Eye exams for children: Why they're important

A children's eye exam is an expert assessment of your child's eye health and vision performed by a paediatric optometrist (OD) or paediatric ophthalmologist (eye MD).

A brief examination of your child's eyes and a vision screening by a paediatrician or family practice doctor is not a substitute for an eye exam performed by an eye doctor.

Only optometrists and ophthalmologists have the advanced training and clinical tools to perform a thorough evaluation of your child's eyes and vision.

Why children's eye exams are important

Eye exams for children are very important to insure your child's eyes are healthy and have no vision problems that could interfere with school performance and potentially affect your child's safety.

Early eye exams also are important because children need the following visual skills that are essential for optimal learning:

Excellent visual acuity at all distances
Accurate and comfortable eye teaming skills
Accurate eye movement skills
Improve your child's ability to learn

When to have your child's eyes examined

Children should have their first comprehensive eye exam at 6 months of age.

The then should have their eyes examined exams at age 3 and just before they enter the first grade — at about age 5 or 6.

School-aged children should have an eye exam at least every two years if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or as recommended by your eye doctor.

Be sure to tell your eye doctor if your child has or displays any of the following:

A history of prematurity
Delayed motor development
Frequent eye rubbing
Excessive blinking
Failure to maintain eye contact
Poor eye tracking skills

Also, be sure to mention if your child has failed a vision screening at school or at a visit to his or her paediatrician.

Your eye doctor also will want to know about previous eye problems and treatments your child has had, such as surgeries and glasses or contact lens wear.

And be sure to inform your eye doctor about any family history of refractive errors, strabismus, amblyopia or eye diseases.

Eye testing for infants

Babies should be able to see as well as adults in terms of focusing ability, colour vision and depth perception by 6 months of age.

To assess whether your baby's eyes are developing normally, the doctor typically will use 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's eyes are able to fixate on and follow an object such as a light as it moves. (Infants should be able to fixate on an object soon after birth and follow an object 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 without the use of a typical eye chart.

Eye testing for preschool children

Some parents are surprised to learn that preschool-age children do not need to know their letters in order to undergo certain eye tests, even when they are too young or too shy to verbalize.

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 to observe the reflection from the back of the eye (retina). This test helps determine if your child has any clouding of the lens of the eye (congenital cataract) or significant refractive error.
Random dot stereopsis testing uses special patterns of dots and 3-D glasses to measure how well your child's eyes work together as a team.

In addition to near-sightedness, farsightedness and astigmatism, common vision problems of school children include:

Lazy eye (amblyopia):

Your eye doctor will want to rule out amblyopia, or "lazy eye," which is decreased vision in one or both eyes without detectable anatomic damage. Unfortunately, amblyopia is not always correctable with eyeglasses or contact lenses and may require eye patching to strengthen the weaker eye.

Misalignment of eyes (strabismus):

Crossed or misaligned eyes (strabismus) can have different causes, such as problems with muscle control in the affected eye or eyes. Strabismus is a common cause of amblyopia and should be treated early in childhood so vision and eye teaming skills can develop normally.

Convergence insufficiency:

This is the inability to maintain eye alignment when viewing near objects. Convergence insufficiency can cause eye discomfort and even double vision when reading.

Focusing problems, poor depth perception and colour blindness:

Your eye doctor also may test your child's focusing ability (accommodation), depth perception, colour vision and more.

Eye health problems:

Your eye doctor will closely examine your child's eyelids to look for abnormal or infected eyelash follicles, bumps, eye discharge and swelling (edema). The doctor also will examine the cornea, iris, and lens to look for cloudiness (opacities) or other irregularities.

Vision screening and performance in school

Remember that appropriate vision testing at an early age is vital to insure your child has the visual skills he or she needs to perform well in school.

A child who is unable to see print or view a blackboard can become easily frustrated, leading to poor academic performance.

Some vision problems, such as lazy eye, are best treated if they are detected and corrected as early as possible while the child's vision system is still developing.