Eye Exams for Children

By Gary Heiting, OD
2
As a parent, you may wonder whether your preschooler has a vision problem or when you should
schedule your child's first eye exam.
Eye exams for children are extremely important, because 5 to 10 percent of preschoolers and 25
percent of school-aged children have vision problems.* Early identification of a child's vision
problem can be crucial because children often are more responsive to treatment when problems
are diagnosed early.
According to the American Optometric Association (AOA), infants should have their
firstcomprehensive eye exam at 6 months of age. Children then should have additional eye exams
at age 3, and just before they enter the first grade at about age 5 or 6.
For school-aged children, the AOA recommends an eye exam every two years if no vision
correction is required. Children who need eyeglasses or contact lenses should be examined
annually or as recommended by their optometrist or ophthalmologist.

Early eye examinations are crucial to make sure children have normal, healthy vision so
they can perform better at schoolwork or play.
Early eye exams also are important because children need the following basic skills related to good
eyesight for learning:
Near vision
Distance vision
Binocular (two eyes) coordination
Eye movement skills
Focusing skills
Peripheral awareness
Hand-eye coordination
For these reasons, some states require a mandatory eye exam for all children entering school for
the first time.
Scheduling Eye Exams for Your Child
The American Academy of Ophthalmology (AAO) says on its website that your family doctor or
pediatrician likely will be the first medical professional to examine your child's eyes.
If eye problems are suspected during routine physical examinations, a referral might be made to
an eye doctor for further evaluation. Eye doctors have specific equipment and training to assist
them with spotting potential vision problems.
When scheduling an eye exam for your child, choose a time when he or she usually is alert and
happy.
Specifics of how eye exams are conducted depend on your child's age, but generally the exams
will include a case history, vision testing, determination of whether eyeglasses are needed, testing
of eye alignment, an eye health evaluation and, if needed, prescription of eyewear.
After you have made the appointment, you may be sent a case history form by mail. Some eye
care practices even have forms on their website that you can download and print at home, before
your visit. Or you may not receive a form until you check in at the doctor's office.
The case history form will ask about your child's birth history (also called perinatal history),
including birth weight and whether or not the child was full-term.
Your eye doctor also may ask whether complications occurred during the pregnancy or delivery.
Other questions will concern your child's medical history, including current medications and past or
present allergies.

Be sure to tell your eye doctor if your child has or displays any of the following:
A history of prematurity
Delayed motor development
Frequent eye rubbing
Excessive blinking
Failure to maintain eye contact
Inability to maintain a gaze (fixation) while looking at objects
Poor eye tracking skills
Also, be sure to mention if your child has failed a vision screening at school or during a visit to his
or her pediatrician.
Your eye doctor also will want to know about previous eye problems and treatments your child has
had, such as surgeries and glasses or contact lens wear.
And be sure to inform your eye doctor about any family history of eye problems requiring vision
correction, such as nearsightedness or farsightedness (refractive errors), lazy
eye(strabismus/amblyopia) or eye diseases.
Eye Exam News
New Waiting Room Book Helps Children Accept the Idea of Wearing Glasses

The next time you take your child to the eye doctor, you may see a children's book there called Now I
Can See! It tells the story of Blandon, a nearsighted bear who has trouble seeing what his friends
can see in the distance. Then he visits the eye doctor and gets new eyeglasses, and he discovers
what he has been missing without good vision.
"Even though children's eyewear is stylish and hip these days, kids may still have some insecurity
concerning how their new look will be received by their peers," said author Kieran Hardy, who is also
president of Live Eyewear, manufacturer of Cocoons and other eyewear brands. Hardy's goal when
writing the book was to help children learn about the concept of prescription eyewear in a fun way.
The limited edition book is available to eye care professionals, who should call Live Eyewear at (800)
834-2563 to purchase copies.


Eye Testing for Infants
Babies should be able to see as well as adults in terms of focusing ability, color vision and depth
perception by 6 months of age. To assess whether your baby's eyes are developing normally, the
doctor typically will use the following tests:
Tests of pupil responses evaluate whether the eye's pupil opens and closes properly in the
presence or absence of light.
"Fixate and follow" testing determines whether your baby's eyes are able to fixate on and follow
an object such as a light as it moves. Infants should be able to fixate on an object soon after birth
and follow an object by the time they are 3 months old.
Preferential looking involves using cards that are blank on one side with stripes on the other
side to attract the gaze of an infant to the stripes. In this way, vision capabilities can be assessed
without the use of a typical eye chart.
[See also: infant vision development]
Eye Testing for Preschool Children
Some parents are surprised to learn that preschool-age children do not need to know their letters
in order to undergo certain eye tests, even when they are too young or too shy to verbalize.

Trained vision screeners may be able to detect certain eye problems in preschoolers.
(Image: VIP Study Center, The Ohio State University College of Optometry)
Some common eye tests used specifically for young children include:
LEA Symbols for young children are similar to regular eye tests using charts with letters, except
that special symbols in these tests include an apple, house, square and circle.
Retinoscopy is a test that involves shining a light into the eye to observe the reflection from the
back of the eye (retina). This test helps eye doctors determine your child's eyeglass prescription.
Random Dot Stereopsis testing uses special patterns of dots and 3-D glasses to measure how
well your child's eyes work together as a team.
In addition to nearsightedness, farsightedness and astigmatism, common vision problems of
schoolchildren include:
Lazy eye (amblyopia): Your eye doctor will want to rule out amblyopia, or "lazy eye," which is
decreased vision in one or both eyes without detectable anatomic damage. Unfortunately,
amblyopia is not always correctable with eyeglasses or contact lenses and may require eye
patching to strengthen the weaker eye.

Your child's eyes should be examined early for vision problems such as "lazy eye"
(amblyopia), in which one eye usually is weaker than the other. With amblyopia, eye
patching often is used to help strengthen the weaker eye. (Image: Eye-Lids Custom-
Made Patches)
Misalignment of eyes (strabismus): Crossed or misaligned eyes (strabismus) can have
different causes, such as problems with muscle control in the affected eye or eyes. Strabismus is a
common cause of amblyopia and should be treated early in childhood so vision and eye teaming
skills can develop normally.
Inability to maintain eye alignment when viewing near objects (convergence
insufficiency): Eye doctors will assess the ability of eyes to pull inward (convergence) and
maintain proper alignment for comfortable reading.
Focusing ability, depth perception and color vision:The eye doctor also may test your child's
focusing (accommodation) ability. Depth perception or ability to gauge distances between objects
also may be examined, and color blind tests may be used to assess your child's color vision. [Read
more about color vision and how the eye refracts light.]
Anterior eye and eyelid health: Your eye doctor will closely examine your child's eyelids to look
for abnormal or infected eyelash follicles, bumps, eye discharge and swelling (edema). The doctor
also will examine the cornea, iris, and lens to look for cloudiness (opacities) or other irregularities.
Vision Screening and Your Child's Performance in School
Remember that appropriate vision testing at an early age is vital to insure your child has the visual
skills he or she needs to perform well in school.
A child who is unable to see print or view a blackboard can become easily frustrated, leading to
poor academic performance. Some vision problems, such as lazy eye, are best treated if they are
detected and corrected as early as possible while the child's vision system is still developing.