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Scoring Guidance©: Family Vision History & Child’s Medical History

Information about a child's family vision history and the child's medical history identifies risks that could affect a child's eye health and/ or vision. Family vision history can reveal hereditary eye conditions, allowing for early detection and intervention, while the child's medical history may uncover health issues or developmental delays that impact visual development.

Caregivers are asked to "check" all statements that apply to their child. Pay attention to any check marks or "Yes" responses that indicate a concern. These concerns may represent a risk factor or indicate a non-urgent issue. Refer to the Scoring Rubric© for further guidance.

Family Vision History (Parents and Siblings)

Is there a family history of eye crossing (strabismus) or vision loss due to eye crossing (amblyopia) in grandparents, parents, or siblings?
"Yes" = Risk Factor
Did anyone in your family need prescription glasses before age 6 years?
"Yes" = Risk Factor
Did caregiver describe any other family vision problems, such as being born with cataracts, glaucoma, or eye cancer?

Family Vision History - Summary Result for Scoring Rubric©

Choose the appropriate summary result to carry forward to the Scoring Rubric©.
No Concerns.
Risk Factor Concerns.

Child’s Medical History

Has the child been diagnosed with or affected by any of the following?
Low birth weight (less than 4.5 pounds)
"Yes"/Check = Risk Factor
Needed oxygen for more than 4 days as a newborn
"Yes"/Check = Risk Factor
Hearing loss
"Yes"/Check = Risk Factor
Born before 30 weeks
"Yes"/Check =  Non-Urgent Concern
Head or facial differences at birth (e.g., cleft lip/palate, craniosynostosis, etc.)
"Yes"/Check =  Non-Urgent Concern
Exposure to infections before birth (e.g., CMV, syphilis, rubella, toxoplasmosis, etc.)
"Yes"/Check =  Non-Urgent Concern
Meningitis or encephalitis
"Yes"/Check =  Non-Urgent Concern
Exposure to drugs or alcohol before birth
"Yes"/Check =  Non-Urgent Concern
Any syndrome or genetic disorder (e.g., Down syndrome, CHARGE syndrome, albinism, etc.)
"Yes"/Check =  Non-Urgent Concern
Brain injury from lack of oxygen, stroke, trauma, etc.
"Yes"/Check =  Non-Urgent Concern
Neurological conditions (e.g., cerebral palsy, seizure disorders, hydrocephalus, etc.)
"Yes"/Check =  Non-Urgent Concern

Child’s Medical History - Summary Result for Scoring Rubric©

Choose the appropriate summary result to carry forward to the Scoring Rubric©.
No Concerns.
Risk Factor Concerns
Non-Urgent Concerns.

A Shared Vision: Partners in Pediatric Blindness & Visual Impairment

EIN 81-4227664