The beginning of the school year is a good time to get your child’s eyes checked. While pediatricians and schools do eye screening exams, a visit to an eye specialist—ophthalmologist or optometrist—is important to catch problems that a simple screening may miss, says Andrew Spinak, MD, of Spinak Medical Eye Center in Pearl River and Stony Point, NY, and attending physician at Montefiore Nyack Hospital.
A Child’s First Eye Exam
Dr Spinak recommends children should have a comprehensive eye exam by age 3. A comprehensive exam involves the use of eye drops to dilate the pupil, so the doctor can thoroughly examine the overall health of the eye and the visual system. The doctor will do a refraction test, or vision test, which tells the doctor whether a child needs eyeglasses and what prescription they need. A child’s vision can be tested with an eye chart or photo screening, which does not require a young child to cooperate with the test. Both tests determine whether a child can focus normally at far, middle and near distances. This is very important to make sure that the child is not developing a lazy eye, since there are no other physical signs of loss of vision.
The doctor will also look for misaligned eyes (strabismus) and "lazy eye” (amblyopia). “It’s important to find and begin treating these conditions as early as possible, by age 8 or 9 at the latest,” Dr. Spinak says. “The sooner these conditions are corrected, the greater the chance of success.”
In strabismus, the eyes are not aligned properly and point in different directions. One eye may look straight ahead, while the other turns outward, inward, up or down. The eye may turn consistently, or the problem may come and go. “Sometimes strabismus is obvious, but sometimes it’s only a slight change, and a parent may not detect it,” says Dr. Spinak.
Treatment is aimed at straightening the eyes and restoring vision in both eyes. In some cases, eyeglasses can be used to straighten the eyes. Other cases require surgery to correct unbalanced eye muscles.
In amblyopia, vision loss occurs because the nerve pathways between the brain and the eye aren’t properly stimulated. The brain sees only blurry images with the amblyopic eye, even if a child wears glasses. The brain ends up favoring one eye, due to poor vision in the other eye. “It’s important to catch amblyopia early, so the brain has time to rewire itself,” he says.
Amblyopia is generally treated by patching or blurring the stronger eye to force the weaker eye to get stronger. “It’s like exercising the bad eye,” Dr. Spinak says. Treatment is usually very successful in the first few years of life. If treatment is delayed, the problem may become permanent.
Common Signs of Vision Problems in Children
Common signs a child's vision problems need to be checked by a doctor include:
- Sitting very close to the TV—or very far away
- Frequent eye rubbing or blinking
- Avoiding reading or other close activities
- Frequent headaches
- Covering one eye
- Tilting the head to one side
- Holding reading materials close to the face
- An eye turning in or out
- Seeing double
- Losing place when reading
How Often Should My Child’s Eyes Be Checked?
If your child has a normal eye exam, then future exams can be done every two years. Children who wear eyeglasses or contacts should be examined every year. Dr. Spinak says, “Kids grow quickly, and as their body changes, their eyes do, too.”