Checklist for Spotting Vision Problems
BY Kathleen Appleby, M. A.
NAME_______________________________ AGE_______ DATE_________
RESPONDENT’S NAME__________________ PHONE_____________________
A one year old child with "normal" visual development can accurately fixate with aligned eyes, smoothly shift gaze, converge eyes to 3" from the nose, and smoothly follow moving objects with no head movement. Acuity continues to improve as the retina matures.
Please complete the above and check any area below that pertains
APPEARANCE |
___One eye turns in or out ___Closes an eye or tilts head for near tasks ___Red eyes or lids, or crust on eyelids ___Excessive blinking or tearing of eyes
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NEAR & DISTANCE VISUAL ACUITY |
___Holds things close to eyes ___Needs to sit close to television to watch it ___Thrusts head forward when looking at distance
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LOW CONTRAST SENSITIVITY |
___Needs more light to read than expected ___Doesn’t see soil spots on clothes or on counters ___Reads print but can’t see the bus on cloudy days
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VISUAL FIELDS |
___Difficulty with step downs ___Bumps into things ___Doesn’t read to the end of a sentence before going to the next
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ADAPTATION TO LIGHTING CHANGES |
___Pauses when coming indoors on sunny days ___Slow adjustment to lighting changes, night travel difficulties
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EYE TRACKING |
___Head moves instead of eyes when reading or looking at pictures ___Loses place when reading and skips lines ___Needs to use finger as a line marker ___Difficulty solving maze puzzles, i.e., word searches
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EYE-TEAMING |
___Fatigues during near visual tasks, short interest span ___Difficulty judging where things are in space ___Difficulty following flight of a ball ___Math errors due to misalignment of numbers ___Tires easily, inattentive, poor concentration
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