When should my child have their first eye exam? 

The official recommendation by the American Optometric Association is that infants between 6-12 months should have their first evaluation by an eye care practitioner. InfantSEE is a program founded by former President Jimmy Carter to provide early vision assessments to all children, regardless of income. Visit the InfantSEE website to find a practitioner in your area.

In our practice, we are comfortable seeing children approximately 4 years old and up. Even if you child is too shy or nervous to read the vision chart (we have pictures for them to look at in addition to the traditional letters or numbers), we are able to perform a few crucial screening tests to rule out serious issues.

The first concern with children is strabismus, or an eye turn. Parents or pediatricians will often be the first to discover an eye turn in obvious cases, but there can be more subtle deviations that do go unnoticed. If an eye deviates either in or out, the brain will have to suppress that eye's image, otherwise the child will see double. Prolonged suppression can lead to a developmental delay for the cells in the brain that perceive vision. In other words, the suppressed eye does not learn how to see properly, thereby resulting in semi-permanent vision loss, or amblyopia (lazy eye).

Another cause of amblyopia is a significant difference in prescription between eyes. This can easily go unnoticed by parents and teachers, especially if the "good" eye is basically 20/20. In that case, the child will not squint, sit too close to the TV, or be unable to see what is expected of them because the "good" eye is doing all the work. Once again, however, the brain will suppress the blurry eye resulting in a developmental delay in vision.

The earlier a deviated eye or lazy eye is detected, the earlier it can be treated. And early treatment enables the visual cells in the brain to develop properly. It is typically difficult to improve the vision in an amblyopic eye after about 7 years old.

How old does my child have to be to wear contact lenses?

There is typically not an age minimum for contact lens wearers. As a general rule-of-thumb, if the prescription is such that a child is wearing glasses full-time, they are likely a candidate for contact lenses. The next most important factor is patient motivation and parent approval. If the parents are pushing for contact lenses and the child is not interested, it will be very difficult to train the child and to expect them to keep up with the necessary maintenance. And obviously if the child wants contacts but the parent does not think they are ready, contacts are not an option. (This can be a good motivation tool for parents to stress responsibility. If a child cannot keep their room clean and keep up with homework and chores, they are likely not ready to assume the responsibility of contact lenses.)

A great option for kids/teenagers are daily disposable contact lenses. These are new lenses that are put on in the morning, and at the end of the day they are taken out and thrown away. This reduces the risk of lenses being kept around for too long and ensures that there are no problems related to solution replacement and contact lens case hygiene. These contacts are more expensive, but the cost is somewhat offset by the fact that solution and cases do not have to be purchased throughout the year.

My child is complaining of headaches. Could they be related to vision?

There are a number of causes for headaches, including sinus issues, stress, nutrition, vision, etc. Vision-related headaches are more likely to be worse towards the end of the school day or with prolonged near work (reading, homework, computer).

Even if a child can see an ant on the side of the house from 100 feet away, that does not necessarily mean the eyes are working as they should. During an eye examination, in addition to checking vision and trying to correct vision to 20/20, we also evaluate how the eyes are working together. Children (and adults) can have problems with eye focusing and eye alignment that contribute to discomfort in the form of headaches or eyestrain.

Should my child be wearing sunglasses?

Yes. Recent studies have shown that most UV damage is done before 18 years old. Children have very clear lenses in their eyes that do not filter out harmful rays. If your child is outdoors for any significant amount of time you should try to get them to wear sunglasses.

As the father of a 3 1/2 year old I know this is easier said than done. If they don't go for the sunglasses at least try for a hat.

How often should my child get an eye exam?

If there is an issue that needs monitoring they need to be seen at least once a year, in some cases more frequently. If after a baseline exam everything looks normal, every other year can be sufficient.