Periodicity Schedule for Visual System Assessment in Infants, Children, and Young Adults
| Assessment | Newborn to 6 mo | 6–12 mo | 1–3 y | 4–5 y | 6 y and older |
|---|---|---|---|---|---|
| Ocular history | x | x | x | x | x |
| External inspection of lids and eyes | x | x | x | x | x |
| Red reflex testing | x | x | x | x | x |
| Pupil examination | x | x | x | x | x |
| Ocular motility assessment | — | x | x | x | x |
| Instrument-based screeninga when available | — | b | x | x | c |
| Visual acuity fixate and follow response | xf | x | x | — | — |
| Visual acuity age- appropriate optotyped assessment | — | — | xe | x | x |
↵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.