Paediatric eye exam: How they are different
A children's eye exam is an expert evaluation of your child's eye health and vision that is performed by an eye doctor (optometrist or ophthalmologist).
A brief examination of your child’s eyes by a pediatrician or family physician is not a substitute for an eye exam performed by an eye doctor. Only optometrists and ophthalmologists have the advanced training and clinical tools to perform a thorough evaluation of your child's eyes and vision.
Why children's eye exams are important
Eye exams for children are very important to insure your child's eyes are healthy and have no vision problems that could interfere with school performance and potentially affect your child's safety.
Experts have estimated that approximately 25 percent of schoolchildren have vision problems that can affect their performance in the classroom. Also, the risk of myopia and progression of myopia continues through the school years.
Early eye exams also are important because children need the following visual skills that are essential for optimal learning.
Excellent visual acuity at all distances
Accurate and comfortable eye teaming skills
Accurate eye movement skills
Accurate and comfortable focusing skills
When To Have Your Child's Eyes Examined
Children should have their first eye exam early in life — at 6 months of age. They then should have additional eye exams at age 3, and just before they enter the first grade — at about age 5 or 6.
FIND A DOCTOR: Don't let poor vision affect your child's life. Find an eye doctor near you for an eye exam.
During the school years, kids should have eye exams at least every two years if no vision problems are detected in early exams. Children who need eyeglasses or contact lenses should be examined annually or as recommended by their eye doctor.
Scheduling eye exams for your child
When scheduling an eye exam for your child, choose a time when he or she usually is alert and happy.
Generally, children’s eye exams include a health and vision questionnaire, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, and a thorough eye health evaluation.
The Health and vision questionnaire usually will contain questions about:
Any history of prematurity
Complications during pregnancy or birth
Delayed motor development
Frequent eye rubbing
Failure to maintain eye contact
Any apparent misalignment of the eyes
Inability to maintain a gaze (fixation) while looking at objects
Poor eye tracking skills
Names and purpose for any current medications
Also, mention if your child has failed a vision screening at school or during a visit to his or her pediatrician.
Your eye doctor also will want to know about previous eye problems and treatments your child has had, such as surgeries and glasses or contact lens wear.
Eye testing for infants
Babies should be able to see as well as adults in terms of focusing ability, color vision and depth perception by 6 months of age. To assess whether your baby's eyes are developing normally, the doctor typically will use 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's eyes are able to fixate on and follow an object such as a light as it moves.
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 without the use of a typical eye test.
Eye testing for preschool children
Some parents are surprised to learn that preschool-age children do not need to know their letters in order to undergo certain eye tests, even when they are too young or too shy to verbalize.
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 observe the reflection from the back of the eye (retina). This test helps eye doctors determine your child's eyeglass prescription.
Random dot stereopsis testing uses special patterns of dots and 3-D glasses to measure how well your child's eyes work together as a team.
Lazy eye (amblyopia). Your eye doctor will want to rule out amblyopia, or "lazy eye," which is decreased vision in one or both eyes without detectable anatomic damage. Unfortunately, amblyopia is not always correctable with eyeglasses or contact lenses and may require eye patching to strengthen the weaker eye.
Misalignment of eyes (strabismus). Crossed or misaligned eyes (strabismus) can have different causes, such as problems with muscle control in the affected eye or eyes. Strabismus is a common cause of amblyopia and should be treated early in childhood so vision and eye teaming skills can develop normally.
Inability to maintain eye alignment when viewing near objects (convergence insufficiency). Your eye doctor will assess your child’s ability to maintain proper eye alignment for comfortable reading.
Focusing ability, depth perception and color vision. Your child's focusing ability (accommodation) also may be tested.
Depth perception or ability to gauge distances between objects also may be examined, and color blind tests may be used to assess your child's color vision. [Read more about color vision and how the eye refracts light.]
Anterior eye and eyelid health. Your eye doctor will closely examine your child's eyelids to look for abnormal or infected eyelashes, bumps, eye discharge and swelling (edema). The doctor also will examine the cornea and lens to look for cloudiness or other irregularities.
Vision screening and your child's performance in school
Appropriate vision testing at an early age is vital to insure your child has the visual skills he or she needs to perform well in school.
A child who is unable to see print or view a chalkboard can become easily frustrated, leading to poor academic performance.
Most vision problems, including lazy eye, are best treated if they are detected and corrected as early as possible while the child's vision system is still developing.
Page published in March 2019
Page updated in April 2020