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June is Child Vision Awareness Month. Taking care of a child’s vision is important for learning and social development. Below are some recommendations and tips for what to expect for your child’s first eye exam.

First exam and frequency of exams

The American Academy of Ophthalmology and the American Academy of Pediatrics recommend that children have their eyes checked starting as newborns. After that, screenings are recommended as follows:

• Newborns: In the newborn period, a pediatrician will do an eye exam to check for abnormalities or infection. Premature babies, babies with signs of eye disease or those babies with a family history of childhood eye disease may need further specialized exams by an eye doctor (ophthalmologist) during the newborn period.
   
• Birth to 6 months: Your child’s pediatrician will perform a physical exam of the eye to look at external structures of the eye, to check the pupils for an appropriate light reflex, and to look for a red reflex (light reflected through the pupil from the back of the eye) using a handheld device called an ophthalmoscope. This is the time to talk with your pediatrician about any family history of childhood vision problems.
   
• 6 months and up: Your child’s pediatrician will continue to perform external eye exams and use the ophthalmoscope as detailed above. The exam will also include checking that each of your child's eyes look at and appropriately follow a toy or face.
   
• Starting at 1 to 2 years: At this age, instrument-based screening devices may begin to be used for vision screening. These may include photoscreeners and autorefractors, computer-automated devices that use light and cameras to gauge how well your child can see.
   
• Starting at 3 years: Visual acuity screening is recommended at ages 4 and 5 years, as well as in cooperative 3-year-olds. This involves asking your child how well they can see the details of letters or symbols from a set distance.

What to Expect at a Vision Screening

Vision screening may be performed in different ways depending on your child's age. Some screenings need your child's cooperation to read or match images in an age-appropriate way. Other screenings use special tools to measure the eye position, reflection of light off the back of the eye or focus of light into the eye.

Infants and children typically have vision screening performed by their primary care doctor/pediatrician. If a comprehensive eye exam is needed, your child will be referred to an ophthalmologist.

The Difference between a Vision Screening and a Comprehensive Eye Exam

A comprehensive eye exam is performed by an eye doctor to determine if there are clear signs of eye disease. Eye drops are applied to widen the pupils of the eyes to allow for a fuller view of the internal eye structures. Instrument-based devices may be used to examine the eye as well.

References

• https://www.healthychildren.org/English/health-issues/conditions/eyes/Pages/Vision-Screenings.aspx
• https://www.aao.org/eye-health/tips-prevention/children-eye-screening
• http://pediatrics.aappublications.org/content/pediatrics/137/1/e20153596.full.pdf