Pediatric Eye Care

Kids Eye ExamsRegular eye exams are a crucial component of health care in young children that often is not given the attention it demands. Most children will have healthy and normal-functioning eyes, but there is always a risk for eye disease or damage, most of which are more easily treatable in children than in adults, which is why pediatric eye exams are so important.

Newborns will undergo an eye examination by the family doctor or pediatrician within the first few days of birth, and most congenital eye conditions will be identifiable then. Most children will not fall into this category, but that does not mean that future eye exams are not necessary. As time passes, your child’s eyes will become stronger and more aligned, and the infant will learn to focus on objects, lights, and sounds and follow their movement around them. All of these milestones will be progressing within the first six months of life.

At six months it is recommended that every child be scheduled for a comprehensive eye exam with an optometrist or ophthalmologist, separate from a scheduled check-up at the pediatrician’s office. These professionals have equipment and training specifically for eye care that can make a difference in your child’s life, and so this appointment is an important juncture for your child’s health and development. Significant issues are not common, but identifying them early will make curing and treating them most successful. In a separate section of this article we will discuss the most common pediatric eye conditions, their implications and treatments.

If at 6 months the child’s eyes appear to be developing normally that does not mean that your child will not require eye care or examination later on. It is recommended that even children with no diagnosed eye conditions get a full eye exam every two years to track progress and development. Definitely before entering kindergarten, around five years old, each child should have an assessment. This is because good vision is so intrinsically associated with school success, and identifying a problem in your child’s vision as he or she enters school will ensure that difficulties in school do not arise out of an eye-related issue, especially if treatment was possible.

What Is Done During Pediatric Eye Exam

Babies have developed vision by three or four months of age, and so testing can begin then for the basic vision functions. Generally at the six month eye exam an optometrist will test for three things: pupil response, fixate and follow, and preferential looking. The test for pupil response is to see if the child’s pupils dilate and shrink appropriately when introduced to different levels of light. By the time a child is three months old he or she should be able to focus on an object and follow its movement, which an eye doctor will test for to ensure that the eyes are strong and working together. Preferential looking tests the normal reactions and functions of the eyes, using blank cards and patterned cards to attract the child’s eyes to the patterns. If any of these tests appear abnormal, it may be a sign that further examination and treatment is necessary.

At this six month appointment it is also already possible to test your child’s visual acuity (the standard test that adults do with letter charts to test clearness of vision), as well as determine if he or she has nearsightedness, farsightedness, or astigmatism.

Parent Tips

To make sure that you get the most out of your appointment, be prepared with information regarding your child’s health history, including birth information (weight, whether or not they were born at full term, etc.). All of this information will be important for your doctor’s assessment of your child, and having it on hand will expedite the process and make your time with the doctor more valuable. It is also helpful to choose a time of day when your child is generally alert and active and happy.

Common Child Eye Conditions

Strabismus

Strabismus is a condition where the eyes do not look together at the same object. One may appear to be pointing up, down, or to the side while the other is focused correctly. This is a physical condition that can occur in adults as well as children, and it is not to be confused with the normal development of infant eyes. It is normal for new infants to appear “cross-eyed” or to notice in general that their eyes do not always appear to be in sync. Their neurological system and muscles are developing, and should get stronger over time. By six months, however, if you are noticing that consistently their eyes do not appear to be working as a team, then that is a sign that your child may have strabismus.

There are many ways to treat strabismus, and treatment generally depends on the severity of the condition, one of the reasons that identifying the problem early on is so beneficial. Often eye exercises and/or a patch will help to strengthen the weaker eye and get them working together again. If this does not work, then eye drops or possibly corrective surgery may be necessary. It is important to get strabismus treated because it can lead to the vision condition amblyopia (‘lazy eye’), and also because good vision is associated with higher motor skills and quicker development in other areas of growth.

Amblyopia

Amblyopia is the vision condition that can occur from the physical condition of strabismus. It can also be caused by severe near-or far-sightedness, as well as trauma to the eye. Technically, the affected eye is called amblyopic, meaning that central vision in that eye has been lost.

The most common practice for treating amblyopia is eye patching. The stronger eye may be patched for several hours a day or even all day as a means of strengthening the muscles around the weaker eye. Eye drops may also be used in the stronger eye to cause blurring, for the same effect. Surgery may be required for more severe cases, and it has been seen to be highly successful. Whatever the method, it is important to get amblyopia treated because it can lead to later vision problems and poor depth perception.

Early treatment is key, because while a child’s brain is developing there is still time to correct the problem permanently. After about age 9, that is much less likely, and the patient will have poor vision for life.

School Screenings

Most states mandate an in-school vision screening for all children, and many parents get the impression that this screening is adequate examination of their child’s eyes and do not therefore take their children to an eye care practitioner to get a comprehensive exam. Truthfully, the school exams simply do not test for all of the important variables in vision, and many conditions could therefore go undiagnosed. The school screenings generally just test distance-acuity, and leave out the near-vision tests for sight within an arm’s length. This occurs even though most of the work a child does in school is at these close distances, such as reading and writing. This can directly affect a child’s performance in school, and often vision problems can go misdiagnosed because they have not been tested for. While the school screenings are important and useful, they are no replacement for the bi-annual exams that all children should have.

Eyewear for Children

Young children diagnosed with nearsightedness or farsightedness will need to be fitted for corrective eyewear, not an easy task.

Eyeglasses: Children of course focus on the “look” of the glasses, and want something similar to parents, older siblings, or other role models, while parents are often concerned about durability and wear-and-tear. Many advances have been made to accommodate both points of view. Now there are lines of children’s glasses that are effectively just smaller versions of adult frames, made with polycarbonate lenses and stainless steel or titanium frames that won’t break easily. Kids’ glasses also often feature spring hinges, which allow the temples to be extended in both directions, because children often overextend the frames outward when taking off or putting on their glasses.

Contacts: Although it may surprise some, many children are ideal customers of contact lenses, as early as 8-10. Kids often ask for them because they feel they will make them look better, and parents can be receptive to these requests, considering their child’s individual behaviors to see whether or not he or she is ready for the responsibility of contacts. If the child performs well at chores and responsibilities around the house and does not need constant reminders to do daily tasks, then he or she might do best with contacts. Often children are much more concerned with following directions and paying attention to details, and so take better care to do exactly what the instructions tell them to, making them better lens wearers than adults who like to cut corners. Most children should start with daily disposable lenses, since those do not require upkeep.

Contact lenses are also very useful for children who are engaged in activities like sports and dance, things that can be difficult to do with eyeglasses on, or may even be dangerous.