What tests are used for preschool vision screening?

• A. Snellen chart alone
• B. HOTV or Lea symbols; cover test; refer if fail
• C. MRI
• D. Pupil dilation test

Answer: (B)

Preschool vision screening relies on quick, child-friendly tests that don’t assume reading ability. The best approach uses symbol-based acuity charts such as HOTV or Lea symbols, which preschoolers can recognize and point to without needing to know letters. While checking how clearly each eye sees at a standard distance, it’s important to assess eye alignment as well; a cover test is used for this purpose. In a cover test, you cover one eye and observe whether the other eye fixates steadily or shifts when it’s uncovered, which can reveal strabismus or refractive issues.

If the child fails either the acuity with symbol charts or the cover test, they should be referred for a comprehensive eye examination by a pediatric eye specialist. MRI is not a screening tool for vision, and dilation is part of a full exam, not a quick preschool screening. That combination—symbol-based acuity testing plus a cover test with referral if needed—is the standard preschool screening approach.