Children's Vision

How often should children have their eyes examined?                

According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. After that, kids should have routine eye exams at age 3 and again at age 5 or 6 (just before they enter kindergarten or the first grade).                         

For school-aged children, the AOA recommends an eye exam every two years if no vision correction is needed. Children who need eyeglasses or contact lenses should be examined annually.                        

My 5-year-old daughter just had a vision screening at school and she passed. Does she still need an eye exam?                         

Yes. School vision screenings are designed to detect gross vision problems. But kids can pass a screening at school and still have vision problems that can affect their learning and school performance. In fact, studies have found that up to 11 percent of children who pass a vision screening actually have a vision problem that needs treatment. A comprehensive eye exam by an optometrist can detect vision problems that a school screening may miss. Also, a comprehensive eye exam includes an evaluation of your child's eye health, which is not part of a school vision screening.                         

What is vision therapy?                   

Vision therapy (also called vision training) is like physical therapy for the visual system. It involves an individualized program of eye exercises designed to correct vision problems, such as amblyopia ("lazy eye"), eye movement and alignment problems, focusing problems, and certain visual-perceptual disorders. Vision therapy is not designed to treat nearsightedness, farsightedness and astigmatism. Vision therapy is usually performed in an optometrist's office, but most treatment plans also include daily vision exercises to be performed at home.                        

Can vision therapy cure learning disabilities?                       

No, vision therapy cannot correct learning disabilities. However, children with learning disabilities often have vision problems as well. Vision therapy can correct underlying vision problems that may be contributing to a child's learning problems.                         

Our active 1-year-old boy needs glasses to correct his farsightedness and the tendency for his eyes to cross. But he pulls them off the second they go on. We've tried an elastic band, holding his arms, tape... He just struggles and cries. How do we get him to wear his glasses?                     

In most cases, it just takes awhile for a toddler to get used to the sensation of wearing glasses. So persistence is the key. Also, you may want to put his glasses on as soon as he wakes up - this will usually help him adapt to the glasses easier.                        

But it's also a good idea to recheck the prescription and make sure his glasses were made correctly and are fitting properly. Today, there are many styles of frames for young children, including some that come with an integrated elastic band to help keep them comfortably on the child's head. Bring your son and the eyewear to our office. Even if you didn't purchase the glasses from us, we will be happy to give you our opinion about why your son is having a tough time wearing them and what you can do about it.                  

Our 3-year-old daughter was just diagnosed with strabismus and amblyopia. What is the likelihood of a cure at this age?                       

With proper treatment, the odds are very good. Many researchers believe the visual system can still develop better visual acuity up to about age 8 to 10. If your daughter's eye turn (strabismus) is constant, it's likely surgery will be necessary to straighten her eyes in order for her therapy for amblyopia (or "lazy eye") to be successful. Strabismus surgery often is followed by eye patching and vision therapy (also called orthoptics) to help both eyes work together as a team. See a pediatric ophthalmologist who specializes in strabismus surgery for more information.                        

My daughter (age 10) is farsighted and has been wearing glasses since age 2. We think she may have problems with depth perception. How can she be tested for this, and if there is a problem, can it be treated?                     

We can perform a very simple stereopsis test to determine if your daughter has normal depth perception. In this test, she wears "3-D glasses" and looks at a number of objects in a special book or on a chart across the room. If she has reduced stereopsis, a program of vision therapy may help improve her depth perception.                        

We have an 11-year-old son who first became nearsighted when he was 7. Every year, his eyes get worse. Is there anything that can be done to prevent this?                     

A number of recent studies suggest it may be possible to slow myopia progression, or even reverse it, during childhood. Currently, four types of treatment are showing promise for controlling myopia: atropine eye drops, multifocal contact lenses, orthokeratology ("ortho-k") and multifocal eyeglasses. A comprehensive examination will help determine which of these options might help the individual needs of your son.                        

My 7-year-old son's teacher thinks he has "convergence insufficiency." What is this, and what can I do about it?                       

Convergence insufficiency (CI) is a common learning-related vision problem where a person's eyes don't stay comfortably aligned when they are reading or doing close work. For reading and other close-up tasks, our eyes need to be pointed slightly inward (converged). A person with convergence insufficiency has a tough time doing this, which leads to eyestrain, headaches, fatigue, blurred vision and reading problems. Usually, a program of vision therapy can effectively treat CI and reduce or eliminate these problems. Sometimes, special reading glasses can also help.                        

My son is 5 years old and has 20/40 vision in both eyes. Should I be concerned, or could this improve with time?                       

Usually, 5-year-olds can see 20/25 or better. But keep in mind that visual acuity testing is a subjective matter - during the test, your child is being asked to read smaller and smaller letters on a wall chart. Sometimes, kids give up at a certain line on the chart when they can actually read smaller letters. Other times, they may say they can't read smaller letters because they want glasses. (Yes, this happens!) Also, if your son had his vision tested at a school screening (where there can be plenty of distractions), it's a good idea to schedule a comprehensive eye exam to rule out nearsightedness, astigmatism or an eye health problem that may be keeping him from having better visual acuity.                        

My daughter has been diagnosed with refractive amblyopia due to severe farsightedness in one eye. She just got her glasses, and the lens for her bad eye is much thicker than the other lens. She complains that the glasses make her dizzy, and she refuses to wear them. Can anything be done about this?                          

In situations like this, where one eye needs a much stronger correction than the other, contact lenses are a better option. With glasses, the unequal lens powers cause an unequal magnification effect, so the two eyes form images in the brain that are different in size. This can cause nausea and dizziness because the brain may not be able to blend the two separate images into a single, three-dimensional one. And, of course, the glasses will be unattractive because one lens will be much thicker than the other.                         

Even if your child is quite young, she can probably handle contact lens wear. Contact lenses don't cause the differences in image magnification that glasses do. Continuous wear lenses (worn day and night for up to 30 days, then discarded) or one-day disposable lenses may be good options.                        

Keep in mind that amblyopia is a condition where one eye doesn't see as well as the other, even with the best possible correction lens in place. Simply wearing the contacts may not improve the vision in her weak eye. Usually a program of vision therapy will also be needed.                        

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Myopia (nearsightedness) is a common vision problem affecting children who can see well up close, while distant objects are blurred. Nearsighted children tend to squint to see distant objects such as the board at school. They also tend to sit closer to the television to see it more clearly.                        

Sometimes, childhood myopia can worsen year after year. This change can be disconcerting to both children and their parents, prompting the question: "Will it ever stop? Or, will this get so bad that, someday, glasses won't help?"                             

Myopia that develops in childhood nearly always stabilizes by age 20. But by then, some kids have become very nearsighted, leading scientists to search for ways to slow down the progression of myopia in children. Four possible treatments that show promise include orthokeratology ("ortho-k"), atropine eye drops, multifocal eyeglasses, and soft multifocal contact lenses.                        

Orthokeratology                        

Orthokeratology, or "ortho-k," is the use of specially designed gas permeable contact lenses to flatten the shape of the cornea and thereby reduce or correct mild to moderate amounts of nearsightedness. The lenses are worn during sleep and removed in the morning. Though temporary eyeglasses may be required during the early stages of ortho-k, many people with low to moderate amounts of myopia can see well without glasses or contact lenses during the day after wearing the corneal reshaping lenses at night.                        

Recent research suggests ortho-k may also reduce the lengthening of the eye itself, indicating that wearing ortho-k lenses during childhood may actually cause a permanent reduction in myopia, even if the lenses are discontinued in adulthood.                        

Atropine                     

Topical atropine is a medicine used to dilate the pupil and temporarily paralyze accommodation and completely relax the eyes' focusing mechanism. Because research has suggested nearsightedness in children may be linked to focusing fatigue, investigators have looked into using atropine to disable the eye's focusing mechanism to control myopia.                         

The results of these studies have been impressive. However, additional research has shown that the myopia control effect from atropine does not continue after the first year of treatment, and that short-term use of atropine may not control nearsightedness significantly in the long run.                        

Multifocal Eyeglasses                             

Some evidence suggests wearing eyeglasses with bifocal or progressive multifocal lenses may slow the progression of nearsightedness in some children. The mechanism here appears to be that the added magnifying power in these lenses reduces focusing fatigue during reading and other close work, a problem that may contribute to increasing myopia.                        

A five-year study published in                                Investigative Ophthalmology & Visual Science           produced an interesting result involving nearsighted children whose mother and father were also nearsighted. These children, who wore eyeglasses with progressive multifocal lenses during the course of the study, had less progression of their myopia than similar children who wore eyeglasses with regular, single vision lenses.                      

Soft Multifocal Contact Lenses                       

New research shows that multifocal contact lenses also may be an effective myopia control treatment, potentially more so than multifocal eyeglasses. A recent study by researchers at Ohio State University found that wearing multifocal contact lenses reduces the rate of progression of myopia in children by 50%.                        

One potential reason why multifocal contact lenses may limit progression is that these lenses appear to reduce the lengthening of the eye, which leads to increasing myopia over time.                         

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There's no question that good vision is important for learning. Experts say more than 80% of what your child is taught in school is presented to them visually.                        

To make sure your child has the visual skills they need for school, the first step is to make sure your child has 20/20 eyesight and that any nearsightedness, farsightedness and/or astigmatism is fully corrected with glasses or contact lenses. But there are other, less obvious learning-related vision problems you should know about as well.                        

Good Vision Is More Than 20/20 Visual Acuity            

Your child can have "20/20" eyesight and still have vision problems that can affect their learning and classroom performance. Visual acuity (how well your child can see letters on a wall chart) is just one aspect of good vision, and it's not even the most important one. Many nearsighted kids may have trouble seeing the board in class, but they read exceptionally well and excel in school.                      

Other important visual skills needed for learning include:                             

Eye movement skills - How smoothly and accurately your child can move their eyes across a printed page in a textbook.       

Eye focusing abilities - How well your child can change focus from far to near and back again (for copying information from the board, for example).       

Eye teaming skills - How well your child's eyes work together as a synchronized team (to converge for proper eye alignment for reading, for example).       

Binocular vision skills - How well your child's eyes can blend visual images from both eyes into a single, three-dimensional image.       

 Visual perceptual skills - How well your child can identify and understand what he sees, judge its importance, and associate it with previous visual information stored in his brain.       

Visual-motor integration - The quality of your child's eye-hand coordination, which is important not only for sports, but also for legible handwriting and the ability to efficiently copy written information from a book or chalkboard.       

Deficiencies in any of these areas can significantly affect your child's learning ability and school performance.                         

Many Kids Have Vision Problems That Affect Learning                         

Many kids have undetected learning-related vision problems. In fact, children are often misdiagnosed with learning problems or ADD/ADHD when, in fact, they have a vision problem.                         

According to the College of Optometrists in Vision Development (COVD), one study indicates 13% of children between the ages of 9 and 13 suffer from moderate to severe convergence insufficiency (an eye teaming problem that can affect reading performance), and as many as one in four school-age children may have at least one learning-related vision problem.                        

Signs and Symptoms of Learning-Related Vision Problems          

There are many signs and symptoms of learning-related vision disorders, including:                             

• Blurred distance or near vision, particularly after reading or other close work       
• Frequent headaches or eye strain       
• Difficulty changing focus from distance to near and back       
• Double vision, especially during or after reading       
• Avoidance of reading       
• Easily distracted when reading       
• Poor reading comprehension       
• Loss of place, repetition, and/or omission of words while reading       
• Letter and word reversals       
• Poor handwriting       

Hyperactivity or impulsiveness during class       

Poor overall school performance       

If your child exhibits one or more of these signs or symptoms and is having problems in school, call us to schedule a comprehensive children's vision exam.                        

Comprehensive Children's Vision Exam           

A comprehensive children's vision exam includes tests performed in a routine eye exam, plus additional tests to detect learning-related vision problems. These extra tests may include an assessment of eye focusing, eye teaming, and eye movement abilities (also called accommodation, binocular vision, and ocular motility testing). Also, depending on the type of problems your child is having, we may recommend other testing, either in our office or with a children's vision and/or vision development specialist.                        

Vision Therapy                       

If it turns out your child has a learning-related vision problem that cannot be corrected with regular glasses or contact lenses, then special reading glasses or vision therapy may help. Vision therapy is a program of eye exercises and other activities specifically tailored for each patient to improve vision skills.                         

Vision and Learning Disabilities                       

A child who is struggling in school could have a learning-related vision problem, a learning disability or both. Vision therapy is a treatment for vision problems; it does not correct a learning disability. However, children with learning disabilities may also have vision problems that are contributing to their difficulties in the classroom.                        

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Many children have vision problems other than simple refractive errors such as nearsightedness, farsightedness and astigmatism. These "other" vision problems include amblyopia ("lazy eye"), eye alignment or eye teaming problems, focusing problems, and visual perceptual disorders. Left untreated, these non-refractive vision problems can cause eyestrain, fatigue, headaches, and learning problems.                        

What Is Vision Therapy?                      

Vision therapy (also called orthoptics or vision training) is an individualized program of eye exercises and other methods to treat non-refractive vision problems. The therapy is usually performed in an optometrist's office, but most treatment plans also include daily visual tasks and eye exercises to be performed at home.                        

Optometrists who specialize in vision therapy and the treatment of learning-related vision problems are sometimes called behavioral optometrists or developmental optometrists.                        

Can Vision Therapy Eliminate the Need for Glasses?                         

Vision therapy is NOT the same as self-help programs that claim to reduce refractive errors and the need for glasses. There is no scientific evidence that these "throw away your glasses" programs work, and most eye care specialists agree they are a hoax.                         

In contrast, vision therapy is approved by the American Optometric Association (AOA) for the treatment of non-refractive vision problems, and there are many studies that demonstrate its effectiveness.                        

The degree of success achieved with vision therapy, however, depends on a number of factors, including the type and severity of the vision problem, the patient's age and motivation, and whether the patient performs all eye exercises and visual tasks as directed. Not every vision problem can be resolved with vision therapy.                         

Vision Therapy Is Customized and Specific                      

The activities and eye exercises prescribed as part of a vision therapy program are tailored to the specific vision problem (or problems) a child has. For example, if a child has amblyopia, the therapy usually includes patching the strong eye, coupled with visual tasks or other stimulation techniques to develop better visual acuity in the weak eye. Once visual acuity is improved in the amblyopic eye, the treatment plan may then include eye teaming exercises to foster the development of clear, comfortable binocular vision to improve depth perception and reading comfort.                        

Vision Therapy and Learning Disabilities                         

Vision therapy does not correct learning disabilities. However, children with learning disabilities often have vision problems as well. Vision therapy can correct underlying vision problems that may be contributing to a child's learning problems.                         

Be sure to tell us if your child has been diagnosed with a learning disability. If we find vision problems that may be contributing to learning problems, we can communicate with your child's teachers and other specialists to explain our findings. Often, vision therapy can be a helpful component of a multidisciplinary approach to remediating learning problems.                         

Schedule a Comprehensive Eye Exam                         

If you suspect your child has a vision problem that may be affecting their performance in school, the first step is to schedule a comprehensive eye exam so we can determine if such a problem exists. If learning-related vision problems are discovered, we can then discuss with you whether a program of vision therapy would be helpful.                         

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One of the greatest moments after the birth of your baby is the first time your newborn daughter or son opens their eyes and makes eye contact with you. But don't be concerned if that doesn't happen right away.                         

The visual system of a newborn infant takes some time to develop. In the first week of life, your newborn's vision is blurry and lacks detail. In fact, newborns see only in shades of gray. It takes several months for your child's vision to develop fully.                         

Knowing the expected milestones of your baby's vision development during their first year of life can insure your child is seeing properly and enjoying their world to the fullest.                        

During Your Pregnancy               

Your child's vision development begins before birth. How you care for your own body during your pregnancy is extremely important for the development of your baby's body and mind, including their eyes and the vision centers in the brain.                         

Be sure to follow the instructions that your obstetrician (OB/GYN doctor) gives you regarding proper nutrition and the proper amount of rest during your pregnancy. And of course, avoid smoking and consuming alcohol or drugs during pregnancy, as these toxins can cause multiple problems for your baby, including serious vision problems.                        

At Birth               

At birth, your baby sees only in black and white. Nerve cells in the retina and brain that control vision are not yet fully developed. Also, newborn eyes don't have the ability to accommodate or focus on near objects. So don't be concerned if your baby doesn't seem to be focusing on your face or other objects right away. It just takes time. It may also assure you to know that, despite these limitations, studies show that within a few days after birth, infants prefer looking at an image of their mother's face over anyone else's.                        

The First Month               

Color vision develops in the first few weeks of life, so your baby is starting to see the world in full color. But visual acuity and eye teaming take a bit longer - so if your infant's eyes occasionally look unfocused or misaligned, don't worry.                        

The eyes of infants are not as sensitive to visible light as adult eyes are, but they need protection from the sun's harmful UV rays. Keep your baby's eyes shaded outdoors with a brimmed cap or some other means.                       

Months 2 and 3          

Your baby's vision is improving, and their two eyes are beginning to move better as a team. They should be following moving objects at this stage, and starting to reach for things they see. Also, infants at this stage are learning how to shift their gaze from one object to another without having to move their head.         

Months 4 to 6          

By 6 months of age, significant advances take place in the vision centers of the brain, allowing your infant to see more distinctly, and move his eyes faster and more accurately to follow moving objects. Six months of age also is an important milestone because this is when your child should have his first eye exam.                        

Visual acuity develops rapidly, improving from about 20/400 at birth to about 20/25 at six months of age. Your child's color vision should be nearly fully developed at age six months as well, enabling them to see all the colors of the rainbow with ease.                        

Children also develop better eye-hand coordination at 4 to 6 months of age. They're able to quickly locate and pick up objects, and accurately direct a bottle (and many other things) to their mouth.                        

Months 7 to 12               

Your child is now mobile, crawling about and covering more distances than you might have expected. At this age, babies are also better at judging distances and are more skilled at locating, grasping and throwing objects, too.                        

During months 7 to 12, children are developing a better awareness of their overall body and learning how to coordinate their vision with their body movements. At this time, watch them closely to keep them from harm as they explore their environment. Keep cabinets that contain cleaning supplies locked, and put a barrier in front of stairwells.                       

When It's Time for an Eye Exam             

If you suspect something is seriously wrong with your baby's eyes in their first few months of life (a bulging eye, a red eye, excessive tearing, or a constant misalignment of the eyes, for example) take your child to a pediatric ophthalmologist or other eye doctor immediately.                         

For routine eye care, the American Optometric Association (AOA) recommends you schedule your baby's first eye exam when they are six months old. Though your baby can't yet read letters on a wall chart, your optometrist can perform non-verbal testing to determine visual acuity, detect excessive or unequal amounts of nearsightedness, farsightedness and astigmatism, and evaluate eye teaming and alignment. At this exam, your doctor will also check the health of your baby's eyes, looking for anything that might interfere with normal and continuing vision development.                         

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