Eye Exams for Children

The importance of pediatric eye exams

While pediatricians often include a basic vision check as part of a child’s yearly check-up, it’s crucial to understand that this quick assessment does not replace the comprehensive examination an optometrist or ophthalmologist can provide.

Eye specialists employ specialized tools and tests to evaluate your child’s vision and eye health comprehensively. Given that many essential learning abilities hinge on robust visual skills—such as depth perception, smooth eye tracking, and clear distance vision—experts advise scheduling your child’s initial eye exam well before they start school.

Seek out an eye care professional in your area who has expertise in evaluating and treating children’s vision to ensure your child’s eyes are healthy and functioning optimally.

Vision screenings vs. comprehensive eye exams

While many educational institutions perform vision screenings to detect potential visual issues that could impact a student's learning capability, passing such a screening does not mean your child's vision is without issues. It's important to recognize that these screenings are not exhaustive and do not cover all potential vision problems that children might face.

Therefore, even if your child has successfully passed a school vision screening, it is highly recommended to arrange for a thorough eye examination. Comprehensive eye exams are designed to identify a wider range of vision problems, ensuring that any undetected issues are caught and addressed early on to support your child’s learning and development effectively.

When should my child have their first eye exam?

Eye care professionals advise that the first eye examination for children should take place at six months old to confirm their eyes are developing correctly.

Following this initial assessment, it is recommended to schedule your child’s next eye exam annually or, at a minimum, by the time they are 2 or 3 years old. Subsequently, ensure another examination is conducted before they begin school. This schedule helps in early detection and treatment of any potential eye issues, supporting optimal visual development as your child grows.

Arrange a detailed eye examination with a local optometrist near you that are experienced in conducting eye exams for children.

Kids eye exam

What to expect: Your child’s first eye exam

When you visit your child's optometrist for the initial appointment, be ready to discuss details about your child's birth, such as any pregnancy or birth complications, their birth weight, and if they were born at term.

The optometrist will inquire about any history of eye diseases in the family and your child’s personal medical history, including any past eye conditions, treatments, or surgeries they might have undergone, along with their current medications and any known allergies.

Make sure to inform the optometrist about any observed delays in your child’s motor skills development, as well as any signs of:

  • Constant eye rubbing or blinking
  • Trouble keeping eye contact
  • Challenges with following objects visually

Additionally, it’s crucial to mention if your child has not passed a vision screening at school or during a check-up with their pediatrician.

Eye testing for infants (6 months to 2 years)

By the age of six months, babies undergo tests to assess their eye focusing abilities, color vision, and depth perception. An eye doctor will generally conduct three specific tests to evaluate if a baby's eyes are developing appropriately.

Pupil Responses: This evaluation checks how the baby’s pupils react—dilating and contracting—in response to light or its absence, providing insight into the basic functioning of the eye.

Fixate and Follow: This assessment determines the baby’s capability to focus on and track a moving object. The skill to fixate on an object is expected to emerge within the first month after birth, while the ability to track movement usually develops by the third month.

Preferential Looking: Through the use of specially designed cards that are plain on one side and patterned on the other, this test gauges the baby’s visual attention. The patterns draw the baby’s gaze, allowing the doctor to infer visual capabilities.

These tests together help ensure a baby’s visual development is on the right track from an early age.

Eye exams for preschool children (2 to 5 years)

At this stage of development, youngsters are mastering the art of coloring, sketching, snipping paper, stacking cubes, constructing with Lego bricks, engaging with balls, among other activities!

A thorough screening for preschool-aged children typically encompasses a variety of evaluations for:

  • Vision sharpness
  • Amblyopia (commonly known as "lazy eye")
  • Depth perception (ability to perceive the world in three dimensions)
  • Eye movement coordination
  • Eye alignment and the ability to focus on close objects
  • Ability to differentiate colors
  • Overall eye health

These visual capabilities are crucial for a child’s proper development and to ensure they are well-prepared for their forthcoming academic years.

Young children are in a constant state of acquiring new abilities that will set the stage for future literacy and numeracy skills. Visual competencies, including visual perception, coordination between the eyes and hands, and fine motor skills, play a pivotal role in educational achievement and overall learning.

Should you observe any signs of developmental delays in your child, or if they struggle with identifying shapes, colors, numbers, or letters, it’s important to consult with your optometrist. Such challenges may point towards a vision issue that needs attention.

For assessing visual acuity in youngsters who are not yet able to recognize the alphabets on a standard eye chart, LEA symbols are employed. These symbols, which consist of an apple, house, square, and circle, are presented to the child. The child’s task is to identify these symbols, which enables the optometrist to evaluate their ability to see clearly at various distances.

To gauge a child’s depth perception, or 3D vision, the random dot stereopsis test is used. This involves assessing how effectively the child’s eyes function in unison. The test utilizes a special chart adorned with patterns of dots and requires the use of 3-D glasses.

Assessment of visual skills to rule out the presence of:

  • Amblyopia— also known as lazy eye
  • Strabismus— also known as crossed-eyes
  • Convergence insufficiency— the inability to view near objects easily
  • Focusing difficulties
  • Poor depth perception

Color vision testing involves the use of specially designed images that are composed of various colors to check if a child is able to distinguish between different hues. The Ishihara Test is one of the most widely used methods for this purpose.

Retinoscopy is a procedure that provides an objective evaluation of a child’s refractive error. During this test, an optometrist employs a retinoscope to project a light beam into the child’s eye and then examines the reflection (reflex) from the retina. This method is crucial for identifying any refractive issues, such as myopia, that could be impacting the child’s eyesight.

An Ocular examination assesses the health of your child’s eyes, focusing on the cornea, iris, lens, retina, and eyelids. This comprehensive evaluation helps the eye doctor identify and exclude potential eye conditions, such as:

  • Congenital cataracts
  • Glaucoma
  • Eye tumors

It’s important to arrange an eye examination with a nearby optometrist to ensure any vision issues your child might be experiencing are promptly identified and addressed.

Eye testing for older children (6 to 18 years)

A thorough examination for an older child mirrors the protocol used for younger children, yet it incorporates extra assessments targeting specific visual abilities crucial for reading, educational success, and sports activities.

The following skills should be tested during an eye exam:

Visual acuity: The ability to see clearly at three distances:

  • Near- for reading a book
  • Intermediate- for computer use
  • Overall eye health

Eye Focusing:

  • The ability to maintain clear vision when switching focus from near to distant objects— a necessary skill for looking at the board and then looking at a notebook on a desk (e.g. taking notes).
  • The ability to maintain clear vision for an extended period of time— when reading a book or completing homework assignments.

Eye tracking: The ability to move the eyes to follow a line of text on a page, or follow a moving object like a ball thrown in the air.

Eye teaming: The ability to use both eyes together, in coordination when reading

Eye-hand coordination: The ability to use visual information to accurately direct the hands when hitting a ball or drawing a picture.

Visual perception: the ability to visually organize images on a page into letters, words, and ideas; and to comprehend and recall text.

  • Recognition: the ability to distinguish between letters like “b” and “d”.
  • Comprehension: the ability to visualize or imagine in our mind the scene of a story
  • Retention: the ability to remember and recall details

Optometrists conduct evaluations to determine if these visual skills are intact, helping to identify any vision issues that do not relate to the standard 20/20 vision acuity.

Often, children face academic and behavioral challenges in school due to unrecognized visual impairments.

Kids with diminished visual abilities might also suffer from physical discomforts like headaches, tiredness, and eye strain.

Evaluating these visual capabilities is a critical component of a complete eye examination.