Vision Screening

The Academy recommends timely vision screening for the early detection and treatment of eye and vision problems in children. Routine vision screenings are an important part of a child's comprehensive medical care — detecting problems at a stage when many conditions can be successfully treated, before they cause permanent vision loss or developmental delays.

The Academy and American Association for Pediatric Ophthalmology and Strabismus (AAPOS) have found that routine comprehensive professional eye examinations performed on normal asymptomatic children have no proven medical benefit. Periodic screenings — conducted at multiple points as a child develops — offer more opportunities to detect disease than a single comprehensive exam performed at one point in time. Funds are better spent on frequent, accessible screenings and referrals to ophthalmologists when needed, rather than on universal comprehensive exams that are not supported by clinical evidence.

The Academy also supports addressing myopia as an emerging public health priority. With myopia becoming increasingly prevalent in children, periodic screening and targeted evaluation of children at risk for myopia progression are important components of a comprehensive approach to children's vision health. 

The Academy works with the AAPOS  as the co-authors of the joint clinical policy statement on children's vision screening. The American Academy of Pediatrics, the American Academy of Family Physicians, and the American Association of Certified Orthoptists also recommend early vision screening and are important allies in this effort.

In 2022, the Academy and AAPOS updated their Vision Screening for Infants and Children joint policy statement, which outlines evidence-based recommendations for when and how children should be screened throughout childhood. The 2022 update elevated myopia as a high-priority concern, noting that interventions to delay the onset of myopia and reduce progression in childhood are now available — making periodic screening and early identification increasingly important.

The Academy continues to engage at the state level to promote evidence-based vision screening policies and to oppose mandates for universal comprehensive eye exams as a substitute for periodic screenings. 

Good vision is essential for children's physical, developmental, and educational progress. The visual system of a young child is not fully mature — equal input from both eyes is required for proper development of the visual centers in the brain. If a growing child's eye does not provide a clear, focused image to the developing brain, irreversible vision loss in one or both eyes can result. Early detection through routine screening, followed by referral for ophthalmological examination when warranted, is the cornerstone of preventing this outcome.

The Academy and AAPOS recommend that children be screened at birth, in infancy, during preschool years, and throughout the school years by pediatricians, family physicians, school nurses, and other trained health care providers. Additional screening should be performed at routine school or well-child visits every one to two years after age five. Any child who does not pass a screening should be referred for an ophthalmological examination.

The U.S. Preventive Services Task Force (USPSTF) recommends vision screening for children ages 3 to 5 specifically to detect amblyopia — a leading cause of preventable vision loss in children — or risk factors for amblyopia.

State requirements for vision screening vary widely. Approximately half of all states now require vision screening for preschool-age children, and the majority require screenings for school-age children. However, significant variation remains in screening methods, criteria, grade levels covered, and reporting requirements — pointing to the ongoing need for evidence-based state legislation that ensures consistent, high-quality screening for all children.