Patient Information

Although babies are able to see as soon as they are born, the visual system rapidly develops in the first few years of life, and continues to develop until about the age of eight. For the visual system to develop properly, children need clear input from the eyes to the brain. If there is a problem that interferes with the vision in either eye, the connections from the eye to the brain can become weak or not develop properly. Crossed eyes (misalignment) or imbalance in the way each eye focuses can interfere with the normal development of the visual system.

A child’s eye exam begins by discussing any problems the parents recognize. It is important to find out if there were problems with the pregnancy or the child’s birth, and if the child’s growth and development are proceeding normally. A history of eye problems in the family is important.

If your child has been treated with medications, glasses or contact lenses, these should be brought to the eye examination. The names and addresses of other physicians who may be treating the child should be supplied so that they may be informed of the findings.

Many parents are surprised that a complete eye exam can be performed on a child of any age. A skilled ophthalmologist can get a good idea of how well a child can see based on the way a child uses his or her eyes to look at and follow attractive toys or lights.

For older children who can talk but who do not yet know their numbers or letters, special charts are used which have pictures common in a child’s world such as birds, birthday cakes, and cars.

One of the less enjoyable, but most essential portions of the eye exam is the dilation of pupils with the eye drops. This not only allows the doctor to view the inside of the eyes, but the dilating drops temporarily relax the child’s focusing power so that nearsightedness, farsightedness, or astigmatism (refractive error) can be accurately measured. After the eye drops have been administered, it takes about 30-60 minutes for them to be fully effective. Expect to be in our office 1 ½-2 hours. We have toys and books in the waiting area for your convenience.

Lights are used to examine the pupils to see if the eyes are working properly. During this portion of the exam, the eyelids and tear canals are also examined. Lights are also used to determine if the eyes are crossed or straight. This is especially important in infants, because their wide nasal bridge may make their straight eyes look crossed. Sometimes the doctor will cover one eye and then the other to determine if the eyes are crossed or straight. If the eyes are not aligned properly, they will jump back and forth when looking at the light or toy. Wedge shaped pieces of clear plastic, called prisms, are used to determine the amount of misalignment between the eyes.

By shining a beam of light into the eye (called a retinoscope), the doctor can see the back of the eye reflecting light, and by holding lenses in the path of this reflection. See whether the child is nearsighted, farsighted or has astigmatism (refractive error). It is a different technique from that used to prescribe glasses in adults, but is, nonetheless, very accurate.

For older children a special computer may be used to evaluate the refractive error.

Once your child’s pupils are dilated, the doctor can get a very good look at the inner eye structures to make sure the inside of the eye is healthy. The inside of the eye holds the retina, which functions much like film in a camera, processing the visual information into signals which are sent down the optic nerve to the brain. The optic nerve itself, as well as blood vessels that supply the retina can also be seen.

About 4- 8 percent of children have ocular problems that can diminish vision in one or both eyes. The three most common types of problems that occur are strabismus (misaligned eyes), amblyopia (lazy eye), and refractive error (focusing problems).

Most primary care physicians examine many parts of the eye during a child’s medical examination. However, they may refer the child to an ophthalmologist if there is difficulty in measuring vision, any sign of inadequate vision, or if they suspect an abnormality of the eye alignment or structure. It is recommended that all children have their vision checked by their pediatrician, family doctor or ophthalmologist by 3 years of age or even sooner (birth to 1 year) if there is a family history of problems.