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Taking Care of Your Preschooler's Vision

Taking Your Child For His Eye Check-Up

Three percent of people in the United States have amblyopia. More commonly known as lazy eye, the condition is almost 100 percent detectable and treatable in up to 90 percent of patients, especially if caught early.

Yet lazy eye – poor vision in an otherwise healthy eye that's not correctible by glasses or contact lenses – is the cause of more serious vision loss in people 45 years of age and under in this country than all other vision problems combined, according to Bruce Moore, a pediatric optometrist and professor of pediatric studies at the New England College of Optometry in Boston, Mass.

Moore believes had this group been screened as young kids, their vision problems today would be largely treated and cause no significant visual disability. "So there's no question in the mind of pediatric eye-care providers" that preschool-age children [should] undergo vision screening or a comprehensive eye exam," Moore says.

Yet the vast majority of kids – 85 percent – have normal eye health, says David Wheeler, a pediatric ophthalmologist for 12 years and associate professor of ophthalmology and pediatrics at Oregon Health & Science University (OHSU) in Portland, Ore.

And Moore acknowledges the question of whether to take in a preschooler to have her eyes dilated, or wait and rely on potentially deficient public school vision screening, remains unanswered. "It's the single most controversial question that exists in pediatric eye care," says Moore, who's been working with kids for 30 years.

Exams vs. Screenings

So what should you do? Take in your 3-year-old now to a specialist, or wait until she's in school full-time to have her vision screened? Bottom line? Trust your instinct. If it feels right, have your preschooler screened now, or even opt for a comprehensive exam.

Vision screening, a more cursory exam, includes testing a child's ability to see objects close up and far away and for correct eye alignment. A comprehensive exam, on the other hand, takes nearly two hours and includes everything in a screening, plus dilating the child's eyes so the doctor can see into the eye itself to ensure good eye and optic nerve health. Vision screenings are conducted at well checks by primary care providers and in most elementary schools for school-age kids, while comprehensive exams are performed by pediatric eye-care specialists.

Laura Luthi is glad she and her husband trusted their gut and took their middle child, then 2 1/2-year-old Mia, to see a pediatric ophthalmologist. The Portland, Ore., resident says she'd observed her daughter as young as 21 months of age crossing her eyes while doing close-up activities, such as eating and scribbling. So Luthi addressed her concern to two pediatricians, who "kind of pooh-poohed us," she says.

A few months later the family went on vacation to North Carolina's sunny Outer Banks. There, Luthi and her husband were with Mia inside a store that had huge, metal-framed, filthy floor-to-ceiling windows.

Mia saw something outside that attracted her attention and took off running "full-boar" and smacked into the glass "like a bird would into a window," her mom says. Thankfully, Mia was only stunned and not otherwise injured. But the experience made Luthi realize her daughter wasn't seeing normally.

Once back in Portland, Luthi took Mia into a pediatric ophthalmologist who, after performing a comprehensive eye exam, found the toddler to be four times more farsighted than the average child her age. Children up until the age of 7 or 8 are naturally somewhat farsighted, meaning they have a hard time seeing close up.

Mia got fitted for wrap-around glasses, and today she sometimes wears a patch over her good eye. Doing so forces her brain to train her weaker eye to see better. "She's always going to be farsighted," Luthi says, but is happy knowing Mia avoided not only further damaging sight in her poor eye, but also problems once she hit school age. In fact, Moore says some children are in special-education classes due not to any learning problem, but to vision problems that manifest as cognitive delays.

Luthi urges parents always to go with their instinct. "If you have any, any feeling that maybe there's a problem, get it checked," she says.

Stacey Cummings has a history of lazy eye and strabismus, which was surgically corrected when she was 5. Worried that strabismus may be passed from a parent to a child and that her then 1-year-old son's eyes crossed occasionally, she raised her concerns to her son's pediatrician, who suggested she make an appointment with an opthalmologist.

Cummings took her son in at ages 1 and 3 and learned he does not have obvious strabismus; he'll be checked again at 5. "Given the family history of strabismus, I would not have felt comfortable with screening being done only by the public schools," Cummings says. "I was glad that we had an opportunity to have our children screened by an experienced ophthalmologist in addition to our very experienced pediatrician."

Wheeler, pediatric ophthalmologist, says the most important thing is for parents to take charge of their kids' overall eye health, at any age. "Anything you can do to prevent an injury or an illness is a good thing," he says.

What to Expect at the Eye Doctor

Experts and parents agree it's key parents choose a pediatric optometrist or ophthalmologist when they decide to see an eye doctor. "There's a real skill to doing good vision examination [in kids]," says pediatric ophthalmologist David Wheeler.

A comprehensive exam includes dilating the child's pupils via special drops to examine the entire eye and optic nerve. Kids also must identify pictures from varying distances and perform other subtle vision tests.

The entire visit can take up to 90 minutes. It is best to see professionals used to dealing with squirmy little ones who probably won't take kindly to having drops put in their eyes and sitting for lengthy periods.

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