Vision screening and eye examination are vital for the detection of conditions that distort or suppress the normal visual image, which may lead to inadequate school performance or, at worst, blindness in children. Retinal abnormalities, cataracts, glaucoma, retinoblastoma, eye muscle imbalances, and systemic disease with ocular manifestations may all be identified by careful examination. Examination of the eyes can be performed at any age, beginning in the newborn period, and should be done at all well infant and well child visits. Vision screening should be performed for a child at the earliest age that is practical, because a small child rarely complains that one eye is not seeing properly. Conditions that interfere with vision are of extreme importance, because visual stimuli are critical to the development of normal vision. Normal visual development requires the brain to receive equally clear, focused images from both eyes simultaneously for visual pathways to develop properly.

Vision screening should be carried out as part of the regular plan for continuing care beginning at 3 years of age. Vision screening guidelines have been endorsed by the American Academy of Pediatrics (AAP), the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and the American Academy of Ophthalmology (AAO). To achieve the most accurate testing possible, the most sophisticated test that the child is capable of performing should be used (see "Appendix 1").1

As with other specialty areas, it is important for the pediatrician to establish contact with an ophthalmologist who is experienced in treating children's eye problems and who practices in the same geographic area.

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