| Condition | Refractive Errors | ||
|---|---|---|---|
| Age < 1 year | Age 1-2 Years | Age 2-3 years | |
| Isoametropia | |||
| Myopia | ≥ -5.00 | ≥ -4.00 | ≥ -3.00 |
| Hyperopia (no strabismus) ☆ | ≥ +6.00 | ≥ +5.00 | ≥ +4.50 |
| Hyperopia with esotropia ★ | ≥ +2.50 | ≥ +2.00 | ≥ +1.50 |
| Astigmatism | ≥ 3.00 | ≥ 2.50 | ≥ 2.00 |
| Anisometropia without strabismus ♠ | |||
| Myopia | ≥ -4.00 | ≥ -3.00 | ≥ -3.00 |
| Hyperopia | ≥ +2.50 | ≥ +2.00 | ≥ +1.50 |
| Astigmatism | ≥ 2.50 | ≥ 2.00 | ≥ 2.00 |
| Oblique Astigmatism ♦ | ≥ 1.00 | ||
☆ may under-correct by +1.00 to +3.00
★ give full plus
♠ Threshold for correction of anisometropia should be lower if the child has strabismus
♦ Defined as >15 degrees from 90 or 180 meridian
- These values are based on consensus of expert opinion (see AAO source below)
- For children 4 years and older: prescriptions should be based on visual acuity measurements and visual functioning when at all possible
- Glasses should be prescribed based on visual acuity testing at distance and near.
- An appropriate screening history should include questions about difficulty with near reading vision and distance vision
Prescribe glasses for children with distance vision worse than 20/30
Prescribe glasses for children with distance or near vision worse than 20/30
- Prescribe glasses for children with vision worse than 20/30 at near or distance
- Prescribing glasses for children with 20/20 vision may be appropriate if vision is worse at near viewing or significant reading difficulty that appears to be related to poor accommodative effort.
- Glasses should have less than the full amount of hyperopia.
- The amount of under-correction can be based on the amount of hyperopia that improves vision
- The amount of under-correction can be from 1 to 3 diopters to help encourage glasses wear.
Prescribe full cycloplegic refraction
- Correct the difference between the two eyes to within 1 diopter
- If one eye is hyperopic and one is myopic it may be appropriate to undercorrect the hyperopic eye by 0.5 to 1 diopter.
- When the child has reached visual maturity, glasses may be discontinued if desired by the family.
- Preschool-Aged children information: Adapted from AAO Preferred Practice Pattern 2012, Pediatric Eye Evaluations p. 19 PDF from AAO Website
- School-Aged Children is consensus from the Pediatric Ophthalmology Section, Department of Ophthalmology and Visual Sciences, University of Iowa
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