Eye Exams for Children – What You Need to Know

July 31, 2019

As summer starts to wane and parents start to think about “back to school”, one of the essential items on their list should be a full eye exam for each of their children. Most children receive a vision screening at school, so parents often mistakenly believe that these quick encounters adequately replace a complete vision exam. Parents may not realize that their child can pass a vision screening conducted by a trained professional at their school, yet still have serious – and possibly life altering – issues with their vision.  

Most school screenings are designed to detect common issues such as myopia (nearsightedness) and astigmatism (blurred vision at all distances). School screenings will not test for hyperopia (farsightedness), as  this condition cannot be spotted in children unless their eyes are dilated and the muscles are fully relaxed. These three issues are collectively known as refractive errors, and refractive errors are the most common cause of vision deficiencies in children. Keep in mind that school screenings rarely test for other issues necessary for total eye health, such as eye disorders, congenital defects and diplopia (double vision).  

One of the most common causes of diplopia in children is strabismus, which is a misalignment of the eyes. One eye will often turn inward or outward, or may even skew upward or downward. In many cases, young children’s brains quickly learn to suppress messages from one eye, eliminating the double image. The dominant eye will suffer from overuse, while the other eye begins to weaken. Strabismus is one of the leading causes of a “lazy eye” (amblyopia), which can cause permanent visual deficiencies if not resolved early in life. You may have seen young children wearing an eyepatch – this is a common treatment for this type of amblyopia that has been proven to be highly effective. Another cause of lazy eye is refractive amblyopia, which occurs when a child has a different prescription in each eye, and one is much stronger than the other. The eye with the lesser prescription becomes the dominant eye, causing amblyopia in the weaker eye with the stronger prescription. 

Another cause of diplopia could be convergence insufficiency (CI), which happens when a lack of coordination between the eyes causes more than one image to be seen. This can cause headaches, eyestrain and general fatigue. A specific test called a Visagraph is used to diagnose this disorder, which is not part of a standard screening. 

Parents often believe their children won’t need to have an eye test until they are ready to start school. However, strabismus isn’t the only issue that can affect young children. Vision screenings performed by a pediatrician in his office will not include tests for focus disorders, depth perception, and structural problems within the eye. It’s rare that a test for color blindness will be done, and pediatricians won’t have the specialized equipment needed to fully examine the cornea, iris and lens of the eye. 

Children as young as six months of age should have their eyes examined by an optometrist. At this age, an infant’s eyes will reliably respond to light, can track objects and work together as a team. Flash cards are often used to help gauge an infant’s ability to see. Since infants respond readily to more interesting images, cards with stripes or patterns are shown, as are white cards. Infants with healthy eyes are consistently drawn to the patterned object. Special instruments can be used to look for refractive errors that an infant can’t describe to an eye doctor. If no issues are found, this critical initial visit should be followed by another complete vision exam at age three, and another before your child starts school at five. Of course, if your child does have vision issues, it’s important that they see an optometrist more often for follow-up visits. 

We love to “see” children at ProOptix Eye Care. Our highly trained eye doctors are the optometrists of choice for Tanglewood and Galleria Area parents when it comes to protecting the health of their children’s eyes. Don’t wait for school to start - make an appointment for your child today! 


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