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Children’s Vision and Eye Care Basics

By Deborah Nurmi
WebMD Feature
Reviewed by Alan Kozarsky, MD

It’s difficult to know if or when your child needs to see an eye care provider. But most experts agree that eye exams -- performed during regular well-child visits -- help protect your child’s vision and provide useful information about his or her eye health.

Children’s eye health begins in the newborn nursery and should continue throughout childhood, says Michael Repka, MD, professor of ophthalmology and pediatrics at Johns Hopkins University School of Medicine. “For many children, an evaluation by a pediatrician may be enough. But if a child has a family history of vision or eye problems or has symptoms, he or she may need to have an official eye exam,” he says. 

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Even if there are no risk factors or family history of eye problems, children need their vision checked at 6 months, 3 years, and before first grade. 

The Importance of Eye Exams

Most states require children to have an eye exam prior to beginning public school. Even if your pediatrician doesn’t see a problem, there may be other signs that your child needs a more thorough eye exam.

According to the Optometrists Network, the symptoms of possible vision problems in children include:

  • Poor school performance
  • Not wanting to go to school
  • Difficulty paying attention
  • Difficulty when reading and writing
  • Trouble seeing information on the chalk board
  • Blurry or double vision           
  • Headaches or eye pain
  • Taking longer than normal to complete homework

According to Repka, including an eye exam as part of each annual physical may be all a child ever needs.

However, if your child has any symptoms of vision problems, or has family members who wear glasses, she may need to visit an eye care professional for examination.

There are three types of eye specialists who can provide children’s eye and vision care.

  • Ophthalmologist
    An ophthalmologist is a medical doctor who provides eye care, such as complete eye exams, prescribing corrective lenses, diagnosing and treating eye diseases, and performing eye surgery.
  • Optometrist
    An optometrist is a health care professional who can provide complete eye exams, prescribe corrective lenses, diagnose common eye disorders, and treat selected eye diseases. Optometrists do not treat more complex eye problems or perform surgery.
  • Optician
    An optician assembles, fits, sells, and fills prescriptions for eyeglasses.

These health care providers can be found in most commercial and residential areas. Some may be located in shopping malls and even larger commercial chains.

What to Expect During an Eye Exam

Pediatric groups in the U.S. have developed a national standard of care for children’s eye health exams.  

Children’s eye exams should include the following components:

  • Inspection of the eye: The health care provider inspects the eyes and eyelids, exams the various eye muscle movements, and examines the pupils and the reflection of light from the back of the eye.
  • Ophthalmoscope: In older children, the eye care professional examines the back of the eye.
  • Corneal light reflex testing: Using a small flashlight, the health care provider looks at spot where the light is reflected from the front surface of the eye, called the cornea. The light reflected should be in sharp focus and centered on both pupils. The test result is abnormal if the corneal light reflex is not crisp and clear, or if it is off-center.
  • Cover testing: This test detects misalignment of the eyes. While the child focuses on a target, the examiner covers each eye one at a time to look for a "shift" in the eyes.
  • Age appropriate visual acuity testing: Using an eye chart, the examiner asks the child to read numerous lines of characters. It is important to test each eye separately and to be sure that the child is not "peeking" with the other eye.

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