Babies are able to see as soon as they are born.  For the visual system to continue to develop properly, children need clear input from both eyes to the brain.  If there is some problem which interferes with vision in either eye or both, the connections from the eye to the brain can become weak or not develop properly.  Crossed or turned eyes or imbalance in the way each eye focuses can interfere with this normal development of the visual system.

A child's eye examination begins by discussing any problems the parent recognize.  It is important to find out if there were problems with the pregnancy or with 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.  The ophthalmologist needs to know about the child's health in general.  Are there other medical problems?  Has the child had any treatment with medications or surgical procedures?  Does the child have any allergies?

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

No matter how the vision is tested, it is important to check each eye separately.  Two to five percent of children have one eye which does not see as well as the other--a condition called amblyopia or "lazy eye."

For older children who can talk but who do not yet know their numbers or the alphabet, special charts are used which have pictures common in a child's world such as birds, birthday cakes, and stars.  Some tests may require the child to point to a letter which matches a letter on a chart.  All of these tests show a child smaller and smaller items in order to get an idea of the child's best visual acuity.

Testing for binocular vision (the ability to use both eyes together) and depth perception can also be done early in childhood.

In some special situations, the measurements may be made of a young child's vision based on brain wave measurements while the child watches striped patterns or by observing the way the child looks at black and white stripes on flash cards.

Lights, lights, and more lights.
Lights are used to examine the pupils to see if the eyes are working properly.   During this portion of the examination the areas around the eyes such as the eyelids and the tear canals are also examined.

The tiny flashlight can also be sued to see if a child's eyes are straight or turned.  If a child is looking straight at the flashlight, the reflection off the front of the child's eyes allows the ophthalmologist to tell whether the eyes are turned or straight.  This is important in infants because their wide noses may make their straight eyes look crossed.  Sometimes, the ophthalmologist will cover one eye and then the other.  If the eyes are not aligned properly, they will jump back and forth when looking at the light or a toy.   Wedge-shaped pieces of clear plastic called prisms can be used to measure the amount of misalignment of the eyes.

One of the less enjoyable but most essential portions of an eye exam is the dilation of the pupil.  This not only allows the ophthalmologist to view the inside of the eye, but the dilating drops temporarily relax the child's focusing power so that nearsightedness, farsightedness or astigmatism (refractive errors) can be accurately measured.  Most doctors have preferences for which dilating drops they use.   Some drops are given once, some are given more than once, and all take about 30 to 60 minutes to be fully effective.  IT may be necessary to have special drops or ointment put in at home and to return to complete the examination at a later date.

Whether your child is attentive or not at his point, or even if he or she is asleep, it can be determined if your child's vision is not in focus by using small lenses and a special flashlight (called a retinoscope).  The ophthalmologist can shine a beam of light into the eye and, by holding lenses in the path of this reflection, detect nearsightedness, farsightedness, or astigmatism.  It is a somewhat different technique from the one used to fit glasses for adults, but it is, nonetheless, very accurate.  From this part of the examination, it can be determined whether your child needs glasses.

Once your child's pupils are dilated, your ophthalmologist can get a very good look at the structures inside the eye to make sure it is healthy.  The inside of the eye is where the retina is located, which is 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 the blood vessels which supply the retina, can be seen in the back of the eye.  Special instruments allow the ophthalmologist to see inside the eye in great detail.

Four percent of children have ocular problems that can diminish vision on one or both eyes.  The three most common types of problems that occur are strabismus (misaligned eyes), amblyopia (lazy eye), and refractive errors (focusing problems).

Strabismus is a general term referring to eyes which are pointed in different directions.   After four months of age, all infants should have straight eyes.  One eye may drift in or out, up or down.  A crossed eye is known as esotropia.  Exotropia refers to eyes that are turned out.  Strabismus may be present all of the time or intermittently.  Children with strabismus are usually unaware of the problem.   Strabismus interferes with the development of coordinated use of both eyes together.

Amblyopia, which is sometimes called "lazy eye," refers to the development of poor vision in one or both eyes.  It occurs in infancy and early childhood during the sensitive period of visual development.  The earlier amblyopia is detected, the easier it is to treat.  When, during late childhood, this early period of visual development passes, visual loss due to amblyopia is no longer a substantial threat.

Most physicians examine many parts of the eye during children's medical examinations.   However, they will refer children to someone who is a specialist in ophthalmology if they encounter any sign of amblyopia, difficulty in measuring vision, or if they suspect an abnormality of the alignment or structure of the eyes.  It is recommended that all children have their vision checked by a pediatrician, family physician, or ophthalmologist by age three, or sooner (age six months to a year) if there is a family history of vision problems.  Fortunately, ophthalmologists can perform a complete eye exam on children of any age.

Drs. Schwartz and Bradford are pediatric ophthalmologists specially trained to diagnose and treat eye diseases in children.  We hope you and your child will have a pleasant and informative visit with us.