At Livermore Optometry, we are passionate about children's eye health and vision. We recognize that early detection of vision problems and diseases in children can change a child's life both academically and in lifestyle. Many parents do not know where to start or what to expect when it comes to their child's vision. This page is designed to take the mystery out of children's vision. Please note that our optometrists are excellent at adjusting their exams for not only a patient's age, but also their personalities and needs. Often times, children are fearful or upset when they come to see a doctor. We understand that and do everything in our power to keep you and your child comfortable throughout the examination.
A child should have his first comprehensive eye exam between the ages of 6 months and 1 year (sooner if you suspect an issue). If the examination is normal, we will see your child back at around age 3 and again near age 5 and every 2 years. This time table may change based on findings from the examination, history or family history.
An eye doctor such as an optometrist at Livermore Optometry, should perform this comprehensive examination. While a pediatrician checks for some eye problems, they do not perform a comprehensive eye examination that will pick up on more subtle complications.
Obviously your infant can not read an eye chart or answer the question, "which is better, 1 or 2?" However, as optometrists, we have techniques that rely entirely on objective measures in order to evaluation a child's vision, prescription, eye coordination and ocular health.
Anomalies in children's vision can have a profound effect on academics, athletics and careers if not discovered and treated early. For example, if a child is found to have amblyopia (lazy eye), treatment is much for effective in younger patients; if left untreated, amblyopia can reduce stereopsis (3-D vision) permanently.
A comprehensive eye examination depends on the age of the patient at the time of the first eye examination. Below will give you a general idea of what to expect when you bring your child in for an eye examination. After the examination, your doctor will discuss with you the results of the testing as well as treatment options, if needed.
- Infant: During this exam, the optometrist will be carefully watching your child's eye movements while talking and engaging with you and your child. We will use a retinoscope to evaluate whether glasses are needed, and an ophthalmoscope, and possibly a binocular indirect ophthalmoscope to use light to view the inside of the eyes. Your optometrist will evaluate the visual system on a neurological level as well. Often times, the optometrist will use drops to dilate the pupils. This serves two purposes: first, it relaxes the infant's very strong focusing muscles and allows an accurate measurement of the refractive error; second, it opens up the pupil so your optometrist has a better view inside the eye. The drops we use on children will make them light sensitive and have blurred vision for the remainder of the day. Sometimes, we will defer to a later date to dilate a child's pupils based on a number of factors.
- School aged: At this age, some children are able to read either a letter or picture chart. We start to rely a little more on subjective measures (the patient's response) but always revert back to our own measurements if there are any discrepancies. We recognize that some kids really just want glasses (or don't!) and we have ways of determining the validity of our patient's responses.
COMMON CHILDHOOD VISION PROBLEMS
Hyperopia is a refractive error that most children are born with and is also known as farsightedness. Hyperopia is a vision condition in which light is not bent enough by the cornea and lens leading to images being projected behind the eye. Internal eye muscles work to move the image forward onto the retina. If there is more hyperopia than muscle ability the result is blurred vision mostly at near but can affect the distance as well in higher amounts. We expect to see certain amounts of hyperopia at particular ages. If a child has too much farsightedness or an uneven amount of farsightedness between the two eyes, a child may develop strabismus or amblyopia (see below).
Astigmatism is a vision condition that is caused by the cornea or the lens of the eye not being perfectly round resulting in light projecting in 2 different locations. People with astigmatism generally have trouble with night vision, computer vision and general blur. A child with high amounts of astigmatism or uneven amounts of astigmatism between the 2 eyes can development amblyopia or, in rare cases, meridional amblyopia (amblyopia in both eyes).
Myopia is also known as nearsightedness and is rare among infants and preschoolers. Myopia is also considered a refractive error but light coming into the eye is focused in front of the retina causing blurred distance vision. No amount of focusing helps myopia. Children become less hyperopic (aka more myopic) as they get older. It is rare that myopic children to develop amblyopia.
Amblyopia - a term used to describe an eye that does not see 20/20 even with glasses and is often called a lazy eye. Normally a child develops amblyopia because one eye is not getting the same visual stimulation as the other eye. This may be caused by an eye turn, something blocking vision in one eye (i.e. a cataract) or a higher, untreated refractive error in one eye than the other. The treatment for amblyopia may include glasses, patching of the worse eye and vision therapy. Early detection and treatment is vital as it can determine the final outcome. Often times, even with treatment, the amblyopic eye never sees quite as well as the good eye.
Strabismus - an eye turn in which one eye either turns too far inward or outward. While this tends to affect one eye, it is considered a binocular vision condition (two eye condition) as it has to do with eye coordination and teaming. There are varying degrees of strabismus ranging from affecting vision only during certain tasks to being a full-time eye turn resulting in amblyopia. Glasses, vision therapy or surgery are potential management options for strabismus depending on the severity and type.