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How do I know that my toddler can see properly?

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Newborns come into the world with vision that is mostly blurry. The visual system develops over time and is fully formed by the teen years.

Regular eye screenings for children are recommended to ensure their eyes are healthy and they have no vision problems that could interfere with school performance and potentially affect their safety.

Your child’s vision can be screened by a primary care provider. The provider will screen your child for eye problems and refer to an ophthalmologist for a comprehensive exam, if needed.

Eye screenings generally are included as part of a well-child visit.

The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend this schedule:

  • Newborn–12 months
    Your child’s health care provider will perform in-office screening tests, including inspection of the eyes and lids, and checking the pupil response and eye movement. For the first few months of life, it’s normal for a baby to have eyes that aren’t tracking together, but this should not be occurring by 4 months. The provider may refer your infant to an ophthalmologist if the baby is born prematurely, has signs of eye disease or a family history of childhood eye disease.
  • 12‒36 months
    At this appointment, a photo screening may be performed to look for focusing problems that could indicate your child is not seeing well with one or both eyes. Photo screening also detects risk factors for amblyopia, or lazy eye, which is a reduction in vision in one or both eyes that prevents normal brain development of the visual system.
  • 36 months–5 years
    Your child’s vision and eye alignment will be checked during this time. Your child may be referred to an ophthalmologistor optometrist if the screening shows signs of misaligned eyes or strabismus, amblyopia, refractive errors, or other focusing problems.
  • 5 years and older
    At age 5 and after, your child will be screened for visual acuity, or sharpness of vision, and eye alignment.

 

Screening versus a comprehensive exam

Vision screening involves tests that are performed on every child, which are sensitive to picking up focusing issues and other eye problems. A comprehensive eye exam helps diagnose any eye disease with greater specificity. Both visual screening and comprehensive eye visits have an important role in identifying eye problems and maintaining good vision.

 

Seek a comprehensive eye exam for your child if they:

  • Fail a vision screening.
  • Have a vision screening that is inconclusive or cannot be performed.
  • Are referred by a health care provider or school nurse.
  • Have a vision complaint or observed abnormal visual behavior, or is at risk for developing eye problems. Children with medical conditions, such as Down syndrome, prematurity, juvenile idiopathic arthritis,neurofibromatosis are at a higher risk for developing eye problems. Children with a family history of amblyopia, strabismus, retinoblastoma, congenital cataracts or glaucoma would also benefit from a comprehensive eye exam.
  • Have a learning disability, developmental delay, neuropsychological condition or behavioral issue.

 

How can the eye doctor tell how much my baby or child can see?

The doctor will use a light source to check your child’s pupil response. The vision is assessed by how well your child can follow lighted toys and small objects. Sometimes the provider will use cards with different sizes of stripes on them called “preferential looking tests” to determine vision. Older children can play matching games with shapes or pictures on the eye chart.

The alignment of the eyes will be assessed to see if they work well together. Other aspects of visual function such as peripheral vision, depth perception and color vision maybe evaluated. The eye doctor also will perform a thorough eye exam to look at all the structures of the eye that are important for vision.Your child’s pupils may be dilated with eyedrops to evaluate for a prescription for eyeglasses. This is done with the help of a special scope that shines light into the eye. This light gets reflected from the retina and helps determine the prescription. Young babies also may need glasses.

Pupil dilation also allows the doctor to examine the back of the eye, including the health of the optic nerve and retina. Additional tests may be needed, depending on symptoms and family history.

These appointments may take up to one to two hours, especially if the eyes need to have dilating drops, so remember to come prepared with diapers and snacks. Also have your child’s prior eyeglasses, if any, and eye history available, as well as your list of questions.

Sasha Mansukhani, M.B.B.S.

Sasha Mansukhani is an ophthalmologist with Mayo Clinic Health System in Eau Claire, Wisconsin.

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