The Eyes of a Child

What parents need to know about pediatric vision care

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Dr. Tina Rutar of Cataract & Laser Institute in Medford examines a patient. Photo provided by Cataract & Laser Institute.

As children grow and develop, so do their eyes. School work often demands a lot of visual involvement, such as reading or writing. However, even outdoor physical activities — including team sports —  requires good vision. If a child has vision problems, he or she may have trouble concentrating, feel tired or have other issues, according to local vision experts. That is why consistent vision screening is an important part of your child’s overall health.

Regular visions screenings

A child should get routine vision screenings every year, during which the pediatrician examines their visual acuity and eye health, says Dr. Mary Murdoch with Southern Oregon Pediatrics in Medford. “Before age two, screenings are frequent, and after 18 months, well care visits and vision checks happen yearly,” she explains. 

A pediatrician will examine a child within their first two days of life, says Dr. Tina Rutar, an ophthalmologist with the Cataract & Laser Institute in Medford. She explains that among other things, pediatricians perform the red reflex test, which screens for abnormalities of the back of the eye. When a child is 6-12 months old, she says pediatricians check eye alignment, and between ages 1-3, they do an instrument-based vision screening test that alerts the doctor to any problems. “After age four, pediatricians use a vision screening device or have the child read pictures or letters one eye at a time. These are also supplemented in preschool or elementary school with kids reading an eye chart.”

However, Rutar says issues arise when a child does not see their pediatrician on a regular basis, because problems can slip through the cracks. “If your pediatrician detects any issues during a regular screening, they will refer you to an optometrist for a full eye exam,” she adds.

Testing devices and guidelines

Murdoch says that in her office, they do an eye exam and screen for acuity problems and eye disease during every well care visit from delivery through the teen years. She explains they use an instrument-based vision screening device that is especially helpful in identifying eye problems in preverbal children. “It’s a handheld device that looks like an old fashioned Polaroid camera. It takes a photo of the eyes and gives us an electronic assessment. We use this until the child is old enough to verbally participate and can tell us what they see,” she says. However, she notes that the letter chart remains a reliable test and an important tool in identifying vision issues. “It’s still used in many medical offices and schools today. But regardless of the screening method, it’s important to catch vision problems early.”

Potential vision problems

The most common vision issues in children are misalignment of the eyes and amblyopia — where the brain fails to process input from one eye and over time favors the other eye. “If a child’s eyes have an unequal prescription, or the eyes are misaligned, the brain shuts off development of the eye that isn’t straight. This category of issues can be treated with glasses that bring the eyes into focus, or if the prescription is unequal, use eye drops in the better eye to force the brain to use the poorly seeing eye,” Rutar explains. And while these vision issues tend to run in families, she notes they are not directly inherited from parent to child.

Additionally, Rutar explains that most children are farsighted. A small amount of farsightedness is normal and happens in almost all young children. However, this doesn’t affect their vision because they can focus despite it, she says. “However, nearsightedness in young kids is uncommon. It tells us they might have other issues or an eye disease, so they should get a complete eye exam right away.”

Visual development is also time sensitive, according to Rutar. “You need to learn how to see appropriately while the visual system is still developing. You don’t want the development window to close, because then it may be too late to intervene,” she explains. Additionally, she says that when children wear glasses or use contact lenses to correct blurry vision, that doesn’t fix the underlying problem of the eyes being out of focus. “For kids, glasses are a medical treatment, so the brain can learn what normal vision is.”

Continue with routine screenings

Murdoch and Rutar agree that regular vision screenings are vitally important for children. “Take your child in for their well care visits, and don’t hesitate to discuss any concerns with your doctor,” says Murdoch.

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More to Explore

Signs of possible vision issues

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Parents should remain vigilant for signs of vision problems, especially in preverbal children, according to Rutar and Murdoch. Watch for these red flags:

  • Squinting or tilting of the head to look at something.
  • Chronically red eyes.
  • A baby who cannot track his or her parents’ faces by the age of  2 months.
  • Eyes that are not straight by 6 months, such as crossed or wandering eyes.
  • Rapid, jiggling eye movement after 2 months old.

Window of vision

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“You need to learn how to see appropriately while the visual system is still developing. You don’t want the development window to close, because then it may be too late to intervene.” 

Dr. Tina Rutar, Cataract & Laser Institute, Medford

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