What to Expect During Your Child's Eye Exam
Pediatric eye care is very important to your child’s overall health, so it is essential that comprehensive eye exams begin early in life. There are several things you can do to ensure your child is comfortable and the exam is successful.
Before the exam, take time to discuss with your child what will happen during the visit. Ensure that your child understands the eye doctor may ask them to identify letters or shapes, put in eye drops, and look at some lights.
Pediatric eye exams will include assessment for:
- Nearsightedness, farsightedness, astigmatism, and lazy eye
- Crossing or wandering of the eyes
- Diseases or structural abnormalities of the eye
- Visual dysfunction affecting reading comfort or efficiency
Scheduling an Appointment
Examining children and individuals with special needs can be tricky and unpredictable, so we encourage you to plan conservatively for up to 2 hours for a comprehensive exam. Follow-up appointments, if needed, may take up to one hour.
If your child has behavioral difficulties or special needs, we welcome the opportunity to serve you! If you anticipate an extended exam duration due to limited cooperation, please let us know in advance so we can accommodate you.
For infants and toddlers, avoid planning your visit during their regular naptime so we can see them when they are alert and happy. It may also be a good idea to bring along some snacks or a favorite toy.
Preparing for Dilation
For a comprehensive exam, the doctor may put some eye drops in your child’s eyes – this will not be painful but may tickle for a moment. The drops will take about 30 minutes to take effect. After the exam, your child will temporarily be more sensitive to sunlight, and it may be beneficial to bring a hat or sunglasses from home. In addition, your child will experience blurred vision which may last the rest of the day and can rarely persist up to 36 hours. Your child will still be able to return to school and participate in most activities but should be exempt from reading tasks and homework during this time.
Dilation of the eyes is necessary for two purposes: first, it allows us to check for abnormalities inside the eye; second, and more importantly for children, it relaxes their focusing which helps us determine the most appropriate glasses prescription.
Infant Eye Exams
Vision develops throughout infancy as the eyes improve their connections with the brain. During this stage, poor vision can limit other aspects of development, so it is important to detect vision problems early (we recommend a preliminary exam around 6-12 months of age). While infants cannot respond to questions, our doctors have a number of child-friendly methods that will maximize the accuracy and completeness of the exam.
FREQUENTLY ASKED PEDIATRIC QUESTIONS
When should I have my child’s eyes examined?
The American Optometric Association recommends an eye exam at 6-12 months, 3 years, 5 years, and every year afterward. In the absence of crossing or other vision concerns, we recommend the first exam be around 10 months of age. Through the InfantSEE® program, we are happy to provide this service at no charge.
Why not just do a vision screening?
Vision screenings measure with limited reliability a child’s ability to see clearly in the distance. They give no information on the amount of effort that must be exerted to achieve that clarity. Furthermore, close-up vision, visual efficiency, eye alignment, and ocular health are all essential components of a comprehensive exam that are not assessed in a vision screening.
Why do my child’s eyes need to be dilated?
Dilation relaxes the focusing muscle in the eye. In adults, the focusing muscle is relatively stable, and a reliable glasses prescription can often be obtained without dilation. In children, however, the focusing muscle is powerful and active and can often mask the true prescription. Dilation allows us to determine an appropriate glasses prescription with much greater accuracy.
How do you prescribe glasses for young children who cannot give reliable responses?
Retinoscopy is a procedure that allows us to find a glasses prescription without requiring input from the child. This can be very challenging for practitioners and is one of the skills that distinguishes pediatric specialists. In this procedure, a combination of lights and lenses are used to objectively determine the correct glasses prescription.
What is the difference between nearsightedness and farsightedness?
Nearsightedness causes blurring of distance vision. A child cannot focus through nearsightedness and must wear glasses or contact lenses to achieve clear distance vision. Farsightedness is not simply the opposite of nearsightedness. Farsighted children can focus through their prescription, which is more difficult when looking close than far away. Farsighted children can wear glasses to reduce the focusing effort required to make their world clear.
How does astigmatism affect my child’s vision?
Astigmatism is similar to nearsightedness and farsightedness in that it can be corrected with glasses, but instead of inducing blur, it creates a distortion of vision. For example, a single traffic light may have an overlapping “ghost image” so that the light appears stretched in one direction. The same effect may be experienced when reading small text and can result in eye strain.
If my child can see perfectly without glasses, why does he/she need them?
Children are very proficient at focusing through their farsightedness to make their world clear. However, when present in moderate to large amounts, it comes at a cost. Imagine holding a bag of groceries out at arm’s length while reading a book in the other hand. It doesn’t seem difficult at first, but after a few minutes your arm will grow tired, and it will be more difficult to remain engaged in the book. Now imagine doing the same task with the groceries resting on the countertop. The countertop (glasses) reduces the workload on your arm, making the groceries (farsightedness) easier to tolerate, with less distraction from the book.
Is there a way to stop the progression of nearsightedness?
There is unfortunately nothing that has been found to completely stop or reverse progression of nearsightedness. Myopia control is the slowing of nearsightedness that can be achieved with two different types of specialty contact lenses. Multifocal soft contact lenses induce a refractive change in the peripheral retina and are worn during the day, whereas corneal reshaping therapy uses a hard contact lens that is worn overnight to mechanically flatten the cornea. Because the flattening temporarily eliminates nearsightedness, this option has the added benefit of allowing one to go without glasses or contact lenses during the day. In addition to myopia control, new evidence is emerging that advocates for spending time outdoors as a preventative measure to reduce the onset of nearsightedness.
At what age can my child wear contact lenses?
With proper training, contact lenses can be worn successfully at any age. There are some conditions in which contact lenses are a viable treatment option even in infants and toddlers. In the absence of medical necessity, the minimum age of successful wear depends on the child’s maturity and the degree of parental involvement – typically around 8 years old. Our training sessions are personally supervised by one of our technicians. Patients and parents are instructed step-by-step how to safely insert and remove the lenses; in addition, lens cleaning and care regimens, lens replacement routines, red-eye protocols, and troubleshooting tips are discussed.
How do glasses make my child’s eyes straight?
If your child has a crossed or wandering eye, glasses may help to realign the eyes. This is due the relationship between focusing (making images clear) and convergence (making images single). When the eyes focus on an object, they also converge or diverge in response. Glasses can change the amount of focusing by the eyes, which in turn changes the amount of convergence or divergence, thereby changing the alignment of the eyes.
Does occlusion therapy reduce the need for glasses?
No. Occlusion therapy helps stimulate vision development which occurs in the brain, while glasses eliminate the refractive error in the eye to create the appropriate environment for vision development. In children with amblyopia (lazy eye), vision development is impeded by the lack of a clear image from the eye. When one eye creates a poor image, the brain will eventually ignore it; this results in the inability to see clearly in the ignored eye, even with the best possible glasses prescription. Occlusion therapy blocks the vision in the good eye which forces the brain to use the ignored eye and reactivate its visual development. Once occlusion therapy is finished, glasses must still be worn to maintain a clear image from each eye and promote continued development.
What is vision therapy?
Vision therapy is a rehabilitation program that aims to eliminate visual inefficiencies that negatively impact reading, homework, and digital device use. When looking at close distances, the eyes must turn inward and focus quickly and efficiently in order to maintain a comfortable viewing experience; when these skills break down, symptoms of eye strain or fatigue, blurred or double vision, or headaches may occur while reading. Undergoing therapeutic visual exercises can improve the neural processes responsible for comfortable, clear, and single vision.
Does vision therapy treat dyslexia or other learning disabilities?
No. Dyslexia and other learning disabilities are disorders of central processing in the brain. We uphold the official position of the American Optometric Association that vision therapy does not aim to treat these central processing disorders. However, visual deficits may coexist with or masquerade as a learning disability. In these specific cases, vision therapy can work to resolve any concurrent visual dysfunction, potentially making the true learning disability easier to manage