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The Advisory Committee to the NCCVEH makes the following updated vision screening recommendations for preschool-age children in the United States, which are supported by research evidence, expert input, and best clinical practice.
The new recommendations for preschool vision screening in 2025 include:
1. In the expert opinion of the committee, children aged 3 to <6 years should be screened annually to identify children who need follow-up eye care. This is consistent with the recommendations from the American Academy of Pediatrics, the American Association of Certified Orthoptists, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology (reaffirmed in February 2022).
2. Vision screening programs should consist of the following assessments:
- Observation
- Monocular full threshold or critical line distance visual acuity testing
- Binocular critical line near visual acuity testing
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Stereopsis screening
Instrument-based screening may be used in place of distance visual acuity and stereopsis screening. However, binocular critical line near visual acuity screening should still be included to assess functional vision at near.
Color vision deficiency screening should be conducted if children have suspected color vision deficiencies or reported family histories.
In addition, children with color deficiencies should receive educational support and guidance on vocational choices as they proceed through school.
3. Visual acuity pass criteria should be 20/50 or better for 3-year-old children, 20/40 or better for 4-year-old children, and 20/32 or better for children aged 5 years or older.
4. Ideally, rescreening for untestable children should occur on the same day but no later than 2 weeks after the initial screening.
To close the gap between referrals from vision screening and confirmatory eye examinations, screening programs should implement a comprehensive follow-up system.
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