Screening for refractive errors, eye diseases, and vision loss is crucial for maintaining eye health — regardless of how old you are. This makes eye exams a critical part of maintaining overall health, especially for children, whose eyes change more frequently than adults.
As summer winds down and children return to school, it is important to ensure they have their vision checked. But, when and how often should they receive a comprehensive eye exam? This blog will answer that question, and it will also help outline common eye disorders that appear in children.
Vision Screenings vs. Eye Exams
Before diving into the recommended frequency for eye exams, we first need to define the difference between a pediatric eye exam and a vision screening.
In medical terms, a screening is a rapid testing process performed to determine if people are at a higher risk for developing a health problem. A screening helps flag people who need more detailed evaluation and possibly treatment.
A vision screening would determine if a child needs a more detailed evaluation by an optometrist or ophthalmologist. Vision screening can be administered in school by a trained professional, or as part of a regular checkup by a pediatrician, family medicine doctor, nurse, or trained technician.
Comprehensive eye exams, on the other hand, are conducted by an eye doctor and include a child’s eyes being dilated along with a detailed assessment of the following:
- Visual acuity
- A refractive error
- Eye alignment
- Eye movement and tracking
- Depth perception
- Color vision
- Visual field (peripheral vision)
- Health of all ocular structures
When Should Children Have Their First Eye Exam?
Your child should have routine vision screenings as they age. The first screening starts as soon as they are born. In the nursery, your doctor will inspect your child’s eyes, pupils, and red reflex (a reflection from the lining of the inside of the eye that causes the pupil to look red in pictures).
Children should also receive vision screenings between the ages of six months and one year and again after they turn 3 years old. Many states have vision screening requirements before school-aged children can enter specific grades. In Oklahoma, the Oklahoma Vision Screening Act requires a vision screening for children before they enter kindergarten, first grade, and third grade.
If an abnormal result occurs at any point during these screenings, your child should be referred to an optometrist or pediatric ophthalmologist to undergo additional testing.
While vision screenings are conducted during the first few years of your child’s life, comprehensive eye exams should be performed at 3 years old and no later than 5 years old. Subsequent eye exams should be conducted every two years or on an as-needed basis throughout their childhood if issues arise. For example, children with a refractive error, such as astigmatism or myopia (nearsightedness), will need annual eye exams to update eyeglass or contact lens prescriptions.
You should schedule an eye exam with a pediatric ophthalmologist while your child is still an infant if there is a family history of pediatric eye disease, or if they have a neuro-developmental delay or significant medical problems.
What Are the Most Common Eye Problems in Children?
More than 6% of children in the U.S. have a diagnosed eye or vision condition, according to the Centers for Disease Control and Prevention (CDC). Here are some of the most common pediatric eye problems:
Refractive Errors
These types of vision problems occur when the shape of the eye prevents light from focusing correctly on the retina (the light-sensitive layer of tissue at the back of the eye). Hyperopia (farsightedness), myopia (nearsightedness), and astigmatism are the three basic refractive errors.
Nearsightedness means objects far away appear blurry, while farsightedness means objects up close are more difficult to see. Astigmatism is a condition in which objects at both distance and near appear blurred. According to Prevent Blindness, between 15 and 28% of children ages 5 to 17 years old have astigmatism, making it the most common eye problem in children. About 9% of children in that same age range are nearsighted, and an additional 3% are farsighted.
Strabismus
This condition describes a misalignment of the eyes in which an eye may be turned inward, outward, upward, or downward. Strabismus in children can result in visual loss (amblyopia). Between 2% and 4% of children 6 have strabismus.
Amblyopia
Also known as “lazy eye,” this condition occurs because the eye and the brain are not working together properly. It affects up to 5% of the population. Strabismus and refractive errors can both lead to a lazy eye. It must be treated in the first decade of life in order to obtain the best vision possible.
Ptosis
This condition refers to drooping of the upper eyelid and may be present at birth (congenital) or is acquired, for example, by neurological conditions.
Conjunctivitis
Also known as pink eye due to the redness and inflammation caused by this condition. Children can have conjunctivitis from a viral or bacterial infection or an allergic reaction. Viral infections cause nearly 80% of all conjunctivitis cases. Pink eye from infection spreads easily via touch from person to person, making outbreaks common among children in schools or daycare centers.
Pediatric Cataracts
In children, a cataract (cloudiness of the normally clear lens of the eye) can occur at birth or early in childhood. The cloudiness can interfere with light passing to the retina and causes blurred vision. Signs of pediatric cataracts include a white area in the pupil and misalignment of the eye.
Blocked Tear Duct
In healthy eyes, tears drain into small ducts in the corners of your eyelids before traveling to the back of the nose. Blocked tear ducts prevent this process from happening and may cause watery, irritated eyes. According to the American Academy of Ophthalmology (AAO), approximately 5% of infants have symptoms of a blocked tear duct. Surgery may be required to treat this condition.
Why Is My Child’s Vision Getting Worse?
Myopia is a common refractive error in children that tends to get worse as they progress through childhood. Children with myopia have a longer-than-normal eyeball, from front to back, that causes the focal point of an image to be in front of the retina instead of on it.
Many cases of myopia are discovered between the ages of 8 and 12 years old. It is common for your child’s vision to become worse as they continue to grow. These vision problems typically stabilize between the ages of 20 and 40.
If your child wears glasses or contacts to correct myopia, it is important to schedule annual comprehensive eye exams to account for any vision changes. They will need stronger prescriptions as the myopia progresses during their adolescent and teenage years.
Talk to your eye doctor about clinical options that can help slow or stop the progression of myopia. MiSight lenses are daily disposable contact lenses that help redirect how light hits the retina to help stabilize myopia. Orthokeratology, which uses custom contact lenses to reshape the cornea, is mainly used to treat children with astigmatism, but it is also an off-label use for stopping or slowing myopia’s progression.
Low dose atropine eye drops are another possible off-label treatment option for myopia progression. The eyedrops are approved to treat lazy eye, but daily low-dose usage for several years can help slow the progression of myopia. See our article, Managing the Progression of Myopia, in our summer issue of DMEI InVision for more information on this.
