Pediatric Eye Exams
As a parent, you may wonder whether your preschooler has a vision problem or when a first eye exam should be scheduled.
Eye exams for children are extremely important. Experts say 5 to 10% of preschoolers and 25% of school-aged children have vision problems. Early identification of a child’s vision problem is crucial because, if left untreated, some childhood vision problems can cause permanent vision loss.
When should kids have their eyes examined?
According to the Alberta Optometry Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. We recommend that children should receive additional eye exams yearly.
Children who need eyeglasses or contact lenses should be examined annually or according to their eye doctor’s recommendations.
Early eye exams also are important because children need the following basic visual skills for learning:
- Near vision
- Distance vision
- Eye teaming (binocularity) skills
- Eye movement skills
- Focusing skills
- Peripheral awareness
- Eye/hand coordination
Because of the importance of good vision for learning, some states require an eye exam for all children entering school for the first time.
Scheduling your child’s eye exam.
Your family doctor or pediatrician likely will be the first medical professional to examine your child’s eyes, however, even if your pediatrician has checked your child’s eyes we still recommend routine exams starting at 6 months of age. Eye doctors have specific equipment and training to help them detect and diagnose potential vision problems and are able to ensure your child’s vision development is on track. .
When scheduling an eye exam, choose a time when your child is usually alert and happy. Specifics of how eye exams are conducted depend on your child’s age, but an exam generally will involve a case history, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, eye tracking and focusing skills, an eye health examination and a consultation with you regarding the findings.
After you’ve made the appointment, you may be sent a case history form by email, or you may be given one when you check in at the doctor’s office. 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. Your eye doctor also may ask whether complications occurred during the pregnancy or delivery. The form will also inquire about your child’s medical history, including current medications and past or present allergies.
Be sure to tell your eye doctor if your child has a history of prematurity, has delayed motor development, engages in frequent eye rubbing, blinks excessively, fails to maintain eye contact, cannot seem to maintain a gaze (fixation) while looking at objects, has poor eye tracking skills or has failed a pediatrician or pre-school vision screening.
Your eye doctor will also want to know about previous ocular diagnosis 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 of eye problems requiring vision correction, such as nearsightedness or farsightedness, misaligned eyes (strabismus) or amblyopia (“lazy eye”).
Eye testing for infants.
It takes some time for a baby’s vision skills to develop. To assess whether your infant’s eyes are developing normally, your eye doctor may use one or more of 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 can fixate on an object (such as a light) and follow it as it moves. Infants should be able to perform this task quite well 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.
Eye testing for preschool children.
Pre-school children can have their eyes thoroughly tested even if they don’t yet know the alphabet or are too young or too shy to answer the doctor’s questions. 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 observing how it reflects from the retina (the light-sensitive inner lining of the back of the eye). This test helps eye doctors determine the child’s eyeglass prescription.
Random Dot Stereopsis uses dot patterns to determine how well the two eyes work as a team.
Eye and vision problems that affect 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.
Strabismus: This is misalignment of the eyes, often caused by a congenital defect in the positioning or strength of muscles that are attached to the eye and which control eye positioning and movement. Left untreated, strabismus can cause amblyopia in the misaligned eye. Depending on its cause and severity, surgery may be required to treat strabismus.
Convergence insufficiency: This is the inability to keep the eye comfortably aligned for reading and other near tasks. Convergence insufficiency can often be successfully treated with vision therapy, a specific program of eye exercises.
Focusing problems: Children with focusing problems (also called accommodation problems) may have trouble changing focus from distance to near and back again (accommodative infacility) or have problems maintaining adequate focus for reading (accommodative insufficiency). These problems often can be successfully treated with vision therapy or glasses.
Eye teaming problems: Many eye teaming (binocularity) problems are more subtle than strabismus. Deficiencies in eye teaming skills can cause problems with depth perception and coordination.
Vision and learning.
Experts say that 80% of what your child learns in school is presented visually. Undetected vision problems can put them at a significant disadvantage. Be sure to schedule a complete eye exam for your child prior to the start of school.
Source: Eye Exams for Children, article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.
Dry Eye Treatment
Dry eyes or dry eye syndrome (DES) is an ongoing condition that treatments may be unable to cure. But the symptoms of dry eye—including dryness, scratchiness and burning—can usually be successfully managed.
Your optometrist may recommend artificial tears, which are lubricating eye drops that may alleviate the dry, scratching feeling and foreign body sensation of dry eyes. Prescription eye drops for dry eyes go one step further: they help increase your tear production.
If you wear contact lenses, be aware that many artificial tears cannot be used during contact lens wear. You may need to remove your lenses before using the drops. Wait 15 minutes or longer (check the label) before reinserting them. For mild dry eye, contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary. Switching to another lens brand could also help.
Check the label, but better yet, check with your doctor before buying any over-the-counter eye drops. Your eye doctor will know which formulas are effective and long-lasting and which are not, as well as which eye drops will work with your contact lenses.
To reduce the effects of sun, wind and dust on dry eyes, wear sunglasses when outdoors. Wraparound styles offer the best protection.
Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that’s too dry because of air conditioning or heating.
For more significant cases of dry eye, your eye doctor may recommend punctal plugs. These tiny devices are inserted in ducts in your lids to slow the drainage of tears away from your eyes, thereby keeping your eyes moist.
Doctors sometimes recommend special nutritional supplements containing certain essential fatty acids to decrease dry eye symptoms. Drinking more water may also relieve symptoms.
If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first.
Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid drops, plus frequent eyelid scrubs with an antibacterial shampoo.
If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until your dry eye condition is successfully treated. Dry eyes increase your risk for poor healing after LASIK, so most surgeons will want to treat the dry eyes first, to ensure a good LASIK outcome. This goes for other types of vision correction surgery, as well.