Children’s Vision and Eye Care Basics

From the WebMD Archives

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.

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.

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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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If Your Child Needs Glasses

If your child needs glasses, there are a few tips to keep in mind. Younger children should have plastic frames for safety. All children should wear lenses made of impact-resistant plastic. To ensure safety, many states regulate what materials may be used in children’s glasses.

An optician with experience in fitting children’s glasses can help your child choose frames and lenses that are stylish and safe. “If possible, let your child choose her own frames,” adds Repka.

If your child wears glasses, the day may come when she asks for contact lenses. Repka says children often begin asking for contacts around the time they start middle school. He encourages parents to let their child’s maturity level and ability to take care of lenses guide their decision about purchasing contact lenses. “Proper hygiene and care are critical to lens use,” he says. “Normal kid behavior can become a problem.”

Very serious eye problems can develop from improper contact lens care. The greatest risk is corneal infection. “Although this condition is uncommon, it can be very serious and may require a corneal transplant,” Repka says.

Children’s eye exams are a powerful tool for overall heath and can help in many ways. Repka recalls a kindergarten student who had a routine eye screening at school. The exam was abnormal and, as a result, they discovered a rare brain tumor. That exam helped save his life.

“He had no symptoms and that visual acuity test was the only way it could have been discovered,” he says.

WebMD Feature Reviewed by Alan Kozarsky, MD on September 02, 2011

Sources

SOURCES:

Pediatrics, April 2003; vol 111: pp 902-907.

Michael X. Repka, MD, professor of ophthalmology and pediatrics, Johns Hopkins University.

Star Pupils: “School Requirements for Children's Vision.”

Optometrists Network: “Vision Checklist for Parents, Teachers, and Friends.”

Mayo Clinic: “Eye Exam.”

KidsHealth from Nemours: “Your Child’s Vision.”

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