Essential Vision Screening for Toddlers: What Parents Need to Know

Q: Essential Vision Screening for Toddlers: What Parents Need to Know

Hello Wendy： For a three-year-old child, it is important to first teach them to recognize the vision chart before assessing their eyesight. <br>The results of vision tests for three-year-olds can vary significantly, sometimes by several diopters. <br>To obtain an accurate measure

Pediatric vision screening?

Hello, Doctor.
I saw in the news that children should have their first vision screening by the age of three, so I took my child to an ophthalmologist this morning.
My child just turned three and was not very cooperative, so we only performed a computer-based vision test (I told him to look at the little house inside, and he really focused and opened his eyes wide, haha) and used glasses with one red and one blue lens to see hidden shapes.
The doctor also examined the child's eyes with a light.
The result from the computer test showed that one eye had -1.00 diopters of myopia and the other had hyperopia, but the doctor explained that I shouldn't worry too much about the computer test results because children's ciliary muscles change rapidly.
Sometimes it can show -1.00 and then suddenly -2.00.
He emphasized that the most important thing is to teach the child to identify the gaps in the vision chart.
For a three-year-old, they should reach a vision level of 0.5 to 0.6.
If they cannot see at that level, a cycloplegic refraction should be performed to check for myopia issues.
However, when I got home and looked online, I saw many people saying that having -1.00 from the computer test is not acceptable (this made me very worried, and to avoid self-diagnosing based on online information, I decided to consult you at Taiwan e-Hospital).
They say that at this age, it is essential to detect hyperopia.
So I would like to ask you, is it true that computer-based vision testing is not accurate at this age? Should we prioritize the vision chart gaps and use cycloplegic refraction as a supplementary method? Should I first teach my child to identify the vision chart, and perhaps take him for another vision check at three and a half years old? Both parents are myopic, with most developing myopia by sixth grade, so I wonder how much attention we should pay to this genetic predisposition to feel reassured.
Thank you, Doctor.

Wendy, 30~39 year old female. Ask Date: 2019/09/06

Dr. Gao Pilin reply Ophthalmology

Hello Wendy: For a three-year-old child, it is important to first teach them to recognize the vision chart before assessing their eyesight.
The results of vision tests for three-year-olds can vary significantly, sometimes by several diopters.
To obtain an accurate measurement, cycloplegic refraction is necessary.
Myopia typically does not get passed down to children if proper eye care is maintained, so there is no need to worry.
The ophthalmology department at Puzi Hospital is open on Monday, Tuesday, Thursday, and Friday mornings from 8:00 AM to 12:00 PM, and Wednesday afternoons from 2:00 PM to 4:30 PM.
Online responses should only be used as a reference; it is essential to seek medical attention at a healthcare facility when necessary.
I hope to have the opportunity to serve you.
Gao Pilin

Reply Date: 2019/09/06

More Info

When it comes to vision screening for toddlers, particularly those around the age of three, there are several important considerations for parents to keep in mind. As you have experienced, the initial vision screening often involves a combination of methods, including computer-based assessments and subjective tests like the visual acuity chart.
Firstly, it is essential to understand that the visual system in young children is still developing. At the age of three, children may not have fully matured visual acuity, and their ability to cooperate during examinations can vary significantly. This is why many pediatricians and eye care professionals emphasize that results from automated refraction (computerized vision tests) should be interpreted with caution. The variability in results can be attributed to the rapid changes in the ciliary muscle (the muscle responsible for adjusting the lens of the eye) and the child's overall visual development.

The recommendation to focus on the visual acuity chart is sound. For a three-year-old, achieving a visual acuity of 0.5 to 0.6 (which corresponds to 20/40 to 20/30 vision) is a reasonable benchmark. If a child cannot achieve this level of vision, further evaluation, including cycloplegic refraction (which involves the use of eye drops to temporarily paralyze the ciliary muscle), may be warranted to accurately assess for refractive errors like myopia (nearsightedness) or hyperopia (farsightedness).

Regarding your concern about the computer-generated result indicating 100 degrees of myopia in one eye and hyperopia in the other, it is important to note that such findings can fluctuate. Children’s eyes are still developing, and their refractive status can change rapidly. Therefore, it is not uncommon for a child to show different levels of refractive error at different times. This is why follow-up assessments are crucial.

As for the hereditary aspect of vision problems, having parents with myopia does increase the likelihood of children developing similar issues. However, it is not a guarantee. Regular screenings are essential, especially if there is a family history of refractive errors. Monitoring your child's vision as they grow will help catch any significant changes early on.

In summary, here are some key points for parents regarding vision screening for toddlers:
1. Initial Screening: Computerized tests can provide preliminary information, but they should not be the sole determinant of a child's visual health. Focus on visual acuity tests and ensure your child can identify shapes or letters on a chart.

2. Follow-Up: If there are concerns about your child's vision, especially if they do not achieve the expected visual acuity, schedule a follow-up appointment for a more comprehensive evaluation, including cycloplegic refraction.

3. Developmental Considerations: Understand that a child's visual system is still developing, and results can vary. Patience and repeated assessments are often necessary.

4. Family History: Be proactive about vision screenings if there is a family history of refractive errors. Early detection and intervention can make a significant difference in managing vision problems.

5. Education: Teaching your child how to read a vision chart can help them become more comfortable with future screenings, making the process smoother.

In conclusion, while the initial results may raise concerns, it is crucial to take a holistic approach to your child's vision health, considering both the developmental stage and the variability of early vision assessments. Regular check-ups and a focus on visual acuity will help ensure that any potential issues are addressed promptly.

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