Families and early childhood program staff may not always notice if a child has trouble seeing. Simply looking at a child isn’t enough. That is why early childhood vision screenings are important. This resource offers information about vision screening and tips for preparing families for their child’s screening.
Children uses their senses through play with toys like puzzles and crayons. Good vision is important for this learning. If a child has an uncorrected vision problem, it can be harder for them to learn when they start school. Vision screening helps find potential issues early so that they can be fixed.
Evidence-based Screening
Evidence-based screenings are developed using the best research and information from experts. It’s a way to find children who might need a closer look at their vision and eye health. Head Start programs are required to do evidence-based vision screening.
Who can do the screening?
Programs can choose to have their staff do screenings or enlist the help of trained staff from community-based agencies or volunteers. Some programs work with service providers such as Lions Clubs, community organizations, or medical schools and ophthalmology training programs.
When should screening happen?
According to the Head Start Program Performance Standard 45 CFR §1302.42(b)(2)-(3), programs have 45 days from a child’s first day to ensure the child receives evidence-based vision screenings. For the home-based program option, children must receive these screenings within 45 days of their first home visit. If a program operates for 90 days or less, it has 30 days from the child’s first day to meet this requirement.
Types of Evidence-based Screening
Here are some types of evidence-based screening:
- Developmental milestones checklist (for infants under 12 months)
- Instrument-based screening for refractive errors, which mean that the shape of the eye does not bend light correctly, leading to blurred vision
- Optotype-based screening to find out if a child can see clearly
Rescreening
Some children may be unable to pay attention, cooperate, or understand what they need to do during the first attempt at screening. These children may be “untestable” rather than having failed the screening.
Rescreen untestable children as soon as possible but no later than six months after the first screening. If a child fails or is untestable on the second attempt, consider referring the child for a full eye examination. Even if a child passes, consider a full eye examination if the family or staff have concerns.
Instrument-based Screening: Uses machines to look at how well the eyes focus, if they line up right, and if there’s anything cloudy in them. This screening doesn’t check how well a person can see at a distance. This test doesn’t need much help from a child, making the screening easy to do. Follow the manufacturer’s instructions for using the instrument.
Optotype-based Screening: Uses letters or shapes to check how well a child can see. Children ages 3 to 5 view special symbols or letters like Lea Symbols® or the letters HOTV. These tools are good for children who are also dual language learners. Learn more in optotype-based vision screenings.
Children who cannot be screened with optotype-based screening can often complete instrument-based screening and vice versa.
Screening Infants and Toddlers
Keep these tips in mind for screening infants and toddlers:
- Health care providers may check vision during well-child visits.
- Instrument-based screening is often used for children ages 12 months to 3 years.
- The National Center for Children’s Vision and Eye Health has a vision development milestone checklist for infants.
- Review Vision Screening and Eye Health for Toddlers in Head Start Programs to learn more.
Ongoing Care
Keep in mind that screening shows a child’s vision at one moment. New concerns may come up, and children’s eyes change as they grow. Promptly discuss any new concerns with families and health care providers.
Some children need a referral to follow-up vision care after the screening. Programs should track these referrals and services they receive. Screening, examination, treatment, follow-up, and family support are all important ways to support a child’s Head Start health experience. Refer to Vision Screening Referrals to learn more.
Preparing Families for Their Child’s Vision Screening
Preparing families for what happens during a vision screening helps them get their child ready. Creating policies that support staff and families working together is important.
Tips for collaborating with families
- Include questions on the family health history form to find children at higher risk of vision problems. For example is there a family history of vision problems or early and serious eye disease?
- Offer resources for families to learn more about healthy eyes and the importance of finding vision problems early.
- Let families know that it isn’t always possible to tell if children have a vision problem just by looking at their eyes.
Before the Vision Screening
- Share information about the screening process with families before getting consent for the screening.
- Explain why vision screening is important and what will happen during it.
- Assure families they can attend the screening.
- Let families know when and how you will share the screening results with them.
If Families Do Not Want Screening
Respect the family’s decision. Make sure family education materials are available in languages that program families speak. Families may have varying cultural expectations for child development, so learn about their concerns. Ask for permission to talk about this later and try again in a few weeks. Document your program’s conversations with families who don’t want screening.
Vision screening helps catch problems early. It makes sure that children can see well and thrive in their learning and daily activities. It's a simple step toward a brighter future!
Last Updated: May 22, 2024