Children and Eye Exams

Eye examinations for children are very important.  It is estimated, 5-10% of preschoolers and 25% of school age children have vision problems.  Early identification of vision problems are crucial because children are often more responsive to treatment when diagnosed early.

The American Optometric Association (AOA) recommends infants have their first examination at 6 months of age, again at 3 years, and prior to the start of kindergarten.  Eye examinations every other year are acceptable for school aged children who do not require vision correction.  In children that do require visual aids, yearly exams are recommended.

Pediatricians or family doctors are the first medical professionals to examine a child's eyes.  If vision problems are suspected, a referral to an eye doctor should be the next step.

What do optometrists and ophthalmologists look for in children at their first eye examination?

1.  Refractive Error:  Near-sighted (myopia), far-sighted (hyperopia), and astigmatism.  These terms refer to the inability of the eye to focus light onto the retina. 

2.  General eye health:  Glaucoma and cataracts don't just happen in the elderly.  Although less common, they affect children as well.  At Avery Eye Clinic, dilation drops are typically used at all routine ocular health exams.

Dilation serves two purposes: 

  1. Dilation makes the pupil larger and allows easier examination of the internal structures of the eye. 
  2. Dilation temporarily paralyzes the focusing muscles of the eye and allows a more accurate assessment of refractive error.

3.  Accommodating or "focusing" issues:  In an visually perfect eye, the focusing muscles should relax to view an object in the distance and contract a normal amount to focus on something up close.

Children have amazingly flexible focusing muscles.  If a child is farsighted, the focusing muscles will involuntarily tighten up to focus on the distance object, but then must work extra hard to maintain focus at near. These children will often pass a vision screening because they can see the 20/20 line in the distance.  However, because of the over-accommodation, the focusing system fatigues easily with prolonged near work.  Children will not recognize this as a problem because it is what they perceive as "normal".  They just know it is not enjoyable to read or concentrate on school work.  Unfortunately, these children are often misdiagnosed as attention deficit.

4.  Amblyopia ("lazy eye"):  Amblyopia is the suppression of vision in one eye.  Amblyopia has two main causes. 

The first is a large difference in the refractive errors between the two eyes.  If one eye is more near-sighted, more far-sighted or has more astigmatism than the other eye, the brain will receive a clear image from one eye and a blurred image from the other eye.  Thus, the brain starts to rely on  the image it receives from the "good eye".  If the "bad eye" is ignored for too long, the retina will not receive the simulation it needs to develop fully and becomes "lazy".  It is important for amblyopia to be diagnosed and treated prior to the age of 8-10 when retina development is complete.

Another common cause of amblyopia is strabismus.  Strabismus refers to crossing or misalignment of the two eyes.  If the eyes do not line up with each other the brain receives two different images.  In order to prevent double images or confusion, the brain will 'turn off' one of the two eyes.  Again, if not caught and treated, the ignored eye becomes "lazy".

5.  Diabetic Retinopathy:  The prevalence of diabetes is on the rise for children and adults. Diabetes affects the integrity of the small blood vessels in the retina.  These tiny blood vessels can rupture leading to small hemorrhages within the retina layers.  Early diabetic changes have no symptoms and may go unnoticed until the hemorrhaging becomes severe and puts the patient at risk for permanent vision loss.  It is strongly recommended that all diabetic patients, regardless of their age, have dilated eye exams at least once per year.

We look forward to working with you to help make the world a "clearer" place for patients age five and older.  If you have any questions or would like to schedule an appointment please come by any of our offices or call us at (936) 539-4500.