Patient guide
Children's eye exams: what happens, and why a school screening is not enough
Call the same day for an eye that has newly started to turn, new double vision, a white or unusual glow in the pupil in flash photos, an eye injury, or a red, painful eye. Call (609) 246-0236. If the office is closed, or you cannot reach us, go to a hospital emergency room — most have an ophthalmologist on call.
A child does not know what normal vision looks like. A child who has always seen a blurred board, or who has one eye doing all the work, assumes everyone does. They rarely complain, and they can pass a school screening with a real problem present. That is why eye care groups recommend a full exam before school starts and every year through school, not just when something seems wrong.
We examine children from age five. This guide covers what the exam involves, how it differs from a screening, the signs worth a visit, and the two problems of childhood that are best caught early.
A screening is not an exam
A school or pediatrician screening checks whether a child can read a chart at a distance, and sometimes how the eyes line up. It is a useful net and it catches many children. It misses the ones it is not designed to find: a child who is farsighted and focuses hard enough to read the chart but tires and gets headaches with reading; a child with astigmatism; a child whose eyes do not work together; and most importantly, a child with one weak eye who reads the chart with the good one.
An exam measures each eye separately and under conditions the child cannot compensate for, checks how the eyes focus and move together, and looks at the health of the eye itself. It finds what the screening is built to miss.
When to bring a child
- 6 to 12 months
- A first assessment, with a pediatric optometrist. The InfantSEE program, run by the American Optometric Association, provides one at no cost.
- 3 to 5 years
- At least one exam, with a practice set up for children who cannot yet read letters.
- Before first grade, then every year
- This is where we come in. From age five, a full exam before school and yearly through the school years, because the eye and the prescription change as the child grows.
- Any age, for a reason
- Any of the signs below, a family history of lazy eye, an eye turn or strong glasses, a premature birth, or a condition such as Down syndrome.
For a child under five, a pediatric optometrist or pediatric ophthalmologist has the tests and the patience the age needs, and we will say so rather than do a poor job of it.
Signs that are worth a visit
- Squinting, tilting the head, or covering one eye to look at something.
- Sitting very close to the television or holding books and screens close.
- An eye that drifts in or out, especially when tired or daydreaming.
- Headaches or tired eyes after school or reading, or avoiding reading altogether.
- Losing the place while reading, or skipping lines.
- Rubbing the eyes a great deal, light sensitivity, or watery eyes.
- Strong objection when one particular eye is covered, as in a game.
- Falling behind at school in a way that does not fit the child.
Often there are no signs at all. That is the case for a yearly exam rather than waiting for one.
What happens at the exam
It is paced for a child and takes about forty-five minutes. Nothing hurts.
- History. Birth, development, school, screens, family eye history, and anything you have noticed.
- How well each eye sees, with letters, numbers or pictures depending on age, each eye on its own.
- How the eyes work together. Covering each eye in turn to catch a drift, tracking a target, depth perception with 3D glasses, and how the eyes focus up close.
- The prescription, measured objectively with a light before the child is asked any questions, so it does not depend on their answers. In many children this is done with drops that relax the focusing muscle, because a child can focus hard enough to hide farsightedness. The drops blur near vision and make the eyes light-sensitive for the rest of the day, sometimes into the next; bring sunglasses and plan a quiet afternoon.
- Color vision, once, usually at the first exam.
- The health of the eye, front and back, including retinal imaging where the child can manage it.
You leave knowing whether glasses are needed and why, whether anything needs watching, and when to come back. If glasses are prescribed, a copy of the prescription is yours to fill anywhere.
The two problems best caught early
- Lazy eye (amblyopia). One eye never develops full sharpness because it sent a blurred or misaligned picture in early childhood. It affects up to three children in a hundred, it is invisible from the outside, and treatment works far better before about age seven than after. What it is and how it is treated.
- Nearsightedness that is increasing. A child whose prescription goes up every year has an eye growing too long, and that growth can now be slowed with special glasses, contact lenses or drops. The earlier it starts, the more it preserves. How myopia management works.
Two habits help every child's eyes: at least two hours a day outdoors in daylight, which is the best-supported protection against becoming nearsighted, and breaks from close work and screens, twenty seconds looking far away every twenty minutes.
Glasses and contact lenses for children
Children's glasses should be made in polycarbonate or Trivex, which do not shatter, with a frame that fits properly and stays put. A spare pair saves a great deal of trouble. Children adapt to new glasses faster than adults and almost never need coaxing once they can see.
Contact lenses are not about age so much as responsibility: a child who can be trusted to wash their hands, follow a routine and take a lens out when an eye is red can wear them, and daily disposables make that safest. For sport, and for myopia control, they can be the better choice. New wearers are taught insertion and removal in the office.
Common questions
My child passed the school screening. Do they still need an exam?
Yes. A screening checks a narrow thing, usually distance vision with both eyes open or each in turn, and a child with a weak eye, farsightedness or astigmatism can pass it. An exam is the test the screening is standing in for.
Will my child be dilated?
Often, at the first exam, because the drops are the only way to measure the true prescription in a child who can focus hard enough to hide it. The drops sting for a few seconds. Near vision is blurry and the eyes are light-sensitive for the rest of the day, occasionally longer with the drops used for younger children. Bring sunglasses, and do not plan on homework that evening.
Will glasses make my child dependent on them, or make their eyes worse?
No. Glasses focus the light; they do not change the eye. A child's nearsightedness tends to increase while they are growing whether or not they wear glasses, which is a reason to look at slowing it, not a reason to withhold the glasses.
Do screens damage children’s eyes?
Screens do not damage the eye. Hours of close focus, on anything, are linked to faster progression of nearsightedness, and screens are the usual way children get those hours. Breaks and outdoor time are the answer, not a filter.
Does a child’s exam go through my vision plan or my medical insurance?
A routine exam for a child usually goes through a vision plan, and many medical plans and NJ FamilyCare also cover a yearly eye exam for children. A visit for a symptom, a turned eye or lazy eye treatment is a medical visit. Vision plans cover routine eye exams and eyewear; medical plans cover conditions. Many patients carry both and are not sure which applies. Vision plan or medical insurance explains the difference, and a call with your plan details before you book sorts it out beforehand rather than afterwards.
Book your child’s exam
New patients are welcome from age five. Fill in the new patient forms beforehand, bring your insurance card, and tell your child the visit is about looking at pictures and lights, which is most of what it is.
Book an exam Call (609) 246-0236
Khoury Eye Care, Hamilton Mall, 4403 Black Horse Pike, Mays Landing.
Sources
The figures and recommendations on this page come from the following. Ask at your visit if you would like a copy of any of them.
- American Optometric Association. Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination. 2017.
- Donahue SP, Baker CN; Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Academy of Pediatrics; American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology. Procedures for the evaluation of the visual system by pediatricians. Pediatrics. 2016;137(1):e20153597.
- US Preventive Services Task Force. Vision screening in children aged 6 months to 5 years: recommendation statement. JAMA. 2017;318(9):836-844.
- American Academy of Ophthalmology. Amblyopia Preferred Practice Pattern. 2022.
- Xiong S, Sankaridurg P, Naduvilath T, et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmologica. 2017;95(6):551-566.