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Vision screening should be part of the evaluation/intake process following each new referral. It should also be an ongoing process for all young children. At any point where a vision problem is suspected, referral for medical evaluation is essential, to identify or to rule out the presence of a visual impairment. When in doubt, refer.

Vision screening for infants and very young children is largely subjective and observational , since most preverbal children cannot tell the evaluator that there is something wrong. Moreover, they do not know how vision ought to function, and are unaware of any problems. It falls upon the observer to notice appearances or behaviors that might suggest abnormal visual function.

To assist the evaluator in the task of identifying visual problems in young children, a series of procedures has been developed. They include a parent questionnaire (to identify "at risk" factors or functional behaviors that might indicate the presence of a visual impairment), an appearance checklist (which is totally observational and a set of functional procedures (which should help to determine whether the child's visual functioning is developmentally appropriate). Formats and descriptions follow. (Note: The forms in this Manual contain the same content as the required ECI forms, but are arranged in a "user friendly" format.)

The Parent Questionnaire should always be administered as part of the intake process and May be used at any time thereafter if a vision problem is suspected later; certainly vision screening should be an ongoing process for children aged B- I and may be repeated at the 6 mos. re-evaluations. One or more "at risk" indicators, plus one or more absent visual behaviors (at age-appropriate levels) should be cause for referral for medical follow-up. Since the Appearance Checklist focuses on indicators of disease or malformation, any positive indicator on this list is reason for referral for medical evaluation. Since the Informal Screening ,.Procedures are subjective, referral for medical follow-up is recommended when the evaluator is uncertain that behaviors were performed correctly (if at all). It is better to refer unnecessarily and find out there is no problem than not to refer and find out (too late) that there is a problem.

In working with very young children, time is an important factor. Development occurs so rapidly in the first year of life that not providing follow-up treatment or intervention can be costly in terms of developmental delays. The VI teacher should be alerted as soon as a vision problem is suspected, and referral for a 1-tinctional Vision Evaluation made as soon as medical follow-up has been achieved. The Functional Vision Evaluation will be the deciding factor when intervention is needed. Although the medical report is an essential document for the files. it is the Functional Vision Evaluation that will determine the visual status for educational purposes. This cannot be stressed too strongly. When in doubt, REFER.

Note: ECI Policy says that if an eye report is already available at intake, the screening procedures (including the questionnaire) are not necessary; referral to the VI teacher at the local school district is made as soon as a visual impairment has been identified on the eye report. It is only when there is no eye report among the medical records that the vision screening questionnaire and testing are used.

Parent Questionnaire

Family History:

Does anyone in your family have a severe vision loss or eye disease? ____Yes ____No (e.g. , albinism, amblyopia, cataracts, glaucoma, strabismus, retinoblastoma)

____Yes _____No If so, what___________________________________________

Did the child's mother have any serious infections or diseases during pregnancy? ____Yes ____No (e.g., rubella, cytomegalovirus, toxoplasmosis, syphilis, herpes)

____Yes _____No If so, what:_______________________

Did the child's mother use drugs or alcohol during pregnancy?

____Yes _____No If so, which:_______________________

Was the child's mother exposed to any environmental hazards during pregnancy? ____Yes ____No (e.g., chemicals, radiation) ___ Yes ____ No. If so, what:

Birth History:

Was the child born prematurely? ____Yes ____No

If so, how early was he/she? _______________________

What was the child's birth weight: _______________________ (3 pounds or under is cause for concern.)

Were there any post-natal infections? ____Yes ____No (e.g., Meningitis, encephalitis hydrocephalus, prolonged fever, convulsions)

_____Yes _____No If so, what:

Was there any kind of head trauma at birth (or shortly thereafter)?

_____Yes _____No If so, describe:_______________________

Other Relevant History:

Has any syndrome been identified? ____Yes ____No

If so, what: _______________________

Has cerebral palsy been identified? ____Yes ____No

Has any neurological disorder been identified? ____Yes ____No (especially the occurrence of seizure activity) ____Yes ____No

Does your child take any medications? ____Yes ____No (e.g., anti-convulsive medication) ____Yes ____No

If so, what:_______________________

Has a hearing problem been identified or suspected? ____Yes ____No

Do you have any concerns about your child's vision? ____Yes ____No

If so, what: _______________________

Functional Skills:

Functional skill is followed by "Age of normal achievement" in parenthesis.


Does your child look at your (or the caregiver's) face, even momentarily? ____Yes ____No (1 Mo.)

Does your child look at his/her own hands? ____Yes ____No (3-4 mos.)

Does your child look at toys? ____Yes ____No (3-4 mos.)

Does your child notice small objects e.g., raisin, Cheerios, lint)? ____Yes ____No (4 mos.)

Does your child watch people at least 6 feet away? ____Yes ____No (6 mos.)

Does your child look for toys that have been dropped? ____Yes ____No (9 mos.)

It your child interested in pictures or picture books? ____Yes ____No (12 mos.)


Does your child bat at objects that are suspended above him/her? ____Yes ____No (3 mos.)

Does your child try to reach out and gasp toys or objects? ____Yes ____No (6 mos.)

Does your child try to pick up a small object? ____Yes ____No (e.g., raisin, Cheerio, lint) (8 mos.)

Does your child try to grab at your glasses or jewelry? ____Yes ____No (9 mos.)

Does your child reach into a container and try to pull out an object? ____Yes ____No (12-18 mos.)


Does your child notice an interesting object at least 5' away and indicate an interest/desire to have it? ____Yes ____No (by pointing, having arms, babbling, making hand movements) (6-7 mos.)

Does your child move, by any means, towards an interesting object at least 5' away? ____Yes ____No (7-8 mos.)


Does your child react differently to different faces or people? ____Yes ____No (6 mos.)

Does your child react to facial expressions (e.g. , smile, frown, "funny face")? ____Yes ____No (10- 12 mos.)


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