Sometimes your baby or young child’s eye or vision issues are obvious or detected in routine physical exams. Other times, it requires a pediatric eye exam to uncover underlying vision issues. These exams are essential because, in some cases, early detection is the only way to solve the problem.
If you wait too long, the body can begin to compensate, and the brain may “cut off” the optical nerve feed from one eye or the other to be more efficient and optimize available vision.
We recommend following the American Academy of Ophthalmology’s (AAO) eye screening schedule for children. Also, never hesitate to contact your optometrist if you suspect something is wrong with your baby or young child’s eye(s) or you feel their vision is compromised. We always prefer to determine that all is well than to find out a parent waited longer than necessary to correct an existing eye condition or their child’s vision loss.
Pediatric Eye Exams: The Basics
Your child’s first pediatric eye exam occurs at the hospital, right after birth, when the doctor does a visual exam to ensure the shape, size, and eyes’ anatomy look okay. After that, initial exams take place at the pediatrician’s office.
Newborn eye exams
During these initial infant eye exams, physicians look for:
Red light reflex. We’ll quickly shine a light in the infant’s eye and look for that telltale red pupil called the red light reflex. If we don’t see the red light reflex, we’ll schedule further exams. Sometimes, it’s a fluke. However, the lack of a red light reflex can indicate cataracts or retinoblastoma. Read our post, Pediatric Eye Exams Catch Retinoblastoma Early, to learn more about that condition.
Blink response. Healthy eyes blink when a light flashes quickly by the eye. Failure to blink in response to a quick flash of light or snapping fingers could indicate more severe vision loss or blindness.
Pupil response. Similarly, the pupil is designed to open wide in darker conditions to allow more light in, becoming smaller in the presence of light to avoid over-exposure or sun-related eye damage. If your baby’s pupil doesn’t dilate (become bigger) and constrict (become smaller) with changes in light, we’ll need to do more tests.
Six to twelve months
From month six to month 12, your pediatrician serves as your baby’s optometrist unless an issue is already identified. In addition to performing the above checks, the pediatrician will also examine the anatomy of the eye and make sure the eyes are correctly aligned and that they track things with age-specific accuracy.
As you’re probably aware, your baby’s ability to focus and “see” the world around them changes dramatically in the first year. During the first weeks and initial months, infants can only see a short distance and cannot decipher the spectrum of colors. However, the ability to enjoy farsighted views and the full-color spectrum opens up with each passing month. By one year, s/he should have nearly full visual ability.
These exams are the most likely to uncover a child’s tendency towards cross-eyes or a lazy eye, although those conditions can develop slightly further along as well. That said, all infants tend to have occasionally crossed eyes or a lazy eye as the eye muscles, and the eye/optic nerve/connection continue to develop. There’s no need for concern if you notice either of these conditions in your baby unless your pediatrician or an optometrist says otherwise.
One to three years
Your pediatrician is still your first-line optometrist unless an issue is detected. The eye and vision checks listed above continue. Your pediatrician will also use a photo screening test at some point, which is a more precise way to identify if a toddler has an official lazy eye.
The good news is that most lazy eyes are easily corrected using “optical” physical therapy and glasses, if necessary. However, note that they can emerge as late as seven years old, which is why routine annual eye exams are essential, especially once your child is in school and learning how to read. An undiagnosed and unmanaged vision issue impacts children’s ability to read and perform well in school.
Three to five years
Even though children at this age are less likely to read, they can identify symbols, and we have special tools that allow us to watch the eyes focus as the child looks at certain pictures or moving dots. Modern, innovative eye exam equipment allows today’s optometrists to identify far more vision conditions than in the past.
We recommend scheduling your child’s first appointment with an optometrist during this window, preferably before s/he begins T-K or kindergarten. In addition to crossed eyes or a lazy eye, your child is now old enough to be diagnosed with nearsightedness (myopia), farsightedness (hyperopia), astigmatism, or other focusing problems.
Pediatric eye exams for five years and up
Once your child is five years old, you should schedule a pediatric eye exam on an annual basis. Children are amazingly adaptive and can have pretty significant vision loss that goes unnoticed without a professional optometrist at the helm. In the early school years, myopia (nearsightedness) is the most likely thing to go wrong. It may correct itself as the child gets older and eye muscles continue to strengthen. However, because children learn during this crucial window, most of which happens at short distances, vision accuracy is essential to their process. Most pediatric myopia is correctable with an eyeglass prescription, and many healthcare plans provide one free pair of glasses per year.
The majority of these pediatric eye exams are considered vision screenings, as opposed to comprehensive eye exams. Your child would only need a comprehensive eye exam if s/he:
- Failed the vision screening or the screening is inconclusive.
- Has been referred by a school nurse or pediatrician.
- Complains about eye pain or other eye issues or experiences abnormal visual behavior.
- Has a condition that puts the child at a higher risk for certain eye conditions such as a genetic history of an inherited condition, Down syndrome, premature birth, juvenile idiopathic arthritis, retinoblastoma, pediatric cataracts, etc.
- Has a neurological disorder, developmental delay, learning disability, or behavioral issues.
Do you suspect something is wrong with your child’s eyes? Have you noticed signs of pediatric vision loss such as watery eyes, difficulty reading, frequent headaches after reading/screentime, etc.? Schedule an eye exam for your child at the Atlantic Eye Institute.