Your Child's Eye Exam

Last Editorial Review: 6/29/2005
The Cleveland Clinic


Your child should have his or her first eye exam done by a pediatrician sometime during the first year of the child's life. If you or your child's pediatrician decide that your child's eyes should be further examined, make an appointment with a qualified pediatric ophthalmologist. Then, with recommendation from your pediatric ophthalmologist, your child's next eye exam will be at the age of 3, and once again before entering kindergarten, or by age 5. From thereon, your child should receive a comprehensive eye exam at least every two years. In-school screenings are used to help detect any severe vision problems early, but your child should still see an eye doctor if there are any symptoms or if he or she fails the screening test.

How Do I Prepare My Child for an Eye Exam?

Make time to sit down and explain what will happen during your child's eye exam. Make sure your child knows that he will be asked to look at and identify objects for the eye doctor. These could be random pictures, letters, or shapes of light on the wall. Explain also that the eye doctor may put drops in his or her eyes, but that it will not hurt.

What Tests Will Be Done on My Child's Eyes?

In the first year of life the pediatric ophthalmologist or pediatrician will check for nearsightedness , farsightedness , astigmatism , amblyopia , eye movement ability, proper eye alignment, how the eye reacts to changes in light and darkness, and any general eye problems. If the eye exam is done by a pediatrician and if problems are found during the examination, the child will usually be referred to a pediatric ophthalmologist, who specializes in diagnosing and treating eye conditions in children. Early diagnosis of childhood eye disease is crucial to effective treatment.

For children between the ages of 3 and 5, the eye doctor will conduct a physical examination of the eyes, but also vision screenings using eye chart tests, pictures, letters, or the "tumbling E game", which test the child's visual acuity, or ability to see form and detail of objects. The "tumbling E game", also called the Random E's Visual Acuity Test is useful in determining the eyesight of children who cannot yet read. The child is asked to identify the direction that the letter "E" opens to by holding out 4 fingers to mimic the letter "E". Standardized pictures such as Allen figures can also be used. Examples of Allen figures your child may be asked to identify include a plane, a house, a duck, or a hand. Correcting poor visual acuity is very important in a child's sight development.

Amblyopia or "lazy eye", is a condition in which there is unequal vision between the two eyes despite using a corrective measure such as glasses. It can be caused by unequal errors of refraction, ocular misalignment or cloudiness in the line of vision due to conditions such as cataracts . Amblyopia is reversible in the first decade of life by patching the better-seeing eye or by blurring its vision using atropine drops. Amblyopia is a leading cause of unilateral vision loss in children and young adults.

Reviewed by the doctors at The Cleveland Clinic Cole Eye Institute.

Edited by Charlotte E. Grayson, MD, WebMD, October 2004.

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