When should children get their first eye examination?
Infants and toddlers
A routine screening eye examination is part of the general physical that is
given to very young children by their neonatologist or pediatrician. The
doctor checks for proper eye alignment, for problems on the outside of the eye,
and how the eye reacts to changes in light and darkness (red pupillary light
reflex). The doctor also checks for the quality of the red reflex.
An abnormal red reflex can be a sign of a problem in the
structures of the eye, such as cataracts (clouding of the lens), high errors in
refraction (how well the eye focuses light), or even tumors. If a problem is
found during any part of the examination, the child is usually referred to a
pediatric ophthalmologist, a doctor who specializes in diagnosing and
treating eye conditions in children.
Children
Vision screenings, such as eye chart tests, determine how well a child can
see the form and details of objects (visual acuity). In children between the
ages of 3 and 5 years, distance visual acuity is tested using pictures, letters,
or the tumbling E game.
Distance visual acuity is recorded as a fraction, such as
20/20. The number on top relates to the distance from the chart (most eye charts
are read at 20 feet). The number on the bottom relates to the distance at which
a normal eye can read the smallest line on the chart. These screenings represent
one of the most effective techniques for detecting eye problems in children.
When does a child need further evaluation?
Pediatricians, family doctors, school nurses, and
public health vision-screening personnel have used a variety of criteria for
determining which children require more comprehensive eye evaluations by an
ophthalmologist. The American Academy of Pediatric Section on Ophthalmology, in
cooperation with the American Association for Pediatric Ophthalmology and
Strabismus (AAPOS), and the American Academy of Ophthalmology have developed
guidelines for use by all pediatric vision screening professionals.
Children are referred to the ophthalmologist if visual acuity
is less than 20/40 or if there are two or more lines of difference in acuity
between the two eyes. Children 6 years of age or older are referred if vision is
20/30, or less or if there is a two-line difference between the eyes. Children of
any age should have their eye alignment checked using the cover test or the
stereo test. Any ocular movement on the cover test or significant errors on the
stereo acuity test should prompt referral.