-3 years:
▪ Observation for proper eye alignment
(strabismus), phorias, and extra ocular
movements; pupillary reflex including
symmetry and the presence of nystagmus.
▪ Examination of the external anatomy of the
eyes, including lids, conjunctiva, cornea, iris
and pupils.
▪ When indicated, the child must receive a
referral for age appropriate diagnostic
vision tests.
For ages 3-5 years:
▪ Perform visual acuity screening using HOTV
or LEA SYMBOLS® wall or flip charts (with
rectangle borders around each line) at 10
feet starting on the 10/25 line.
In addition for ages 5 years and older:
▪ Perform Plus Lens Screening for those who
pass visual acuity screening.
For ages 6 years and older:
▪ Perform visual acuity screening using a
Sloan chart at 10 feet starting at 10/25 line.
PASS Criteria:
▪ Age 3-5 years must match any 4 optotypes
(symbols or letters) on the passing line or
lower.
▪ Age 3 years passing line – 10/25
(20/50).
▪ Age 4 years passing line – 10/20
(20/40).
▪ Age 5 years passing line – 10/16
(20/32).
VISION SCREENING C&TC FACT SHEET
▪
▪
Ages 6 years and older can miss no more
than two letters of ten on the 10/16 (20/32)
line or lower.
For all ages, must have a one or no line
difference between the eyes.
Important facts about vision
screening
▪
▪
▪
Amblyopia (“lazy eye”) is reduced visual
acuity usually associated with risk factors
that interfere with normal binocular vision
(United States Preventive Services Task
Force, 2011).
One study in a large urban population found
over 5 percent of preschool age children
had refractive errors that would benefit
from glasses (Giordano, 2009).
An estimated 20 percent of children ages 915 years old need glasses but only 10
percent had them (Zaba, 2011).
Professional Recommendations
American Academy of Pediatrics (AAP)
▪ All children who have an ocular abnormality
or who do not pass vision screening should
be referred to a pediatric ophthalmologist
or an eye care specialist appropriately
trained to treat pediatric patients.
▪ Instrument-based vision screening can be
an alternative when the child is not able to
reliably perform testing with vision charts
(American Academy of Pediatrics, 2012)
▪ “Once children can read an eye chart easily,
optotype-based acuity should supplement
instrument-based testing,” (Donahue &
Baker, 2016).
U.S. Preventive Services Task Force (USPSTF)
▪ Recommends vision screening at least once
for all children between the ages of 3 to 5
years (Chou, Dana, & Bougatsos, 2011).
▪ Recognizes instrument-based vision
screening as an appropriate method for
screening children ages 3 to 5 years (Chou,
Dana, & Bougatsos, 2011).
Minnesota Vision Screening
Mandates
Minnesota Statute §121A.17 requires all
children to receive vision screening once
2
between 3 to 5 years of age before entrance to
kindergarten.
Resources
American Academy of Pediatrics
▪ Bright Futures: Guidelines for Health
Supervision of Infants, Children, and
Adolescents (www.brightfutures.aap.org)
Minnesota Department of Human Services
▪ Minnesota Health Care Programs Provider
Manual C&TC Section (www.dhs.state.mn.us)
▪ Child and Teen Checkups (C&TC) Screening
Components Standards and Guidelines
(www.dhs.state.mn.us)
Minnesota Department of Health
▪ Child and Teen Checkups
(www.health.state.mn.us)
▪ Vision Screening (www.health.state.mn.us)
References
American Academy of Pediatrics. (2012). Instrument Based
Pediatric Vision Screening Policy Statement. Pediatrics,
130(5), 983-986.
Chou, R., Dana, T., & Bougatsos, C. (2011). Screening for
Visual Impairment in Children Ages 1-5 Years: Update for
the USPSTF. Pediatrics, 127(2), e442-e479.
Donahue, S., & Baker, C. (2016). Procedures for the
Evaluation of the Visual System by Pediatricians.
Pediatrics, 137(1), 1-9.
Giordano, L. (2009). Prevalence of refractive error among
preschool children in an urban population: the Baltimore
pediatric eye disease study. Opthamology, 140-147.
United States Preventive Services Task Force. (2011).
Vision Screening for Children 1 to 5 Years of Age:
Preventive Services Task Force Recommendation
Statement. Pediatrics, 341-346.
Zaba, J. (2011). Children's Vision Care in the 21st Century
& Its Impact on Education, Literacy, Social Issues, & the
Workplace: A Call To Action. Journal of Behavioral
Optometry, 22(2), 39-41.
For More Information
Minnesota Department of Health
Child and Teen Checkups Program
PO Box 64882,
St. Paul, MN 55164-0882
651-201-3760
[email protected]
www.health.state.mn.us
Revised: 04/2016
To obtain this information in a different format, call:
651-201-3760.