How children's eye exams differ from an adult’s eye exam

Anyone who has ever spent time or worked with young children understands they have different needs than adults do to keep them comfortable and engaged. Eye doctors, in particular children’s optometrists and pediatric ophthalmologists, make certain accommodations to provide kiddos with specialized care and attention.

5 ways children's eye exams differ from an adult's eye exam

Curious as to what those accommodations are? From what eye doctors look for in an eye exam, to the tools that they use to do so, here are five differences between a child’s eye exam and an adult’s eye exam:

1. Different equipment is used

Many of us associate eye exams with a phoropter — the tool that resembles big binoculars and enables you to choose “one or two,” “two or three” as the clearest image. For children, verbalizing what is clear or blurry can be difficult, so other tools tend to better determine the clarity of their vision.

“An old-fashioned retinoscope is usually preferable for children,“ says Dr. Megan Lott, OD, functional optometrist at Belle Vue Specialty Eye Care

“A retinoscope can estimate the refractive error from a distance that is non threatening to a child. Also, when measuring intraocular pressure, there are child-friendly devices that do not require drops.” 

Using different tools allows eye doctors to effectively examine a child’s vision without overwhelming or stressing the child out. This typically leads to better cooperation from the child and an overall smoother eye exam.

SEE RELATED: Children's optometrist near me

2. Children are checked for different eye conditions 

In an adult eye exam, doctors are on the lookout for signs of conditions like glaucoma and cataracts. While eye doctors still look for red flags in a child’s eye exam, the conditions are different and pose a unique threat to children’s vision.

Dr. Benjamin Ticho, MD, associate professor at the University of Illinois Eye & Ear Infirmary, says eye doctors look for developmental issues in a child’s vision because if the problems aren’t corrected early enough, the child’s vision could be affected for the rest of their lives.

“It’s a little like being left-handed; the right hand may be structurally normal, but the brain doesn’t learn how to use it as well as the dominant hand,” Ticho says. “If you force a lefty to write right handed early in life you can get some reasonable righty function, but if you wait too long, much of the developmental potential is lost.”

3. Testing for visual acuity and depth perception varies

To test visual acuity in adults, they are asked to read from an eye chart. However, as Lott says, young children may not feel comfortable enough to do this, so other tactics are required.

“In infants, this task is too complicated,” says Dr. Lott. “So we use preferential viewing to measure eyesight. This is done by showing the child a patterned image and a blank image. The child’s natural tendency will be to look at the more detailed or patterned image. The preference for a patterned image is a reflection of acuity.”

Having a child choose between two different pictures is also used to measure a child’s depth perception.

“As with the visual acuity, I prefer a test that uses a smiley face on one card and blank on the other,” she says. “I am then able to observe the child and see which picture they prefer. If they do not have depth perception, both cards will appear blank and the child will show no interest in the game.” 

4. Children receive functional eye exams

Typically, when a child has trouble in school, poor eyesight is at least part of the problem. Functional eye exams can pinpoint any issues that may affect a child’s ability to learn.

“A large portion of childhood is spent performing near-point tasks — sitting in a classroom writing, reading, computers, video games, etc.,” says Lott. “These tasks require not only adequate eyesight, but other visual skills such as eye alignment, tracking, focusing and visual-motor skills.”

She goes on to explain that a functional eye exam is beneficial for all children, but for children who struggle in school, it’s critical.

“Functional eye exams look at how the eyes are performing in daily or academic conditions. It goes beyond 20/20 and looks at the vast array of all visual skills.” 

5. Games are used to test vision

Eye care professionals recommend that children should have their first comprehensive eye exam at 6 months old. Because of the age of their patients, pediatric eye doctors will often play games with the child. 

Don’t let the fun and games fool you — eye doctors are trained to carefully observe the child’s eyes throughout the exam. Through “play,” eye doctors are able to examine a child’s eye alignment, tracking, head posture, eye-hand coordination and peripheral vision. 

Ticho explains that in addition to games, a pediatric exam typically requires eye doctors to cater to their audience.

“In general, pediatric eye doctors must be prepared to play, cajole and charm their patients to get the desired clinical information,” says Ticho. “Toys, stories and funny voices all have roles in a successful eye exam.” 

Watch our video on the importance of eye exams for children.

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