Baby’s First Exam

Although the physician examines babies at birth, it’s a good idea for an eye doctor to observe how a 6-month-old baby focuses, and whether both eyes are used together as a team. At this age, the doctor will also check to make sure there are no diseases such as congenital cataracts or other eye problems, and will determine whether nearsightedness, farsightedness, or astigmatism is present. Although a baby can’t provide any “subjective” input at this age, the doctor can conduct several tests that will provide input about the child’s sight.

The First Comprehensive Exam

Barring any obvious eye problems or injuries, the next regular eye examination for a child should be conducted between the ages of 3 and 4 when the child can begin to give coherent answers to questions. The child’s eyes will be tested using eye charts that contain pictures, numbers, or letters. At this stage, the doctor measures a child’s visual acuity, checks depth perception and color vision, examines the health of the eyes, and looks for any signs of crosseye or other congenital disorders.

Another eye abnormality that eye specialists can detect is amblyopia, or “lazy eye,” a condition in which sight does not develop normally in one eye. But 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, which 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

It is important for children to have an eye exam before starting school. Vision screenings conducted through schools are not complete eye examinations. A comprehensive children’s eye exam should check health of the eyes, visual acuity, proper eye alignment and muscle function. It should also include a refractive test to determine whether a child’s vision needs correction. A recent study showed that only 14 percent of children entering school in the United States had ever had an eye exam, even though early detection and treatment of vision problems or eye disease is very important to the health and normal development of a child.

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 a complete eye examination every two years throughout their school years. The eye doctor will check the health of their eyes and will be on the alert for any underlying health problems, such as diabetes, that may first be manifested in the eyes. The doctor also tests for any changes in eyesight that may call for corrective lenses.

Preparation for the Exam

Eye appointments for young children or babies should be scheduled for times when they are well rested — usually in the morning. Young children can be prepared 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.

An infant exam should be scheduled for the baby’s least fussy time — after he or she has napped and been feed. And, because those quiet times between naps and feedings often don’t last very long, it’s best not to spend time completing required paperwork at the doctor’s office. Instead, paperwork should be prepared and sent to the doctor’s office ahead of time or brought along to the appointment.

The Examination

As soon as a child reaches school age, an eye doctor should perform a pediatric eye exam, making allowances for a child’s limited ability to read. This exam will include an overall look at the appearance of the eye and surrounding area, checking for signs such as squinting, drooping of eyelids, facial muscles that do not appear to be working properly, and signs of irritation such as redness or swelling. A check of pupil function will also be done at this point using a pen light to see if the pupil responds normally. In addition, the eye care professional will perform the following checks:

• 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 also be paid to the detection and treatment of 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, the eye doctor may administer a developmental visual perceptual screening test to help diagnose and manage visual perceptual problems. These tests can help assess developmental level, detect visual perceptual dysfunction, and enable early identification of children at risk for the development of learning-related vision problems.

Visual Trouble Signs

Symptoms that require immediate attention from a physician are:

• 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, include the following:

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

Parents should be attuned to signs of potential visual problems that children aged 2 to 6 may exhibit:

• 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

Should any of these symptoms be noticed, an appointment should be made with an eye doctor.