When should my child get their first eye exam?
The American Optometric Association recommendation:
- Baseline eye exam in infancy between 6 to 12 months. This exam is to rule out any congenital eye diseases, which are things that patients may be born with. At this age glasses are only prescribed if the prescription is excessively high, there is a large difference between the prescription of the right eye and left eye, or if the infant is developing an eye turn or lazy eye known as strabismus and amblyopia.
- Between the ages of 3-5. At this age not only is the visual system developing at a fast rate, but the visual demand increases every day. Most infants have some sort of eyeglass prescription, but during development the value tends to develop more towards zero. If by ages 3-5 the prescription remains over a certain threshold, your eye doctor may determine that glasses are required to ensure the brain is able to develop quality vision. We perceive with our brain, so if the eye is not providing the brain with a clear image, then those connections are never fully developed, resulting in less than perfect vision. The plasticity of these connections wanes after age 6, which means it is imperative to make sure the vision is developing and there is no amblyopia or lazy eye prior to the child's 6th birthday.
- Entering 1st grade and then part of the back-to-school yearly routine after that. At this age, children are transitioning from "learning to read" to "reading to learn". This means books with smaller fonts and less pictures. Children also tend to be in classrooms sitting further from the teacher and what they are demonstrating at the front of the room. If a child has experienced blurry or double vision there entire life, they do not know that it isn't supposed to look that way and often cannot articulate how they see. Kids may get by with squinting or moving closer to things, but we want them to see their best subconsciously so that their focus can be exclusively on what they are learning. There is even evidence that a large portion of students diagnosed with learning or behavior disorders simply could not see and once they are provided their first pair of glasses their grades and socialization have an opportunity to normalize.
- Between the ages of 8-12 is when myopia, nearsightnedness, typically will manifest. If a patient is showing nearsightnedness at this age, it is likely that their prescription will continue to progress as long as they are growing. Typically, when we stop growing, our eye stops growing, and our prescription plateaus. If we let this natural progression occur from age 8 well into your mid 20s, that can result in a prescription so high that it not only handicaps learning, sports, and socialization, but also can put the patient at higher risk for blinding eye conditions like: glaucoma, retinal detachment, and myopic maculopathy. Given that myopia, nearsightnedness, is consider a global epidemic because of the fast rate in which kids and young adults are becoming increasingly myopic, there are now options to slow the progression of nearsightnedness. We call this Myopia Management, and it is best achieved through specialty contact lenses. We find that fitting patients when they are first introduced to glasses for nearsightnedness between the ages of 8-12 is the best time to attempt to slow the progression of their prescription. Despite what most people assume, patients at this age make excellent contact lens wearers because they are able to follow instructions given to them, they are used to things being in routine, and typically have a parent or guardian helping with the daily process. Our eye doctor at SeeSharp is one of the few eye doctors in Philadelphia that is specially certified to fit contact lenses for Myopia Management. Orthokeratology, also referred to as ortho-k, are extremely popular in countries where myopia is more prevalent, but is gaining popularity in the US, for good reason. These are special contact lenses custom fit to be worn at night while the patient is sleeping. They gently shape the cornea overnight and are removed in the morning to provide clear vision at distance without the need for eyeglasses or contacts during the day. Originally, these lenses were fit in the pediatric population because of their ease of wear and for kids to not have to wear glasses and contacts during the day. They found the children wearing these lenses showed less progression of their nearsightnedness compared to those that wore traditional glasses and contact lenses. There are now long-term studies showing strong evidence that these lenses can slow the progression of myopia by up to 60%. There is no way of knowing how each individual may progress, but if your prescription is already at -1.00 by age 8, then that patient may be destined to end up -6.00 or higher in adulthood. Reducing that progression by 60% results in a mature prescription of -3.00, which is a significantly less handicap than -6.00, which is also the threshold where eye diseases like glaucoma, retinal detachment, and myopic maculopathy are at increased risk.
How often should kids get eye exams?
Children should be getting their eyes checked towards the end of every summer break before the next school year. At this age, everything is developing so quickly and changes in vision can happen seemingly overnight. Especially between the ages of 8-12 with a family history of nearsightedness, a child's prescription can significantly change every 6 months. Luckily, there are now options for Myopia Management, which can control a child's progression of nearsightnedness. An example of Myopia Management is by orthokeratology, which is a therapy of wearing special contact lenses overnight while sleeping to reshape the cornea temporarily and provide clear vision the following day without the need of glasses or contact lenses.
Learning in a classroom setting is so dependent on that child's ability to see what the teacher is presenting or writing on the board. We all want our children to be as successful at learning as possible and do not want their education to be inhibited by something as easily fixable as wearing glasses or contact lenses. Schools often provide brief vision screenings at the nurse's office, but there is a high rate of false negatives and false positives from vision screenings, even when performed by eye care professionals. Formal routine eye exams at an optometrists office are relatively quick, affordable, and often covered by programs or insurance in your local area and state.
Learning in a classroom setting is so dependent on that child's ability to see what the teacher is presenting or writing on the board. We all want our children to be as successful at learning as possible and do not want their education to be inhibited by something as easily fixable as wearing glasses or contact lenses. Schools often provide brief vision screenings at the nurse's office, but there is a high rate of false negatives and false positives from vision screenings, even when performed by eye care professionals. Formal routine eye exams at an optometrists office are relatively quick, affordable, and often covered by programs or insurance in your local area and state.
What to expect at my child's first eye exam?
A child's first eye exam with an optometrist or ophthalmologist will vary depending on their age. An eye exam for an infant relies solely on objective testing because the eye doctor is unable to ask the patient subjective questions like, "which is better: one or two." Often these exams are to observe the patient's eye movements by approaching with a toy or light. Their peripheral vision can be grossly measured by bringing a toy into view and monitoring when the infant detects it. Using handheld lights and microscopes, your eye doctor can assess the gross anatomy of the eyes and detect if there are congenital conditions, things we are born with, such as cataracts glaucoma or cancers like retinoblastoma.
Exams for children 3+ can now incorporate aspects of the traditional eye exam, but geared more towards children and their attention span. We are able to get estimates of their eyeglass prescription objectively while they watch a movie on the eye chart. We can also test their visual acuity by having them read letters, numbers, or shapes on the eye chart. The dilation portion of the eye exam at this age is important for two reasons. When the pupil is dilated with the use of eye drops it allows the eye doctor to see inside the eye to detect signs of any eye diseases. The side effect of pupil dilation is called cycloplegia, which temporarily inhibits the eye's ability to focus, known as accommodation. This is especially important in children because their accommodation, focusing ability, is extremely active and can result in unreliable prescription readings. By measuring a child's eyeglass prescription while they are dilated it can help to determine if their eyes are working abnormally hard while reading at near, which can lead to being labeled as poor students or a learning disability because the child cannot articulate that they are experiencing eye strain while reading. Patients with farsightnedness can often fall through the cracks because they can see and read things that are shown to them, but are straining their eyes in order to do so, and that can lead to strain, headaches, and even crossed eyes.
The health part of the exam is composed of mostly bright lights, but is painless. Most children are intrigued by the lights and microscopes and find humor in this part of the examination rather than being bothered by it. We may give them targets to look at like toys, a movie, or a dancing parent while we efficiently examine the structures of their eye.
Exams for children 3+ can now incorporate aspects of the traditional eye exam, but geared more towards children and their attention span. We are able to get estimates of their eyeglass prescription objectively while they watch a movie on the eye chart. We can also test their visual acuity by having them read letters, numbers, or shapes on the eye chart. The dilation portion of the eye exam at this age is important for two reasons. When the pupil is dilated with the use of eye drops it allows the eye doctor to see inside the eye to detect signs of any eye diseases. The side effect of pupil dilation is called cycloplegia, which temporarily inhibits the eye's ability to focus, known as accommodation. This is especially important in children because their accommodation, focusing ability, is extremely active and can result in unreliable prescription readings. By measuring a child's eyeglass prescription while they are dilated it can help to determine if their eyes are working abnormally hard while reading at near, which can lead to being labeled as poor students or a learning disability because the child cannot articulate that they are experiencing eye strain while reading. Patients with farsightnedness can often fall through the cracks because they can see and read things that are shown to them, but are straining their eyes in order to do so, and that can lead to strain, headaches, and even crossed eyes.
The health part of the exam is composed of mostly bright lights, but is painless. Most children are intrigued by the lights and microscopes and find humor in this part of the examination rather than being bothered by it. We may give them targets to look at like toys, a movie, or a dancing parent while we efficiently examine the structures of their eye.
