PEDIATRIC EYE EXAM

Children’s Vision

 

Find amazing styles of children’s glasses at Couture Optical.

The American Optometric Association (AOA) is the premier educational source for parents on children’s vision and comprehensive eye exams. It is crucial to detect any eye problems your child may have and get your so/ daughter properly outfitted with children’s prescription glasses so he/she has clear vision at all times. Vision problems that are left uncorrected may lead to learning problems at school and may even pave the way to a more serious eye disease.

 

Eye Exams for Children

 

As a parent, you may wonder whether your preschooler has a vision problem or when he/she should get his/her first eye exam.

You should prioritize getting your child’s vision checked out. Some experts estimate that about 5 percent to 10 percent of preschoolers and 25 percent of school-aged children have vision problems. If you suspect that your child has a vision problem, then you had best arrange an eye examination with your optometrist immediately lest your child’s eyes are left unchecked and free to develop a permanent loss of vision later on.

 

When Should Children Have Their Eyes Examined?

 

According to the AOA, infants up to 2 years old should have eye exams every 6 months and again once they reach the age of 3. School-age children should get another examination when they enter kindergarten or 1st grade.

Those who are nor at risk for vision and/or eye problems or don’t have any vision problems should continue to get examined every 2 years thereafter up until they become adults at the age of 18.

It is recommended that those children who do wear eyeglasses or contact lenses should have their eyes examined annually or according to the instructions of the optometrist.

It is stressed to ensure that children receive comprehensive eye exams as soon and frequently as possible because these types of vision are quintessential to stable early learning development:

  • Near and distance vision
  • Eye coordination (binocularity) skills
  • Eye movement skills
  • The ability of the eyes to focus
  • Peripheral awareness
  • Hand/eye coordination

This has led some states to mandate eye examinations for all children entering school for the first time.

 

How to Schedule an Eye Exam

 

Your family doctor/pediatrician will most likely be the first medical professional who examines your child’s eyes. If and when eye problems are suspected during routine physical examinations, the pediatrician may make a referral to an optometrist for further testing. Optometrists possess specific equipment and skill sets that help them detect and diagnose any and all potential vision problems.

It is best if you can schedule the exam at a time when your child is usually alert and happy, if at all possible to ensure that your child cooperates and the testing can be done safely and thoroughly. The specifics of how these exams are conducted are dependent on your child’s age. Generally, eye exams will involve a case history, vision testing, a determination of the need for eyeglasses, testing of the alignment of the eyes, an eye health examination, and a consultation with you regarding our findings.

After you’ve made the appointment, you will be able to complete the case history form when you check into our office. The form will ask about your child’s birth/perinatal history, including potentially applicable items such as birth weight, whether or not the child was full-term, and any complications during pregnancy and/or delivery. Further inquiries involve your child’s medical history, including current medications and past or present allergies.

You need to make sure to tell the optometrist if your child has a history of prematurity, suffers from belated motor development, frequently rubs his/her eyes, blinks too much, fails to maintain proper eye contact, seems unable to maintain a gaze or fixate while looking at objects, has poor eye tracking skills, or has failed a pediatrician or pre-school vision screening. These may be risk factors for or symptoms of an eye disease.

Further items of interest include any previous ocular diagnoses and treatments, such as possible surgeries and glasses or contact lens wear. Make sure that you inform the optometrist of any family history of eye problems requiring vision correction, such as nearsightedness or farsightedness, misaligned (crossed) eyes (strabismus) or amblyopia (“lazy eye”) because, as was mentioned before, these could be potential risk factors or causes for the development of an eye disorder.

 

Controlling Nearsightedness in Children

 

Myopia, AKA nearsightedness, is a common vision problem that affects children who have normal near vision, but suffer from impaired distance vision. This impairment involves the blurring of objects viewed in the distance, such as the chalkboard or blackboard, requiring your child to squint or sit closer to see it more clearly.

In some cases, childhood onset myopia can worsen by the year. This change can be disconcerting to both children and parents alike, prompting them to wonder if it progressively worsens to the point that recovery is impossible.

Childhood onset myopia will nearly always stabilize by the time that your child reaches age 20. But by then, the damage has already been done – some children have become very nearsighted and it is very difficult for a significant salvage of this damaged vision. Here are 3 possible ways to mitigate the progression of myopia in children:

 

Gas Permeable Contact Lenses

 

Gas permeable contact lenses (GP lenses) may retard the development of nearsightedness in children. The speculation is that this result is due to the massaging action of the rigid GP lens on the eye during blinking, which may keep the eye from lengthening and thereby reduces the tendency for advancing nearsightedness.

In 2001 to 2004, the National Eye Institute (NEI) performed a controlled experiment to determine whether or not the usage of GP lenses is efficient in slowing the progression of myopia in children. There were 116 participants in the study, all of who were aged 8 to 11 years old when the research study began.

At the end of the three-year study period, the children who wore GP lenses had only 0.63 diopter (D) (unit of measurement of optical power of lens) less nearsightedness than the children in the control group who wore soft contact lenses.

The study additionally found that wearing GP lenses does not slow the growth of the eye, which is the primary cause most of childhood onset myopia. The reduced advancement of myopia among those children wearing GP lenses was due solely to the effect the lenses had on the front surface of the eye, specifically the cornea. Children who wore the GP lenses had a lesser increase in corneal curvature than those who wore soft contact lenses. The researchers at the NEI have reason to believe these GP lens-induced changes in corneal curvature are not likely to be permanent, and therefore the effect of GP lenses on curbing myopia progression may not be permanent either.

 

Orthokeratology

 

Orthokeratology, AKA “ortho-k,” involves the usage of specially designed GP contact lenses to flatten the shape of the cornea and thereby correct cases of mild to moderate amounts of nearsightedness. Think of it as a further evolution of the original GP lenses that builds on its strengths. You should take care to wear the lenses while you sleep and remove them when you wake up in the morning. Though you may need to also wear temporary eyeglasses during the early stages of ortho-k, many people with low to moderate amounts of myopia can see well without glasses or contact lenses during the day after wearing these custom, corneal reshaping lenses at night.

Recently, research has suggested that ortho-k may also play a role in reducing the lengthening of the eye itself, indicating that their usage during childhood may actually cause a permanent reduction in myopia, even if their usage is discontinued in adulthood.

 

Bifocals

 

There is some evidence that suggests that bifocal or progressive multifocal lenses in eyeglasses may obstruct the progression of nearsightedness in some children. It’s to be caused by the enhanced magnifying power of these lenses, which helps to diminish focusing fatigue during reading and other close work, which are significant contributing problems that aggravate myopia.

A five-year study published in the February 2007 issue of Investigative Ophthalmology & Visual Science produced an interesting result involving nearsighted children whose parents were also nearsighted.  These children, who wore eyeglasses with progressive multifocal lenses during the course of the study, had a lesser degree of progression of their myopia than similar children who wore eyeglasses with regular, single vision lenses.

 

See Us For A Consultation

 

If you are concerned about your child becoming more nearsighted year-to-year, call us here at Couture Optical to schedule a comprehensive eye exam and consultation. We can evaluate the development of his/her myopia and discuss the best treatment options with you.

 

Learning-Related Vision Problems

 

It’s indubitable that good vision is important for learning. Experts say more than 80% of what your child is taught in school is presented through a visual medium.

To ascertain that your child has the visual skills they need for school, the first step is to make sure your child has 20/20 eyesight, and that any nearsightedness, farsightedness and/or astigmatism is fully corrected with glasses or contact lenses. But there are other, less obvious learning-related vision problems you should know about as well.

 

Good vision is more than 20/20 visual acuity.

 

There is a myth that a measurement of “20/20” eyesight means that you have perfectly normal vision. The fact of the matter is that your child can have “20/20” eyesight and still have vision problems that can affect his/her learning and performance in school. Visual acuity (sharpness of vision) is just one aspect of good vision, and it’s not even the most important one. Many nearsighted kids may have trouble seeing the board in class, but they can still read exceptionally well and excel in school.

Other important visual skills needed for learning include:

  • Eye movement skills – a measurement of how smoothly and accurately your child can move his/her eyes across a printed page in a textbook.
  • Eye focusing abilities – a measurement of how well they can change focus from far to near and back again (ex. copying information from the board).
  • Eye coordination skills – a measurement of how well your child’s eyes work together as a synchronized team (ex. to unite for proper eye alignment for reading).
  • Binocular vision skills – a measurement of how well your child’s eyes can blend visual images from both eyes into a single, three-dimensional image.
  • Visual perception skills – a measurement of how well your child can identify and understand what he/she sees, judge its importance, and associate it with previous visual information stored in his/her brain.
  • Visual-motor integration – the quality of your child’s eye-hand coordination, which is important not only for sports, but also for legible handwriting and the ability to efficiently copy written information from a book or chalkboard.

Impairments in any of these important visual skills can significantly hamper your child’s learning ability and school performance.

 

Many kids have vision problems that affect learning

 

A majority of children have learning-related vision problems that have gone unnoticed. According to the College of Optometrists in Vision Development (COVD), one study indicates 13% of children between the ages of 9 and 13 suffer from moderate to severe convergence insufficiency (an eye coordination problem that can hinder reading performance), and as many as 1 in 4 school-age children may have at least one learning-related vision problem.

Signs and symptoms of learning-related vision problems

There are many signs and symptoms of learning-related vision disorders, including:

  • Blurred distance and/or near vision, especially after doing close work such as reading
  • Frequent headaches or eye strain
  • Difficulty changing focus from distance to near and vice versa
  • Double vision, especially during or after reading
  • Avoidance of reading
  • Becoming easily distracted when reading
  • Lackluster reading comprehension and handwriting
  • Loss of place, repetition, and/or omission of words while reading
  • Letter and word reversals
  • Hyperactivity or impulsiveness during class
  • Poor overall school performance

If your child exhibits at least one of these symptoms and is having problems with his/her performance in school, call us to schedule a comprehensive children’s vision exam.

 

Comprehensive Children’s Vision Exam

 

A comprehensive children’s vision exam includes the standard battery of tests performed in a routine eye exam, plus a batch of additional tests that are designed to detect learning-related vision problems. Such tests may include an assessment of eye focusing ability, eye coordination, and eye movement abilities (also called accommodation, binocular vision, and ocular motility testing, respectively). Also, depending on the type of problems your child is having, we may recommend other testing, either in our office, or with a children’s vision and/or vision development specialist.

 

Vision Therapy for Children

 

Many children have vision problems other than simple, common refractive errors such as nearsightedness, farsightedness and astigmatism. Other vision problems could include amblyopia, AKA lazy eye, eye alignment or coordination problems, focusing problems, and visual perception disorders. If left unnoticed, these non-refractive vision problems can cause eyestrain, fatigue, headaches, and learning problems.

 

What is vision therapy?

 

Vision therapy (also called orthoptics or vision training) is a personalized program of eye exercises and other methods to treat non-refractive vision problems. The optometrist usually conducts the therapy in his/her office, but most treatment plans also include daily visual tasks and eye exercises that are to be performed at home to accommodate and work with vision therapy.

Those optometrists who specialize in vision therapy and the treatment of learning-related vision problems are called behavioral optometrists or developmental optometrists.

 

Can vision therapy eliminate the need for glasses?

 

Vision therapy is NOT equivalent to self-help programs that claim to reduce refractive errors and the need for glasses. There is no scientific evidence to support that these “throw away your glasses” programs actually work. Most eye care specialists agree that they are a means of swindling and misdirection.

In contrast, the AOA has approved vision therapy for the treatment of non-refractive vision problems, and there are many studies that demonstrate its effectiveness and utility.

The degree of success that one achieves with vision therapy, however, is dependent on a number of factors, including the type and severity of the vision problem in question, the patient’s age and motivation, and whether the patient performs all eye exercises and visual tasks as directed. Unfortunately, not every vision problem can be resolved with vision therapy.

 

Vision therapy is customized and specific

 

The activities and eye exercises that are prescribed as part of a vision therapy program are customized to deal with the specific vision problem (s) a child has. For example, if a child has amblyopia, the therapy usually involves patching the strong eye, combined with visual tasks or other stimulation techniques to better improve visual acuity in the weak eye. Once visual acuity has improved in the amblyopic eye, the treatment plan may then be amended to include eye coordination exercises to promote the development of clear, comfortable binocular vision to improve depth perception and reading comfort.

 

Vision therapy and learning disabilities

 

Vision therapy does not correct learning disabilities. However, and most unfortunately, children with learning disabilities often have co-occurring vision problems as well that contribute to their stunted learning development. Vision therapy can help correct these underlying vision problems. You must make sure to inform us if your child has been diagnosed with a learning disability. If we find vision problems that may be contributing to learning problems, we can communicate with his/her teachers and other specialists to explain our findings and come up with an effective multifaceted treatment plan to remediate your child’s learning problems.

 

Schedule a comprehensive eye exam

 

If you suspect that your child has a vision problem that may be affecting his/her performance in school, then your first step should be to schedule a comprehensive eye exam so we can determine if such a problem does indeed exist. If we discover learning-related vision problems, we can then consult with you whether a program of vision therapy would be advantageous.

If we don’t have the proper provisions to offer the type of vision therapy your child needs, then we will happily refer you to an optometrist who with greater expertise in the practice of developmental vision and vision therapy who is better equipped to help your child.

 

Your Infant’s Visual Development

 

One of the greatest moments after the birth of your child is the first time your newborn son/daughter opens his/her eyes and you two make eye contact with each other. There are some instances in which this may not occur. But do not despair if that doesn’t happen right away.

The first week of life sees blurred vision, with only shades of gray being visible. It takes time, usually over a period of several months, for your child’s vision to evolve and mature.

If you as a parent know and understand the expected milestones that come with your child’s visual development during his/her first year of life, you will be better able to insure that your child has normal visual acuity and clarity and can enjoy his/her world to the fullest.

 

During Pregnancy

 

Your child’s visual development begins during your pregnancy. Your care for your body during this period is the foundation for the development of your child’s body and mind, including his/her eyes and the vision centers in his/her brain.

You had best follow the instructions that your obstetrician/midwife (OB/GYN doctor) gives you regarding proper nutrition and amount of rest that you need during the course of your pregnancy. And of course, avoid smoking and consuming alcohol or drugs during pregnancy. The toxic chemicals within can cause a multitude of problems for your kid, which includes serious vision problems.

At Birth

As mentioned before, during the first week of his/her life, your baby will only be able to see in shades of gray. The nerve cells in his/her eyes and brain that govern vision aren’t completely developed. His/her eyes also don’t yet have the ability to change focus and have clear near vision. So don’t be too concerned if your baby doesn’t seem to be focusing on objects right away, including your face. It just takes time. Even with these limitations, you can take comfort studies that have shown that within a few days after birth, infants prefer looking at an image of their mother’s face to anyone else’s.

The First Month

This period of the evolution of your child’s vision sees the first instances and development of color vision. Visual acuity and eye coordination will still take a bit longer – so your child’s unfocused or crossed eyes should not be too much of a worry at this point.

The eyes of infants lack the sensitivity to visible light that adult eyes have, but they still need protection from the sun’s harmful UV rays. It is recommended that you keep your kid’s eyes shaded outdoors with a brimmed cap or some other means.

Months 2 and 3

Vision is improving even more, especially in regards to eye coordination. Your child should be starting to follow objects in motion at this stage and reach for things they see. Additionally, children at this age are starting to learn how to move his/her gaze from one object to another without having to move the head.

Months 4 to 6

By the time that your child is 6 months old, the vision centers in the brain have been significantly developed, allowing for more distinct vision. Your child is now able to move his/her eyes faster and with more accuracy, and possesses a greater ability to follow object in motion.

Sharpness in vision is seeing rapid development, rocketing from about 20/400 at birth to approximately 20/25 at six months of age. Color vision is nearly fully developed at the age of 6 months as well, enabling your child to see all the colors of the rainbow spectrum easily.

Furthermore, this period sees progression in hand/eye coordination. The child should now be able to quickly locate and pick up objects. You should expect to see him/her accurately direct the bottle (and many other things) to his/her mouth.

 

Months 7 to 12

This period sees the child showing a better understanding of his/her overall body and learning how to synchronize his/her vision with his/her body movements. Combined with greater mobility, you will notice that he/she is crawling about and covering more distances than you might have expected at his/her age. They have become better able to judge distances and show greater skill at locating, grasping, and throwing objects. At this time, you should watch him/her closely to keep him/her from harm as he/she explores his/her environment. Keep cabinets that contain cleaning supplies locked, and put a barrier in front of stairwells in order to prevent any unfortunate accidents from occurring.

 

When its time for an eye exam

 

If you suspect that something is amiss with your child’s eyes in his/her first few months of life (ex. a bulging eye or red eye, excessive tearing, or a constant, improper crossing of the eyes) take your child to a pediatric ophthalmologist or other eye care specialist immediately when the child is at least 6 months old.

Although your kid can’t yet read letters on a wall chart, your optometrist can work around that by performing non-verbal testing to determine visual acuity and clarity, identify excessive or amounts of nearsightedness, farsightedness and astigmatism, and evaluate eye coordination and alignment. Your child’s eye health will also be examined to check for anything that could interfere with normal and continuing vision development.

We are happy to provide eye care for even the youngest of children. If you would like more in-depth information regarding children’s eye exams or scheduling your child’s first eye exam, please call our office.

 

Eye testing for infants

 

The optometrist will commonly use these tests to check your infant’s vision:

  • Tests of pupil responses – this is a means of evaluating whether the pupils in the eyes contract and dilate in the presence or absence of light, respectively.
  • “Fixate and follow” testing – this helps to determine whether or not your child can fixate or focus on an object (ex. such as a light) and follow it as it moves. As previously discussed, infants should be able to quite skilled with performing this task by the time that they are 3 months old.
  • Preferential looking – this test involves the usage of special cards that are blank on one side with stripes on the other side to attract an infant to stare at the stripes in order to measure the capabilities of his/her vision

Eye testing for pre-school children

 

Pre-school children can have their eyes tested every meticulously, even if they don’t yet know the alphabet or are too young or timid to answer the doctor’s questions. These eye tests are personalized specifically for preschoolers:

  • LEA Symbols – these are similar to the standard eye charts with letters, except that special symbols in these tests include an apple, house, square and circle, which children should be very familiar with seeing by that age.
  • Retinoscopy – this test involves exposing the eye to light in order to observe how the retina (the light-sensitive, inner lining of the back of the eye) reflects the light away from it. This test is very helpful with determining the child’s prescription power.
  • Random Dot Stereopsis – this test uses dot patterns to determine how strong eye coordination is

 

Eye and vision problems that affect children

 

Besides looking for the problems of nearsightedness, farsightedness and astigmatism (refractive errors), which are common in the general population, your eye doctor will also be examining your child’s eyes for signs of these eye and vision problems commonly found in young children:

  • Amblyopia (“lazy eye”) – this disease has already been mentioned several times in this text, so you should come to expect by now how serious it is. With amblyopia, one or both of the eyes may experience impaired vision, despite the absence of any eye health problem or damage. The most common causes of lazy eye include strabismus (see below) and a substantial difference in the refractive errors of the two eyes. One of the most typical treatment methods includes patching the amblyopic eye.
  • Strabismus – this is the misalignment of the eyes, which can be frequently observed as crossed eyes. It is usually caused by a hereditary defect in the positioning or strength of muscles that are attached to the eye and delegate eye positioning and movement. If this condition is left untreated, strabismus can lead to amblyopia in the misaligned eye. Treatment options are dependent on the cause and severity of the strabismus, with the more severe cases being treated by surgery.
  • Convergence insufficiency – this disorder is marked by the inability to keep the eye comfortably aligned for reading and other close work tasks. This problem can usually be successfully treated with a program of vision therapy and complementary eye exercises.
  • Focusing problems – one type of focusing problem involves a trouble with changing focus between distance and near vision. This is usually referred to as accommodative infacility. Another focusing problem may be an inability to maintain adequate focus for reading, which is known as accommodative insufficiency. Vision therapy has also proven to be successful with treating these types of problems.
  • Eye coordination problems – many eye coordination (binocularity) problems are subtler than strabismus. These can cause great difficulties with depth perception

 

Children and Computer Vision Syndrome

 

As you know, computer use has become integrated in the daily lives of children.

Surveys show the average American child spends anywhere in the range of 1 to 3 hours daily on a computer while doing homework, talking online with friends, playing video games, and browsing the Internet. As many as 90% of school-aged children in the U.S. now have access to a computer, whether it’s at home or in school.

Even then, kids are starting to use computers at a younger age. Among college students who were interviewed in these surveys, 1 out of 5 said that they had began using a computer before they were even 9 years old.

Is There a Connection Between Computer Use and Myopia? 

So how does all of this computer use at a young age affect the eyes?

Many developmental optometrists say that sustained computer use puts children at a higher risk for childhood onset myopia, AKA nearsightedness. They point out that, although myopia affects approximately 1 out of every 4 Americans, nearly half of U.S. adult computer users with a college education are nearsighted. This disparity could be a result of heavy computer use while visual development is still occurring.

Research seems to back this working theory. A study of 253 children between the ages of 6 and 10 at the University of California at Berkeley School of Optometry found a strong relationship between the amount of time young children spend on the computer and their development of myopia.

Why computers can be hard on kids’ eyes 

Computer use strains the eyes more than reading a book or magazine because it’s more difficult to retain focus on computer-generated images compared to printed images.

This is especially true for young children, whose visual systems have not yet been fully developed.

According to the AOA, children may have a great deal of vulnerability to computer-related vision problems because:

  • Children have limited self-awareness. They may be occupied with the tasks on the computer for hours with few breaks in between. This kind of prolonged activity can cause impediments in the ability of the eyes to focus and increase the occurrences eyestrain.
  • Children assume that their vision is normal – even if their vision is compromised or slowly dwindling.
  • Children are smaller than adults. Since computer workstations are often customized for adult usage, this can escalate the incidences of children who sit too closely to the screen or adopt unusual postures that can lead to greater eyestrain and pain in neck, shoulders, and the back.

Tips for preventing Computer Vision Syndrome in children

If you seek for your child to avoid the development of eyestrain and other CVS symptoms (including the rapid development of myopia), consider these suggestions:

  1. As has been mentioned multiple times due to its importance, before they start school, make sure that your children have a comprehensive eye exam – including an evaluation of their near-point (ex. computer and reading) vision skills.
  2. Ascertain that your child’s computer workstation is prepared to accommodate his/her body size. It is recommended that the distance between the monitor and the eyes of your child is 18 – 28 inches to avoid the risk of eyestrain with closer viewing. Additionally, the screen should be a few inches below the child’s eyes. The chair should be adjusted so that its arms are parallel with the desk surface and the feet rest comfortably on the floor. These adjustments help avoid any potential posture problems and strained muscles.
  3. You should make sure to be alert for any of the signs and symptoms that denote vision problems, such as the redness of the eyes, excessive rubbing of the eyes, head turning and other unusual postures, or complaints of blurred vision or eye fatigue. An unusual avoidance of the computer or schoolwork may also indicate a vision problem.

 

Take care to mention any problems related to CVS when you make an appointment for an eye exam. The optometrist may want to set aside extra time to perform tests that are specifically designed to detect CVS.