PEDIATRICS

Signs of eye and vision problems

Squinting, turning head, or holding near objects close: may indicate the need for glasses correction.

Excessive tearing may indicate blocked tear ducts.

Red or encrusted eyelids could be a sign of an eye infection.

Constant eye turning may signal a problem with eye muscle control.

Extreme sensitivity to light may indicate an issue with the cornea.

The appearance of a white pupil may indicate the presence of eye cancer.

WHAT TO EXPECT?

At your child's first eye exam, we will ask a detailed history including developmental milestones, any schooling difficulties, and pregnancy/birth history.

Some of the testing to expect:

Visual Acuity: Using letters/numbers/or pictures

Cover Test: Determines eye alignment

Stereo Acuity: Determines depth perception

Color Vision

Convergence abilities and overall extra-ocular muscle movement.

Confrontation Visual Fields/Pupils

Dry Retinoscopy/Dry Refraction: Determines prescription

Anterior/Posterior Segment Evaluation: Evaluate health of front and back of eye

Tonometry: Pressures of the eye

Wet Retinoscopy/Refraction: Confirms finalized prescription

We are comfortable modifying exams to meet the needs of each child.

how often should my child have eye exams?

8-14 month (at least once)

Infants will be screened for any serious ocular disease, eye turns, or large prescriptions that may prevent a child from learning vision properly.

3-5 Years Old (at least once)

Surprising to most parents, an adult eye exam including all major parts of a complete comprehensive eye exam can be performed on most children 3 years of age and older. This is a very important visit that will expand upon the initial results of the infant exam and serve as an excellent baseline visit for future monitoring.

Pre-School/Kindergarten and Beyond (annually)

Once children enter school, they should start having yearly routine straight through high school. A child’s body is constantly changing through this age range and the eyes are no different.

A child’s prescription will statistically change more during this time than at any other time during their lives and therefore require routine monitoring.

Common Eye Findings

Amblyopia ("lazy eye") is poor vision in an eye that may appear to be normal. Two common causes are crossed eyes and a difference in the refractive error between the two eyes. If untreated, amblyopia can cause irreversible visual loss in the affected eye. (By then, the brain's "programming" will ignore signals from that eye.) Amblyopia is best treated as early as possible, ideally before a child is 8 years old.

Strabismus is a misalignment of the eyes; they may turn in, out, up, or down. If the same eye is chronically misaligned, amblyopia may also develop in that eye.

Refractive errors mean that the shape of the eye doesn't refract (bend) light properly, so images appear blurred. The different types include:

Nearsightedness is poor distance vision (also called myopia), which is usually treated with glasses or contacts.

Farsightedness (also called hyperopia), which is usually treated with glasses or contacts.

Astigmatism is imperfect curvature of the front surface of the eye, which is usually treated with glasses if it causes blurred vision or discomfort.

Additional Eye Conditions

Retinoblastoma is a malignant tumor that usually appears in the first 3 years of life. The affected eye or eyes may have visual loss and whiteness in the pupil.

Infantile cataracts can occur in newborns. A cataract is a clouding of the eye's lens.

Congenital glaucoma in infants is a rare condition that may be inherited. It is the result of high pressure in the eye from incorrect or incomplete development of the eye drainage canals before birth and can be treated with medication and surgery.

Retinopathy of Prematurity (ROP) is a potentially blinding disease caused by abnormal development of retinal blood vessels in premature infants. Babies 1250 grams or less and are born before 31 weeks gestation are at highest risk.

PROGRESSION OF VISION

Birth to Three Months

• At birth, a baby’s visual system is in overload. Colors, shapes, light, moving objects, and foreign designs flood the visual system and the eyes begin to make connections to the occipital lobe of the brain (all the way in the back) which starts the vision development process.

• At this point, a newborn’s vision is very poor. Typically infants are only able to focus up to 8-10 inches away, but this improves rapidly.

• During the first two months of life it is extremely normal for an infant’s eyes to lack coordination and the eyes may appear to wander or cross. Although usually normal, if an eye appears turned in or out continuously, this should be evaluation.

• By three months, eye coordination will have improved as the brain learns to control and coordinate the six muscles that move each eye and babies will begin tracking and following moving objects and reaching out for things.

Five to Eight Months

• During these months, control of eye movements and visual related skills continue to improve.

• Depth perception, which is the ability to judge if objects are nearer or farther away than other objects, is not present at birth. It is not until around the fifth month that the eyes are capable of working together to form a three-dimensional view of the world and infants begin to see depth.

• Although an infant’s color vision is not as sensitive as an adult’s, it is generally believed that babies have learned the ability to see pretty good color vision by five months of age.

• At this point, learned visual skills will begin coordinating with motor skills as a child learns to use the visual information given to the brain to point, crawl, and grasp objects with some precision.

Nine to Twelve Months

• By the age of nine to twelve months, babies should be using their eyes and hands together.

• At around 9 months of age, babies begin to pull themselves up to a standing position. By 10 months of age, a baby should be able to communicate between the eyes and hands enough to grasp objects with the thumb and forefinger.

• By twelve months of age, most babies will be crawling and trying to walk. Parents should encourage crawling rather than early walking to help the child develop better eye-hand coordination.

• Babies can now judge distances fairly well and throw things with precision.

One to Two Years Old

• By two years of age, a child’s eye-hand coordination and depth perception should be well developed.

• For the first time, the connections between the eyes and developing brain with allow children adult like – 20/20 visual acuity.

• Children this age are highly interested in exploring their environment and incorporating not only vision, but also integrating what the child sees with movement, balance, and senses like sound, smell, and touch to fully experience the world around them.