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Childhood Vision Screenings : What does it mean if your child fails?

A.Vijay Mudgil, MD, Ophthalmologist
The Chester County Hospital

Published: July 28, 2008

Vision screening examinations are sometimes performed as part of your child's routine visit to his or her doctor, and vision screening exams are also mandated by the Pennsylvania Department of Health to be performed in schools. With this dual mechanism in place to screen for vision problems, it is not unlikely for your child to be referred to a specialist for having "failed" a vision screening test.

A failed vision screening examination should never be taken lightly. Visual problems can affect the educational, social and emotional development of children. The protocols for vision screening, whether by a primary care doctor or the public school system, are intentionally devised to identify vision problems at the earliest possible age for two very important reasons. First, the earlier a vision threatening condition is identified and treated, the less likely it is to result in permanent vision loss (i.e. amblyopia). Second, earlier detection and treatment for a vision disorder gives the child the best opportunity to develop educationally, socially and physically.

If your child has failed a vision screening examination, do not panic, but do not delay in having your child evaluated. Parents must realize that a vision screening is not a diagnostic test. It is only meant to be an efficient and economical process by which a large number of children are tested to separate them into two different groups: those who probably have no problems versus those who require more detailed ophthalmological testing.

How likely is it that your child will actually have a problem? Vision problems are estimated to affect one-in-20 preschoolers and one-in-four school-age children (Source: Prevent Blindness America, 2000). According to the American Academy of Ophthalmology, "two to four percent of America's children develop strabismus (wandering/crossed eye) and/or amblyopia (lazy eye)." According to the American Academy of Pediatrics, approximately five percent of children in the first grade may have errors of refraction, and this increases to nearly 20% of the pediatric population before the late teenage years. Children who should especially be examined by an ophthalmologist include all who were high-risk infants, such as those who were at risk to develop retinopathy of prematurity; or those with a family history of childhood cataracts, glaucoma, retinoblastoma, retinal dystrophy/degeneration or systemic diseases associated with eye problems, such as juvenile rheumatoid arthritis.

If your child requires a comprehensive eye examination, be advised that a thorough examination is not to be confused with what many insurers unfortunately refer to as "routine vision exam." A comprehensive examination in a child who has "failed" a screening test consists of more than just an acuity test. It also includes a sensorimotor examination for assessing ocular alignment at distance/near and depth perception (to check for strabismus); cycloplegic refraction to check for abnormal refractive errors that can result in amblyopia; often color vision testing; slit-lamp examination for children who are age-appropriate; and dilated fundus examination on all children.

We are fortunate to have a rigorous system in place for vision screening of preschool and early school-age children. Parents whose children have benefited from this process will readily attest to the fact that early detection of treatable eye disease can have far-reaching implications for vision and, in some cases, for general health.

This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.

Last Updated: 7/27/2009