Children's Vision

Eye Exams for Children

As a parent, you may wonder whether your pre-schooler has a vision problem or when a first eye exam should be scheduled.

Eye exams for children are extremely important. Experts say 5 percent-10 percent of pre-schoolers and 25 percent of school-aged children have vision problems. Early identification of a child’s vision problem is crucial because, if left untreated, some childhood vision problems can cause permanent vision loss.

When should kids have their eyes examined?

According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. Children then should receive additional eye exams at 3 years of age, and just before they enter kindergarten or the first grade at about age 5 or 6.

For school-aged children, the AOA recommends an eye exam every two years if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or according to their eye doctor’s recommendations.

Early eye exams also are important because children need the following basic visual skills for learning:

  • Near vision
  • Distance vision
  • Eye teaming (binocularity) skills
  • Eye movement skills
  • Focusing skills
  • Peripheral awareness
  • Eye/hand coordination

Because of the importance of good vision for learning, some states require an eye exam for all children entering school for the first time.

Scheduling your child’s eye exam

Your family doctor or pediatrician likely will be the first medical professional to examine your child’s eyes. If eye problems are suspected during routine physical examinations, a referral might be made to an ophthalmologist or optometrist for further evaluation. Eye doctors have specific equipment and training to help them detect and diagnose potential vision problems.

When scheduling an eye exam, choose a time when your child is usually alert and happy. Specifics of how eye exams are conducted depend on your child’s age, but an exam generally will involve a case history, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, an eye health examination and a consultation with you regarding the findings.

After you’ve made the appointment, you may be sent a case history form by mail, or you may be given one when you check in at the doctor’s office. The case history form will ask about your child’s birth history (also called perinatal history), such as 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. The form will also inquire about your child’s medical history, including current medications and past or present allergies.

Be sure to tell your eye doctor if your child has a history of prematurity, has delayed motor development, engages in frequent eye rubbing, blinks excessively, fails to maintain eye contact, cannot seem to maintain a gaze (fixation) while looking at objects, has poor eye tracking skills or has failed a pediatrician or pre-school vision screening.

Your eye doctor will also want to know about previous ocular diagnoses and treatments involving your child, such as possible surgeries and glasses or contact lens wear. Be sure you inform your eye doctor if there is a family history of eye problems requiring vision correction, such as nearsightedness or farsightedness, misaligned eyes (strabismus) or amblyopia (“lazy eye”).

Eye testing for infants

It takes some time for a baby’s vision skills to develop. To assess whether your infant’s eyes are developing normally, your eye doctor may use one or more of 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 can fixate on an object (such as a light) and follow it as it moves. Infants should be able to perform this task quite well 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.

Eye testing for pre-school children

Pre-school children can have their eyes thoroughly tested even if they don’t yet know the alphabet or are too young or too shy to answer the doctor’s questions. Some common eye tests used specifically for young children include:

  • 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 observing how it reflects from the retina (the light-sensitive inner lining of the back of the eye). This test helps eye doctors determine the child’s eyeglass prescription.
  • Random Dot Stereopsis uses dot patterns to determine how well the two eyes work as a team.

Eye and vision problems that affect children

Besides looking
for nearsightedness, farsightedness and
astigmatism (refractive errors), your eye doctor will be examining your child’s eyes for signs of these eye and vision problems commonly found in young children:

Amblyopia. Also commonly called “lazy eye,” this is decreased vision in one or both eyes despite the absence of any eye health problem or damage. Common causes of amblyopia include strabismus (see below) and a significant difference in the refractive errors of the two eyes. Treatment of amblyopia may include patching the dominant eye to strengthen the weaker eye.

Strabismus. This is misalignment of the eyes, often caused by a congenital defect in the positioning or strength of muscles that are attached to the eye and which control eye positioning and movement. Left untreated, strabismus can cause amblyopia in the misaligned eye. Depending on its cause and severity, surgery may be required to treat strabismus.

Convergence insufficiency. This is the inability to keep the eye comfortably aligned for reading and other near tasks. Convergence insufficiency can often be successfully treated with vision therapy, a specific program of eye exercises.

Focusing problems. Children with focusing problems (also called accommodation problems) may have trouble changing focus from distance to near and back again (accommodative infacility) or have problems maintaining adequate focus for reading (accommodative insufficiency). These problems often can be successfully treated with vision therapy.

Eye teaming problems. Many eye teaming (binocularity) problems are more subtle than strabismus. Deficiencies in eye teaming skills can cause problems with depth perception and coordination.

Vision and learning

Experts say that 80% of what your child learns in school is presented visually. Undetected vision problems can put them at a significant disadvantage. Be sure to schedule a complete eye exam for your child prior to the start of school.

For more information on eye exams and vision problems, visit All About Vision®.

Article ©2008 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited

Your Infant's Visual Development


One of the greatest moments after the birth of your baby is the first time your newborn daughter or son opens their eyes and makes eye contact with you. But don’t be concerned if that doesn’t happen right away.

The visual system of a newborn infant takes some time to develop. In the first week of life, your newborn’s vision is quite blurry, and they see only in shades of gray. It takes several months for your child’s vision to fully develop.

Knowing the expected milestones of your baby’s vision development during their first year of life can insure your child is seeing properly and enjoying their world to the fullest.

During your pregnancy

Your child’s vision development begins before birth. How you care for your own body during your pregnancy is extremely important for the development of your baby’s body and mind, including their eyes and the vision centers in their brain.

Be sure to follow the instructions your obstetrician (OB/GYN doctor) gives you regarding proper nutrition and the proper amount of rest during your pregnancy. And of course, avoid smoking and consuming alcohol or drugs during pregnancy, as these toxins can cause multiple problems for your baby, including serious vision problems.

At birth

At birth, your baby sees only in shades of gray. Nerve cells in their eyes and brain that control vision aren’t fully developed. Also, their eyes don’t have the ability to change focus and see close object clearly. So don’t be concerned if your baby doesn’t seem to be focusing on objects right away, including your face. It just takes time. (Despite these limitations, studies show that within a few days after birth, infants prefer looking at an image of their mother’s face over anyone else’s.)

The first month

Color vision develops in the first few weeks of life, so your baby is starting to see the world in full color. But visual acuity and eye teaming takes a bit longer — so if your infant’s eyes occasionally look unfocused or misaligned, don’t worry.

The eyes of infants are not as sensitive to visible light as adult eyes are, but they need protection from the sun’s harmful UV rays. Keep your baby’s eyes shaded outdoors with a brimmed cap or some other means.

Months 2 and 3

Your baby’s vision is improving and their two eyes are beginning to move better as a team. They should be following moving objects at this stage, and starting to reach for things they see. Also, infants at this stage are learning how to shift their gaze from one object to another without having to move their head.

Months 4 to 6

By 6 months of age, significant advances take place in the vision centers of the brain, allowing your infant to see more distinctly, move their eyes faster and more accurately, and have a better ability to follow moving objects with their eyes.

Visual acuity develops rapidly, improving from about 20/400 at birth to about 20/25 at six months of age. Your child’s color vision should be nearly fully developed at age six months as well, enabling them to see all the colors of the rainbow with ease.

Children also develop better eye-hand coordination at 4 to 6 months of age. They’re able to quickly locate and pick up objects, and accurately direct a bottle (and many other things) to their mouth.

Months 7 to 12

Your child is now mobile, crawling about and covering more distances than you might have expected. They are also better at judging distances and more skilled at locating, grasping and throwing objects, too.

During months 7 to 12, your child is developing a better awareness of their overall body and learning how to coordinate their vision with their body movements. At this time, watch them closely to keep them from harm as they explore their environment. Keep cabinets that contain cleaning supplies locked, and put a barrier in front of stairwells.

When its time for an eye exam

If you suspect something is seriously wrong with your baby’s eyes in their first few months of life (a bulging eye, a red eye, excess tearing, or a constant misalignment of the eyes, for example) take your child to a pediatric ophthalmologist or other eye doctor immediately.

For routine eye care, the American Optometric Association (AOA) recommends you schedule your baby’s first eye exam when they are six months old. Though your baby can’t yet read letters on a wall chart, your optometrist can perform non-verbal testing to determine visual acuity, detect excessive or unequal amounts of nearsightedness, farsightedness and astigmatism, and evaluate eye teaming and alignment. At this exam, your doctor will also check the health of your baby’s eyes, looking for anything that might interfere with normal and continuing vision development.

We welcome providing eye care for even the youngest children. For more information about eye exams for kids or to schedule your child’s first eye exam, please call our office.

For more information on children’s vision, visit All About Vision®.

Article ©2008 Access Media Group LLC. All rights reserved. Reproduction oth

er than for one-time personal use is strictly prohibited

Children and Computer Vision Syndrome

Computer use has become a routine part of kids’ lives.

Surveys show the average American child spends one to three hours daily on a computer while surfing the Internet, doing homework, talking online with friends and playing video games. About 90% of school-aged children in the U.S. have access to a computer at home or in school.

And kids are starting to use computers at a younger age. Among college students who were interviewed, 20% said they began using a computer before they were 9 years old.

A connection between computer use and myopia?

So how is all this computer use at a young age affecting kids’ eyes?

Many eye doctors who specialize in children’s vision say sustained computer use puts kids at higher risk for childhood myopia (nearsightedness). They point out that, though myopia affects approximately 25% of the U.S. population, nearly 50% of adult computer users with a college education are nearsighted. Computer use, especially among youngsters whose eyes are still changing, may be the reason for this disparity.

Research seems to support this theory. A study of 253 children between the ages of 6 and 10 at the University of California at Berkeley School of Optometry found a strong correlation between the amount of time young children spend on the computer and their development of nearsightedness.

Why computers can be hard on kids’ eyes

Computer use stresses the eyes more than reading a book or magazine because it’s harder to maintain focus on computer-generated images than on printed images.

This is especially true for young children, whose visual system is not fully developed.

According to the American Optometric Association, children may be especially vulnerable to computer-related vision problems because:

  • Children have a limited degree of self-awareness. They may perform a task on the computer for hours with few breaks. This prolonged activity can cause focusing and eyestrain problems.

  • Children assume that what they see and how they see is normal – even if their vision is impaired or slowly deteriorating.
  • Children are smaller than adults. Because computer workstations are often arranged for adult use, this can increase the risk of children sitting too near the screen or adopting unusual postures that can lead to eyestrain and neck, shoulder and back pain.
  • Tips for preventing Computer Vision Syndrome in children

    To prevent your child from developing eyestrain and other CVS symptoms (including increasing myopia), follow these tips:

    1. Before they start school, make sure your kids have a comprehensive eye exam–including an assessment of their near-point (computer and reading) vision skills.
    2. Make sure your child’s computer workstation is arranged to suit body size. For children, the recommended distance between the monitor and the eye is 18 to 28 inches to avoid risk of eyestrain with closer viewing. Also, the screen should be a few inches below the child’s eyes. The chair should be adjusted so arms are parallel with the desk surface and feet rest comfortably on the floor. These adjustments help avoid posture problems and strained muscles.
    3. Be aware of the signs and symptoms of vision problems, such as eye redness, frequent rubbing of the eyes, head turns and other unusual postures or complaints of blurriness or eye fatigue. Avoidance of the computer or school work may also indicate a vision problem.

    If you suspect your child may be developing a vision problem related to computer use, be sure to mention this when you make an appointment for an eye exam. Your doctor may want to set aside extra time to perform tests specifically designed to detect computer vision problems.

    For more information on myopia and computer vision syndrome, visit All About Vision®.

    Article ©2008 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.


    Vision Therapy for Children


    Many children have vision problems other than simple refractive errors such as nearsightedness, farsightedness and astigmatism. These “other” vision problems include amblyopia (“lazy eye”), eye alignment or eye teaming problems, focusing problems, and visual perceptual disorders. Left untreated, these non-refractive vision problems can cause eyestrain, fatigue, headaches, and learning problems.

    What is vision therapy?

    Vision therapy (also called orthoptics or vision training) is an individualized program of eye exercises and other methods to treat non-refractive vision problems. The therapy is usually performed in an optometrist’s office, but most treatment plans also include daily visual tasks and eye exercises to be performed at home.

    Optometrists who specialize in vision therapy and the treatment of learning-related vision problems are sometimes called behavioral optometrists or developmental optometrists.

    Can vision therapy eliminate the need for glasses?

    Vision therapy is NOT the same as self-help programs that claim to reduce refractive errors and the need for glasses. There is no scientific evidence that these “throw away your glasses” programs work, and most eye care specialists agree they are a hoax.

    In contrast, vision therapy is approved by the American Optometric Association (AOA) for the treatment of non-refractive vision problems, and there are many studies that demonstrate its effectiveness.

    The degree of success achieved with vision therapy, however, depends on a number of factors, including the type and severity of the vision problem, the patient’s age and motivation, and whether the patient performs all eye exercises and visual tasked as directed. Not every vision problem can be resolved with vision therapy.

    Vision therapy is customized and specific

    The activities and eye exercises prescribed as part of a vision therapy program are tailored to the specific vision problem (or problems) a child has. For example, if a child hasamblyopia, the therapy usually includes patching the strong eye, coupled with visual tasks or other stimulation techniques to develop better visual acuity in the weak eye. Once visual acuity is improved in the amblyopic eye, the treatment plan may then include eye teaming exercises to foster the development of clear, comfortable binocular vision to improve depth perception and reading comfort.

    Vision therapy and learning disabilities

    Vision therapy does not correct learning disabilities. However, children with learning disabilities often have vision problems as well. Vision therapy can correct underlying vision problems that may be contributing to a child’s learning problems.

    Be sure to tell us if your child has been diagnosed as having a learning disability. If we find vision problems that may be contributing to learning problems, we can communicate with their teachers and other specialists to explain our findings. Often, vision therapy can be a helpful component of a multidisciplinary approach to remediating learning problems.

    Schedule a comprehensive eye exam

    If you suspect your child has a vision problem that may be affecting their performance in school, the first step is to schedule a comprehensive eye exam so we can determine if such a problem exists. If learning-related vision problems are discovered, we can then discuss with you whether a program of vision therapy would be helpful.

    If we don’t provide the type of vision therapy your child needs, we will refer you to an optometrist who specializes in developmental vision and vision therapy.

    For more information on vision therapy, visit All About Vision®.

    Article ©2008 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited

    Learning Related Vision Problems

    There’s no question that good vision is important for learning. Experts say more than 80% of what your child is taught in school is presented to them visually.

    To make sure your child has the visual skills they need for school, the first step is to make sure your child has 20/20 eyesight and that any nearsightedness, farsightedness and/or astigmatism is fully corrected with glasses or contact lenses. But there are other, less obvious learning-related vision problems you should know about as well.

    Good vision is more than 20/20 visual acuity

    Your child can have “20/20” eyesight and still have vision problems that can affect their learning and classroom performance. Visual acuity (how well your child can see letters on a wall chart) is just one aspect of good vision, and it’s not even the most important one. Many nearsighted kids may have trouble seeing the board in class, but they read exceptionally well and excel in school.

    Other important visual skills needed for learning include:

    • Eye movement skills – How smoothly and accurately your child can move their eyes across a printed page in a textbook.
    • Eye focusing abilities – How well they can change focus from far to near and back again (for copying information from the board, for example).
    • Eye teaming skills – How well your child’s eyes work together as a synchronized team (to converge for proper eye alignment for reading, for example).
    • Binocular vision skills – How well your child’s eyes can blend visual images from both eyes into a single, three-dimensional image.
    • Visual perceptual skills – How well your child can identify and understand what they see, judge its importance, and associate it with previous visual information stored in their brain.
    • Visual-motor integration – The quality of your child’s eye-hand coordination, which is important not only for sports, but also for legible handwriting and the ability to efficiently copy written information from a book or chalkboard.

    Deficiencies in any of these important visual skills can significantly affect your child’s learning ability and school performance.

    Many kids have vision problems that affect learning

    Many kids have undetected learning-related vision problems. According to the College of Optometrists in Vision Development (COVD), one study indicates 13% of children between the ages of 9 and 13 suffer from moderate to severe convergence insufficiency (an eye teaming problem that can affect reading performance), and as many as one in four school-age children may have at least one learning-related vision problem.

    Signs and symptoms of learning-related vision problems

    There are many signs and symptoms of learning-related vision disorders, including:

    • Blurred distance or near vision, particularly after reading or other close work
    • Frequent headaches or eye strain
    • Difficulty changing focus from distance to near and back
    • Double vision, especially during or after reading
    • Avoidance of reading
    • Easily distracted when reading
    • Poor reading comprehension
    • Loss of place, repetition, and/or omission of words while reading
    • Letter and word reversals
    • Poor handwriting
    • Hyperactivity or impulsiveness during class
    • Poor overall school performance

    If your child exhibits one or more of these signs or symptoms and is having problems in school, call us to schedule a comprehensive children’s vision exam.

    Comprehensive children’s vision exam

    A comprehensive children’s vision exam includes tests performed in a routine eye exam, plus additional tests to detect learning-related vision problems. These extra tests may include an assessment of eye focusing, eye teaming, and eye movement abilities (also called accommodation, binocular vision, and ocular motility testing). Also, depending on the type of problems your child is having, we may recommend other testing, either in our office or with a children’s vision and/or vision development specialist.

    Vision therapy

    If it turns out your child has a learning-related vision problem that cannot be corrected with regular glasses or contact lenses, then special reading glasses or vision therapy may help. Vision therapy is a program of eye exercises and other activities specifically tailored for each patient to improve their vision skills.

    Vision and learning disabilities

    A child who is struggling in school could have a learning-related vision problem, a learning disability or both. Vision therapy is a treatment for vision problems; it does not correct a learning disability. However, children with learning disabilities may also have vision problems that are contributing to their difficulties in the classroom.

    After your child’s comprehensive vision exam, we will advise you about whether a program of vision therapy would be helpful. If we don’t provide the services we believe your child needs, we
    will refer you to a children’s vision specialist or education/learning specialist who does.

    For more information on children’s vision, visit All About Vision®.

    Article ©2008 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.


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