What is normal vision for a 6-year-old?

Normal Vision for a 6-Year-Old

Normal vision for a 6-year-old child is 20/30 or better (10/15 or better when tested at 10 feet), as established by the American Academy of Pediatrics guidelines. 1

Visual Acuity Standards for 6-Year-Olds

The American Academy of Pediatrics (AAP) provides clear guidelines for normal visual acuity in children:

• For children 6 years and older: Normal vision is considered 20/30 or better
• Testing is typically performed at 10 feet (resulting in a 10/15 notation, equivalent to 20/30)
• A two-line difference between eyes, even within the passing range, is considered abnormal and requires referral 1

Referral Criteria

Children should be referred for comprehensive eye examination if they demonstrate:

• Visual acuity less than 10/15 (20/30) in either eye
• A two-line difference between eyes, even if both are within normal range (e.g., 10/10 and 10/15, or 20/20 and 20/30) 1

Testing Methods for 6-Year-Olds

Several age-appropriate visual acuity tests can be used for 6-year-olds:

• Snellen letters
• Snellen numbers
• Tumbling E
• HOTV test
• Picture tests (Allen figures, LEA symbols) 1

Testing Considerations

• Testing distance of 10 feet is recommended for all visual acuity tests
• A line of figures is preferred over single figures
• The non-tested eye should be properly occluded using an occluder held by the examiner or an adhesive occluder patch 1

Prevalence of Refractive Errors in 6-Year-Olds

Understanding the prevalence of refractive errors provides context for what is "normal" in this age group:

• Myopia (nearsightedness): Generally low in 6-year-olds, with prevalence rates of:

  • 2.4% in the Netherlands
  • 3.3% in Ireland
  • 3-4% in Australia
  • 8% in Taiwan (after outdoor activity intervention; previously 15%) 1

• Hyperopia (farsightedness): More common than myopia in this age group

  • 13.2% in Australian 6-year-olds 1

• Astigmatism: Varies by population

  • 19% in Irish 6-7 year-olds (≥1.00 D) 1

Comprehensive Eye Examination Components

For children who fail vision screening, a comprehensive eye examination should include:

• Visual acuity testing
• Ocular alignment assessment (cross cover test)
• Stereopsis testing (depth perception)
• Red reflex examination
• Pupillary examination
• External eye examination
• Cycloplegic refraction when indicated 1

Common Pitfalls in Vision Assessment

• Using inappropriate testing methods for age
• Failing to properly occlude the non-tested eye
• Not testing at the recommended distance
• Accepting single-figure testing when line testing is more accurate
• Overlooking a two-line difference between eyes even when both are in normal range
• Not accounting for ethnicity-based differences in refractive error prevalence 1

Remember that visual acuity testing represents one of the most sensitive techniques for detecting eye abnormalities in children, and proper technique is essential for accurate results.