Home > toddlers with glasses > visual acuity in young children – what is “normal”?

visual acuity in young children – what is “normal”?

When people ask what Zoe’s vision is, they’re normally expecting to hear her visual acuity – usually given as 20/20 or the metric equivalent 6/6 – and then they want to know how she compares with other children.  I don’t actually know what her uncorrected acuity is, but I was curious about what you might expect a preschooler’s acuity to be.

The Snellen and the Tumbling Eye Charts, both used to measure visual acuity.  Image from AllAboutVision.com.  (http://www.allaboutvision.com/eye-test/)

The Snellen and the Tumbling Eye Charts, both used to measure visual acuity. Image from AllAboutVision.com. (http://www.allaboutvision.com/eye-test/)

Visual acuity is the measurement of how clearly we see at a specific distance, usually 20 feet or 6 meters, though that can vary.  It is generally tested in adults with the well-known Snellen eye chart (the one with the big E on top) and with a variety of charts for children.  The acuity is usually presented as two numbers that indicate how close a person will need to be to an eye chart to see the letters or symbols clearly, compared to what a person with “normal” vision would see.    Let’s say my uncorrected visual acuity is 20/200 – that’s 6/60 in metric – (which it is, more or less, in my right eye).  That means that I have to stand 20 feet – or 6 meters – away from the eye chart to read the big E.  A person with good vision, on the other hand, could see the E at the top of an eye chart from 200 feet – or 60 meters – away.

It’s worth keeping in mind that visual acuity is not the whole picture (so to speak) when it comes to measuring vision.  Visual acuity does not indicate how well the eyes work together, or peripheral vision, or even what the prescription needs to be to correct vision.

For adults, it’s pretty easy to look at the acuity numbers to see how good your vision is: if the first and second numbers are the same, 20/20 or 6/6, that means normal visual acuity.  If the second number is smaller than the first, you have better than normal acuity, and if it’s larger than the first your vision is poorer.  But for young children, it’s not quite as straight forward.  Because children’s vision hasn’t completely developed, a child can have “normal” vision that is worse than 20/20.

In 2003, the American Academy of Pediatrics adopted a policy on Eye Examination in Infants, Children, and Young Adults by Pediatricians.  According to those standards, pediatricians should refer any child under the age of 5 with a visual acuity of worse than 20/40 – that’s 6/12 in metric – to an eye doctor.  At age 6 and older, they should refer any child with acuity of 20/30 – 6/9 metric – or worse.

More recently, though, a study called the Multiethnic Pediatric Eye Disease Study looked at visual acuity norms in preschool children with the goal of gaining more accurate visual acuity norms for children.  The results were published in Optometry and Vision Science in June 2009 (abstract and full citation).  They measured the visual acuity of 1,722 children ages 30 to 72 months with no significant refractive errors – so kids that should have good vision.  From those measurements they determined the threshholds for visual acuity that would include 95% of the children tested.  That means that if the test were done by pediatricians and these guidelines were followed, you’d expect that 5% of children with no refractive error would be referred on to an eye doctor for a follow up.  You’d hope that all of the kids with visual problems would also be caught with the testing and also be referred on to an eye doctor.  That’s not necessarily the case, the researchers note that children who have “normal” visual acuity may still have visual problems, but that’s a topic for a different post.  The nice thing about this study is that it breaks out the age range in to more detail, understanding that vision is still developing significantly in children between the ages of 2 1/2 and 6.

So, according to this most recent study, normal visual acuity for preschoolers may be better defined as:

30 – 35 months:  20/63  (6/20) or better

36 – 47 months:  20/50  (6/15) or better

48 – 59 months:  20/40  (6/12) or better

60 – 72 months:   20/32 (6/10) or better

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Categories: toddlers with glasses
  1. July 27, 2009 at 7:34 pm

    The American Optometric Association wants to stamp our amblyopia/lazy eye in our lifetimes. That’s why they started a program called InfantSee. Don’t wait for your pediatrician to send you to an optometrist…do it now. Find an eye doctor who will assess your little one’s vision at no cost by going to http://www.infantsee.org today. For the latest in children’s vision research go to http://www.mainosmemos.blogspot.com

  2. amomofelly
    July 28, 2009 at 3:19 am

    Thanks Dominick, I try to pass the infantsee information to all my moms groups and think it is a great program.

    I really haven’t stayed on-top of Elly’s visual acuity. In the beginning she was estimated at 20/ 1200 and in a -5.5 perscription. In the last year she has dropped to a -8 perscription. Does the visual acuity change… this is something I will try to remember and ask the vision specialist in the morning.

  3. July 28, 2009 at 5:19 pm

    Elly’s prescription change means the little one became more nearsighted not less. The higher the number the “more” the refractive error amount. As you become more nearsighted usually your visual acuity reduceds until you are given a new pair of spectacles. Then you should see OK. You might want to have a VEP/Sweep VEP (Visually Evoked Potential) done to get a better handle on the visual acuity.

  4. Belinda
    January 21, 2010 at 7:05 am

    Hi there my 7 year old daughters VA is 3/19 (metres), everything that i see on the internet is is always referred to from 6 metres distance. Is there a way to convert her VA of 3/19 to the 6 metre distance? cheers Belinda

    • January 21, 2010 at 4:16 pm

      Hi Belinda, You should be able to just multiply both numbers by 2, so 3/19 would be 6/38.

  5. amberhj
    January 4, 2011 at 10:51 pm

    This is such wonderful info. I can’t believe Stella, at 28 months, has one eye at 20/20. I remember being told, before she had glasses, that her visual acuity was above average for her age. But after that, the left eye’s acuity started going down, but now it’s back up to 20/30. Like you said, visual acuity is just one piece of the puzzle. It’s all so confusing yet fascinating.

  6. manorama
    November 16, 2011 at 12:07 pm

    hi ann,

    My kid who is 5 1/2 years old has visual acuity of 6/9 or 20/30. From the above it looks like this should be acceptable below 6 years. Does that mean they dont require glasses?

    Thanks,
    Man

  7. Rossana
    March 9, 2012 at 1:45 am

    My son is almost 6 years old, and I was told by an optometrist that he is farsighted. Giving us a correction of +2 ou, for reading. But then the doctor mentioned that sometimes this is normal, so if my son doesn’t have any problems to leave it alone.
    I don’t know what do. Is it normal? should I get my son reading glasses?

    • March 9, 2012 at 5:54 pm

      Farsightedness or hyperopia is a bit trickier than nearsightedness (myopia) and astigmatism. With farsightedness the vision system is never at rest. For instance when we look far away our focusing system should be resting….and then turned on as we look closer and closer. With farsightedness you have to continually focus for all distances all the time. What is “normal” for a child with farsightedness will vary with age and visual demands. For a child who is six years of age I would consider +2.00 right on the edge of where I might recommend glasses. Does the child have any other vision problems? Blurred vision, headaches, eye turns, etc? If not I might wait before prescribing glasses. The other thing to remember that our academic curriculum has shifted downward significantly…children are being taught to read and reading at much earlier ages. This is not necessarily a good thing…especially if the child has farsightedness….which can make reading very difficult. When in doubt….seek a second opinion. Beware that doctors will vary widely when it comes prescribing…especially for hyperopia…..and MDs do not tyically prescribe as often as ODs. For a doc who could give you a good second opinion, I would suggesting go to the College of Optometrists in Vision Development at http://www.covd.org and click on their Dr. Locator button in the upper right field. Hope this helped a bit.

      • March 9, 2012 at 10:04 pm

        Thank you so much, Dr. Maino, that was a fantastically clear and helpful explanation. I feel like I’m always learning something when you post here!

        Sent from my iPhone

      • Rossana
        March 10, 2012 at 12:15 am

        Thank you so much, this really helped. You are basically said the same thing as the optometrist, you are my second opinion.
        My son doesn’t have any other problems such as, crossed eye, headaches, poor school performance; about the blurry vision I don’t think he would know any different. Anyways, he is in kindergarten, doing great in school and reading above grade level. So, I am just going to wait and see.
        Thank you again,
        Rossana

  8. harpal virdi
    March 27, 2012 at 9:07 pm

    Hi my daughter has just turned 5 yrs old, I booked her for a routine eye test, my daughter has no complaints with near or far distance, how ever when optometrist did ret it showed her right eye was -4.50ds and le -3.00ds, on snellen chart she managed to read 6/9 with out refraction, with refraction le -1.50ds she read no better on chart but he was adiment that le prescription is -1.50ds with a +1.00ds blur le was 6/12+, in re with over refraction of -3.00ds she saw 6/10, again over refraction did not make her read any better. The optometrist has rebooked her for another day a morning test, to do the eye test again, and to refer her to the hospital, I am very concerned on what the outcome will be. concerned mum

    • March 27, 2012 at 9:57 pm

      Your daughter has a fair amount of myopia (nearsightedness) that could cause amblyopia (lazy eye). The visual acuity without refraction seems much too good to be true unless your child was squinting….in any case, I might take the visual acuities with a large grain of salt. Did the doc use dilating/anti-focusing drops and then re-check not only the eye health but also the amount of nearsightedness present? Bringing your little one back for a re-check is a good idea….don’t know why she would need a referral to a hospital at this point. If she has amblyopia…once the prescription is verified the best thing to do (as shown by research clinical trials) is to put a pair of glasses on her for full time wear and then to follow her closely. If the glasses do not get her to the visual acuity we would like, then more aggressive therapy is needed (optometric vision therapy…check out http://www.covd.org). Keep me posted on her progress.

  9. deepti
    March 30, 2012 at 2:04 pm

    my daughter is 4yrs old. her vision is 6/6 in rt eye and 6/9 in left. auto raf gave the cylindrical power of -2.5 in left eye and -.75 in rt eye. shud i go for dialatation test.her binocular vision is 6/6.

  10. Anuj Tayal
    August 5, 2012 at 9:42 am

    Hi all, I yesterday found that my 19 months old son vihan needs glasses to wear +6.5 for left and +4.5 for right eye. He actuall had started showing squinting eyes so we took him to paediatric opthamologist. Dr prescribed him for glasses and to conduct ERG for some suspected spots in his eye. I don’t know what to do dr says right now it’s difficult to say about vision, n we need to see a doc every 3 months or so? R we late ? Will the vision deteriorate further ? Pls suggest”……

  11. Chanda
    August 28, 2012 at 4:50 pm

    My just-turned 10-year-old son’s eyes were tested and found to be 20/30 in both eyes. The doctor recommended glasses, but my husband is not sure we should do that yet, fearing that wearing the glasses will cause a reliance on them and worsening of our son’s eyesight sooner. My son has no complaints about his vision, no headaches, squinting, etc. He says he can see the board at school with no problems, etc.

    • August 31, 2012 at 5:21 pm

      Glasses DO NOT cause dependence….just like shoes do not make your feet dependent upon them… Both shoes and glasses make it easier to do what needs to be done… See or walk. I want all my patients to see the best they can. 20/30 is not bad vision….but if he can see 20/20 wouldn’t you want him to? Since I have not examined you child, I do not know what else is involved here…but in general…trust your doc!

  12. August 31, 2012 at 5:22 pm

    BTW….as far as children not complaining. …. They do not know what they are missing…They think everyone sees the same way….lack of a complaint doesn’t mean the lack of a problem….

    • September 2, 2012 at 3:03 am

      Thank you again, Dr. Maino, for your expertise and helpful explanations!

  13. karen
    November 4, 2012 at 7:40 pm

    My son is 11 and has a visual acuity of 6/12 (we are in the UK) with his glasses on. I have been told that there is nothing they can do for him now because of his age. He was never patched as a child, my other son was sent to Great Ormond Street Hospital as he had both ptosis and a lazy eye. The Ptosis was operated on when he was 3 and his lazy eye treated successfully with atropine eye drops twice a week. Some advise on what I can do, should I ask our optometrist to refer my elder son to a hosipital, I am not prepared to give up on my soe only see half of what I see and if things go as planned in the UK he may never be able to drive.

  14. Gagan Bajaj
    November 16, 2012 at 8:38 am

    Hi, my daughter is 5 1/2 years old and on a routine checkup in school, we were told that her vision acuity was 6/9. Pl. advise should i take her to an eye specialist or is it normal for a kid of her age ?

    • March 19, 2013 at 2:57 pm

      All children should have a comprehensive eye examination between 6-12 months of age, than at age 2 and yearly after that. It is hard to tell just from a visual acuity what should be done.

  15. Bel
    January 15, 2013 at 5:12 am

    Hi! Dr. I just would like to know if it is normal for my 2 turning 3 years old son to have -300 cylinder on both eyes.. I have checked him only to AR finding only… Is there anything I have to be bother or eyes will still develop in time? thanks and more power- D.Bel

    • March 19, 2013 at 3:00 pm

      -3.00 cylinder is high enough to cause amblyopia if left uncorrected and depending upon what “axis” it is…. also depending upon many other factors I would watch him closely and let the doctor decide how best to care for your son…with your input of course!

  16. Jamie
    January 22, 2013 at 3:40 am

    My 3 and a half year old failed his pediatrician’s eye exam and we were referred to an optometrist. Here we were told his left eye needed a prescription of +2.50 and the right eye was needed no prescription. His final prescription given was +1.50 in both the left and right eye which we were told was for balance? I am wondering if this is common or if I should seek a second opinion.

    Thank you for your help.

    • January 22, 2013 at 6:30 pm

      Jamie, I would get a second opinion. I’ve never heard of putting a higher than needed prescription in for “balance”, though of course i am not an eye doctor and don’t know all the details of your son’s vision. If you do get a second opinion, I’d be really interested to hear how it goes!

  17. Abby
    January 27, 2013 at 8:57 pm

    Hi there,
    I just have a vision test for my 9 year old son and was shocked with the result as we have never noticed any thing unusual with his vision and we don’t have a family history of problems in vision at all.

    The result was:

    Dist: OD Sphere. -1.75. OD Cylinder: -0.75 OD Axis: 180

    Dist: OS Sphere: -1.25. OS Cylinder: – 0.50 OS Axis: 030

    I have some queries and would highly appreciate your feedback:

    1- what does this mean in 6/6 and 20/20 ?

    2- how bad is his vision according to this result?

    3- what are the possibilities to have errors in this result ? I am asking this for a couple of reasons. My son was tired and exhausted when he had this vision test. He also was confused of what the optician was expecting from him when he was reading the chart and was reading the numbers that are at the beginning of each line and therefore couldn’t read most of the lines. When I realized this, I asked him to forget about the numbers and to read the letters only. The optician did NOT redo the chart test for him after realizing my kid was confused.

    4- In case this result was accurate, what are the possibilities to have his vision back to normal and what should I do to strengthen his eyesight ?

    Thanks in advance and best regards

  18. Denisse Mraz
    March 19, 2013 at 2:43 pm

    My son is seven years old , Not complains at School however he gets lost whenever reading book , eyer redness while watching tv for more than 30 min . his vision was tested and recived 20/25 and 20/20 should take him to see and optamologist myself ?

  19. March 19, 2013 at 3:02 pm

    Denisse….this sounds like a potential binocular vision problems such as convergence insufficiency. I would suggest he be seen by one of my colleagues who is a member of the College of Optometrists in Vision Development to determine an appropriate course of action. Go to http://www.covd.org to find a doc who can help.

  20. La loca
    April 8, 2013 at 12:17 pm

    My 4 years old just had a physical and her vision was 20/40 ou. Is that normal? What does it mean. Should I be concern.

  21. dr. yousif
    April 10, 2013 at 7:36 pm

    what the VA of 2 years old child

  22. Erin Myrtle
    September 7, 2013 at 4:52 pm

    My daughter is 34 months (was a preemie) and we just had her eyes checked. I was told she was at a +4 in each eye, equaling 20/40, with a astigmatism. My husband and I are wondering if it is too soon to put her in glasses? I know that most kids around 3 are 20/30 and really she isn’t that far off. So should we just recheck in 3-6 months. Or go with glasses. Or are there types of eye therapy we can be doing? I don’t want to hinder her learning, but also don’t want to put her in glasses if we don’t need to yet.

  23. Gen Creighton
    September 27, 2013 at 6:10 pm

    My child is 5 years old and has been wearing glasses with patching for a year and a half to resolve amblyopia. Her vision is now equal in both eyes and her prescription is +2.00. Does anyone know if she will continue to have to wear glasses? Her eye sight is now in the “normal” range of farsightedness for her age.

    • September 28, 2013 at 2:48 am

      Do her eyes cross at all without her glasses? I know that some farsighted kids certainly can outgrow their need for glasses, especially if they have a relatively low prescription. Have you asked her eye doctor about trying to step down her prescription? Zoe’s eye doctor has said that she would be willing to try stepping back Zoe’s prescription so long as her eyes aren’t crossing, unfortunately, that hasn’t been the case yet.

  24. Kathy
    October 11, 2013 at 8:05 pm

    My 6 year old daughter was just seen as a result of a failed eye exam at the doctors office. She has Hyperopia with astigmatism. The Cyclopegic Refration was:
    R: Sphere +3.00 Cylinder +1.75 Axis 092
    L: Sphere +3.00 Cylinder +1.25 Axis 093

    Her final RX for glasses was:
    R: Sphere +2.00 Cylinder +1.50 Axis 092
    L: Sphere +2.00 Cylinder +1.00 Axis 093

    She has been given glasses to reduce permanently reduce vision to her right eye. She has never complained about vision issues.

    How bad is her vision per this information? Is there a possiblity her vision will strenghten, as I know it can get better with farsightedness, to the point see will not require glasses or will she always require them due to the astigmatism?

    • October 15, 2013 at 11:42 pm

      Hi Kathy, it looks like she has moderate farsightedness and astigmatism, certainly enough that she might experience eye strain, especially as she starts doing more close-up work at school. Some children will outgrow their farsightedness, though it’s not a sure thing. As for astigmatism, that can change through childhood. There’s more information about understanding glasses prescriptions here.

  25. kylie
    October 15, 2013 at 10:49 pm

    my son has had a lazy eye intermittently since he was 3. he is now 4 and I am waiting for my appointment at Royal childrens hospital (Melbourne, Australia) to see a specialist at the eye clinic. his vision was 6/6 rt and lt (Sheridan gardiner test). Cycloplegic refraction was apporx +2.00/-0.50×90 rt and lt. I have tried to stress my concerns for over a yr and it has finally been picked up. what should I expect from here.? I hate waiting and I would like to know what to prepare for. thankyou.

  26. kylie
    October 15, 2013 at 11:29 pm

    can I also add.. he has been “seeing” bugs every night for the last 6mths. He wakes up seeing them and is frightened to sleep. atleast twice a night. Do you think this could be floaters or something to do with his vision? I have tried to find answers but cant seem to find them. I know it has something to do with his vision. (mum instinct) but was wondering if you have heard others express the same problem/or similar?

    • October 15, 2013 at 11:56 pm

      That really sounds like floaters. Does he say if they are dark or if they’re flashes of light? Usually, floaters are harmless, but they can be a sign of serious vision issues especially if they are accompanied by flashes of light or started suddenly.

      And good for you for pushing to get your son’s vision checked, I’m so frustrated that your concerns have been ignored for so long. If your son is occasionally crossing his eyes, then it’s very likely that he will be prescribed glasses for farsightedness, even though his prescription is not terribly strong. It’s possible that he’s developed some amblyopia (lazy eye), though a lot of doctors prefer to treat with glasses first since some cases of amblyopia resolve simply by correcting with vision. Otherwise, the treatment for amblyopia is typically patching the strong eye.

      Good luck!

      • kylie
        October 16, 2013 at 12:16 am

        he says the bugs are in my eyes. its traumatising for him and me. He said he sees flashes of light but his more worried about the bugs. I took him to the eye doctor 12mths ago and because he was so young he wouldn’t sit still, the doctor said “bring him back in 12mhs when his older”. (Im not happy about this at all).. I took him to a pedatrian when he was 3 because he started complaining of pain and his eye “wobbling”. because of his age he was put to sleep and had a MRI on his brain. results came back normal and that was the end of that??? He dosnt complain of pain anymore (probably due to the fact that he has compisated with the strong eye). He rubs his eyes a lot, squints and sometimes closes one eye (lazy eye) to focus. The bugs at night worry me ALOT because of all this other stuff going on with his eyes. But im dismissed when have tried to get to the bottom of it. Frustrating to say the least.

  27. Rose
    February 9, 2014 at 4:56 pm

    I can’t seem to find where to ask questions so I’m trying here.

    My 5 year old had an in school screening the other day. Her results were 20/63 bilaterally. My husband and I were both prescribed glasses for distance and astigmatism by the age of 7. We are seeing the Pediatric Opthamologist Tuesday. I’m trying to figure out if the results warrant glasses or not. She is asking tons of questions and I’m not sure which direction to steer her in. I realize each child is different, but I’m wondering if the norm would be glasses or not. I appreciate any insight. Thanks
    Rose

    • February 10, 2014 at 4:00 am

      Hi Rose! With that acuity, I think glasses would be warranted. Especially as she’s school-age now, and poor acuity is closely related to difficulties in school. I’m glad that you have an appointment coming up. Please let me know how it goes.

      • February 25, 2014 at 4:15 pm

        So, we saw the Peds Opho. Results, no corrective lenses. yet… The results of her examination were – astigmatism in both eyes. .75 and 1.25. He said one eye was nearsighted and 1 was farsighted and her v/a was 20/63. This docs opinion was to wait it out and told me to bring her back in a year. He feels her eyes will worsen and she will become bilaterally near or farsighted so wait for that and then correct it. (My husband and I both started with glasses by age 7.) When I questioned his recommendation he explained that with her age and academic requirements (no looking at black or smart boards, no lengthy reading etc.) correction was not necessary. However, now that I am aware of her vision deficit I see her leaning very closely to paper to color and write, her heads right in the book (so I can’t read the words because her head is in my way) when reading stories and she’s inches away from the page when working on eye spy or search and find. Before learning of her v/a I chalked this up to an eager 5 year old but now I’m thinking otherwise. I am thinking a second opinion is a good idea. Any thoughts?

        • March 3, 2014 at 9:25 pm

          I would absolutely support getting a second opinion, especially if you’re now noticing what looks like her struggling to see.

  28. sushil
    August 16, 2014 at 1:33 pm

    Hi, Mywson is 4 yr old, he was prescribes by doctor for specs and said following thing

    Sphere: OD +, OS +0.25
    Cylender: OD +1.00
    Axis: 10*
    what does it mean? and any possibility specs could be removed

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