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infant child eye exams

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Eye exams 0 to 18: What parents need to know

When, with whom and why to schedule exams early and often

When and how often should your child’s eye health be checked? It depends on who you ask.

The pediatric eye care schedule recommendations differ slightly between the American Academy of Ophthalmology (AAO), the American Optometric Association (AOA), and the American Academy of Pediatrics, but align

  • Newborns should be given an eye exam and a “red reflex test” soon after birth, preferably while in the hospital. The latter can reveal problems in the cornea, lens, and vitreous and is particularly useful in identifying major eye problems in young children. This first look at your baby’s eyes can be conducted by a pediatrician, family physician, or other trained healthcare provider. If your child does not receive a red reflex test at the hospital after birth, consult your pediatrician about getting one in the first weeks after birth. Babies with a negative red reflex test must be seen by an ophthalmologist immediately. Further, an ophthalmologist should examine all high-risk infants, for example, premature babies. 
  • Babies should have their eye development checked at early well-baby visits or at least once between 6 months and one year.
  • Toddlers and preschoolers should have their eyes examined at least once at well-child visits between 15 months and 30 months. AAP recommends a yearly eye exam from age 3.
  • A visual acuity (vision) test should happen between ages 3 ½ and 4, but not later than age 5. A pediatrician, family practitioner, ophthalmologist, optometrist, orthoptist, nurse, or another appropriately trained individual can conduct the test. According to a report in The Washington Post, eye specialists say preschool vision assessment is critical — most kids can cooperate with the test at that age and it’s a time when vision problems are more easily identified.
  • Medical organizations differ on how often a child should have an eye health assessment and vision exams beyond age 5. The AAP recommends screening at routine school checks or well-child visits every 1-2 years after age 5. The AOA recommends annual exams starting at first grade. 

Are early eye exams that important? 

Yes. The Vision Health and Surveillance System of Centers for Disease Control and Prevention estimates that 600,000 U.S. children from birth to age 17 have a vision disorder, and 45,500 have some form of blindness. The CDC and the National Institutes of Health stress that many serious eye conditions are treatable if identified through screening between birth and age 5, especially when a child is at a higher risk due to prematurity or a family history of eye disease. 

And yet, despite the universal recommendation of eye and vision exams before age 5, many kids in the U.S. don’t get them. A national survey of children’s health conducted in 2016-17 found that 61 percent of kids ages 5 and under had not undergone any eye exams. 

That’s a problem, especially when there’s a problem, said Dr. Christopher Clark, an optometrist in Seattle: “Vision is a learned activity. A little treatment goes a long way when children are younger. If they’re older, the same treatment will take many more months.”

Who to see when

Dr. Francine Baran, a pediatric ophthalmologist at Seattle Children’s Hospital and assistant professor of ophthalmology at the University of Washington School of Medicine, believes that pediatric or family practice screenings are fine for most babies, as long as they are not premature and there is no family history of significant eye problems or health concerns.

“Our family practitioners and pediatricians do a great job in screening children for eye alignment, performing an external exam of the eye and face, monitoring visual behavior, which includes tracking and following, as well as performing the red reflex test to evaluate for intrinsic eye disease,” Baran says. 

Kids born premature, have a family eye disease history or have been diagnosed with an eye concern should be seen by an ophthalmologist.

Checking for common concerns by preschool

When a child is 3 to 3½, eye specialists will look closely for the most common vision problem for preschoolers, amblyopia or “lazy eye.” That’s when one eye is weaker, and the other becomes dominant. The preschool years are also an opportune time to find misalignment of the six eye muscles, which can cause eyes to cross or one or both eyes to wander outward, downward, or inward.

Testing vision acuity 

Between ages 3 and 5, visual acuity tests focus on visual skills needed for school. Doctors will check for nearsightedness, farsightedness, and astigmatism (distorted Vision because the eyeball is not perfectly round). They will also look at how well eyes work together (eye teaming), how well they track, and how easily they shift focus from near to far. Vision tests should be repeated every one or two years depending on which optometry member organization your pediatrician sides with.

When to go to the specialist

Eye care professionals and pediatricians agree that you should take your children to an optometrist or ophthalmologist if they have headaches, issues with eye-hand coordination, or problems with focus or attention.

Here are some indications that your child may have a vision problem, according to the American Optometric Association and Dr. Karen Preston of Northwest Pediatric Eye Care in Bellevue, past president of the Optometric Physicians of Washington:

  • Eyes don’t line up; one eye appears crossed or wanders out.
  • Eyes are watery, red, inflamed, or “goopy.”
  • The child rubs her eyes a lot when she is not sleepy.
  • She seems to have difficulty seeing detail at a distance or close at hand.
  • She closes or covers one eye to read, watch TV, or see better.
  • She avoids activities that require near Vision, such as coloring, reading, or using the computer.
  • She consistently sits too close to the TV or holds a book too close.
  • She thrusts her head forward or tilts it to see better.
  • She omits or confuses small words or frequently reverses words when reading or writing.
  • She blinks more than usual, squints, or frowns.
  • Her eyes feel itchy or as if they’re burning.
  • She says her Vision is blurred or fuzzy, or she sees double.
  • She feels dizzy, sick, nauseous, or has a headache after reading.

Get kids outside

According to most researchers, nearsightedness, or myopia, has increased markedly worldwide in the last 50 years. Myopia often begins during the school-age years and increases progressively during adolescence and young adulthood. Today, nearly 30 percent of people in the United States are nearsighted, up from 25 percent a decade ago.

One culprit? Kids spend less time outdoors than they used to and more time on screens and other “close” activities, such as reading and studying. Researchers, including those in a large one out of the University of Sydney, have concluded that lack of outside time contributes to increased myopia rates and other health problems. Outdoor light and the outdoor environment help slow down myopia development due to how the eye is exposed to light and how the eyes function in large spaces. 

Dr. Michelle Trager Cabrera, pediatric ophthalmologist and clinical chief of ophthalmology at Seattle Children’s Hospital, gives this advice: “If you spend more time outdoors, you’ll get less myopia. It’s a great preventive measure because spending time outdoors is also healthy for getting exercise and preventing obesity. It tends to be a very safe intervention that we know works.” 

Shoot for more hours out than in

A 2009 study by the New England College of Optometry found that children who developed nearsightedness spent an average of 8.3 hours a week on outdoor activities and watched an average of 12.5 hours of TV a week were more likely to develop myopia. Children who reversed those indoor/door hours were less likely to develop the disease.

“One possibility is that all the hours spent viewing objects at a distance rather than up close, as happens outdoors, provides a ‘stop’ signal to block myopia progression,” the study’s author, Jane Gwiazda, theorizes. For more on myopia and how to beat it or treat it, read our article “More nearsightedness in kids than ever.”

Although researchers cannot yet account for what causes the correlation between decreased outdoor time and higher rates of myopia, one answer to help reduce the risk is clear.

“Go outside and play,” Baran concurred.

More at Seattle’s Child:

More nearsightedness in kids than ever

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About the Author

Wenda Reed with Seattle's Child Staff