To determine the rate of preschool vision screening in family practice. To evaluate attitudes and beliefs about the importance of, and barriers to, preschool vision screening. Mail survey of a national sample of family physicians. The response rate was 35% (237 of 671 eligible respondents). Most (90%) considered preschool vision screening important. The majority (91%) included some component of the eye examination as part of their routine well-child care for preschool-aged children. The likelihood of formal screening increased with age (3 years, 36%; 4 years, 58%; 5 years, 73%; P < .01). Most (88%) used a wall chart to test for visual acuity. Stereoacuity was rarely (7%) tested. Barriers included the perception that children are uncooperative (39%) and that screening is too time-consuming (21%). Fifty-nine percent would only consider using a vision screening test if its false-positive rate was 10% or less. Some (26%) reported that all children should be examined by an optometrist or ophthalmologist prior to school entry, regardless of any screening. The rate of screening by family physicians is similar to that by pediatricians. Providing education regarding optimal vision screening strategies and expected outcomes of screening may be important for improving both the rate and the quality of preschool vision screening. Ophthalmologists may play an important role in this process through the feedback they provide to referring physicians.