ABC Checklist FVA

ABC Checklist for Vision Observation and History

There are three common areas to look for when determining whether a child has a vision problem.

Observe the child's eyes and activities and check the boxes that you observe below.

Question Title

* 1. What is your name?

Question Title

* 2. What is your email address?

Question Title

* 3. What is your relationship to the child in question?

Question Title

* 4. What is the child's name?

Question Title

* 5. A = Appearance
Do you see anything abnormal about the eyes?

Eyes turn in or out

Crusty or red eyelids

Different size pupils or eyes

Swelling of eyelids

Conjunctivitis (Pink Eye)

Drooping eyelid(s)

Any other observation about "eyes that just don't look right"?

Question Title

* 6. B = Behavior
Do you see any of these behaviors?

Tilts head to see

Covers or closes one eye to see

Difficulty keeping in place while reading (or they use their finger to keep track of where they are)

Disinterested in activities involving critical seeing (watching tv, reading picture books, etc)

Excessuve stumbling or awkwardness

Excessive "zoning out" or daydreaming

Holds printed material in an unusual position or distance from face

Has difficulty seeing at night or in the dark

Other behaviors that seem to indicate vision problems?

Question Title

* 7. C = Complaints
Child's statements or your own observations that the child is experiencing discomfort during visual tasks.

Eyes hurt or blur while reading

Headaches when reading

Words "move" or "jump" when reading

Double vision

Cannot see the chalkboard or smartboard

Cannot see well at night or in dark/dim environments

Eyes hurt or bother the child when in bright lighting

Any other complaints or observations that might mean a child is experiencing discomfort during visual tasks?

ABC Checklist FVA

ABC Checklist for Vision Observation and History

Question Title

* 1. What is your name?

Question Title

* 2. What is your email address?

Question Title

* 3. What is your relationship to the child in question?

Question Title

* 4. What is the child's name?

Question Title

* 5. A = AppearanceDo you see anything abnormal about the eyes?

Question Title

* 6. B = BehaviorDo you see any of these behaviors?

Question Title

* 7. C = ComplaintsChild's statements or your own observations that the child is experiencing discomfort during visual tasks.

Question Title

* 8. Any other comments or questions?

* 5. A = Appearance
Do you see anything abnormal about the eyes?

* 6. B = Behavior
Do you see any of these behaviors?

* 7. C = Complaints
Child's statements or your own observations that the child is experiencing discomfort during visual tasks.