Does my child need glasses?

This is probably one of the most common questions I get asked by parents.

How do I know if my child has poor vision?

Usually this question is asked when the children are pre-verbal or if they can't quite yet read the eye chart. A lot of parents mistakenly think that there is no way to figure out if the infant or toddler needs glasses and that just isn't true.  As parents, there are a couple signs and symptoms you can look out for which may indicate that your child is having difficulty seeing. These might not always mean that your child needs glasses.   Sometimes, certain things can be habit (squinting or tilting the head) or sometimes they can mean your child needs glasses or has a more serious eye problem.- Squinting or tilting the head or face-Headaches- Eye crossing or drifting out (strabismus)-Closes one eye when reading-Difficulty walking or meeting developmental tasks - I had one little 9 month old girl as a patient, her parents noticed that she wasn't able to pick up her Cheerios as well as the other babies her age.  They brought her in to see me and it turned out that she had strabismus (misalignment of the eyes).  I operated on it and within a few weeks, she had taken her first steps.  Click here to read the full story of this patient.-Trouble in school.  - Your child's teacher may comment that your child is inattentive or has trouble with certain tasks.

When should my child's eyes be examined (or vision tested?)

The American Academy of Pediatrics and American Academy of Ophthalmology recommends that all children have their vision checked at the 4 year old visit at the pediatrician's office.  If your child is premature, has other medical problems, or you have noticed abnormalities, the child can be checked earlier.A lot of times, parents second guess themselves.  You know your child.  Please do not listen to anyone (doctor or otherwise) who tells you that your child is too young to have their eyes are examined.  This is simply not true.  I have caught many problems when examining young babies, because their parents (and their pediatricians) were astute enough to know that something was not right with their kid's vision.  Listen to your instincts - they are often right.So, on to the second part of the question.  You think there might be something wrong with your child's vision.  But, you child is only 1 or 2 years old -surely an exam can't be done, you wonder?  Wrong!  I can do a full and complete eye exam on almost any child and examine infants routinely.  The nice part of being a pediatric ophthalmologist is that I actually don't need the patient to really tell me too much of anything.  I can take measurements and deduce exactly what needs to be done.  So, to the second question:

 How does the eye doctor know if my child needs glasses?

Examining a child is different than examining an adult.  Obviously, I can't ask your kid "which is clearer, one or two?" and have them help me decide what glasses to prescribe.  But, there are lots of other techniques that a pediatric ophthalmologist uses to figure out what your child is seeing and how well.  The most important things I have are toys and a separate waiting room for kids with lots of things to occupy them.In the exam room, I have movies for kids to watch and lots of patience...and I'm quick.  It takes a certain personality to examine kids and those are the people who are typically pediatric ophthalmologists.   

For kids, I always perform a comprehensive eye exam.  I check vision whenever possible.  If the child does not know his letters, then I use a substitute, such as some of the charts below.

If they're too young to know their shapes, then I will use a toy and cover one eye at a time, testing to see if they follow the toy around.  I then check to make sure the eyes are straight by checking the corneal light reflex and cover/uncover test.  If the child is old enough, I will use the slit lamp to examine the anterior structures of their eye, but if they are too young, then I will use a strong light and a magnifying glass.

But, how does the doctor check what glasses prescription they need?

I dilate the pupils to relax the focusing muscles of the eye to obtain accurate measurements of refraction.  I use a special instrument, called a retinoscope and lenses of different powers, to arrive at the correct prescription.

 The nice thing is that I don't need your child to tell me if his/her vision is blurry, or if they see better with a certain lens.  This is the way I can figure out the correct glasses prescription that an infant requires. (I have given glasses to a child as young as 9 months old!).  And it also means I can tell when a child just says their vision is blurry to get glasses, but they don't really need them.  By placing the different lenses in front of the child's eye and using the retinoscope, I look for a certain reflex of light back through the pupil.  When the correct lens is in place, the reflex becomes very bright and fills the lens.

And, you might ask -

Why are kids' eyes dilated?

Children have a large accommodative amplitudes (measurement of the eye's ability to focus on near objects) and that can change the measurement of the prescription.  If a child is not dilated, then a prescription that is more myopic (minus) than necessary may mistakenly be given.  That is why it is important that the ophthalmologist or optometrist you take your chid to, should always dilate his/her eyes before determining the glasses prescription.  Click here for the handout I give all my patients regarding dilating drops in children.Dilating Drops handout

And, if your child needs glasses - don't despair.  Often, I have found that parents are more upset about the prospect of the child wearing glasses than the child is themselves.  I tell the parents to let the child choose the frames, so that they are happy with the glasses.  We have so many new great pediatric frames in our Optical Shop, that 99% of the time the child is able to find something they really like.  Almost all of the designer frames in our shop have a 2 year warranty, which is also really important with kids.    My patient below actually chose these super cute frames himself (he's 3 years old and he knew exactly what he wanted!).Bottom line, if you, your pediatrician, or your child's teacher are concerned about your child's vision, please take your child to see a pediatric ophthalmologist. There is no age too young for an examination.