Improving Pre-School Eye Care in Children: Keeping Eye Care Health and Good Vision Habits a Priority


Babies are born with complete visual structures. However, at birth, they cannot see as well as older children or adults. Their eyes and visual system are not completely developed at birth and their vision continues to develop throughout their pre-school years.

–       Noting that the period from birth through school age is critical for visual development. Any abnormality in this period can lead to permanent visual impairments.

–       Recognizing that amblyopia (lazy eye) is the most common cause of visual impairment in children with a prevalence of about 2-2.6% in the U.S.1-2

–       Noting that most vision conditions in children during the pre-school years cannot be determined on gross physical examination and may remain undiagnosed till children can read standard visual acuity charts around the age of 5.3

–       Realizing that binocular visual impairment can lead to problems in motor and intellectual development.4-6

–       Noting that the majority of pediatricians perform limited eye and vision exams.7

–       Recognizing that the AAO, AAP, AAPOS, and the U.S. PHS emphasized on the need for eye screening in all children under age 3; those with amblyopia should be diagnosed and treated as early as possible.8-12


  • All children should undergo a regular complete eye exam at the ages of 6 months, 2 and 4 years.
  • Health care providers should be encouraged to educate parents on the importance of comprehensive eye exam.
  • Pediatricians should recommend all children receive a complete eye exam.
  • All schools districts in every state should require a complete eye and vision exam – just as they require up-to-date vaccinations – as a condition for completing a child’s registration therein.

AAO: American Academy of Ophthalmology, AAP: American Academy of Pediatrics, AAPOS: American Association for Pediatric ophthalmology and Strabismus, the U.S. PHS: public health services.


1. Friedman DS, Repka MX, Katz J, et al. Prevalence of amblyopia and strabismus in white and African American children aged 6 through 71 months the Baltimore Pediatric Eye Disease Study. Ophthalmology. 2009 Nov;116 (11):2128-34.e1-2.

2. Multi-ethnic Pediatric Eye Disease Study Group. Prevalence of amblyopia and strabismus in African American and Hispanic children ages 6 to 72 months the multi-ethnic pediatric eye disease study. Ophthalmology. 2008 Jul;115(7):1229-1236.

3. Arnaud C, Baille MF, Grandjean H, et al. Visual impairment in children: prevalence, aetiology and care, 1976-85. Paediatr Perinat Epidemiol 1998;12:228-39.

4. Rosner J, Gruber J. Differences in the perceptual skills development of young myopes and hyperopes. Am J Optom Physiol Opt 1985;62:501-04.

5. Rosner J, Rosner J. Some observations of the relationship between visual perceptual skills development of young hyperopes and age of first lens correction. Clin Exper Optom 1986;69:166- 68.

6. Williams SM, Sanderson GF, Share DL, Silva PA. Refractive error, IQ, and reading ability: A longitudinal study from age seven to 11. Devel Med Child Neurol 1988;30:735-42.

7. Wasserman RC, Croft CA, Brotherton SE. Preschool vision screenings in pediatric practice: a study from the pediatric research in office settings (PROS) network. Pediatrics 1992;89:834-38.

8. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology. Eye examination and vision screening in infants, children, and young adults. Pediatrics 1996; 98:153-7.

9. American Academy of Ophthalmology. Pediatric Eye Evaluations. Preferred Practice Pattern. San Francisco: American Academy of Ophthalmology, 1997.

10. The American Association for Pediatric Ophthalmology and Strabismus. Eye care for the children of America. J Pediatr Ophthalmol Strabismus 1991;28:64-7

11. American Optometric Association Consensus Panel on Pediatric Eye and Vision Examination. Optometric clinical practice guidelines: pediatric eye and vision examination. St. Louis: American Optometric Association, 1994.

12. U.S. Public Health Services Task Force. Guide to clinical preventive services, Second Edition. Washington, DC: U.S. Department of Health and Human Services, 1996.


  1. Building a Comprehensive Child Vision Care System. A Report of the National Commission on Vision on Health (2009). Available at:
  2. American Association for Pediatric Ophthalmology and Strabismus (AAPOS);
  3. American Academy of Ophthalmology (AAO).
  4. American Public Health Society (APHS)
  5. American Optometric Society (AOS).
  6. Vision First Foundation.
  7. Star pupils.
  8. World Health Organization; Prevention of Blindness and Visual Impairment.

2 Responses to “Improving Pre-School Eye Care in Children: Keeping Eye Care Health and Good Vision Habits a Priority”

  1. Oscar Minoso y de Cal Says:

    A dilated fundus exam on all 6 month olds???Is that an AAO recommendation???

  2. Improving Pre-School Eye Care in Children: Keeping Eye Care … | Eyecare Opinion Says:

    […] original article: Improving Pre-School Eye Care in Children: Keeping Eye Care … Share Blog, eye care, eye care health, featured, Uncategorized child, children, […]

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