Does Your Child Need Glasses?
When Laurie Wheeler's 8-year-old son, Michael, began telling her that his eyes hurt, she wasn't convinced that he was really having difficulty seeing.
"He's at that age where I wasn't sure if he just said his eyes were bad because he wanted to wear glasses," Laurie says. "I even watched him closely for a few days and I couldn't tell if he was rubbing [his eyes] because he knew I was watching or because they were really bothering him."
To help her get a better idea of whether or not Michael was trying to fake her out, Laurie scheduled an appointment with Dr. Paul Collins, an optometrist at Sterling Optical in Newburgh, N.Y. Collins, who sees a great many children in his practice, not only has a way with children, but he has no difficulty telling which kids are trying to throw the exam so they can get a pair of stylish frames.
"A lot of kids come in and really are disappointed when they don't get to wear glasses," Dr. Collins says. "Some are even upset when I tell them their eyes are OK without glasses."
The Eye Exam
Dr. Collins uses a technique called retinoscopy which enables him to tell a person's lens prescription very accurately within the first few minutes of the exam. He also tests his patients for myopia (nearsightedness), hyperopia (farsightedness), astigmatism (mis-shaped refractive surface) and strabismus (one eye turns farther out or in than the other). Unless there is a strong family history or other factors that signal a eye pressure problem, he says it is not recommended to test patients younger than age 10 for glaucoma.
Often, patients come in to have an eye exam and are surprised to find that their vision is not as sharp as it could be.
"You can get amazingly poor acuity from people who don't even realize it. They get so used to it over time," Collins says, although he adds that some refractive error is normal in children younger than 10.
"Some farsightedness is normal at that age as it necessary for growth," he says. Once the child enters the preteen years, their farsightedness is closer to the normal range for an adult.
Frequency of Eye Exams
Because of the difficulties that can result when your child can't see clearly, regular exams -- one at least every year beginning at age 5 or when your child starts school -- are important. Although most school nurses conduct eye exams, the exams are not nearly as comprehensive as one done by an optometrist. "They're pretty good with catching nearsightedness but they have trouble catching convergence and depth perception difficulties that corrective lenses and eye exercises can help correct," Dr. Collins says.
Of course, if you suspect that your child is having difficulties with his or her eyes and the fifth birthday hasn't yet, make an appointment anyway. Even if your child doesn't know the alphabet, they can be tested using numbers or pictures of familiar objects.
"I would say if you notice that your child is sitting closer to the television than usual or if he begins holding books or the Gameboy really close to his face, it may be time to see if his eyes are the culprit," says Sterling Optical Manager Robin Stettner. "Also look for excessive eye rubbing and complaints of headaches or eye strain."
Dr. Collins says you can do an informal test at home to see if your child's difficulties are real or imagined, especially if he or she is too young to complain of eye strain, read or play video games. "But it is hard to say what is really wrong without an actual eye exam," he adds.
Also, because the eye is rich with blood vessels, lots of other physical ailments -- including high blood pressure and diabetes -- can often be detected during a routine eye exam.
"Anything that affects the vascular system can be virtually diagnosed from the optic nerve and the retina," Dr. Collins says. "We can also detect immune reactions and seasonal allergies by the blood vessels in the retina." If a problem is noticed, Dr. Collins usually refers the patient to his or her doctor or a specialist for follow-up -- all the more reason to add the eye doctor to your child's list of yearly "must sees."
Choosing the Right Doctor for Your Child
Like your child's pediatrician and dentist, it is a good idea to find an eye doctor that works well with children and helps make them feel at ease when they walk into the office. Dr. Collins says he tells children visiting for their first exam what they won't get from their visit. "I tell them that, unlike some doctor's visits, they'll never get a needle or any pain from an eye exam," he says.
Stettner says it is also important to look for a staff that has a good report with children, especially when it comes to choosing frames for eye glasses.
"The staff person should include the child when talking about the frames, getting down on their knees to speak at the child's level," she says. "They should also not talk down to a child with 'baby' talk or young language. Kids are kids, but they're also people. The person helping them with their frames shouldn't forget that."
So, before you schedule an appointment, ask parents of your child's playmates about good eye doctors in your area, then take a visit yourself and look around. Is the staff attentive and courteous? Would the waiting and exam rooms be intimidating and scary to your child? Does the doctor explain what he is going to do before he does it? Also ask how long the exam will take and what type of tests will be performed so you can give your child a better idea of what to expect during the test. A few minutes of research before the visit can help you know if the doctor is right for your child.
Michael was diagnosed by Dr. Collins as being slightly nearsighted, which, he says, is perfectly normal for kids his age. Laurie was given a slight prescription for corrective lenses and had it filled the day of the exam.
"He had fun picking out the frames," Laurie said. "That took more time than the exam did."