Recommended practices for vision screening in pre-school-age children: A 2025 update

Abstract

Significance: Despite significant evidence supporting the utility of vision screening for identifying children who need further evaluation by an eye care professional, there is considerable variability in screening guidelines along with a lack of consensus for monitoring and reporting outcomes. This article provides updated vision screening recommendations for pre-school-age children (aged 3 to <6 years) in the United States.

Purpose: The goal of vision screening programs is to identify, refer, and help ensure eye examinations for children who may have vision disorders, such as significant uncorrected refractive errors, amblyopia, strabismus, reduced visual acuity, and other vision and eye health problems. This article provides an update to the 2015 recommendations for vision screening in pre-school-age children in the United States, which were developed by the National Expert Panel to the National Center for Children's Vision and Eye Health (NCCVEH) at Prevent Blindness.

Methods: Recommendations for vision screening for pre-school-age children were developed by the NCCVEH and published in 2015. The updated recommendations in this article were developed through a targeted literature review (PubMed and Science Direct) and expert opinion from the committee, which approved the final recommendations.

Results: The committee recommends that vision screening programs have follow-up systems to ensure that referred children receive comprehensive eye examinations. In addition, screening programs should consist of observation, threshold or critical line (age-specific minimal acuity line to pass) distance visual acuity, binocular critical line near visual acuity, and stereopsis, all of which should be performed annually. Instrument-based screening may be used in place of distance visual acuity and stereopsis, though additional research is needed to guide the recommendation for specific devices.

Conclusions: The NCCVEH recommends that children aged 3 to <6 years have their vision screened annually to identify potential eye health and vision disorders. These updated vision screening recommendations provide lay screeners with a standardized approach for detecting vision problems and ensuring timely intervention and treatment. The NCCVEH will continue to provide vision screening updates at http://nationalcenter.preventblindness.org.