Effective Vision Screening in School Age

  • Always measure visual acuity until threshold.

  • First binocularly, then both monocular values.

  • If visual acuity at distance has decreased from its previous value, but visual acuity values at near are normal and symmetric, the cause of decrease of distance visual acuity is mild myopia which requires referral first when the child does not comfortably see to read text written on the blackboard or on the overhead.

  • If there is decrease in both the distance and the near vision acuity, the most common reason for that is a change in refractive error but it may be caused by a disease. Therefore, if the change can be recorded also in a second measurement during the same day, the child needs to be referred.

The target population of vision screening, like any screening, are symptom free children. If a child has any kind of symptoms or signs (s)he is referred for treatment independent of visual acuity values.

Passing limit should not be one single visual acuity value but based on the vision needs of a particular child:
If the child is in the shortest or the middle third of the class and if (s)he can sit close to the podium, binocular visual acuity of 0.2 - 0.3 (20/100 - 20/60, 6/30 - 6/18) may cause no difficulty in the class room. On the other hand if the child is tall and is required to sit far from the blackboard, visual acuity of 0.8 (20/25, 6/9) may be required for normal working in the classroom.

It should be clearly remembered that vision screening at school age is arranged to find those children who may need glasses in order to see well in the classroom.

We are not looking for diseases and therefore the deciding fact is whether the child sees well enough in the classroom or not. Myopia is not a disease and the child’s vision has not become worse if distance visual acuity is lower than before.

Vision screening should be a positive experience to each child and teach the children a correct attitude to changes in refraction. Refractive power of the eyes may change the same way as the size of clothing and shoes. Therefore spectacles are changed when they have become uncomfortable, not once a year.

Visual acuity screening is for healthy schoolchildren. If children have disabilities or diseases, their visual development is followed based on specific advice from the child’s physicians and the assessment of their visual functioning for the IEP/ILP* covers all visual functions.

*Individual Learning Plan (more child centred than the IEP)

Visual Acuity Tests I Paediatric Vision Tests I Vision Tests I Main Page

Edited in July 2009.