A pediatric eye exam is an important part of a child’s healthcare regimen. Like visits to the pediatrician or family doctor, regular eye exams for children help them stay or get healthy.
When should a child have their first eye exam? It’s recommended that kids get an eye exam in their first year of life (generally at around six months), again between ages three and five, and annually for school-aged kids. However, children might need additional eye exams if they exhibit symptoms of an eye condition or signs they may need eyeglasses.
In this article, we’ll discuss what could happen at a pediatric eye exam. We’ll also go over the difference between a pediatric vision screening (such as children’s eye testing at school) and a comprehensive eye exam. And we’ll give you tips on how to prepare for your child’s eye exam.
Why Are Kids’ Eye Exams Important?
Children’s eyes are their windows to the world. Vision and eye health are essential for children’s social, cognitive, and academic development. The ability to see plays a big part in how kids function in their environment.
Pediatric eye exams serve two general purposes:
- To uncover vision problems needing correction: Proper vision is critical for learning and safety. Children with vision issues such as myopia (nearsightedness), hyperopia (farsightedness), or astigmatism may need corrective lenses. Kids with myopia may also benefit from myopia management to help slow its progression.
- To detect eye conditions: Early detection and treatment of some eye conditions are vital to help preserve vision. Some common childhood eye issues, like strabismus (misaligned or crossed eyes) and amblyopia (lazy eye), and rarer conditions like childhood cataracts or glaucoma, could affect a child’s eyesight well into the future.
Pediatric Vision Screening vs. Pediatric Eye Exam
It’s important to know that pediatric vision screening and comprehensive eye exams for kids are not the same thing. The difference between them is a little like skimming through a book vs. reading every word. Let’s take a look:
- Pediatric vision screening: A pediatric vision screening is a basic check for vision issues or eye conditions in children. Vision screenings are often done by a pediatrician, family doctor, or school nurse. If a problem is suspected, kids may be recommended for a pediatric eye exam. Vision screenings aren’t a substitute for pediatric eye exams. Even if your child passes a screening, getting regular eye exams is a good idea.
- Pediatric eye exam: A pediatric eye exam is a much more thorough look at a child’s vision and eye health. They’re done by a professional eye care practitioner like an optometrist or ophthalmologist who can diagnose issues and recommend treatment.
What to Expect at Kids’ Eye Exams
What happens at a pediatric eye exam depends on a few factors. The child’s age usually determines the exact structure of the exam, but it could also depend on the doctor and how they prefer to work.
The doctor performs tests based on why the child is there. A routine check requires the usual tests, but different tests may be needed if the child has symptoms of an eye issue or if the family has a history of eye conditions.
A pediatric eye exam usually happens in two parts. First, the doctor and caregiver talk about the child’s health history. Then, the doctor performs a few tests or evaluations.
The health history discussion might include:
- Prenatal and postnatal history (for a baby’s eye exam)
- Family history of eye problems and health issues.
- Results of pediatric vision screenings done at school or by a pediatrician or family doctor
- Surgeries the child has had or medications they take
- Developmental history
- School performance (for school-age children)
- Time spent outside and any involvement in sports
- Typical amount of screen time
- Parental concerns about the child’s eyes
After the health history discussion, the doctor usually evaluates the child’s eyes. Let’s take a look at some common vision and eye tests for three age groups.
Newborn Through Age 2
An eye exam for a baby or young toddler is geared toward children with no or limited ability to express themselves verbally or to identify letters or pictures. Often, the doctor can do the exam with the child sitting on a caregiver’s lap. The exam may include some of these or similar tests:
- Fixating and following: Doctors may check visual acuity, eye alignment, and ocular motility (eye movement) by seeing if an infant or young child’s eyes can track a moving object, like a toy or point of light.
- Preferential looking: This visual acuity test is a preferential looking test, also called a forced choice. This test displays a striped card next to a monochromatic gray card. Children who can detect the more interesting card tend to look at that instead of the mundane one-color card.
- Cover and uncover: To check eye alignment, the doctor covers one of the child’s eyes while the child looks at a specific object or target. The doctor then observes the movement of the uncovered eye.
- Refraction: The doctor may evaluate refractive errors, like myopia or astigmatism, by performing a retinoscopy test. To do this, the doctor uses a handheld instrument to shine a light into the eyes and observes how the light reflects off the retina. The test can sometimes be done without dilating the eyes.
Preschool: 3 to 5 Years
An eye exam for kids in the three to five age group is more comprehensive than an exam for very young children. The tests could differ depending on how well a child can follow directions. The exam may include these tests:
- Symbol or letter matching: Children who don’t recognize letters may be asked to identify symbols (optotypes) from a chart to test visual acuity. Doctors might use a more standard letter eye chart for children who can recognize letters.
- Refraction: The doctor may use retinoscopy to check for refractive errors. Depending on how well the child can tolerate pupil dilation, the doctor may use eye drops or a spray. Or, the doctor could use an autorefractor to roughly estimate refraction.
- Near point of convergence: The test for binocular vision determines how well a child’s eyes work together. The doctor usually moves one object toward the child’s nose and asks the child to say when they see two objects (diplopia). The doctor then moves the object away until the child can fixate on the object with both eyes.
- Stereopsis (depth perception): One common way to measure stereopsis in children is to have them look at special cards while wearing 3D glasses. The children then attempt to identify images on the cards.
- Color vision: To test for color deficiency, the doctor will ask the child to view a picture made up of dots of one color with a number or symbol made of dots of another color “hidden” in the picture. The doctor asks the child to identify the hidden number or symbol.
5 Years and Up
Tests for children on the younger end of this age group could be similar to those for children ages three to five. However, pediatric eye exams for older children may more closely resemble a comprehensive eye exam for adults. Some common tests for kids in this large age group could include:
- Visual acuity: The Snellen eye chart is the standard eye chart used in many eye care practices to measure distance visual acuity. The chart displays lines of letters, with each line getting progressively smaller. Children might be asked to identify the letters on each line. To test near visual acuity, they may be asked to read a line of text.
- Retinal exam (biomicroscopy or ophthalmoscopy): Dilation is sometimes required to examine the back of the eye, including the retina, optic disc, optic nerve, and blood vessels. But, some doctors may use retinal imaging, which tends not to require dilation. The retinal exam can help detect conditions like uncontrolled hypertension, a detached retina, or diabetic retinopathy.
- Intraocular pressure (tonometry): This test measures eye pressure for early detection of glaucoma, a serious eye disease. The test often involves using numbing eye drops and taking a pressure measurement with a handheld electronic instrument. Glaucoma is unusual in kids, but can cause vision loss or blindness if not detected early.
Eye Exams for Kids: How to Prepare
Taking your child for an eye exam may seem like a daunting task, but remember, it’s essential for your child’s overall health. And there’s no need to worry—your eye doctor is there to make the process go smoothly and, dare we say, even make it fun. Even so, we’ve got some tips for making your child’s eye exam easier.
- Allow enough time: When you make the appointment, ask for an estimate of how long the exam will take.
- Go on a day when you’re not too busy: If you can, make the appointment for a day when you have ample time before and after the exam. This way, you’re not in a rush and can concentrate on making your child comfortable.
- Make sure everyone is well-rested: This goes for the child and the caregiver, too! Consider booking the appointment for early morning or after a child’s nap.
- Minimize eye strain: On the day of the exam, it might be a good idea to cut down on screen viewing or other activities that can cause eye strain in children. This way, your child’s eyes will be well rested, too.
- Make sure no one is hungry or needs a “change”: A “hangry” or thirsty child can cause stress and increase the likelihood of a meltdown. Bring diapers with you and do a diaper change before you leave for the appointment.
- Bring comforting items: Having familiar objects on hand, like a favorite stuffed toy or cozy blanket, can help put children at ease.
- Talk to your child: For children who can understand, calmly explain in advance where you’re going and why.
Stay On Top of Your Kids’ Eye Exams
Pediatric eye exams do more than help your kids see well. They can help detect eye diseases early, so children get treatment and ensure their vision is preserved. Be sure to schedule a comprehensive children’s eye exam in your child’s first year of life, between ages three and five, and annually while they’re in school. And, of course, book an exam whenever you suspect an issue.
