FAQs About Childrens' Vision

A Full Vision Exam May Prevent Childhood Blindness

The author's son has a form of amblyopia caused by unequal vision in each eye. A vision exam at the age of three prevented him from going blind in the right eye.
The author's son has a form of amblyopia caused by unequal vision in each eye. A vision exam at the age of three prevented him from going blind in the right eye. | Source

Should My Child Have a Comprehensive Vision Exam?

Yes, every child should have routine comprehensive vision examinations.

According to the American Optometric Association (AOA), only 1/3 of children entering elementary school have had a full vision exam. By high school, 11.5% of children have undetected problems with their vision.

Many children do not receive a full (comprehensive) vision exam as part of their routine medical care. While many children are screened for vision problems in the pediatrician's office or at school, these screenings do not take the place of a comprehensive exam. Vision screenings often miss the most detrimental vision problems in children. A common screening tool is simply having a child read an eye chart at a specified distance. This is the most common method used at elementary schools and in the pediatrician's office - the problem is this method misses the following conditions:

  • Farsightedness: children who are farsighted are often not able to see close objects. This may impact the ability to read or cause significant eye strain as the child's eyes cross to bring the object into focus.
  • Amblyopia: sometimes referred to as "lazy eye," this condition is quite serious and can cause permanent blindness. When the vision in both eyes is not equal, the brain cannot obtain a uniform picture. In early childhood, the eye with poorer vision will be shut off, and the brain will only receive a picture from the good eye. If not caught early enough, the eye with poorer vision will be ignored by the brain and become permanently blind. This condition is entirely invisible and may only be detected during a comprehensive vision exam.
  • Strabismus: this condition is when the eyes are not in alignment - the eyes will either cross or wander outward. Strabismus sometimes causes amblyopia.

The vast majority of children entering school have not had a full vision exam. Many parents believe that "passing" a vision screening program means that a child does not have a vision problem. This is untrue, as screenings are not diagnostic and will only find a portion of children who have a vision problem.


When Should Children Have Their First Vision Exam?

The AOA recommends each child have a first vision exam between the ages of 6-12 months of age. Obtaining a full exam at this age will allow for the detection of eye disorders that affect the developing visual system. By catching vision problems early, blindness may be prevented.

A free vision exam for babies in this age group may be obtained through the InfantSEE program. Optometrists cooperating with the InfantSEE program provide eye exams free of charge for infants 6-12 months old.

First Vision Exam: A Poll

When did your child have their first, full vision exam?

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Routine Vision Exams are Vital

If no vision problems are identified by the age of three, children should have exams every other year from that point forward. Children with vision problems will receive more frequent care.
If no vision problems are identified by the age of three, children should have exams every other year from that point forward. Children with vision problems will receive more frequent care. | Source

How Often Should Children Have Vision Exams?

A child's first exam should be in infancy (from 6-12 months of age). If no vision problems are detected, the child should return for another full exam at the age of three years. If no vision problems are found at the age of three years, the child should return for exams every 2 years.

If a vision problem is identified, the child's optometrist or pediatric ophthalmologist will schedule appointments more frequently (depending on the specific disorder).

What are Signs of Vision Problems?

Signs of vision problems in infants Include:

  • Crossing or wandering eyes - this indicates a problem with the ability to focus.
  • Constant production of tears - this could be caused by blocked tear ducts.
  • Pupil that appears white - this may be caused by a type of eye cancer.
  • Inability to tolerate light - this could indicate excessive pressure in the eye (glaucoma).
  • Red, inflamed, or "crusty" eyes - this could indicate an eye infection.
  • Fluttering eyes - this is called nystagmus and may indicate vision problems.

Signs of vision problems in children include those listed for infants, in addition to:

  • Sitting too close to the TV or holding books extremely close to read the print.
  • Rubbing of the eyes.
  • Closing one eye to focus on objects.
  • Tilting of the head to see an object better.
  • Confusing or omitting small words when reading.
  • Refusal to do close work.
  • Using a finger to track words when reading.

Eye Alignment Problems

A full vision exam will determine whether the eyes are properly aligned (in this example, the child's left eye is wandering out - a condition known as exotropia).
A full vision exam will determine whether the eyes are properly aligned (in this example, the child's left eye is wandering out - a condition known as exotropia). | Source

Which Children are High Risk for Vision Problems?

Some children are considered "high risk" when it comes to vision problems. Certain conditions are more likely to affect the eyes, and these children should all be under the care of a pediatric ophthalmologist to receive routine, thorough eye examinations:

  1. Children with nystagmus.
  2. Premature babies.
  3. Infants and children with developmental delay.
  4. Children with a family history of vision disorders including glaucoma, retinoblastoma, childhood cataracts, systemic diseases affecting the eye, or retinal degeneration in childhood.
  5. Children with sensorineural hearing loss (permanent hearing loss), or with a family history of strabismus or amblyopia.

How is a Baby's Vision Tested?

Obviously, an infant cannot cooperate and communicate well enough to have an adult-style vision exam performed. How are vision exams performed on infants?

The optometrist (or ophthalmologist) will perform a series of checks on the baby's ability to move his or her eyes - this tests the motility of the eyes. A bright, interesting toy will be held in different positions and the baby's ability to track the object will be assessed.

Sometimes, a baby's ability to see in three dimensions will be assessed - stereoscopic glasses (like those used for 3-D movies at the cinema) will be placed on the baby and a three-dimensional picture will be shown to the baby. Often, a baby will try to reach and "pick up" the 3-D object. This test is not always performed on infants, and may be reserved for slightly older children.

Finally, the baby's eyes are dilated with eye drops. This allows the doctor to examine the anatomy of the baby's eye and check for cataracts or other physical problems with the baby's eye. A light is shone through a series of lenses to determine the baby's visual acuity: the doctor can see where the light is focused on the back of the baby's eye (the retina) and determine whether the baby is nearsighted farsighted, or has astigmatism. If the baby requires glasses, the prescription may be determined using this method.

Infant Eye Exam

Vision Screening

The author's son received a screening from the Lion's Club using a sophisticated photoscreening device. While it was not diagnostic, the screening did indicate a potential problem. Nearsightedness, astigmatism, and amblyopia were later diagnosed.
The author's son received a screening from the Lion's Club using a sophisticated photoscreening device. While it was not diagnostic, the screening did indicate a potential problem. Nearsightedness, astigmatism, and amblyopia were later diagnosed. | Source

What is the Difference Between a Screening and an Exam?

A vision screening often focuses on the ability of a child to see at a distance. The most common method used is an eye chart at a distance of 20 feet. The child covers each eye in turn and reads letters (or describes pictures) of decreasing size on the chart. Other (more sensitive) methods include the use of automated screening devices, such as the PediaVision Spot Device. The Lion's Club uses these devices, which detect vision differences that may indicate amblyopia, astigmatism, farsightedness, and more.

Screenings may never take the place of a full vision exam, however, even if the screening device is sophisticated. A full vision exam will:

  • Measure visual acuity.
  • Measure the use of binocular vision (how well the child uses both eyes together).
  • Assess eye tracking skills.
  • Assess the alignment of the eyes.
  • Observe the range of motion for the eyes.
  • Test for color vision.
  • The anatomy of the eye is assessed for physical problems (i.e. the retina, fluid inside the eye, and lens are examined for problems).


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Comments 6 comments

LongTimeMother profile image

LongTimeMother 3 years ago from Australia

Awesome hub, leahlefler. I'm sharing it. All parents should be aware of this valuable information. Thank you for making the effort to educate us.


leahlefler profile image

leahlefler 3 years ago from Western New York Author

I feel strongly about vision exams for children - my own son "passed" the screenings at the pediatrician's office, and was legally blind in his right eye! We were fortunate that his preschool had a Lion's Club official perform a more sophisticated screening technique, and we were able to identify and treat his amblyopia in time. His vision corrects to near-normal levels now, which is a huge relief! Thanks for the comment, LongTimeMother!


teaches12345 profile image

teaches12345 3 years ago

Leah, this is an interesting topic and well done. I remember when my son was in elementary school his vision was tested and resulted in his need for glasses. Wish it would have been sooner as he may have missed some learning due to poor vision. I learned much today from your post.


leahlefler profile image

leahlefler 3 years ago from Western New York Author

Vision affects learning in so many different ways - the visual system develops over a significant period of time in childhood and catching vision problems early can prevent blindness in many children! I am so glad your son's vision problem was found in school - children often don't complain about vision trouble because it is the way they have always seen the world - they don't know how it "should" look! Thanks for the comment, teaches12345~


RTalloni profile image

RTalloni 3 years ago from the short journey

Glad to see this important post. You've filled it with important details and direction on getting children's vision checked. I'm learning about vision therapy first hand right now and wish I had known about it a long time ago. It is amazing to see how much benefit little ones can get from it.


leahlefler profile image

leahlefler 3 years ago from Western New York Author

We are so fortunate that our son's vision problem was found through his preschool vision screening, RTalloni. He was legally blind in his right eye at the time, and is now correcting to 20/20 (with glasses) - it took three years, but we finally have defeated the amblyopia!

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