Pediatric Eye Care

Baby’s First Exam

Although the physician examines babies at birth, it’s a good idea for an eye doctor to observe a 6-month-old to check eye focus and ensure that the eyes work as a team.

We will also check for congenital cataracts or other eye problems and determine whether the baby has nearsightedness, farsightedness, or astigmatism. Although a baby can’t tell us anything, we can conduct several tests that will give us information about the child’s sight.

The First Comprehensive Exam

Barring any obvious eye problems or injuries, the child should next have a regular eye exam between ages 3-4, when the child can clearly answer questions. We will test the child with eye charts that contain pictures, numbers, or letters. At this stage, we can measure visual acuity, check depth perception and color vision, determine eye health, and look for any signs of cross-eye or other congenital disorders.

We can also detect amblyopia, or “lazy eye,” a condition in which sight does not develop normally in one eye. Unless the eye is misaligned, it is possible that neither the child nor the parents may be aware of the condition. If left untreated during early childhood, amblyopia may not be treatable in later years. The amblyopic eye may develop a permanent visual defect and/or depth perception may be lost.

Conditions that are not urgent but require attention by an eye care professional, occur when baby’s eyes seem to move continuously and when baby does not look directly at a person.

The Preschool Exam

Children should have an eye exam before starting school. Vision screenings conducted through schools are not complete eye examinations.

A comprehensive children’s eye exam will include tests for eye health, visual acuity, proper eye alignment, and muscle function. Also, a refractive test will determine whether a child’s vision needs correction. A recent study showed that only 14 percent of U.S. children entering school had ever had an eye exam, even though early detection and treatment of vision problems or eye disease is very important to a child’s health, normal development, and learning ability.

School Age Exams

Youngsters with vision problems that make it difficult for them to see the blackboard or up close (reading and writing) will undoubtedly have trouble with their studies. And children with a vision problem may not know they have one — they think everyone sees the way they do.

Children should have complete eye exams every two years throughout their school years. We will check the health of their eyes as well as any signs of underlying health problems, such as diabetes, that may first show up in the eyes. The doctor also tests for changes in eyesight that may call for corrective lenses.

Preparation for the Exam

It is best to schedule eye appointments for young children or babies for times when they are well rested — usually in the morning. You can prepare young children for the exam by telling them they’ll be looking at pictures and talking to the doctor. Parents should take along a favorite toy or juice in case there is waiting time or the child needs some familiar comfort.

Schedule an infant’s exam for the baby’s least fussy time — after he or she has napped and been fed. And, because those quiet times between naps and feedings often don’t last very long, it’s best to complete required paperwork before coming to the appointment, rather than in the doctor’s office.

The Examination

A pediatric eye exam will include allowances for a child’s limited ability to read. We will look at the overall appearance of the eyes and surrounding area, checking for squinting, drooping of eyelids, facial muscles that do not appear to be working properly, and any redness or swelling. We will also check pupil function using a pen light to see if the pupil responds normally. We will also check the following:

  • Eye alignment
  • Near convergence – point at which both eyes together can see a single image
  • Near point of accommodation – closest point at which an image is seen clearly
  • Stereopsis – ability to see three dimensionally
  • Color vision
  • Confrontation fields – a test of peripheral (side) vision

If any of these initial tests indicate a potential problem, more extensive testing may be done later in the exam.

To test visual acuity in children who do not yet read and therefore cannot use the standard Snellen Eye Chart of alphabet letters, the eye care professional will use a chart in which the letter E is headed up, down, left and right. The child can then point in the same direction as the prongs of the E.

Special attention will be given to detecting congenital disorders such as strabismus (cross-eye), amblyopia (lazy eye) and color vision deficiency.

If a child’s history indicates a possible developmental lag or a learning problem, we may administer a developmental visual perceptual screening test to help diagnose and manage visual perceptual problems, assess development, and identify children at risk for learning-related vision problems.

Visual Trouble Signs

Symptoms that require immediate attention from a physician:

  • A white pupil
  • Sudden swelling or drooping of a lid, accompanied by a red eye
  • Enlarged cornea in one or both eyes

Other conditions, which are not as urgent but still require attention by a specialist:

  • One or both eyes turning in or out
  • Tearing, redness, or discharge that lasts for several days
  • One pupil that appears larger than the other

Signs of potential visual problems in children aged 2-6:

  • Covering one eye when looking at a book or object
  • Suffering from headaches
  • Asking to sit closer to the blackboard at school
  • Sitting too close to the television
  • Squinting or rubbing eyes excessively
  • Difficulty catching a ball
  • Not wanting to look at books

If you notice any of these symptoms, you should make an appointment with an eye doctor.