Back to School: Does My Child Need a Comprehensive Eye Exam?

As summer winds down and preparations for a new school year begin, for many children this means a return to the primary care provider for a back to school physical. For kids who wear glasses, this is also a common time of year to return to the eye doctor for a routine eye health checkup and an updated glasses prescription. 

Given the importance of good vision on school performance and behavior, it’s natural for many parents (whose children do not wear glasses) to wonder whether their child needs a formal comprehensive eye exam, or if a screening test alone is sufficient. 

Vision screening, when done properly, has been shown to be an effective & cost efficient way of identifying visually significant refractive error and detecting amblyopia, or “lazy eye”, a potentially irreversible cause of permanent vision loss if not identified and treated at an early age. Vision screenings are typically done by schools and/or primary care offices, and generally can be performed in two broad categories: Optotype-based (e.g. reading letters, picture matching) or instrument-based (e.g. photoscreeners, autorefractors). 

More details on these types of screening options including age-appropriate vision thresholds, as recommended by the American Association for Pediatric Ophthalmology and Strabismus, can be found online at the website listed in the reference section below. 

A comprehensive exam including refraction by an experienced pediatric eye care provider is always recommended for children who fail a screening test. Additional reasons to consider a comprehensive eye exam for your child include: 

  • Vision screening is inconclusive or cannot be performed. 
  • Squinting or atypical head positions with viewing. 
  • Difficulty seeing the board at school. 
  • Concerns about reading at age level. 
  • Frequent complaints of eyestrain or headache. 
  • Family history of glasses at similar age in parents or siblings. 
  • Strabismus detected in the office at any age or parental concerns of “drifting,” “wandering,” or “crossing” eyes. 
  • Concerns about learning disability, developmental delay, neuropsychological condition, or behavioral issue. 
  • If there is an underlying systemic condition that is known to be associated with eye problems (e.g. diabetes). 
  • Any other persistent visual concerns despite “passing” a screening. 

In conclusion, it is critical that children undergo frequent age- appropriate vision screening in order to detect or prevent amblyopia before its development becomes irreversible. Be sure to make vision care and eye checks a part of your child’s routine medical care. Stay alert for any signs of vision impairment, including developmental delays, which may signal an undiagnosed vision problem. Parents should advocate for a comprehensive eye exam if their child displays any of the vision issues previously mentioned. During the comprehensive eye exam, share your observations and concerns with the doctor and clinical team. Do not hesitate to ask questions regarding your child’s eye health. An experienced pediatric eye clinic will perform a comprehensive eye exam that is typically enjoyable for kids, educational for parents, and informative to the medical care team. 


1. AAPOS Vision Screening Recommendations: Techniques for Pediatric Vision Screening. [Available at]: https://www.aapos.org/terms/conditions/131 

About the author

Image of Jeffrey T. Lynch, M.D., M.P.H.

Jeffrey T. Lynch, M.D., M.P.H.

Pediatric Ophthalmology, Adult Eye Muscle Disorders, Eye Muscle Surgery,

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Dr. Lynch joined Associated Eye Care in 2012. He was born and raised in Iowa City, IA, and received his Medical Degree and Master’s Degree in Public Health from the University of Iowa. As a medical student he was elected by peers & faculty i...

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