Here’s What You Really Need to Know about Eye Exams for Children…

Everything You Need to Know about Eye Exams for Children :: Part 1 | Houston Moms Blog

My Story ::

I had my first real eye exam at the age of six and a half. Up to that point, the fact that my right eye sometimes turned in was normal to my family. I found it difficult to focus on tasks like reading and writing, and this was dismissed as having a short attention span and overactive tendencies by teachers. I became the kid who was disruptive, unable to focus, and who did poorly on standardized tests. My parents were baffled. They had spent 6 years with a precocious child who loved to learn … and something wasn’t adding up.

I tentatively entered first grade full of adult anxiety of “not living up to my potential” and dreading isolated nap times so I didn’t disrupt others {in hindsight that actually just is a me thing}. Within two days, my new teacher kindly suggested to my parents that I needed an eye exam. In her opinion, although we had regular screeners at school, there were other eye conditions that may have been limiting my success. Sure enough, every “issue” I had was easily resolved with that eye exam! Life changing is the only way it can be described, and it isn’t too surprising that I became an eye doctor myself! I’m thankful to be surrounded by many experts in the field of pediatric optometry, and I had some questions for Dr. Suzanne Wickum, Clinical Professor at the University of Houston College of Optometry

Interview with Dr. Suzanne Wickum ::

*Suzanne Wickum is an OD and Clinical Professor at University of Houston College of Optometry where she specializes pediatrics, special needs, and traumatic brain injury patients for over 20 years.

Hi Dr. Wickum – thanks for taking time to talk to me today! I know that 80% of learning is visual, so when should parents consider getting their child’s first eye exam? Do they need to go somewhere special?

I usually tell families to schedule their child’s first eye exam around 8 months of age, as we can do a lot of testing at that age and much of the visual system has developed by then too.  However, if there is any concern about poor vision, an eye turn, a family history of serious eye disease/tumor, etc. then bring the baby in earlier.  We can start exams as soon as an infant is born if need be.  {A good resource is the American Optometric Association.}

If a patient is school age and never had an eye exam before, then most optometrists would be able to examine the child.  If the patient is an infant, toddler, or preschooler, you may need to find a pediatric optometrist or ophthalmologist or at least ask the office you call if the doctor examines young children.

Can you explain how a full eye exam is different than a screening at school? As a practicing optometrist I know most screeners just consist of reading letters on a chart – what else happens in the full exam?

In children, including infants/toddlers/preschoolers, we evaluate the same things that we evaluate in adults, but we go about it differently.  We use objective testing, rather than subjective testing, meaning that we don’t necessarily need verbal input from the patients to do our testing.  We assess the visual acuity {how well the child sees}, the refractive error {the power of the eyes which determines if glasses/contact lenses are needed}, the binocular status {eye teaming skills}, the accommodation {focusing skills}, the ocular motility {how well the eyes move}, the ocular health {are there any eye diseases}, and here at the University Eye Institute Pediatrics/Binocular Vision Service we also screen the patient’s developmental status and/or perceptual skills development which can relate back to their school performance.

Okay, so say a parent says “I’ve noticed my child’s eye turning in or out on occasion. Is that a problem?”

During the first couple months of life, babies can make some unusual eye movements due to the eyes not being well coordinated yet.  If there are brief moments of inconsistent eye misalignment during the first couple of months of life, it’s probably not of concern.  If, however, there is a consistent direction to the eye turn and the eye turn frequency increases over time or is constant, this needs to be addressed.  The sooner eye misalignment can be diagnosed and treated the better the long-term outcome for the child.  If an eye turn becomes constant during the early developmental years. it can lead to a loss of 3-D vision as well as lead to amblyopia {“lazy eye”} meaning that one eye does not see as clearly as the other, despite wearing glasses.  So, I would say it’s better to err on the side of caution and have your child examined if there is any concern of abnormal eye alignment.

What are some other findings from typical children in eye exams?

  • Studies estimate that 1 in 5 preschool children have vision problems.
  • In the US, about 1 in 4 school-age children wear glasses and/or contact lenses.
  • Amblyopia {lazy eye} prevalence is approximately 2.5% in the general population.
  • Strabismus {eye turn} prevalence in the general population is between 2.5-4.6%.
  • Convergence insufficiency {reduced ability to pull they eyes inward at near} affects just over 8% of school-aged children.
  • Convergence excess {pulling the eyes in too much at near} affects about 7% of children.
  • Accommodative {focusing at near} disorders affect about 5% of children.
  • Color deficiency occurs in approximately 8% of white males but only 2-2.5% of Hispanic, African American, and Asian males, but less than 0.4% of females in all ethnic groups.
  • Many educational activities include color coding which must be modified for children with color deficiencies.
  • Other types of ocular diseases are relatively rare in children in general, but if present, can be very serious {cataract, retinoblastoma, pediatric glaucoma, optic nerve hypoplasia, retinopathy of prematurity, etc}.
  • Children with disabilities tend to have a higher prevalence of vision disorders.

 Any other final thoughts for parents regarding their children’s vision?

It’s good for parents to remember that just because their child “passes” a school vision screening does not mean they are without ocular/visual anomalies.

Signs/symptoms of reduced vision would include :: getting close to items to view them, squinting, excessive blinking, frequent eye rubbing, headaches.

Signs/symptoms of eye coordination and/or focusing problems include :: eyestrain, headaches with near work, blurred vision, double vision, sleepiness, trouble concentrating, movement of print when reading, loss of place when reading, loss of comprehension over time, avoidance of near work, watery eyes, closing/covering one eye to do near work.

Thank you to Dr. Wickum for taking the time out to answer these questions and for giving my daughter M her very first eye exam at 7 months!

Everything You Need to Know about Eye Exams for Children:: Part 1 | Houston Moms Blog

Everything You Need to Know about Eye Exams for Children:: Part 1 | Houston Moms Blog

Currently University of Houston College of Optometry is doing research on children and eye exams. Here is the link for the CB43 study with Dr. Ruth Manny offering a FREE eye exam to children under the age of 3!

Next month we will discuss treatments for common eye conditions {including my personal experience} and what new research suggests to slow down the progression of nearsightedness!

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Ana T
Ana T. enjoys sharing her life observations with a healthy dose of humor as she navigates life with her pint size sassy sidekick M {November 2014}. She comes from a loving, loud Croatian family raised in Cleveland, Ohio. In 2008 she made the jump to Houston where she full time practices and teaches optometry. 2014 - 2015 was a blur of survival for her: difficulty conceiving, a rough pregnancy, a seemingly happy marriage shattered in a Lifetime Story–esque way. Being alone as full-time single parent/career woman with a newborn living miles away from her family definitely wasn't the plan. Despite all this, Ana T. and M are tearing up play spots, eating their way through town, traveling all over, and THRIVING. Ana T. is into trying out and laughing at fitness fads, ridiculous Facebook statusing, and at 34 still searching for ANY craft she could have a smidgeon of talent in {currently it’s knitting… stay tuned}.


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