December 19, 2017
The laws mandating vision screening for school-age children vary by state. The vast majority of states have some mandates, although Idaho, Iowa, New Hampshire, North Dakota, and South Dakota do not have vision screening requirements. Arizona, Montana, and South Carolina recommend vision screenings, but do not require them. Kentucky requires a vision exam and Nebraska requires a visual evaluation, both of which are similar to screenings. Most of the states with vision screening legislation require the first screening to take place prior to entry into kindergarten and then periodically during elementary to high school years.
Vision impairments affect more than one in 20 preschool-age children, therefore many health- or vision-related organizations support vision screenings in children younger than kindergarten age. The National Center for Children’s Vision and Eye Health at Prevent Blindness advocates for a full continuum of care for young children by identifying vision conditions early, linking children to appropriate care, and ensuring they receive the care they need.
The U.S. Preventive Services Task Force (USPSTF) recommends vision screenings for all children at least once between ages 3-5 to detect the presence of amblyopia or its risk factors. The USPSTF found adequate evidence that treating amblyopia in this age group leads to moderately improved visual acuity. Evidence was lacking, however, linking treatment with a reduced incidence of long-term amblyopia or improved school performance, functioning, or quality of life. They also noted higher false-positive rates in the youngest children, which could lead to overdiagnosis or unnecessary treatment. The USPSTF concluded the benefits outweighed the small risks, finding adequate proof vision screening tools are accurate in detecting vision abnormalities such as refractive errors, strabismus, and amblyopia in young children.
The American Academy of Pediatrics and other professional societies recommend tests of visual acuity and stereoacuity or the use of an autorefractor or photoscreener. Currently, vision screenings in preschool children are required in only 16 states, so that means many youngsters could have amblyopia or other undetected vision problems by the time they enter school. Prevent Blindness has the only national certification program for children’s vision screening, providing course participants with certification in the most current, evidence-based vision screening and eye health best practices for preschool- and school-age children.
Vision screenings are routinely offered in most primary care settings and also in some schools. The screening rates in 3-year-olds is about 40%, although this increases with age. The Centers for Disease Control and Prevention (CDC) published data on the number of children who received vision screenings before age 6, utilizing 2009-2010 data. According to CDC findings, nearly 78% of 1,141 5-year-olds had their vision checked by a doctor or other healthcare provider and only four of those attempts were unsuccessful.
The American Optometric Association says the information obtained from a vision screening is akin to numbers obtained from a blood pressure measurement. When blood pressure is in the normal range, that doesn’t rule out other health problems. Likewise, vision screenings may detect possible issues, but only a comprehensive eye and vision examination can evaluate overall eye health and vision.
Limited testing: Many vision screenings only test visual acuity for distance. This does not take into account how well the eyes focus up close, their ability to work together, nor yield any information on potential underlying eye diseases. Some screenings include a plus lens test for farsightedness and a test of eye coordination. Yet even when additional screening tests are administered, vision problems are often missed.
Untrained personnel: Some administrative personnel or volunteers who conduct vision screenings may not have adequate training, therefore they cannot competently assess screening results.
Inadequate testing equipment: At primary care practices, the accuracy of vision screening may be limited by the type of testing equipment available. Room lighting, testing distances, and maintenance of the testing equipment can also skew results.
A Vision Service Plan Q&A with optometrist Michael McQuillan, OD, provides further insights on the limitations of vision screenings. He estimates 15-20% of school children have vision problems a screening is likely to miss. Binocular vision dysfunction, which can cause reading problems, is often not uncovered in screenings. Moreover, since distance learning is often the only thing tested, a child may have perfect 20/20 vision for seeing the school blackboard, but have difficulty reading books or seeing a computer screen.
Unlike one-time vision screenings, EyeQue Insight enables you to test your children’s eyes and your own eyes from the convenience of your home as many times as you wish. Insight is the world’s first gamified 20/20 screener, combining a binocular viewer, a mobile application, and cloud-based service. Its random tumbling-E chart provides a simple and accurate measurement of an individual’s visual acuity, so you can check how well you or your children see without correction – and with current glasses or contact lenses. Click here to learn more about Insight.