Pediatric Vision Care

Key Takeaways

• About 3% of American children under 18 experience visual impairment or blindness⁵
• Pediatric eye care is an essential part of maintaining healthy vision in children
• All children should undergo routine vision screenings to check their visual acuity and eye alignment
• A vision screening can help detect early signs of vision and determine whether your child needs a comprehensive eye exam
• Untreated vision problems can cause long-term vision problems and difficulties with learning or performing in school
• Early detection can help prevent visual impairment or permanent vision loss.

What Is Pediatric Eye Care?

Pediatric eye and vision care focuses on maintaining healthy eyes and vision in young people from infancy through 17. If your child needs vision correction or has an eye problem that needs treatment, their doctor may refer you to a pediatric eye care specialist (ophthalmologist). 

When to Schedule a Vision Screening for Your Child

Don’t wait until your child begins school to check for vision problems. Your child's visual acuity (sharpness) should be checked when they're old enough to read an eye chart.

However, their basic eye health should be checked shortly after birth. The American Academy of Ophthalmology recommends the following screening schedule for your child’s eye care:¹

Newborn

A qualified health professional should check your newborn’s eyes for basic signs of health, such as pupil response. Your baby may need a comprehensive eye exam from a pediatric ophthalmologist if they:

• Were born prematurely
• Show signs of eye disease
• Have a family history of childhood eye health problems

6 to 12 Months

Infants should get a second screening at their well-child exam, usually between 6 and 12 months of age. In addition to the tests performed at their first screening, the doctor will check your child’s eye movement and alignment.

12 to 36 Months

Toddlers should be checked for healthy eye development between 12 and 36 months of age. This screening includes checking for early signs of lazy eye, children's most common vision problem.⁴ If your doctor detects a problem, they may refer you to a pediatric ophthalmologist for an eye exam. 

3 to 5 Years

Your child's eye alignment and vision should be checked between ages 3 and 5. This screening can be done by an eye doctor, pediatrician, or family physician. 

They will use an eye chart to assess your child's visual acuity. Most children have some level of farsightedness (hyperopia). This typically goes away without the need for glasses or other vision correction. 

Your child may need to see an ophthalmologist if they show signs of:

• Eye misalignment (strabismus)
• Lazy eye (amblyopia)
• Refractive errors

Getting an early diagnosis and treatment for eye problems is the best thing you can do to protect your child's vision.

5 Years and Older 

Visual acuity and alignment should be checked at age 5. Nearsightedness (myopia) is the most common vision problem in children this age.¹ 

Untreated nearsightedness can cause poor academic performance in school-aged children. Fortunately, it’s easy to treat with eyeglasses or contact lenses.

When to Schedule a Pediatric Eye Exam

Despite the importance of pediatric vision screening, most children don’t need comprehensive annual eye exams unless there’s a problem. You should schedule a comprehensive eye exam for your child if they:

• Fail a routine vision screening
• Are diagnosed with a vision health issue
• Have a family history of vision or eye health problems

Sometimes, your child won’t need glasses even if they don’t pass a vision screening. Doctors typically prescribe glasses to children with eye misalignment, refractive errors, or crossed eyes.

However, you should speak to your child’s doctor if you notice any of the following:

• Squinting
• Eye crossing
• Eye rubbing
• Complaints about reading or seeing double
• Problems with schoolwork
• Poor hand-eye coordination
• Frequent headaches
• Light sensitivity
• White pupils
• Chronic redness or tearing of the eyes

When Does Your Child Need an Advanced Eye Health Test?

Children rarely need advanced eye health testing like retinal imaging. This might be necessary if your child:

• Is diagnosed with optic nerve or retinal issues
• Has diabetes
• Has low vision that isn’t corrected with prescription eyewear

Pediatric ophthalmologists can provide information about comprehensive eye and vision care for your child. Early detection is essential.

Many children outgrow their eye problems without intervention. However, getting input from a pediatric eye care specialist is still essential.

Vision Screening vs. Comprehensive Eye Exam

Vision screenings are different from comprehensive eye exams. The main difference is that an eye exam is more extensive.

A vision screening test will check for an overall refractive error. It won't assess your child’s eye health or look for any underlying problems.

During a comprehensive eye exam, an ophthalmologist will check for signs of eye diseases, including glaucoma and cataracts. The American Academy of Ophthalmology recommends scheduling a comprehensive eye exam for your child if:

• They fail a vision screening
• Vision screening cannot be done or is inconclusive
• They're referred by a school nurse or other healthcare provider
• They have a medical condition, such as down syndrome, that puts them at higher risk of developing pediatric eye problems
• They have a family history of pediatric eye problems 
• They have a developmental disability or neurological condition 

What Happens During a Pediatric Vision Test?

During a pediatric vision exam, your child will undergo the following:

1. Visual Acuity Tests

Visual acuity testing involves testing your visual acuity or how well your child can see. It consists of reading the smallest letters on an eye chart to determine if they need corrective lenses. 

2. Eye-Muscle Evaluation

During an eye-muscle evaluation test, the doctor examines your child’s eye-muscle coordination. They'll also check for signs of crossed or lazy eyes (amblyopia).

3. Retina Tests

Doctors can perform retina tests to check for any retina damage or abnormalities. It involves dilating your child's pupils to visualize the retina. 

4. Color Vision Tests

Color vision tests measure how well your child can distinguish between different colors. The most common color vision test is the Ishihara Test. It shows your child a series of circles in different colors and patterns to determine if they have any color blindness.

Vision Skills for School-Aged Kids

According to the American Optometric Association (AOA), the following skills are essential for effective reading and learning:²

• Eye focusing. The ability to maintain visual clarity as the distance between objects changes, such as looking from the desk to the front of the room 
• Visual acuity. The ability to see clearly at a distance, up close, and in-between
• Eye tracking. The eyes’ ability to follow a target, such as a moving ball or words on a printed page
• Eye teaming. Using both eyes together in a coordinated way, including the ability to judge distances and depth 
• Eye-hand coordination. The ability to use visual information to direct and monitor the movement of the hands
• Visual Perception. Skills for recognizing letters, reading comprehension, and remembering details about what they read

Signs Your Child May Have a Vision Problem

Your child may not tell you they’re having difficulty seeing, even after they reach school age. Here are some common signs of children's vision problems:

• Tilting their head to see clearly
• Covering one eye
• Losing their place while reading
• Having a short attention span
• Difficulty remembering what they read 
• Avoiding reading and other close-up activities
• Complaints of headaches, discomfort, and fatigue

Untreated children's vision problems can cause some of the same signs and symptoms as Attention-Deficit/Hyperactivity Disorder (ADHD).² To avoid misdiagnosis, scheduling a comprehensive exam with the children's eye doctor is essential.