GHS Cares: Pediatric Eye Screening


Most of us remember reading the vision chart at the doctor’s office when we were children. I remember being disappointed when they deemed me old enough to read the letter chart rather than the picture-laden chart with images of umbrellas and houses. With that being said, unless the teacher raises a concern about vision due to a child not being able to see the SMART Board (so much for black boards), parents rarely voice concerns about vision at children’s check-ups. Nevertheless, pediatric vision screening is very important.

Fact #1 Children’s brains must learn to interpret visual input from the eye, and if this process isn’t started early, children develop permanent vision issues.

During our early years, our eyes and brains learn how to communicate. If vision is poor in one eye, the brain does not learn to interpret signals from that eye. The brain will ignore the problematic eye’s input, which results in that area of the brain’s cortex not developing properly. Even if eyesight is restored in that eye later in the life, the brain cortex is not developed enough to interpret the signals that the eyesight is better. The name for poor vision due to this disconnect between the brain and the eyes is amblyopia.

Fact #2 Vision screening involves several steps at a doctor’s office, which can help treat vision problems in children.

Luckily, amblyopia, poor visual acuity (not being able to read the letter chart), and other vision problems are issues physicians can screen for and treat. All children should undergo vision screening during their well-child doctor’s visit starting at age three (although earlier is good practice).

Vision screening involves several elements: The first is evaluating sight with the Snellen chart. This is the letter or picture chart associated with vision screening. If a child age five or older cannot see at 20 feet what an adult can see at 30 feet, they need to be referred for further evaluation. A second part of vision screening involves a doctor shining a light in a child’s eye. This test looks for a red reflection of light from the back of the eye. If this reflection is abnormal it can be a sign that something like a cataract or tumor is blocking the reflection.

Fact #3 Eye alignment can affect a child’s sight, whether it be more obvious or subtle.

Finally, vision screening should include some evaluation of the alignment of the eyes. Sometimes children have obvious poor eye alignment, which many refer to as “cross-eyed” or “lazy eye.” Other times, the alignment issue is more subtle. Poor alignment can be critical to indicate, as it can cause the brain to effectively ignore one eye which results in amblyopia or poor vision in that eye.

The most important message to take away is that if you suspect vision issues in any child, you should not delay in having them evaluated. Many visual issues can be corrected in young children but become more difficult to treat or even impossible to fix in older children and adults. Your primary care provider should be able to do an initial evaluation and coordinate referrals if your child needs to see a specialist.

Dr. Liz Baltaro and Dr. Amy Nayo are primary care physicians expanding community access to quality pediatric and family medicine at Granville Primary Care, Butner-Creedmoor, located at 1614 NC Highway 56, Butner. To schedule your primary care appointment, please call 919-575-6103 or schedule online at You can schedule a primary care appointment with a provider as far as 12 months in advance through online scheduling.

Have a health-related question for Dr. Liz Baltaro and Dr. Amy Nayo? Click here to submit your question and receive an answer in a timely manner!

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