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“There are optimum times in a child’s life when his or her eyes should be checked,” says Dr. G. Robert LaRoche, head of the division of ophthalmology in the department of surgery at the IWK Health Centre in Halifax, and a professor in the department of ophthalmology and visual sciences at Dalhousie University.

“The first happens shortly after the child is born, and is usually conducted by the family doctor, to make sure there are no congenital anomalies or cataracts, and that the lids are opening normally and everything looks normal,” he says.

The next screening occurs during a checkup visit at around six months of age, when the child’s family doctor or nurse practitioner looks for many of the same things. He or she will do “red reflex” testing, which can help determine whether the child’s eyes are free of significant abnormalities and diseases like cancer (retinoblastoma).

“These screening procedures can detect problems at different ages—problems that can, and should, be dealt with at those ages,” says Dr. LaRoche.

A child is usually screened again before he or she starts school. If anything out of the ordinary is noticed during any of these visits, the child is referred to an optometrist or ophthalmologist to undergo a full exam.

This exam varies according to the child’s age, but will likely involve some measurement of visual acuity; an examination of the eye with magnification; an examination of how the eyes work together; and the use of drops to allow the examiner to see the inside of the eye and determine if the child needs glasses.

Factors like other health issues and family history may mean that more frequent exams are required. The need and timing for a full exam is based on each child’s risk factors, says Dr. LaRoche.

Those factors can include having been born prematurely, having neurological issues, or having a strong family history (in father, mother, brother, sister or first cousin) of any kind of eye misalignment, lazy eye or significant eye disease.

If parents notice their child’s eyes wandering or crossing after three months of age, they should take the child to an eye doctor right away. And it’s worth noting that children don’t need to know how to read to have a thorough eye exam.

“At-risk children, in general, are to be seen on a yearly basis,” says Dr. LaRoche. “Depending on what is found during the exam, they will be seen (by the eye doctor) more or less frequently.

“But barring these clearly indicated risk factors and situations, the absolute need for an eye exam is low,” he says.

“If the vision is equal in both eyes and the eyes are straight and the child functions well, that’s what we are looking for.”

Signs to watch for

Kids who have always seen well may show signs if their vision is deteriorating—by squinting, for instance. Other clues include headache, reading less often than before, or having a teacher express concern about a new lack of attention. “These are definitely all signs that they should have their vision checked,” says Dr. LaRoche.

What about a child who sits too close to the TV? “That doesn’t tell us much,” he says, noting that many kids just like to be close to the action. “However, if they bring toys or books up close to their eyes, that’s definitely a clue that children may have a vision problem.”
Some of the most common eye problems include nearsightedness (being able to see well at close range, but not at a distance), farsightedness (the reverse) and astigmatism (blurred vision caused by abnormal curvature of the cornea), all of which can be helped very effectively with glasses.

Another common problem is the eyes not working well together, in that they are misaligned (strabismus). The images that the eyes send to the brain don’t correspond to one another, Dr. LaRoche explains. “You see double. Or, if you are a child, your brain adapts, and turns one image off. That’s when you get into the lazy eye issue (amblyopia), which can also happen if a child needs strong glasses or lenses of different strengths in either eye.

“The sooner you find these things out in the preschool child, the better, so treatment can be effective.” In general, Dr. LaRoche says, after age nine, treatment of amblyopia can be very problematic, and after age 12, it’s almost impossible to correct.

“That’s why it’s important to treat amblyopia and its causes in children while the system is still pliable enough—well before age six.”

Ophthalmologist: A medical doctor who specializes in eye and vision care. An ophthalmologist diagnoses and treats all eye diseases and performs eye surgeries. Some ophthalmologists are involved in scientific research, and some specialize in the care of certain conditions, like children’s eye diseases and misalignment (strabismus).

Optician: A technician who designs, verifies and fits eyeglass lenses and frames, contact lenses, and other devices to correct eyesight. Opticians do not diagnose or treat eye diseases.

Optometrist: A health care professional who provides primary vision care, ranging from sight testing and optical correction to the diagnosis and management of vision changes. While optometrists are not medical doctors, in many jurisdictions, like Nova Scotia, they work hand-in-hand with ophthalmologists to improve access to eye care.

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