Eye health is important, and early detection of disorders is essential to keep sight from getting worse. Many vision problems, in fact, develop in childhood and may first be detected when a child has trouble being able to focus on white boards at the front of the classroom or concentrate on the written word in books or on screens in school. Children’s Eye Health and Safety Month is a reminder to have your child’s eyes examined before heading back to school, whether the instruction be in person or remote.
Detecting Eye Problems in Children
More than 12 million children suffer from vision impairment in the United States. Routine pediatric wellness exams can detect the following eye disorders:
- Myopia (nearsightedness)—objects nearby are easily seen, while objects farther away are blurry
- Hyperopia (farsightedness)—objects at a distance are clearly seen, but objects up close are blurry
- Amblyopia (lazy eye)—the brain fails to process inputs from one eye and over time relies on the stronger eye, causing the weaker one to get worse
- Strabismus (crossed eyes)—eyes do not align when looking at an object
- Ptosis (drooping of the eyelid)—the upper eyelids may droop over one or both eyes, which can limit or block vision
- Color deficiency (color blindness)—eyes cannot detect colors or the differences in color in a normal way
Warning signs of a disorder may include:
- Wandering or crossed eyes
- A family history of vision problems in children
- Disinterest or difficulty in reading or in seeing objects at a distance
- Squinting or turning the head in an unusual way to watch TV
If a pediatrician detects a vision problem, he or she will refer the patient to a vision specialist.
Types of Eye Doctors
A comprehensive eye exam is essential to detect vision problems. There are three types of eye doctors that your pediatrician may recommend your child see. They are:
- Optometrist (OD)—Doctors of optometry are like primary care physicians for the eyes. They perform vision tests and routine eye-health procedures, prescribing glasses or contact lenses to patients with otherwise healthy eyes. Optometrists have an undergraduate degree followed by four years of post-graduate doctoral training.
- Ophthalmologists (MD)—These are medical doctors and surgeons who provide full eye care and can treat complex issues of the eye, correcting vision problems by surgical means, if necessary. Ophthalmologists have an undergraduate degree, a four-year medical degree, and a three-year residency in ophthalmology.
- Orthoptists (CO)—These are eye-care professionals who address specific eye problems, including vision, eye alignment, and eye movement disorders. Orthoptists work with an ophthalmologist to develop a treatment plan to improve the way muscles and nerves function in and around the eyes. Orthoptists have an undergraduate degree and two years of orthoptic fellowship training before being certified by the American Orthoptic Council.
An optician cannot provide eye health evaluations but will fill prescriptions for eyeglasses and assemble, fit, and sell the glasses to patients. They may also sell contact lenses.
What to Expect at a Child’s First Eye Exam
An optometrist is usually the first eye doctor a child will see, although an ophthalmologist may be recommended by your child’s pediatrician depending on the severity of the problem. The doctor will perform a comprehensive eye exam, checking for visual acuity and clarity, assessing eye alignment and movement, and looking for color blindness, depth perception, peripheral vision, and eye pressure.
After asking the parent about the child’s eye health, the doctor will exam the eyelids, the cornea (the clear covering over the front of the eye), and the lens. A pupil test will be performed to see how well your child’s eyes respond to light. For this test, a bright light will be shined into each eye.
Drops will be placed in the child’s eyes to allow the pupils to dilate so the doctor can see the retina and optic nerve near the back of the eye. After about a 30-minute wait, the doctor will use lights and lenses and a camera to examine the eyes. The drops may cause temporary blurred vision for up to 24 hours.
If corrective lenses are needed, a child will sit in front of a phoropter, an instrument that allows a doctor to precisely determine the numerical prescription for glasses or contacts. The phoropter has multiple lenses that the doctor will flip throughout the exam while the patient looks into them at an eye chart, letting the doctor know when the vision is clear.
For a child too young or uncooperative to sit behind a phoropter, he or she will be examined with an instrument called a retinoscope, which analyzes light reflected through the pupil from the back of the eye.
Doctors can detect eye problems in infants as young as three months old by seeing if the child can fixate, or lock their eyes, on an object. Children as young as six months old should be able to focus, discern color, and show depth perception as well as adults. A doctor may examine visual acuity in babies by using cards that are blank on one side and have stripes of differing widths and contrasts on the other. The doctor will test whether the baby is attracted to the stripes and then be able to measure the sharpness of vision.
What Is 20/20 Vision?
The term “20/20 vision” expresses normal visual acuity measured at a distance of 20 feet. People with 20/20 vision can clearly see objects that are 20 feet away.
An eye chart measures visual acuity. The top number is the distance in feet from the chart, and the bottom number is the distance at which a person with normal eyesight can read the same line. Someone with 20/30 vision, therefore, has worse than average vision, meaning that person can read letters at 20 feet that most people can read from 30 feet away.
A person can have better than 20/20 vision. For instance, a person with 20/15 vision can see at 20 feet what average people can only see at 15.
Some children lose their 20/20 vision at age eight or nine, so it is important to have a child tested on an eye chart around this time. After age eight or nine, a person’s visual acuity typically stays the same until middle age, when seeing up close becomes more difficult, a condition called presbyopia.
Can Screens Harm Children’s Eyes?
While the American Academy of Ophthalmology (AAO) has yet to specify the amount of screen time that is safe for children, parents should be aware of possible adverse effects of screen use on children’s eyes, such as:
- Myopia: The number of reported cases of nearsightedness has nearly doubled since 1971. In Asia, for instance, around 90 percent of teens and adults are nearsighted, showing a dramatic increase from past generations. A 2019 study in the AAO journal Ophthalmology suggests that the worldwide increase in nearsightedness is caused by people being within close proximity to their work activities, including computer screens, and not spending time outdoors, where the eyes can focus on distant objects.
- Digital Eye Strain: Concentrating on a digital screen can cause dry eyes, itchy eyes, blurry vision, and headaches. Blinking often and looking up from the screen every 20 minutes, focusing at least 20 feet away for 20 seconds (the 20-20-20 rule) can help.
- Sleep Disruption: Screen use too close to bedtime can interfere with sleep quality, which can harm children.
Teaching children good habits like occasionally blinking and following the 20-20-20 rule can prevent eye and vision problems. Other recommendations include the following:
- adjusting the brightness on screens to make them more comfortable
- practicing good posture when using a screen to reduce muscle tightness and headaches associated with eye strain
- holding digital media farther away (18 to 24 inches is best)
- alternating ebook reading with book reading
- marking a book with a paperclip or using the bookmark on an ebook to alert children when it is time to look up and away
- wearing blue light–blocking glasses (which have a slightly yellow tint) to reduce the level of blue-violet rays coming from electronic media
Keeping Children’s Eyes Safe
Healthy vision also includes keeping your children’s eyes safe. Eye injuries are common and a leading cause of vision loss in children. About 42,000 sports-related eye injuries occur annually, with children suffering from most of these. Ways to reduce injuries include:
- Wearing eye protection while playing sports or participating in recreational activities
- Purchasing age-appropriate toys to avoid sharp or protruding parts
Eye injuries can include:
- Routine irritations, such as sand, dirt, or foreign bodies entering the eye—flush the eye with lukewarm water for up to 15 minutes and see a doctor to detect a scratched cornea
- Embedded foreign object—seek emergency medical help
- Chemical exposure—look on the product label for emergency care instructions and begin flushing the eye for 15 to 30 minutes; seek emergency medical help, including contacting the poison control center for specific instructions (800-222-1222)
- Black eyes and blunt injuries—often minor but can result from eye injury or trauma; apply a cold compress intermittently (5 to 10 minutes on, 10 to 15 minutes off), covering ice in a towel, and call a doctor for further instructions
Good vision is important for quality of life. According to the Centers for Disease Control and Prevention, around 6.8 percent of American children under age 18 have a diagnosed eye condition and nearly 3 percent are blind or visually impaired. Consider having your children’s eyes examined before they head off to school this year. It could save their vision for life.
Sources: All About Vision, What Are Signs That a Baby Needs Glasses? https://www.allaboutvision.com/eyeglasses/faq/baby-needs-eyeglasses.htm; American Academy of Ophthalmology (AAO), Screen Use for Kids, https://www.aao.org/eye-health/tips-prevention/screen-use-kids; AAO, What Does 20/20 Vision Mean? https://www.aao.org/eye-health/tips-prevention/what-does-20-20-vision-mean; Centers for Disease Control and Prevention, Vision Health Initiative, Fast Facts of Common Eye Disorders, https://www.cdc.gov/visionhealth/basics/ced/fastfacts.htm; Children’s Hospital of Philadelphia, What Kind of Eye Doctor Should My Child See? https://www.chop.edu/news/health-tip/what-kind-eye-doctor-should-my-child-see; Mayo Clinic, Eye Exam, https://www.mayoclinic.org/tests-procedures/eye-exam/about/pac-20384655; Mayo Clinic, Symptom Checker, https://www.mayoclinic.org/symptom-checker/eye-problems-in-children-child/related-factors/itt-20009075; National Institutes of Health, National Eye Institute, Amblyopia, https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/amblyopia-lazy-eye; Oregon Eyes, Children’s Eye Exams: What to Expect, https://www.oregoneyes.net/childrens-eye-exams-what-to-expect/; Your Sight Matters, August Is Children’s Eye Health and Safety Month, https://yoursightmatters.com/august-childrens-eye-health-safety-month/
Graphics: American Academy of Ophthalmology, https://www.aao.org/eye-health/tips-prevention/home-eye-test-children-adults; American Optometric Association, https://www.aoa.org/news/inside-optometry/aoa-news/kids-vision-project-flourish?sso=y; UCLA Health, https://www.uclahealth.org/eye/