Neonatal Orthoptic Screening Battery (NOSB): Four-decade Experience of Orthoptic Best Practice


  • Mondelli Flora "Italian Association of Orthoptists Assistants in Ophthalmology, 98039 Taormina, Italy" & "Order of Healthcare Technicians of Medical Radiology and Technical Healthcare Professions, Rehabilitation and Prevention, 9700 Ragusa, Italy"
  • Barone Rita "Child Neuropsychiatry – Department of Clinical and Experimental Medicine – University of Catania, 95199 Catania, Italy" & "Orthoptics and Ophtalmologic Assistance school - Department of Biomedical and Biotechnological Sciences - University of Catania, 95199 Catania, Italy"
  • Buscemi Andrea "Italian Association of Orthoptists Assistants in Ophthalmology, 98039 Taormina, Italy", "Study Center of Italian Osteopathy, 95100 Catania, Italy" & "Horus Social Cooperative, 97100 Ragusa, Italy"
  • Coco Marinella "Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, 95100 Catania, Italy" & "Department of Educational Sciences, University of Catania, 95100 Catania, Italy"



Newborn, Screening, Visual defects, Orthoptic, Best practice


The present study describes the neonatal orthoptic screening battery (NOSB), a comprehensive orthoptic screening, based on four decades of application, aimed at early identification of signs and symptoms of ocular pathology or functional disorders. The NOSB allows for verifying the integrity of ocular components and early detection of functional alterations in ocular movements that could lead to the development of amblyopia or strabismus. The NOSB is the result of 45 years of screening activity in a primary health center assured by the National Health System in the city of Ragusa – Italy. It aims to examine and assess the neonate within the first 3 days of extrauterine life to identify visual system issues as early as possible. The NOSB may be conducted by Orthoptists, healthcare professionals specializing in neonatal and pediatric visual prevention. The Neonatal Orthoptic Screening battery (NOSB) here reported is proposed as a standard suitable for widespread adoption to be considered a "Best Practice".


Committee on Practice and Ambulatory Medicine Section on Ophthalmology et al. "Eye examination in infants, children, and young adults by pediatricians: organizational principles to guide and define the child health care system and/or improve the health of all children." Ophthalmology 2003; 110(4): 860-5.

Committee on Practice and Ambulatory Medicine, Section on Ophthalmology. American Association of Certified Orthoptists et al. "Eye examination in infants, children, and young adults by pediatricians." Pediatrics vol. 111,4 Pt 1 (2003): 902-7.

Holmes, Jonathan M, and Michael P Clarke. "Amblyopia." Lancet (London, England) vol. 367, 9519 (2006): 1343-51.

Wright, K. W., Spiegel, P. H. & Hengst, T. Pediatric Ophthalmology and Strabismus (Springer, 2013).

Long E, Lin Z, Chen J, Liu Z, Cao Q, Lin H, Chen W, Liu Y. Monitoring and Morphologic Classification of Pediatric Cataract Using Slit-Lamp-Adapted Photography. Transl Vis Sci Technol. 2017 Nov 2; 6(6): 2.

Rossi A, Gnesi M, Montomoli C, Chirico G, Malerba L, Merabet LB; NAVEG Study Group; Fazzi E. Neonatal Assessment Visual European Grid (NAVEG): Unveiling neurological risk. Infant Behav Dev. 2017 Nov; 49: 21-30.

Mondelli F. - Prevenzione oculare dalla nascita all'età prescolare - Prisma, 1999; 3: 5-7

Mondelli F. - Elementi di screening ortottico neonatale - AA. Vari - Guida alla professione di ortottista - capitolo 6, 485-497 2009, ISBN 998-88-7351-268-4

Mondelli F. - Prevenzione visiva: piano di lavoro per gli Ortottisti - Prisma 2012; 2: 5-7.

Artusio V. Ruolo dell'ortottista all'interno del reparto di neonatologia: screening ortottico neonatale. Prisma 2019; 1: 8-13.

Wu P, Ma J, Zhang T, Ma D. Advances in the Genetics of Congenital Ptosis. Ophthalmic Res. 2022; 65(2): 131-139.

Zegeer LJ. Oculocephalic and vestibulo-ocular responses: significance for nursing care. J Neurosci Nurs. 1989 Feb; 21(1): 46-55.

Snir M, Hasanreisoglu M, Goldenberg-Cohen N, Friling R, Katz K, Nachum Y, Benjamini Y, Herscovici Z, Axer-Siegel R. Suppression of the oculocephalic reflex (doll's eyes phenomenon) in normal full-term babies. Curr Eye Res. 2010 May; 35(5): 370-4.

Pinheiro HM, da Costa RM. Pupillary light reflex as a diagnostic aid from computational viewpoint: A systematic literature review. J Biomed Inform. 2021 May; 117: 103757.

Kardon, R. "Pupillary light reflex." Current opinion in ophthalmology 1995; 6(6): 20-6.

Derrickson, 2006 - Principi di anatomia e fisiologia. CEA, 2011. EAN: 9788808182326. ISBN: 8808182320

American Academy of Pediatrics et al. "Red reflex examination in neonates, infants, and children." Pediatrics 2008; 122(6): 1401-4.

Lam, Matthew, and Donny Suh. "Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases." Children (Basel, Switzerland) vol. 9,12 1939. 10 Dec. 2022.

Mondelli F., Fresta R., Zasa A. Prevenzione ortottica in neonatologia - G.I.O., 2018, 10, 55-60; ISSN1973-5170

Stjerna S, Sairanen V, Gröhn R, Andersson S, Metsäranta M, Lano A, Vanhatalo S. Visual fixation in human newborns correlates with extensive white matter networks and predicts long-term neurocognitive development. J Neurosci. 2015 Mar 25; 35(12): 4824-9.

Buscema D, Campo C., Mondelli F., Pavone G., Spampinato R. Dépistage oftalmologico neonatale limiti e possibilità. Giornale Italiano d'Ortottica (e Tecnica Srumentale Oftalmica). 1981; 8: 147-150. ISSN 0390-279X

Contratto Collettivo Nazionale di Lavoro relativo al personale del comparto sanità triennio2019-2021. 31/03/2023.

Brazelton T.B., Nugent J.K.; La scala di valutazione del comportamento del neonato, Masson et Cie. Milano 1997.

Beeghly, M et al. "Specificity of preventative pediatric intervention effects in early infancy." Journal of developmental and behavioral pediatrics: JDBP 1995; 16(3): 158-66.

Decreto del presidente del consiglio dei ministri 12 gennaio 2017, Gazzetta Ufficiale Serie Generale, n. 65 del 18 marzo 2017.

Bolger, P G et al. "Vision screening in preschool children: comparison of orthoptists and clinical medical officers as primary screeners." BMJ (Clinical research ed.) 1991; 303(6813): 1291-4.

Moran CA, Costa VSLP, Marx LO, Fernandes Costa M. Visual stimulation in the neonatal intensive care unit: A systematic literature review. J Child Health Care. 2024 Jan 11:13674935241227344. Epub ahead of print. PMID: 38213009.




How to Cite

Flora, M. ., Rita, B. ., Andrea, B. ., & Marinella, C. . (2024). Neonatal Orthoptic Screening Battery (NOSB): Four-decade Experience of Orthoptic Best Practice. International Journal of Pediatrics and Child Health, 12, 8–13.