Pediatric Eye Exams

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The Importance of Pediatric Eye Examinations for Children

Comprehensive pediatric eye examinations are critical for monitoring vision and overall eye health in children.

A pediatric eye exam is more than a simple screening, it is an assessment of your child's visual function and development and eye health including:

Eye diseases and disorders
Infections
Evidence of visual-motor, cognitive, and neurological deficits.

An accurate description of visual strength not only takes acuity into account but our ability to gather and process visual information. A child may have "perfect" vision but struggle with optometric deficits that affect learning. Studies show that most vision problems that affect learning are not caused by poor eyesight. In many instances, there is nothing wrong with the visual system. Often, issues related to visual-motor or cognitive-developmental delay can be detected during such examinations.

Vision Development

While fundamental stages of visual advancement take place in infancy and toddlerhood, it is possible to develop these skills in young adulthood and beyond. They are important for monitoring conditions that might affect learning in school which can lead to stress and anxiety. Vision is crucial for learning and development for the following reasons:

More than 85% of our brain is linked to vision
It is the brain’s fastest and most effective way of processing information.
The early development of visual skills and neuroplasticity allows children to meet age-related visual demands as they get older. As new nerve pathways are developed, they have a greater chance of being visually on par with their peers.
It allows children to develop critical skills needed to process what they read, learn, and how to interact with the world around them.

Who is at Risk For Eye Disorders?

Although certain populations are at greater risk for developing eye disorders than others, it is important to remember that child development is very individual and must be treated as such. All children should be evaluated for eye disorders even if they do not seem to be at risk.

Individuals at particular risk include those who with:

Neurological or developmental challenges
Autism
Downs Syndrome
Cerebral Palsy
Genetic disorders
Were born prematurely
Present with a family history

Signs of Visual Problems

Reduced hand-eye coordination: An example can be seen when a child is unable to catch a ball that is thrown towards them. The inability to do so points to their difficulty in interpreting speed in relation to where they are.
Compensation: When a child points to each word they read. Doing so is often a way for them to compensate for their inability to track words.
Avoidance: If a child finds it too difficult to read or track the words on a page, she may avoid the material altogether. This kind of avoidance is often displayed through excessive movements, such as squirming in their seat, speaking out of turn, or "spacing out" because they cannot focus on the material.

Physical Symptoms

Eye problems that involve an inability to focus or poor vision often present as physical symptoms. These include:

Headaches
Red eyes
Eye rubbing
Eyestrain
Complaints of poor vision ("I can't see!")

Knowing What to Look For Problems with Visual Perception

A child who struggles with visual perception will often struggle with mastery of any number of tasks. That is why it is important to recognize the signs that suggest the presence of a deficit, particularly if they have:

Poor handwriting
Difficulty in copying from a whiteboard
A tendency to omit or re-read words
Poor reading comprehension
Difficulties with letter and number reversals, such as confusing “b” with “d”.

Emotional Symptoms of Visual Perceptual Problems

The emotional effects of having a visual perception problem can be devastating. The inability to perform well in school often leads to low self-esteem and can lead a child to think they are stupid, causing them to lose the motivation needed to succeed. Being able to identify signs of emotional distress is critical, particularly if a child exhibits:

Signs and symptoms of depression or stress
Extreme irritability or temper tantrums
A short attention span
Difficulty focusing on tasks

Common Eye Problems Found In Children

Many optometrists recommend at least one comprehensive pediatric eye exam before your child begins school. Some common eye conditions in children include:

Myopia (nearsightedness)
Hyperopia (farsightedness)
Genetic diseases
Astigmatism
Amblyopia (lazy eye). This condition occurs in the absence of normal visual development. Treatments include vision therapy, patching, and eye drops.
Strabismus (double vision)

Vision Screening from a Pediatrician vs. Eye Exams From A Pediatric Optometrist

It's important not to get confused between a rudimentary screening performed by a pediatrician (or a school nurse) and a comprehensive eye examination from a pediatric optometrist. The former is done by a pediatrician as part of a standard physical exam. The latter is an exam by a trained eye doctor, which can extensively test all aspects of visual health.

Anatomy of a Pediatric Eye Exam: What to Expect

The examination will begin with a case history of the child, including family and personal medical history, observations from the school, and complaints from the child. Following this, the optometrist will examine the following:

"Good vision" or visual acuity: Tests involve the eyes working together and the individual eye. For children and babies unable to communicate there are special technologies for babies using pictures to assess their vision.
Usage: Tests include the cover test, testing for color, 3d, track
Phoropter for older children to check if they need prescription lenses.
Slit-lamp gives a good look at the eye
dilating drops allow for analysis of the back of the eye.
Review of findings, recommendations, treatments, scheduling future testing

Early Stages of Testing

Newborns: Newborns require a proper assessment to check the startle reflex and any noticeable signs of eye disease, in particular if there is a family history of such complications. Such tests can be done by the pediatrician.
Babies 6-12 months: Within the first year, the pediatrician will assess eye movement, alignment, and overall eye health.
12 to 36 months: Overall eye health is assessed often with the aid of photo screening to monitor for signs of eye problems. If any problems are noted, follow-up will usually involve an eye doctor.
3-5 years: The child will be checked for issues of alignment and vision. If there are signs that further intervention is required, they will usually involve an optometrist.
5 years and older: Further assessment of eye alignment and to gauge visual acuity. Signs of eye issues will be addressed by an optometrist.

Common Questions

What Are Some Of The Common Challenges Of A Pediatric Eye Exam?

The challenges for a pediatric eye exam depend on age, maturity, and temperament. Depending on the child, an exam can seem scary, tedious, boring, etc. Many pediatricians are wonderful with children and they are trained to deal with different types of children using humor and friendliness to make the exam more fun. Do your research to find practitioners with excellent reputations working with children. Additionally, prepare your child before the exam.

What Are Some Common Signs Of Pediatric Eye Difficulties?

Problems include squinting, eye-rubbing, headaches, blurry vision, needing to sit near the board, etc.

Is A School Vision Screening Enough For My Child? What About A Pediatric Screening?

Neither a school vision screening nor a pediatric screening is sufficient for assessing overall ocular health. They are rudimentary tools for identifying possible problems to be followed up with an optometrist.

What tests are done at an eye exam?

Most exams follow a similar layout in terms of tests performed. There is a visual acuity test, retinoscopy, refraction, external exam, slit lamp, and a dilation. These tests center around clarity of vision, retinal health and general eye health.

Does my child need a pediatric eye exam?

You should schedule an eye exam with a pediatric eye doctor to assess the aspects of visual development that are not assessed at a routine eye exam. Furthermore as a child starts reading it is critical to identify if there are any visual processes that may impact school performance. Since so much of learning is visual it is our recommendation that you do not wait for symptoms to present before taking your child for a pediatric or developmental eye exam, rather you should assess your child's vision by a pediatric optometrist around the time they enter into first grade. If your child has had a pediatric or developmental eye exam and nothing was identified, they can then go for a comprehensive eye exam at the time table recommended by the optometrist (usually every 2 years if your child does not need glasses or annually if they do). If your child has pre-myopia or myopia (nearsighted) they should visit a pediatric optometrist to begin myopia management, which is a specialized contact lens or eye drops that slow down the rate of progression of myopia. This is extremely important as studies show that myopia that progresses to -5 or worse increases the risks of serious eye disease by as much as 2200 percent later in life.

Pediatric Eye Exams Are Important

There are no substitutes for routine pediatric examinations to monitor and maintain overall ocular health to detect eye disorders and visual motor neurological deficits. Contact us to find out more.

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Testimonials

Such a nice optician. My grandson is only 4 and needs glasses. We were so sad, but he explained the issues, and we will follow up as he suggested.

Anna P.

I had such a good experience with the clinic. Very friendly staff and doctor, did not have to wait for long to be called, and was treated respectfully. Thanks, American Family.

June S.

Dr. Zurcher has gone above and beyond what any other eye doctor has ever done to figure out what is going on with my eyes. Very happy with American Family Vision.

Christine R.

Family Vision Clinic changed our lives! My daughter was frequently car sick, and she was getting headaches every day, often painful enough that they brought her to tears. We saw a string of doctors and therapists, but we made no progress. Finally, we found Dr. Levi Zurcher and his eye therapist Rain. After ten weeks of eye therapy my daughter no longer gets headaches, and she no longer gets car sick. Daily tears are a thing of the past. I really can’t say enough about this clinic. It was fascinating to watch Dr. Zurcher work. For the first time, someone who knew what they were doing was intently studying my daughter, really trying to figure out all of her eye issues, and his therapist Rain is one of the most patient and lovely people that I’ve ever had the good fortune to meet. We’re finished with eye therapy—yay!—and I have switched to American Family Vision Clinic for all of my family’s other eye health needs.

Lars Wulff

Very professional, yet kind and helpful. They do what they can to make the appointment comfortable. I was running a bit late, I made sure ti call. They were able to switch me with a patient who was already there, they treated me with respect, and helped my son have confidence by getting him the eye care he needed that day. Thank you so much! Would recommend to anyone. It's a blessing that they care enough to work with people who have all different types of insurance from work to state coverage.