Visual screening in toddlers – baby and family

In the meantime, some pediatricians offer eye screening for toddlers that works without annoying eye drops. But how reliable are the results?

"Do you see me, little one?" Visual performance is now easier to measure

Glasses yes or no? A new procedure promises to facilitate the diagnosis of ametropia in children and make it possible from the age of six months. "With the So-called vision screeners can be used to measure ametropia in diopters, astigmatism and a deviation of the visual axis, i.e. squint", says pediatrician Dr. Matthias Krueger from Klingenberg am Main, who uses the method in his practice.

Infrared measurement

The measuring instrument is a mobile refractometer, a handy device that, depending on the model, reminds a little of a large hair dryer, a tablet PC or an earlier photo camera. The principle of operation is simple and harmless to the child: "Infrared radiation is projected into the child’s eye using the device", explains Prof. Dr. Klaus Rüther, specialist for ophthalmology from Berlin. For the measurement, the child has to be about a meter away from the measuring device and look directly into it. The screening protocol lists various measured values ​​that provide information on ametropia, on pupil malfunctions or irregularities and clouding of the eye lens.

Painless and safe method

Advantage of the method: Neither drops to dilate the pupils nor a direct manual examination of the eye are necessary. "The device emits sounds, such as the chirping of birds, and shows colored lights, which automatically draw the gaze of the little ones", says Matthias Krueger. "For restless children you have to Repeat the measurement sometimes a few times, but since we only need a few seconds to take a picture and can test both eyes at the same time, we usually have results that can be easily evaluated, even for those under one year old." In the event of abnormalities, the child is referred to the ophthalmologist to carry out further tests and possibly to initiate treatment.

False positive results possible

According to the manufacturer, the measurement accuracy corresponds to that of a so-called skiascopy – an assessment of the refractive power of the eye – that the ophthalmologist performs with a translucent mirror in the case of dilated pupils. However, Klaus Rüther points out that the two methods are not comparable in every respect. "In order to reliably determine farsightedness, eye drops must be administered."

As a further shortcoming, the ophthalmologist names measurement inaccuracies: "Some children who were classified as needing control are not noticeable at the subsequent ophthalmological examination." Conversely, existing eye diseases can remain undetected, for example a very small squint angle. "This measurement method is therefore not suitable for mass screening, although overall I find the functional principle of the device to be good", according to Rüther’s assessment.

Test serves as a guide

Despite these reservations, ophthalmologist Rüther does not categorically advise against the simple eye test: "The results should not be seen as a definitive diagnosis. Even if the test is normal, I recommend an ophthalmological examination for all children investigation between the 30th and 42nd month of life." And pediatrician Matthias Krueger considers the use of the screening instrument to be particularly useful if the parents are not exactly informed about risk factors such as eye diseases in the family history. "The measurement can then help to show or rule out a possible amblyopia, an irretrievable impairment of vision, at an early stage." Visual screening is an IGeL service (approx. 20 euros), but some health insurance companies already cover the costs. It is worth asking.


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Christina Cherry
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