Your Child’s Eyes

Probably one of the most common questions I am asked is, “When should my child get an eye exam?” The answer is . . . “It depends.” I see children of all ages in my practice from newborns to teenagers. Many children have an absolutely normal exam; however, some require frequent exams and close follow up.  We will address some of the warning signs that parents should watch for which may warrant an eye exam. As well, we will look at when routine exams should be performed.

Routine Exams

All children should have a dilated eye exam at 4 or 5 years of age. At this age, they are able to verbalize and give us feedback that makes their exams more effective. More importantly, they are about to start school where optimal eye sight is a necessity. I often see children with conditions that could have been prevented with early diagnosis, treatment and close follow up. School screening exams are effective and pick up many problems that otherwise might be overlooked. It does not, however, substitute for a dilated eye exam. I cannot tell you how many parents have told me, “I had no idea my child could not see.”

Another milestone is at 10 to 12 years of age when children begin to grow rapidly. This is a time when glasses prescriptions can change dramatically or when a child can begin to become nearsighted. I would recommend annual eye exams for any child already in glasses, however if your child is not in glasses, then every 2 years is probably sufficient. If they begin complaining of visual difficulties or parents or teachers notice a significant change in their school work, then an eye exam should be scheduled sooner than every 2 years.

Common Eye Conditions

Amblyopia, also known as “lazy eye,” is the most common cause of preventable visual loss in children. Amblyopia is caused by many things but most commonly it is caused by crossing or untreated blurry vision. It also can be difficult to notice as children will see well with the stronger eye, therefore showing no symptoms except for reduced vision in the affected eye. This problem is treatable with glasses, patching or drops or a combination of these. If vision is going to be improved, then children must be placed in glasses and treated with patching before 8 years of age. We know that after the age of 8 it is very difficult to treat amblyopia as children have passed the critical period for treatment. As well, the sooner it is diagnosed, the better the odds are for successful treatment. If you have a family history of poor uncorrectable vision since childhood then you most likely have a family history of amblyopia and your children should get an exam by 4 years of age.

Strabismus or “crossed eyes” is another warning sign that children need an eye exam. Babies under 4 months will often cross but after 6 months of age their eyes should generally be straight. Congenital esotropia or turning in of the eyes will present from 6 months to 1 year with constant large amounts of crossing. Another condition is accommodative esotropia and it usually presents from 18 months to 3 years. These children can be crossed all the time or when looking at things up close. Finally, exotropia or turning out of the eyes can also occur, but it is usually intermittent and clears with a blink. All of these conditions may require surgery for treatment, however sometimes glasses are all that is needed. Bottom line, if you are concerned that your child’s eyes might cross, bring them in for a dilated eye exam. Early treatment is critical for optimal vision.

We have all seen the red eyes that can be seen in pictures. This is red reflex and is actually quite normal, though sometimes annoying for photographers. A white or dim reflex on pictures could also be a sign of serious eye conditions such as cataracts, eye cancer or retinal problems. While rare, these are very serious conditions and these children need an eye exam right away. Time is of the essence when treating these conditions.

Some diseases like diabetes, juvenile rheumatoid arthritis, sickle cell and Marfan’s need a yearly dilated eye exam. We will look for retinal changes, inflammation and retinal detachments. Again, prevention is the best medicine.

Finally, you can not talk about children without mentioning eye trauma. Most of the time, eye trauma is easily preventable with proper eye protection and a dose of common sense. If your child plays sports, encourage them to wear sunglasses or protective eye treatment. But more importantly, common sense and good judgment will prevent most eye injuries. If your child sustains eye trauma, this warrants an exam the same day. Please contact your eye care provider if you have any questions.

Dr. Stephen D. Hammond, Jr. is a graduate of Union University in Jackson. He obtained his medical degree from the University of Tennessee College of Medicine, Memphis and served his residency at the Medical College of Georgia. He is a member of Alpha Omega Alpha Medical Honor Society and is published in the Journal of Organic Chemistry as well as Current Opinions in Ophthalmology. Dr. Hammond is Board Certified American Board of Ophthalmology.