Children and Eye Exams

Hello,

Here's a question: when should you bring your child in for an eye exam?

It's a very good question because the answer is not known by many. Eye exams check for vision problems AND eye disease. You'd be surprised how many patients that I see who are in their 40's...who come in for their FIRST EVER eye exam. Many people think that if they can see fine, then their eyes are fine, too.

The American Optometric Association (AOA) recommends that asymptomatic children get checked at 6 months, 3 years AND before the First Grade. That's three different eye exams BEFORE a child starts school.

The reason for this to to prevent amblyopia. Amblyopia is a fancy name for "lazy eye," which can happen for a variety of reasons. Amblyopia is a term used for an eye that is not seeing it's full potential, which is weaker than the better-seeing eye.

Did you ever hear the phrase, "Use it or lose it?" Well, that's the rule when it comes to amblyopia. An amblyopic eye is at risk for not developing the proper neuronal connections that allows the eye to see properly. If you have an eye that sees great and an eye that sees not-so-great, the eye that sees great will do all of the work. This causes neuronal connections of the not-so-great eye to NOT develop properly.

Sometimes the amblyopia is caused from an actual and physical eye turn. The turned eye is caused from an eye muscle imbalance. This causes double vision, so for the brain to compensate, it learns to turn off one of the images. It get rids of the double vision, but now the brain is refusing to use the turned eye. This is bad.

Amblyopia can also be caused by an eye that has a much higher prescription than the other eye. Since the two eyes are never in focus equally, the brain chooses to favor the eye that's more in focus and ignores the more out-of-focus other eye. This is also bad.

Finally, amblyopia can also be caused by ocular disease, such as congenital cataracts, corneal opacities, problems with the retina, and a variety of other ocular conditions. This is very bad!

Amblyopia doesn't just cause one eye to see poorly. It causes problems with depth perception, reading, learning and behavioral difficulties.

The good news is that amblyopia is correctable. If it's something like a cataract, surgery is required. If it's a turned eye or weaker eye, eyeglasses, patching an eye and/or eye exercises (vision therapy) allow the amblyopic eye to see better, which forces the brain to start using it. Surgery can also be a form of treatment when it comes to eye muscle imbalances.

Many kids aren't brought in for an eye exam until AFTER they begin school when they're in the 5-7 year old range, and some wait to come in until much later. The brain and the neuronal connections in a child are very flexible. Meaning, that if amblyopia is found, the EARLIER the treatment, the BETTER! As a child gets older, those neuronal connections get "hard-wired" into place, so that treatments such as eye exercises (vision therapy), eyeglasses and surgery won't correct the vision as well (if at all).

Many pre-schools and schools have vision screenings, which are extremely helpful to "catch" children who have an eye problem that may not have been detected until they were much older. However, vision screenings are not a substitute for an eye exam. Also, vision screenings do not "catch" all children with vision problems. Also, not all kids found to have a problem at a vision screening get that problem checked by an eye doctor.

So, here are just some of the things to look out for in a infant/child: does not recognize faces, a physically turned eye, a white pupil, avoids reading, frequent headaches (especially with near work), covers or closes one eye for certain tasks, bumping into walls, holds reading material extremely close, squinting, trouble seeing the television or board in school, etc.

Lazyeyetest.org has an online test as a screening tool (remember the difference between screening and exam) for children, which also has more information about amblyopia as well.

So, if you ever form the question in your mind, (When should I bring my child in for an eye exam?) you probably already know the answer.

Sincerely,
Dr. Weaver