TABLE 1

Periodicity Schedule for Visual System Assessment in Infants, Children, and Young Adults

AssessmentNewborn to 6 mo6–12 mo1–3 y4–5 y6 y and older
Ocular historyxxxxx
External inspection of lids and eyesxxxxx
Red reflex testingxxxxx
Pupil examinationxxxxx
Ocular motility assessmentxxxx
Instrument-based screeninga when availablebxxc
Visual acuity fixate and follow responsexfxx
Visual acuity age- appropriate optotyped assessmentxexx
  • a Current Procedural Terminology code 99174.

  • b The American Academy of Ophthalmology (AAO) has recommended instrument-based screening at age 6 mo. However, the rate of false-positive results is high for this age group, and the likelihood of ophthalmic intervention is low.16 A future AAO policy statement will likely reconcile what appears to be a discrepancy.

  • c Instrument-based screening at any age is suggested if unable to test visual acuity monocularly with age-appropriate optotypes.

  • d Current Procedural Terminology code 99173.

  • e Visual acuity screening may be attempted in cooperative 3-y-old children.

  • f Development of fixating on and following a target should occur by 6 months of age; children who do not meet this milestone should be referred.