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Children’s Vision and Eye Care Basics

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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.

Your child’s health care provider may also ask you the following questions:

  • Does your child seem to see well?
  • Does your child hold books or other objects close to his or her face?
  • Do your child’s eyes appear straight and focused? Or do they seem to cross or drift?
  • Do your child’s eyes appear unusual in any way?
  • Do your child’s eyelids droop or does one eyelid tend to close more than the other?
  • Has your child ever had an eye injury?

Repka recommends that parents find an eye care professional who has experience treating children and who is familiar with children’s eye diseases.

Common Eye Problems in Children

During the preschool years, many vision problems can be detected during a routine vision screening. Your child’s health care provider will use an acuity chart during this exam. Common eye problems in children may include:

  • Amblyopia:Sometimes called a lazy eye, this is poor vision in an eye that appears to be normal. If untreated during childhood, amblyopia can lead to permanent vision loss or impairment in the affected eye.
  • Strabismus: A misalignment of the eyes, commonly known as cross-eyed, which causes eyes to wander. Both eyes do not always aim at the same object. If one eye is misaligned constantly, amblyopia may develop in that eye. Healthy vision can be restored by patching the properly aligned eye and forcing the misaligned one to work harder. Surgery or specially designed glasses may also help.
  • Refractive errors: These errors occur when the eye is incorrectly shaped and vision is blurry. The most common of these are:
    • Nearsightedness, also known as myopia or poor distance vision. Nearsightedness is usually treated with glasses.
    • Farsightedness, or hyperopia, is poor near-vision and is usually treated with glasses.
    • Astigmatism is an abnormal curve of the front surface of the eye and is treated with glasses.

 

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