Back-to-School Eye Exams

It’s back-to-school time, and parents may wonder whether their child should undergo a full eye exam, also known as a comprehensive eye exam, as a preventive measure. If a child is having vision problems, he or she should be seen by an eye professional experienced in the care of children for an exam.  As an effective safety net, all Texas children undergo vision screenings during their school years to identify problems that don’t always have symptoms.

Texas law requires that children receive routine vision screenings in kindergarten/preschool, and 1st, 3rd, 5th and 7th grades. These screenings are performed in the public school educational setting at no extra cost to families.  If your child attends a private school, ask your principal about vision screening for students.

Texas law follows a nationally accepted standard of care; Texas law aligns with the American Academy of Pediatrics’ recommendation that vision screening be conducted in the medical home (a pediatrician’s office, for example) and that a referral to a specialist for a comprehensive eye examination should be performed only upon detection of an abnormality that necessitates further evaluation.  Pediatrics January 2016, Volume 137, Issue 1. (

These regular screenings provide multiple opportunities to detect problems such as amblyopia (lazy eye) strabismus (eye muscle imbalance), the need for glasses or other eye abnormalities. If a problem is detected, the child will be referred to an eye care professional experienced in the care of children for a comprehensive eye exam where the eyes will be dilated and further examined.

What Is the Difference Between Vision Screening and a Comprehensive Eye Exam, and Which Is More Appropriate for Most Children?

Vision screening is more efficient and cost effective (which allows many more children to be checked) than a complete examination on every child. Only about 2 to 4 percent of children have an eye problem that requires treatment, so it is not practical to perform a comprehensive eye examination on every child. In addition, some problems are missed on a one-time comprehensive eye examination, so it is preferable to have several screenings performed over time as the child develops. But a child experiencing vision or eye problems at any point in time should undergo a comprehensive eye exam with an eye care professional experienced in the care of children.

The Experts Agree on Vision Screenings

Requirements for Vision Screening as part of the Preventative Care visits with the pediatrician are published in the Periodicity Schedule ( by the American Academy of Pediatrics found in the ‘2019 Recommendations for Preventive Pediatric Health Care’. Pediatrics, March 2019, Volume 143, Issue 3. (

The American Academy of Pediatrics (AAP) remains the largest voice in vision screening efforts in the United States. The consensus report by the AAP, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology and the American Association of Certified Orthoptists is the most commonly used reference for vision screening standards. This joint policy statement, Visual System Assessment in Infants, Children, and Young Adults by Pediatricians, is reviewed by the respective organizations on an ongoing basis to remain current with clinical research. This document offers specific recommendations for eye and vision screening by age.

Which Eye Care Professionals Provide Care to Children?

If a vision screening identifies your child as one who needs a comprehensive examination, you should have your child examined by an eye care professional as soon as possible. When selecting an eye care professional for your child it is important to select one experienced in the care of children.  There are two types of eye care professionals: Ophthalmologists and Optometrists.

Optometrists attend optometry school and graduate with a Doctor of Optometry degree (O.D.).  They are trained to fit contact lenses and glasses and to diagnose and treat certain eye conditions.  Their offices are commonly found adjacent to large eyeglass stores.

Ophthalmologists attend four years of medical school and graduate with a Doctor of Medicine degree (M.D.).  Following medical school, physicians perform a one-year internship in internal medicine, pediatrics or general surgery and take state medical boards to become a licensed physician. Physicians then go on to take a three-year surgical residency in ophthalmology to become an eye physician and surgeon (ophthalmologist). They then sit for written and oral tests to become a board-certified Ophthalmologist.  Some continue on to do fellowship training to become a pediatric ophthalmologist, retina surgeon or glaucoma specialist.

After all of this training, an ophthalmologist is deemed prepared to diagnose injuries, disease and conditions of the eye and to treat the eyes.