Pediatric Eye Exams

Pediatric Eye Exams Optometrist
Table of Contents

The Importance of Pediatric Eye Examinations for Children

Comprehensive pediatric eye examinations are critical for monitoring vision and overall eye health in children.

A pediatric eye exam is more than a simple screening, it is an assessment of your child's visual function and development and eye health including:

  • Eye diseases and disorders
  • Infections
  • Evidence of visual-motor, cognitive, and neurological deficits. 

An accurate description of visual strength not only takes acuity into account but our ability to gather and process visual information. A child may have "perfect" vision but struggle with optometric deficits that affect learning. Studies show that most vision problems that affect learning are not caused by poor eyesight. In many instances, there is nothing wrong with the visual system. Often, issues related to visual-motor or cognitive-developmental delay can be detected during such examinations.

Specialty Vision

Vision Development

While fundamental stages of visual advancement take place in infancy and toddlerhood, it is possible to develop these skills in young adulthood and beyond. They are important for monitoring conditions that might affect learning in school which can lead to stress and anxiety. Vision is crucial for learning and development for the following reasons:

  • More than 85% of our brain is linked to vision
  • It is the brain’s fastest and most effective way of processing information. 
  • The early development of visual skills and neuroplasticity allows children to meet age-related visual demands as they get older.  As new nerve pathways are developed, they have a greater chance of being visually on par with their peers. 
  • It allows children to develop critical skills needed to process what they read, learn, and how to interact with the world around them.

Who is at Risk For Eye Disorders?

Although certain populations are at greater risk for developing eye disorders than others, it is important to remember that child development is very individual and must be treated as such. All children should be evaluated for eye disorders even if they do not seem to be at risk.

Individuals at particular risk include those who with:
  • Neurological or developmental challenges
  • Autism
  • Downs Syndrome
  • Cerebral Palsy
  • Genetic disorders
  • Were born prematurely
  • Present with a family history

Signs of Visual Problems

  • Reduced hand-eye coordination: An example can be seen when a child is unable to catch a ball that is thrown towards them. The inability to do so points to their difficulty in interpreting speed in relation to where they are. 
  • Compensation: When a child points to each word they read. Doing so is often a way for them to compensate for their inability to track words. 
  • Avoidance: If a child finds it too difficult to read or track the words on a page, she may avoid the material altogether. This kind of avoidance is often displayed through excessive movements, such as squirming in their seat, speaking out of turn, or "spacing out" because they cannot focus on the material.

Physical Symptoms

Eye problems that involve an inability to focus or poor vision often present as physical symptoms. These include:

  • Headaches
  • Red eyes
  • Eye rubbing
  • Eyestrain
  • Complaints of poor vision ("I can't see!")

Knowing What to Look For Problems with Visual Perception

A child who struggles with visual perception will often struggle with mastery of any number of tasks. That is why it is important to recognize the signs that suggest the presence of a deficit, particularly if they have:

  • Poor handwriting
  • Difficulty in copying from a whiteboard
  • A tendency to omit or re-read words
  • Poor reading comprehension
  • Difficulties with letter and number reversals, such as confusing “b” with “d”.

Emotional Symptoms of Visual Perceptual Problems

The emotional effects of having a visual perception problem can be devastating. The inability to perform well in school often leads to low self-esteem and can lead a child to think they are stupid, causing them to lose the motivation needed to succeed. Being able to identify signs of emotional distress is critical, particularly if a child exhibits:

  • Signs and symptoms of depression or stress
  • Extreme irritability or temper tantrums
  • A short attention span
  • Difficulty focusing on tasks

Common Eye Problems Found In Children

Many optometrists recommend at least one comprehensive pediatric eye exam before your child begins school. Some common eye conditions in children include:

  • Myopia (nearsightedness)
  • Hyperopia (farsightedness)
  • Genetic diseases
  • Astigmatism
  • Amblyopia (lazy eye). This condition occurs in  the absence of normal visual development. Treatments include vision therapy, patching, and eye drops.
  • Strabismus (double vision)

Vision Screening from a Pediatrician vs. Eye Exams From A Pediatric Optometrist

It's important not to get confused between a rudimentary screening performed by a pediatrician (or a school nurse) and a comprehensive eye examination from a pediatric optometrist. The former is done by a pediatrician as part of a standard physical exam. The latter is an exam by a trained eye doctor, which can extensively test all aspects of visual health. 

Anatomy of a Pediatric Eye Exam: What to Expect

The examination will begin with a case history of the child, including family and personal medical history, observations from the school, and complaints from the child. Following this, the optometrist will examine the following:

  • "Good vision" or visual acuity: Tests involve the eyes working together and the individual eye. For children and babies unable to communicate there are special technologies for babies using pictures to assess their vision.
  • Usage: Tests include the cover test, testing for color, 3d, track
  • Phoropter for older children to check if they need prescription lenses.
  • Slit-lamp gives a good look at the eye
  • dilating drops allow for analysis of the back of the eye.
  • Review of findings, recommendations, treatments, scheduling future testing

Early Stages of Testing

  • Newborns: Newborns require a proper assessment to check the startle reflex and any noticeable signs of eye disease, in particular if there is a family history of such complications. Such tests can be done by the pediatrician.
  • Babies 6-12 months: Within the first year, the pediatrician will assess eye movement, alignment, and overall eye health.  
  • 12 to 36 months: Overall eye health is assessed often with the aid of photo screening to monitor for signs of eye problems.  If any problems are noted, follow-up will usually involve an eye doctor. 
  • 3-5 years: The child will be checked for issues of alignment and vision. If there are signs that further intervention is required, they will usually involve an optometrist.
  • 5 years and older: Further assessment of eye alignment and to gauge visual acuity. Signs of eye issues will be addressed by an optometrist.

Common Questions

The challenges for a pediatric eye exam depend on age, maturity, and temperament. Depending on the child, an exam can seem scary, tedious, boring, etc. Many pediatricians are wonderful with children and they are trained to deal with different types of children using humor and friendliness to make the exam more fun. Do your research to find practitioners with excellent reputations working with children. Additionally, prepare your child before the exam.
Problems include squinting, eye-rubbing, headaches, blurry vision, needing to sit near the board, etc.
Neither a school vision screening nor a pediatric screening is sufficient for assessing overall ocular health. They are rudimentary tools for identifying possible problems to be followed up with an optometrist.
Most exams follow a similar layout in terms of tests performed. There is a visual acuity test, retinoscopy, refraction, external exam, slit lamp, and a dilation. These tests center around clarity of vision, retinal health and general eye health.
You should schedule an eye exam with a pediatric eye doctor to assess the aspects of visual development that are not assessed at a routine eye exam. Furthermore as a child starts reading it is critical to identify if there are any visual processes that may impact school performance. Since so much of learning is visual it is our recommendation that you do not wait for symptoms to present before taking your child for a pediatric or developmental eye exam, rather you should assess your child's vision by a pediatric optometrist around the time they enter into first grade. If your child has had a pediatric or developmental eye exam and nothing was identified, they can then go for a comprehensive eye exam at the time table recommended by the optometrist (usually every 2 years if your child does not need glasses or annually if they do). If your child has pre-myopia or myopia (nearsighted) they should visit a pediatric optometrist to begin myopia management, which is a specialized contact lens or eye drops that slow down the rate of progression of myopia. This is extremely important as studies show that myopia that progresses to -5 or worse increases the risks of serious eye disease by as much as 2200 percent later in life.
If parents suspect their child has an eye problem, they should schedule an appointment with our optometrist as soon as possible. Our eye doctor will perform a comprehensive eye exam and recommend any necessary treatment such as glasses, contact lenses, and patches. Parents should keep track of any symptoms their child is experiencing and discuss them with our eye doctor during the appointment. Regular eye exams are also important for children, especially for those who have a family history of eye problems or other risk factors. If you are looking for a pediatric eye exam, you can reach out to your nearest Amplify EyeCare practice either via a call or in-person visit. Our team of eye care professionals is ready and equipped to provide you with the care you need.
Common treatments for pediatric eye problems include eyeglasses or contact lenses to correct refractive errors, patching or atropine drops to treat amblyopia, and surgery to correct strabismus.
Children with ADHD or learning disabilities may have difficulty with visual processing, which can affect their ability to read, write, and perform other visual tasks. They may also have problems with eye tracking and focusing, leading to symptoms such as headaches, fatigue, and difficulty reading. An eye exam can help identify underlying vision problems and specific visual therapy can be recommended to help improve visual processing skills. It is important for parents, teachers, and healthcare professionals to be aware of these potential issues and address them promptly.
Children who spend a lot of time using technology, such as smartphones, tablets, and computers, may be at risk for developing digital eye strain, which can cause symptoms such as dry eyes, eye fatigue, and headaches. Parents can help to reduce the risk of digital eye strain by setting limits on screen time and encouraging their children to take regular breaks and to engage in other activities such as playing sports or reading a book.
Yes, premature babies are at risk of developing eye problems, particularly retinopathy of prematurity (ROP). ROP is a disease that affects the blood vessels in the retina of premature babies, it occurs when the blood vessels in the retina do not develop properly. This can lead to scarring and detachment of the retina, which can cause blindness if not treated promptly. Babies born before 31 weeks of gestation or with a very low birth weight are at the highest risk of developing ROP. However, even babies born at full-term can develop ROP if they have other risk factors such as low oxygen levels during their stay in the NICU.
Yes, there is a link between genetics and certain pediatric eye problems. Some eye problems such as myopia, hyperopia, and astigmatism are inherited, meaning that if a parent has these conditions, their child is more likely to develop them as well. Other eye problems such as congenital cataracts, congenital glaucoma, and retinoblastoma are also inherited and caused by genetic mutations. Genetic disorders such as Stargardt disease, which is a form of macular degeneration, also cause eye problems in children. It is important to note that genetics is only one of many factors that can contribute to the development of eye problems in children. Environmental factors such as poor nutrition, smoking and exposure to UV rays, can also play a role. Regular eye exams can detect any potential issues early, and early detection and treatment can help prevent more serious problems from developing later on.
Proper nutrition is important for maintaining overall eye health and preventing eye diseases in children. A diet rich in fruits and vegetables, particularly those high in vitamins A, C, and E, as well as omega-3 fatty acids, can help to promote healthy eye development and function. Vitamin A is essential for the normal functioning of the retina, vitamin C helps to protect the eyes from damage caused by free radicals, and vitamin E helps to protect cell membranes from oxidative damage. Omega-3 fatty acids are important for maintaining the health of the retina. A deficiency in any of these nutrients can lead to eye problems, such as night blindness, dry eyes, and even blindness.
Yes, it is necessary for children to wear sunglasses to protect their eyes from harmful ultraviolet (UV) rays. UV rays can cause damage to the retina and increase the risk of cataracts and other eye problems later in life. It is important to choose sunglasses that provide 100% UV protection. Children's eyes are more susceptible to UV damage than adult's eyes because the lens of the eye is not as effective at blocking UV rays in children. Additionally, children spend more time outdoors than adults and are more likely to be active outside, which increases their exposure to UV rays. Wearing sunglasses can help protect children's eyes from sunburn, cataracts, and other eye diseases later in.
Common eye problems in infants include congenital cataracts, congenital glaucoma, infantile esotropia (crossed eyes), nystagmus, refractive errors such as myopia, hyperopia, and astigmatism, and retinopathy of prematurity. Many of these problems may not have any signs or symptoms and are often detected during routine eye exams. Early detection and treatment of eye problems in infants is important to prevent vision loss.
Children who wear contact lenses should be monitored closely by our optometrist to ensure proper fit and to check for any complications. Children may have trouble handling and caring for contact lenses, so it is important to teach them proper hygiene and lens care techniques. It's also important to schedule regular check-ups to monitor the health of their eyes and the contact lenses.
Age-related macular degeneration (AMD) is a degenerative condition that affects the macula, the part of the retina responsible for central vision. AMD is most commonly diagnosed in older adults, typically those over the age of 60. However, in rare cases, children can develop a genetic form of AMD known as Stargardt disease which is an inherited disorder that causes progressive vision loss, usually starting in childhood. Stargardt disease is caused by mutations in the ABCA4 gene, this gene provides instructions for making a protein that helps to transport waste products out of cells in the retina. When this protein doesn't work properly, waste products build up in the retina, causing damage to the light-sensitive cells and leading to vision loss. Early diagnosis and treatment of Stargardt disease is important to slow down the progression of the disease and preserve vision.
Yes, children with diabetes can develop diabetic retinopathy, a complication of diabetes that affects the blood vessels in the retina. Diabetic retinopathy can cause damage to the blood vessels in the retina, leading to vision loss or blindness if not treated promptly. This is why regular eye exams are important for children with diabetes, to detect and treat diabetic retinopathy early. The risk of developing diabetic retinopathy increases with the duration and poor control of diabetes. Factors such as high blood pressure, high cholesterol and smoking also increases the risk of diabetic retinopathy.
Yes, children can develop diabetes. Type 1 diabetes, also known as juvenile diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone that regulates blood sugar levels. Type 1 diabetes is usually diagnosed in children and young adults and is an autoimmune disorder. Type 2 diabetes, which used to be known as adult-onset diabetes, is also increasingly being diagnosed in children, particularly those who are overweight or obese. This type of diabetes is caused by the body's inability to properly use insulin, often due to lifestyle factors such as poor diet and lack of physical activity.
It is recommended that children have their first eye exam at the age of 6 months. This is because many eye problems can develop before a child reaches their first birthday, and early detection and treatment can help prevent more serious problems from developing later on. This exam should be done by our pediatric optometrist, who is an eye doctor that specializes in treating children's eyes. They will perform a comprehensive eye exam, including visual acuity, refractive error, eye muscle function, and overall eye health. They may also check for any signs of strabismus (eye turn), amblyopia (lazy eye), and other issues that can affect vision development.
Signs that a child may need an eye exam include frequent eye rubbing, squinting, sitting too close to the television or holding books too close, frequent headaches, and difficulty with school work.
During a pediatric eye exam, our pediatric optometrist will perform a comprehensive examination of the child's eyes. The examination will include testing visual acuity, checking for any refractive errors, evaluating eye muscle function and overall eye health, checking for any signs of disease or injury, assessing the pupil's response to light, and checking for any misalignment or lazy eye. Our eye doctor may also take photographs of the child's eyes for future reference. The examination should be done in a child-friendly environment and may include the use of toys or games to make the child feel at ease and cooperate during the exam.
Common eye problems in children include nearsightedness, farsightedness, and astigmatism, as well as amblyopia (lazy eye) and strabismus (crossed eyes or wandering eyes).
Parents can help prevent eye problems in children by scheduling regular eye exams, ensuring that the child gets enough sleep and eats a healthy diet, and protecting their eyes from harmful UV rays by wearing sunglasses or a wide-brimmed hat.
Pediatric Eye Exams
Amplify EyeCare cartoon

Pediatric Eye Exams Are Important

There are no substitutes for routine pediatric examinations to monitor and maintain overall ocular health to detect eye disorders and visual motor neurological deficits. Contact us to find out more.