Eye testing for infants
It takes some time for a baby's vision skills to develop. To assess whether your infant's eyes are developing normally, as eye doctors we may use one or more of the following tests:
- Tests of pupil responses evaluate whether the eye's pupil opens and closes properly in the presence or absence of light.
- "Fixate and follow" testing determines whether your baby can fixate on an object (such as a light) and follow it as it moves. Infants should be able to perform this task quite well by the time they are 3 months old.
- Preferential looking involves using cards that are blank on one side with stripes on the other side to attract the gaze of an infant to the stripes. In this way, vision capabilities can be assessed.
Newborns have all the ocular structures necessary to see, although these are not yet fully developed. At birth, your baby can see blurred patterns of light and dark.
During the first four months, their visual horizon will expand from a few centimetres to many metres. Their vision will become clearer and colour vision will begin to develop. Their two eyes will start working together. By four months of age, an infant’s colour vision is similar to an adult’s, and by the sixth month, your baby will acquire eye movement control and develop eye-hand coordination skills.
For the first six months, an infant’s eyes can appear slightly crossed or out of alignment, but this is usually normal. But if your infant’s eyes appear significantly crossed or remain misaligned after six months of age, contact your Doctor of Optometry right away. Your child may have strabismus, commonly known as crossed eyes, a condition that needs to be treated with eyeglasses, contact lenses, prisms and/or vision therapy and, in some cases, surgery. If left untreated, the ignored eye will become unable to function normally and will become largely unused. This may result in the development of lazy eye.
Lazy eye, or amblyopia, is another condition that becomes apparent within the first six months of your baby’s life. This condition describes weak vision or vision loss in one eye as a result of an uncorrected prescription. If detected or treated before eight years of age, it will often resolve completely. It’s important to treat amblyopia early – with vision therapy, eyeglasses and/or contact lenses, or patching – as treatment becomes very difficult later on. Untreated, amblyopia can lead to blindness in the affected eye.
Visual abilities play a big role in early development. Doctors of Optometry recommend infants have their first eye exam at six months of age, and then annually after that. A Doctor of Optometry can complete an eye exam even if your child doesn’t know their ABCs. A Doctor of Optometry can use shapes, pictures and other child-friendly ways to evaluate vision and eye health.
Pediatric Eye Exams
As a parent, you may wonder whether your pre-schooler has a vision problem or when a first eye exam should be scheduled.
Eye exams for children are extremely important. Experts say 5 to 10% of pre-schoolers and 25% of school-aged children have vision problems. Early identification of a child's vision problem is crucial because, if left untreated, some childhood vision problems can cause permanent vision loss.
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When should kids have their eyes examined?
According to the Canadian Association of Optometrists (CAO), infants should have their first comprehensive eye exam at 6 months of age. Children then should receive additional eye exams at 3 years of age, and just before they enter kindergarten or the first grade at about age 5 or 6.
For school-aged children, the AOA recommends an eye exam every two years if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or according to their eye doctor's recommendations.
Early eye exams also are important because children need the following basic visual skills for learning:
- Near vision
- Distance vision
- Eye teaming (binocularity) skills
- Eye movement skills
- Focusing skills
- Peripheral awareness
- Eye/hand coordination
Scheduling your child's eye exam
Your family doctor or pediatrician likely will be the first medical professional to examine your child's eyes. If eye problems are suspected during routine physical examinations, a referral might be made to an ophthalmologist or optometrist for further evaluation. Eye doctors have specific equipment and training to help them detect and diagnose potential vision problems.
When scheduling an eye exam, choose a time when your child is usually alert and happy. Specifics of how eye exams are conducted depend on your child's age, but an exam generally will involve a case history, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, an eye health examination and a consultation with you regarding the findings.
After you've made the appointment, you may be sent a case history form by mail, or you may be given one when you check in at the doctor's office. The case history form will ask about your child's birth history (also called perinatal history), such as birth weight and whether or not the child was full-term. Your eye doctor also may ask whether complications occurred during the pregnancy or delivery. The form will also inquire about your child's medical history, including current medications and past or present allergies.
Be sure to tell your eye doctor if your child has a history of prematurity, has delayed motor development, engages in frequent eye rubbing, blinks excessively, fails to maintain eye contact, cannot seem to maintain a gaze (fixation) while looking at objects, has poor eye tracking skills or has failed a pediatrician or pre-school vision screening.
Your eye doctor will also want to know about previous ocular diagnoses and treatments involving your child, such as possible surgeries and glasses or contact lens wear. Be sure you inform your eye doctor if there is a family history of eye problems requiring vision correction, such as nearsightedness or farsightedness, misaligned eyes (strabismus) or amblyopia ("lazy eye").
Eye testing for pre-school children
Pre-school children can have their eyes thoroughly tested even if they don't yet know the alphabet or are too young or too shy to answer the doctor's questions. Some common eye tests used specifically for young children include:
- LEA Symbols for young children are similar to regular eye tests using charts with letters, except that special symbols in these tests include an apple, house, square and circle.
- Retinoscopy is a test that involves shining a light into the eye to observing how it reflects from the retina (the light-sensitive inner lining of the back of the eye). This test helps eye doctors determine the child's eyeglass prescription.
- Random Dot Stereopsis uses dot patterns to determine how well the two eyes work as a team.
Eye and vision problems that affect children
Besides looking for nearsightedness, farsightedness and astigmatism (refractive errors), your eye doctor will be examining your child's eyes for signs of these eye and vision problems commonly found in young children:
- Amblyopia. Also commonly called "lazy eye," this is decreased vision in one or both eyes despite the absence of any eye health problem or damage. Common causes of amblyopia include strabismus (see below) and a significant difference in the refractive errors of the two eyes. Treatment of amblyopia may include patching the dominant eye to strengthen the weaker eye.
- Strabismus. This is misalignment of the eyes, often caused by a congenital defect in the positioning or strength of muscles that are attached to the eye and which control eye positioning and movement. Left untreated, strabismus can cause amblyopia in the misaligned eye. Depending on its cause and severity, surgery may be required to treat strabismus.
- Convergence insufficiency. This is the inability to keep the eye comfortably aligned for reading and other near tasks. Convergence insufficiency can often be successfully treated with vision therapy, a specific program of eye exercises.
- Focusing problems. Children with focusing problems (also called accommodation problems) may have trouble changing focus from distance to near and back again (accommodative infacility) or have problems maintaining adequate focus for reading (accommodative insufficiency). These problems often can be successfully treated with vision therapy.
- Eye teaming problems. Many eye teaming (binocularity) problems are more subtle than strabismus. Deficiencies in eye teaming skills can cause problems with depth perception and coordination.