Pediatric Eye Exams

Many parents ask us, “When should I bring in my child for an eye exam?”

We believe eye exams for children are very important. We are able to provide thorough eye exams for children at around four years of age. It is helpful for them to be able to identify shapes, know the alphabet or identify numbers 0 through 9. We can identify vision problems in addition to the monitor the ocular health and possible need for a prescription or if necessary, direct them for vision therapy.

Once the child enters school and has no need for vision correction, we recommend an eye exam every two years. Children who need eyeglasses or contact lenses often need more frequent care. We recommend comprehensive eye exams annually.

Basic visual skills are important for learning. Children need good:

  • Distance vision
  • Near vision
  • Focusing ability
  • Eye movement
  • Tracking skills
  • And the ability to use their eyes together.

Scheduling eye exams for your child

Pediatrician do a wonderful job of checking for serious eye disease and dramatic eye turns. Pediatricians are often the first medical professional to examine the child’s eyes. If eye problems are suspected during routine physical examinations, a referral might be made to pediatric ophthalmologist or pediatric optometrist for further evaluation.

It is preferable to perform a pediatric eye exam, when your child is alert and likely to be cooperative. Pediatric eye exams offer certain challenges, and the process can vary for a child’s eye exam. are conducted depend on your child’s age, but an exam generally will involve a case history, vision testing, determination of whether your child will benefit from eyeglasses, testing of binocularity, an eye health examination and a consultation with you regarding the findings.

Be sure to tell the staff and the eye doctor of the reason(s) you want to have your child’s eyes examined or if your child has failed a pediatrician or pre-school vision screening. Please include in the history of behaviors such as frequent eye rubbing, frequent blinking, fails to maintain eye contact, seems unable to maintain a gaze (fixation) while looking at objects, has poor eye tracking skills.

The case history form will ask about your child’s birth history (also called perinatal history), such as birth weight and whether or not the child was full-term. It can also be important for the doctor to know if your child has a history of prematurity, demonstrates any developmental delays, or if complications occurred during the pregnancy or delivery. The history includes your child’s medical history, current medications and any allergies.

Your eye doctor will also want to know about previous ocular diagnoses and treatments involving your child, such as possible surgeries and glasses or contact lens wear. Be sure you inform your eye doctor if there is a family history vision concerns, such as eye turns (strabismus) or a lazy eye (amblyopia), or vision corrections for astigmatism, farsightedness (hyperopia), or nearsightedness (myopia).

Vision problems commonly found in young children

Besides looking for nearsightedness, farsightedness and astigmatism (refractive errors), your eye doctor will be examining your child’s eyes for signs of these eye and vision problems commonly found in young children:

  • Amblyopia. Also commonly called “lazy eye,” this is decreased vision in one or both eyes despite the absence of any eye health problem or damage. Common causes of amblyopia include strabismus (see below) and a significant difference in the refractive errors of the two eyes. Treatment of amblyopia may include patching the dominant eye to strengthen the weaker eye.
  • Binocularity Problems. Subtle problems with how the eyes struggle to work together. Binocularity difficulties lead to problems with depth perception, tracking and binocular coordination.
  • Convergence insufficiency. This is the inability to keep the eye looking at the same point at near for tasks like reading. Eye exercises (vision therapy) are often useful in managing convergence insufficiency.
  • Focusing problems. Focusing problems (accommodation problems) can limit the child’s ability to control their focus when looking from distance to near and back again (accommodative infacility) or have problems maintaining adequate focus for reading (accommodative insufficiency). Vision therapy and eyeglasses are often used to manage these different problems.
  • Refractive Error. Refractive errors include optical differences that can blur the image of an object to the child. There is a lot of changes in what is known about refractive errors and higher order aberrations and the way it affects the visual system. We often only talk about myopia, hyperopia and astigmatism and how the visual system develops. This will change in the future as more is learned through research.
  • Strabismus. Strabismus or an eye turn, is often caused by a congenital defect in the positioning or strength of muscles that are attached to the outside of the eyeball. These muscles control eye positioning and range of movement. Eye turns can lead to amblyopia. Surgery may be required to treat strabismus to improve the use of both eyes together or for just cosmetics.

The Importance of Vision to learning

It is often reported that 80% of what your child learns in school is through vision. A child with a problem with their vision will potentially have more difficulty competing in the classroom and playground. Be sure to schedule a complete eye exam for your child prior to the start of school.