CHILDREN'S VISION · CONCORD EYECARE

Your child's StEPS result — what now?

Got a referral letter from your child's preschool vision screening? We'll explain what it means and what to do next. No GP referral needed. Bulk-billed.

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Reviewed by Dr Mark Joung, B.Optom (Hons) UNSW · Last updated May 2026

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STEPS VISION SCREENING

What is the StEPS vision screening?

A free NSW Health program for every 4-year-old

The Statewide Eyesight Preschooler Screening (StEPS) is a free NSW Health program that screens the vision of 4-year-old children at preschools and daycare centres across New South Wales. Trained screeners test each eye separately using a HOTV logMAR chart to check how clearly your child can see at a distance.

StEPS is a screening — not a full eye test. It checks one thing: whether your child can read letters at a set distance with each eye. If the screener finds a possible issue, you'll receive a referral letter in your child's preschool bag recommending a follow-up eye test with an optometrist.

Around 1 in 5 children screened through StEPS are referred for further assessment. That sounds like a lot — but it includes borderline results, shy children who struggled in the screening environment, and genuine vision issues that need attention.

SCREENING VS FULL EYE TEST

What does StEPS actually test — and what doesn't it check?

A screening checks one thing. A proper eye test checks everything.

StEPS Screening Checks

Distance vision (each eye)

Comprehensive Eye Test Also Checks

Distance vision (each eye)
Near focusing ability
Eye teaming and coordination
Eye tracking and movement
Colour vision
Eye health and structure
Myopia risk assessment

This is why we recommend a comprehensive eye test for all children before starting school — even if they've passed their StEPS screen. We regularly see children who passed their screening but had issues with focusing, eye teaming, or early myopia that the screening wasn't designed to detect.

AFTER THE STEPS REFERRAL

My child was referred after StEPS — what happens next?

Don't panic. This is exactly what the program is designed to do.

If your child received a referral letter from StEPS, the next step is a comprehensive eye test with an optometrist. You don't need a GP referral. The test is bulk-billed through Medicare — there's no cost. Bring the StEPS referral letter and feedback form to your appointment.

A StEPS referral doesn't mean your child definitely has a vision problem. Sometimes children are referred because they were shy or distracted during the screening — a time-pressured environment where dozens of kids are being tested in quick succession. That can produce a "fail" that doesn't reflect their actual vision.

Other times, the screening picks up a genuine issue — most commonly a refractive error (long-sightedness, short-sightedness, or astigmatism) that wasn't apparent to parents because the child had never complained.

"We had a 4-year-old referred through StEPS with high hyperopia — significant long-sightedness — but no obvious symptoms at home. He was behind in reading, and his parents hadn't connected it to his eyes. Without StEPS picking it up, it could have gone unnoticed for years."

During your child's appointment, we'll do a thorough assessment covering everything StEPS couldn't — near vision, eye coordination, tracking, colour vision, and eye health. We complete the StEPS feedback form for you and return it to the program, so your child's records stay up to date.

What to bring: Your child's StEPS referral letter, the StEPS feedback form (included with the letter), your Medicare card, and your child's NSW Personal Health Record (Blue Book) if you have it.

PASSED STEPS?

What if my child passed their StEPS screening?

Passing is good news — but it doesn't mean everything's fine.

A pass means your child's distance vision met the threshold in both eyes on the day of screening. That's reassuring. But StEPS doesn't check how well your child focuses up close for reading, whether their eyes work together as a pair, or whether conditions like myopia are developing.

We recommend all children have a comprehensive eye test before starting school — ideally at age 4, and then annually from age 6 onwards. This is especially important if there's a family history of glasses, lazy eye, or eye conditions. Medicare covers children's eye tests at no cost, and you don't need a GP referral.

If you'd like to know more about the signs that your child might need glasses, we've put together a guide for parents covering what to watch for at different ages.

Ready to book your child's eye test?

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or call (02) 8765 9600

FREQUENTLY ASKED QUESTIONS

StEPS screening — common questions from parents

Do I need a GP referral to see an optometrist after StEPS?

No. You can book directly with an optometrist — no GP referral is required. Just bring your child's StEPS referral letter and feedback form to the appointment.

Is the follow-up eye test covered by Medicare?

Yes. Children's eye tests are bulk-billed through Medicare, so there's no out-of-pocket cost for the consultation. If your child needs glasses, that's a separate cost — we'll discuss options and pricing with you at the appointment.

What if my child was too shy or couldn't do the StEPS test?

This happens more often than you'd think. Some children find the screening environment overwhelming. If your child was marked "unable to be screened," we'd still recommend a comprehensive children's eye test. We have more time, and a calmer one-on-one setting often makes all the difference.

Does StEPS check for colour vision problems?

No. StEPS only tests distance visual acuity — it doesn't screen for colour vision deficiency, which affects around 8% of boys. We include colour vision testing as part of every children's eye test, and it's especially important to identify before school starts.

What if myopia is found at my child's follow-up eye test?

If your child is found to be short-sighted, we'll discuss whether myopia control is appropriate. There are now several evidence-based options — special lenses, eye drops, and overnight contact lenses — that can slow progression during the critical growth years. The earlier myopia is detected, the more options are available.

When should my child have their next eye test after StEPS?

We recommend annual eye tests from age 6 onwards — that's when vision demands increase with school and when conditions like myopia commonly begin developing. If any issue was found at the StEPS follow-up, we'll advise a specific review schedule.

Dr Mark Joung, optometrist at Concord Eyecare

Dr Mark Joung

B.Optom (Hons) UNSW · Grad Cert Ocular Therapeutics · Advanced Paediatric Eye Care

Mark is the principal optometrist at Concord Eyecare. All three optometrists at the practice hold advanced training in children's vision and are therapeutically endorsed.

SOURCES

References

1. NSW Health. Statewide Eyesight Preschooler Screening (StEPS) Policy Directive. PD2018_015. health.nsw.gov.au

2. Robaei D, Kifley A, Mitchell P, et al. Vision Screening in Children: The New South Wales Statewide Eyesight Preschooler Screening (StEPS) Program. Ophthalmol Sci. 2022;3(1):100234. 564,825 children screened; 19.2% referral rate.

3. NSW Health. Statewide Eyesight Preschooler Screening (StEPS). health.nsw.gov.au/steps

4. Optometry Australia. Clinical Practice Guide for Paediatric Optometry. Recommends comprehensive eye examination for all children prior to school entry.

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