At what age should a child have their first eye exam?

  1. For healthy children with no obvious eye or vision problems, and with no significant family history, a vision screen as part of their annual physical exam at their primary physician’s office in the first year of life and a vision screen (the child is asked to name or match far away shapes one eye at a time ) as a preschooler at age 4-5 years, also at their pediatrician’s office should be fine.
  2. For signs of obvious eye problems that require immediate attention see “Warning signs” section.

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If a child appears to have normal vision, is the screening in kindergarten sufficient or should they see a medical professional?

Most vision screens are designed to catch all the kids with vision problems and then some, meaning a few normal kids are referred as well because they were borderline or they were difficult to measure accurately. If there is any doubt in the parents or teachers the vision should be checked as part of the annual physical in a 4-5 year old, on top of the kindergarten school screen.

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My child is having difficulty reading in school. Is this a medical problem? What can be done about this?

Parents who are concerned with their child’s reading difficulty should relay this to the patient’s pediatrician. Fortunately this is rarely due to an eye problem. If there is any doubt regarding the child’s eyes, your pediatrician will refer you to a pediatric eye doctor who specialized in children who can further evaluate your child’s eyes. They will be able to diagnose and offer treatment for eye related conditions. Such as glasses, eye exercises or eye muscle surgery.

If the child’s eyes are normal and healthy, then the next step is to have a formal reading evaluation. This may be performed by the school or a private specialist to evaluate for dyslexia or other reading problems. The best therapy for kids with reading difficulties and normal healthy eyes is a one on one reading tutor that is familiar with your child’s school’s teaching approach. It is important to offer the child a consistent approach to reading.

This is an area of special interest to Dr. Vicente since he had reading difficulties as a child.

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What is a pediatric ophthalmologist?

Ophthalmologists (watch for the extra “h”) after college go to medical school for 4 years. They learn all about medicine and surgery. They graduate as Medical Doctors M.D’s. Then they specialize through a residency for another 4 years in which they learned how to do eye surgery (ie cataracts, lasers, eye muscles, etc.) and take care of medical eye problems such as glaucoma or diabetes. They also learn how to prescribe glasses and contacts. Some then go on to do a 1-2 year fellowship in which they sub-specialize in one area of the eye, for example the retina, the cornea or pediatric eye surgery. One of the most common areas operated on by pediatric ophthalmologist are the external eye muscles. When adults have eye muscle problems such as strabismus, double vision or deviated eyes they will be referred to a pediatric ophthalmologist since they are the ones with the most experience in treating these patients.

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What is “lazy eye”?

Lazy eye is a lay term used to describe a variety of eye conditions. I have heard patient’s families use it to describe droopy lids (ptosis), misaligned eyes, or eyes with amblyopia.

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Do carrots really help your eyesight?

Yes, if you’re living in a third world country and are malnourished.

Carrots are high in vitamin A, a nutrient essential for good vision. I dare say most kids in the US get enough vitamin A eating a normal balanced diet (found in milk, cheese, and eggs). Eating extra carrots won’t help, but if you do not eat enough your night vision may be affected.

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Is it true reading in dim light is bad for your eyes?

Reading in dim light is not harmful to the eyes. It can be a bit more difficult to read if the lights are very dim, but it will not harm the person’s eyes. As I have told many parents: “Pick your battles, dim lights and sitting close to the TV are two that will not harm your child.”

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What is the best way to wash foreign objects out of a child’s eye?

With lots, and lots, and lots of water, either squirt, wash or splash. If the object is small say an eyelash you’re ok with water and a Q-Tip. Anything else get an MD to see your child since their is a risk of a corneal abrasion or scratch.

IF YOU EVER THINK YOUR CHILD WAS SPLASHED IN THE EYE BY A CHEMICAL, IMMEDIATELY WASH VIGOUROUSLY FOR 5-10 MINUTES, BRIEFLY DUNK THE CHILD’S FACE IN WATER IF NEEDED. THEN CALL YOUR DOCTOR or GO DIRECTLY TO THE NEAREST EMERGENCY ROOM. Most ERs take these very seriously and you’ll be seen right away.

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Is it true that small words on a page are difficult for a young child to look at, so you shouldn’t start letter recognition with children unless books have large print?

Around the age of four kids can see almost as good as a healthy adult. Small print will not harm the child, but anytime you learn something new, it is easier to start with a few simple things in front of you. Their attention span is usually brief. They like big bright colorful things up close. This is why every child enjoys sitting up close to the TV. If you were learning Chinese characters you would not want to start with a page full of small characters.

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Will my vision be blurry after my appointment? Does an eye appointment hurt?

A visit to a pediatric eye doctor is often described as the easiest doctor visit ever. There is no pain. We do not give shots or injections. We play games, and watch movies. We do not do anything that hurts. We often use pediatric eye drops to help us see the eyes better. These will make the patient’s vision temporarily blurry. It will be difficult to read, or drive for the rest of the day.

The only restriction after your visit to a pediatric eye doctor is no driving. The patients can go back to school, play, swim, etc. A note may be given for the patient’s teacher indicating temporary difficulty with reading assignments.

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How can you measure a young child’s vision?

There are several ways to measure your child’s vision. Even if your child can not name letters yet, we can play a “matching game” with letters or shapes. Please see the figure on the right or the attached pdf. In our office we can show these shapes far away at a 20/20 size and ask your child to name them or point to an identical shape on a card. This is a way we can tell how well your child sees in each eye. Feel free to download and print two copies of the shapes. Cut one page into individual pictures and use the other as card your child can hold. The parent should hold the individual cards and show them one at a time and ask your child to name them or point to a matching shape on their card. Repeat this while standing further back each time, and repeat it with both eyes open or while blocking one eye at a time. This will make the testing in our office faster and more accurate.

Download the HOTV chart

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How can you measure a young child for glasses?

There is a very objective way of measuring a child’s refractive prescription. The simplest way I can explain it to parents is as follows:

Many of us have seen the “red eye” in photographs. This is the light from the camera’s flash reflecting or bouncing back out of the eye through the person’s pupil (the dark round opening in the center of the colored iris.) This small “window” normally looks black because the inside of the eye is dark like the inside of a camera. Using an instrument called a retinoscope we evaluate the childs dilated pupils and holding up different lenses we focus the red light coming out. By a principle of physical optics if the light coming out is in focus, the light entering the eye must be in focus as well. Then we look at what lens strength it took to bring the red reflex into focus and this is the prescription for the child’s glasses. If it is a low prescription we often do not recommend glasses.

Unfortunately this important portion of the eye exam is often not covered by most insurance companies and carries a charge payable at the end of the exam.

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