Vision Problems in Children
Many parents have wondered how we check vision on young children. Some even think we must be guessing at their child’s visual performance. When adults think of measuring visual performance, they usually remember reading letters or symbols on an eye chart. For adults and older children, measuring visual acuity on an eye chart is usually fairly straightforward and accurate. But for infants, toddlers, and pre-reading pre-schoolers it is more challenging. At school age, most children can participate with testing on an eye chart. The goal is to identify children with vision issues, whether they are medical eye issues or just a need for glasses.
For newborns, vision is still fairly blurry and we mostly note whether the infant reacts to bright lights and assure there are no structural problems with the eye. Over the first few months of life, we start to watch for other clues of normal vision development. A newborn’s brain is programmed to fixate (look directly) at their mother’s face and then other faces early, so observing this is a good sign. Infants will later start fixating on other objects of interest around them such as toys, lights, etc. We will note how well they “fix and follow” with each eye.
Most infants are seeing fairly normal by 6 months of age, though of course, we aren’t able to measure this on an eye chart yet. The most important assessment of vision during the early months and years is whether vision is developing equally between both eyes. This can be checked by doing a prism test in the office that makes the child see double when looking at a target toy or other object and observing whether they will choose to use the eyes equally or always favor one over the other.
For preschool-aged children, often around the age of 3, we can start to truly measure visual acuity by doing matching games on the eye chart with either symbols of letters. By using easily recognizable letters and doing matching, even children who do not yet know their letters can participate. If this testing is done carefully and correctly, the measured vision on the eye chart is actually quite accurate. Don’t worry if your young child does not measure 20/20 on the eye chart right away. They could still be in the normal range for their age and will continue to improve over time. Ask your eye doctor if you aren’t sure or are worried about their vision testing results. Thereafter, by early grade school, things get easier and most children are able to cooperate and help us accurately measure their vision.
For school-aged children, vision screenings are mandated by state law for Washington public schools for children in Kindergarten and Grades 1, 2, 3, 5 & 7. Screenings are often administered by our school nurses. Spokane Eye Clinic partners with local school nurses and give educational lectures to them.
If your child fails a vision screening at school, don't panic but get it checked out. You could have the screening repeated at your pediatrician's office or proceed directly to an appointment of an eye exam.
The pediatric ophthalmologist will perform a comprehensive eye exam looking to identify any potential vision loss that might be reversible if caught and treated early in childhood (amblyopia). We can also check for any need for glasses that might help the child see better and function their best at school and in life. Some children who fail vision screenings will test normal on a formal eye exam and not even need glasses. But if they fail a screening, it is vital to check and be sure.
Even if a child does not fail a vision screening, there may be other potential signs of eye or vision trouble that would merit a visit to see us. These would include crossing or wandering eyes, excessive squinting or blinking, difficulty with reading or near tasks, difficulty seeing things far away, eye redness or pain, or excessive eye rubbing. If you have these concerns or others, bring them on in and get checked.
(Note that this discussion is different than how we check small children for their glasses measurements. For more information on that, see Dr. Weed’s video on retinoscopy on our Facebook page).