Pediatric Eye Exams

These are some common questions moms and dads ask about eye care for kids:

• When should I bring my little one in for his or her first eye exam?
• How do I know if my toddler has a vision problem?
• Should I be concerned about that turned in eye, or will it correct itself?
• Why do I need to bring my child in for an eye exam every year, if the teacher or school nurse didn’t say there was anything wrong?
• My child complains about headaches, and I heard it could be related to eyesight. Is it?

Here is some information about children’s eye exams and pediatric eye care from your Madison optometrist at the Steinhauer Family Eye Clinic.

Children’s eye exams are really critical. Vision problems are thought to impact 5 to 10% of pre-schoolers and 25% of school children. Detecting such problems as early as possible can make a big difference. Early intervention is associated with better recovery and prevention of vision loss. Furthermore, since eyesight can affect learning, an untreated eye condition can put a child at a disadvantage in school.

Children need the following basic visual skills for learning:

• Near vision
• Distance vision
• Eye teaming (binocularity) skills
• Eye movement skills
• Focusing skills
• Peripheral awareness
• Eye/hand coordination

When should kids have their eyes examined?

The American Optometric Association (AOA) recommends a preliminary eye exam for infants between 6 and 12 months; then, at 3 years old during kindergarten; and again at 6 years old before starting 1st grade. Throughout school, the general advice is to have an eye exam every two years if no vision correction is required. Kids who wear eyeglasses or contact lenses should have an eye exam every year, or according to their eye doctor’s recommendations.

In Madison, students attending public or private preschools are required to have vision screening tests as specified by the Board of Education Vision and Hearing Screening Requirements. All 4 year olds, kindergarten entrants and all other first-time entrants; subsequent vision screening is required for 1st, 3rd, 5th and 7th graders. Pediatric eye exams in Madison are available at Steinhauer Family Eye Clinic.

Booking your child’s Eye Exam in Madison

Our optometrist in Madison often gets referrals from school nurses, pediatricians or family doctors who suspect an eye problem during a routine vision screening test. Eye doctors have specific equipment and training to help them diagnose and potential vision problems and treat them effectively.

Scheduling an eye exam should take into account your availability as well as the child’s schedule. Our Madison eye doctor’s office is open 6 days a week, until 6 pm most days. We recommend you choose a time when your child is usually alert and happy. Most children (and their parents) are less nervous if they are prepped for the test. Here is what you can expect at your kid’s pediatric eye exam:

Eye exams are tailored to the child’s age, but generally a pediatric eye exam includes a case history, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, an eye health examination and a consultation with the parent and child (if old enough) regarding the results of the eye exam.

Before the appointment, you may be asked fill out a simple form about your child’s medical history and eyes. The case history form will include questions from birth until now, like whether he or she was premature and developed normally or if there were delays. These help us get a better idea of the kinds of eye conditions to look out for. The form will also inquire about your child’s medical history, including medication, procedures and allergies.

Let us know if you notice your child rubs his eyes a lot, or blinks more often than normal, or anything else out of the ordinary, like not making eye contact or gazing at an object, having trouble reading in school and the like. Also, if your child already took a vision screening test at school or at the doctor, please let us know the results.

As your eye doctor, we will also want to know about previous ocular diagnoses and treatments involving your child, such as possible surgeries and glasses or contact lens wear. Be sure you inform your eye doctor if there is a family history of eye problems requiring vision correction, such as nearsightedness or farsightedness, strabismus / misaligned eyes or lazy eye / amblyopia.

Eye and vision problems that affect children

Nearsightedness, farsightedness and astigmatism (refractive errors) are some of the main eyesight problems we diagnose, but there are other eye conditions that are common in children so we test for them also during a pediatric eye exam:

• Convergence insufficiency. This is the inability to keep the eye comfortably aligned for reading and other near tasks. Convergence insufficiency can often be successfully treated with vision therapy, a specific program of eye exercises.
• Amblyopia. Also commonly called “lazy eye,” this is decreased vision in one or both eyes despite the absence of any eye health problem or damage. Common causes of amblyopia include strabismus (see below) and a significant difference in the refractive errors of the two eyes. Treatment of amblyopia may include patching the dominant eye to strengthen the weaker eye.
• Strabismus. This is misalignment of the eyes, often caused by a congenital defect in the positioning or strength of muscles that are attached to the eye and which control eye positioning and movement. Left untreated, strabismus can cause amblyopia in the misaligned eye. Depending on its cause and severity, surgery may be required to treat strabismus.
• Eye teaming problems. Many eye teaming (binocularity) problems are more subtle than strabismus. Deficiencies in eye teaming skills can cause problems with depth perception and coordination.
• Focusing problems. Children with focusing problems (also called accommodation problems) may have trouble changing focus from distance to near and back again (accommodative infacility) or have problems maintaining adequate focus for reading (accommodative insufficiency). These problems often can be successfully treated with vision therapy.

Eye testing in Madison for pre-school children

Young children who don’t know how to read may not be able to read the letters on the Big E chart, but they can – and should – still have an eye exam. We know young kids can be shy and nervous, so we have some special eye exam tests that are easy and provide objective results that don’t necessarily require patient input. Here are some of the techniques we use to test children’s vision:

• Retinoscopy is a test that involves shining a light into the eye to observing how it reflects from the retina (the light-sensitive inner lining of the back of the eye). This test helps eye doctors determine the child’s eyeglass prescription.
• Random Dot Stereopsis uses dot patterns to determine how well the two eyes work as a team.
• LEA Symbols for young children are similar to regular eye tests using charts with letters, except that special symbols in these tests include an apple, house, square and circle.

Infant Eye Tests

A baby’s eyesight develops over time. Babies can see when they are newborns, but the visual system continues to strengthen during the first year. During the first year, vision is so important to development; that’s why baby should have an eye exam between 6 to 12 months of age, and that is why we provide infant eye exams for free. To assess whether your infant’s eyes are developing normally, your eye doctor may use one or more of the following tests:

• Preferential looking involves using cards that are blank on one side with stripes on the other side to attract the gaze of an infant to the stripes. In this way, vision capabilities can be assessed.
• Tests of pupil responses evaluate whether the eye’s pupil opens and closes properly in the presence or absence of light.
• “Fixate and follow” testing determines whether your baby can fixate on an object (such as a light) and follow it as it moves. Infants should be able to perform this task quite well by the time they are 3 months old.