CHILDHOOD EYE CARE

Costello Eye Physicians and Surgeons accepts children as patients. When appropriate and with your permission, we will communicate your child’s visual needs with their pediatrician, school nurse, teacher and sometimes special therapists to ensure that all caregivers are participating in your child’s visual development.

As a parent, you may wonder whether your preschooler has a vision problem or when you should schedule your child’s first eye exam.

Eye exams for children are extremely important, because 5 to 10 percent of preschoolers and 25 percent of school-aged children have vision problems. Early identification of a child’s vision problem can be crucial because children often are more responsive to treatment when problems are diagnosed early.

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Infants should have their first comprehensive eye exam at 6 months of age. Children then should have additional eye exams at age 3, and just before they enter the first grade — at about age 5 or 6.

For school-aged children, guidelines are for an eye exam every two years if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or as recommended by their eye doctor.

Early eye exams also are important because children need the following basic skills related to good eyesight for learning:

• Near vision
• Distance vision
• Binocular (two eyes) coordination
• Peripheral awareness
• Hand-eye coordination

For these reasons, some states require a mandatory eye exam for all children entering school for the first time.

Scheduling Eye Exams for Your Child

Your family doctor or pediatrician may be the first medical professional to examine your child’s eyes. Often a school nurse may detect poor vision during a routine vision screening.

If eye problems are suspected during routine physical examinations, a referral might be made to an eye doctor for further evaluation. Eye doctors have specific equipment and training to assist them with spotting potential vision problems.

When scheduling an eye exam for your child, choose a time when he or she usually is alert and happy.

Specifics of how eye exams are conducted depend on your child’s age, but generally the exams will include a detailed case history, family history and developmental history, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, an eye health evaluation and, if needed, prescription of eye-wear.

After you have made the appointment, you may be sent a case history form by mail. Some eye care practices even have forms on their website that you can download and print at home, before your visit. Or you may not receive a form until you check in at the doctor’s office.

The case history form will ask about your child’s birth history (also called perinatal history), including 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. Other questions will concern your child’s medical history, including current medications and past or present allergies.

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
• Inability to maintain a gaze (fixation) while looking at objects
• Poor eye tracking skills
• Also, be sure to mention if your child has failed a vision screening at school or during a visit to his or her pediatrician.

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 eye problems requiring vision correction, such as nearsightedness or farsightedness (refractive errors), lazy eye (strabismus/amblyopia) or eye diseases.

Eye Testing for Infants

Babies should be able to see as well as adults in terms of focusing ability, color 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.

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 observe the reflection from the back of the eye (retina). This test helps eye doctors determine your child’s eyeglass prescription.

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 nearsightedness, farsightedness and astigmatism, common vision problems of schoolchildren 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.

Inability to maintain eye alignment when viewing near objects (convergence insufficiency): Eye doctors will assess the ability of eyes to pull inward (convergence) and maintain proper alignment for comfortable reading.

Focusing ability, depth perception and color vision: The eye doctor also may test your child’s focusing (accommodation) ability. Depth perception or ability to gauge distances between objects also may be examined, and color blind tests may be used to assess your child’s color vision.