Pediatric Exam

The eyes and visual system are extremely important during formative years. It’s estimated that more than 70% of learning is processed through the visual system. Additionally, approximately one in five preschool children have vision problems with one in four school-age children wearing some form of corrective lenses. Eye and vision disorders can significantly impact a child’s normal development. Early recognition is extremely important and critical to school performance, social interactions and self-esteem.

A child’s first visual assessment should be prior to the age of 1. This can be provided through the InfantSEE program developed by the American Optometric Association. Visit www.InfantSEE.org for more information.

A child’s first eye examination should be between the ages of 3 and 5 and then annually during development up to the age of 18.

Vision screenings at school and the pediatrician’s office are important but they are not a substitute for a comprehensive eye examination and often offer a false sense of security regarding the functioning of the visual system. Be alert for symptoms that may indicate your child is having difficulty seeing. Watch for any of the following in your child:

• Frequently loses their place while reading
• Avoids near work
• Holds reading materials closer than normal
• Sits closer than normal to distant objects, such as the TV or computer
• Rubs their eyes
• Complains of headaches, particularly later in the day
• Develops a head turn or tilt
• Closes or covers an eye while reading

Refractive errors such as hyperopia (far-sightedness), myopia (near-sightedness) and astigmatism are the most common causes of reduced vision in children. In children up to five years of age hyperopia has a high prevalence with a significant risk for the development of strabismus and amblyopia.

Myopia is seen more frequently as children develop during their early years, increasing in magnitude as they age. The prevalence of myopia has increased to nearly epidemic portions. Higher rates of myopia places children at risk for development retinal detachment, myopic maculopathy, and glaucoma later in life. Specific treatment options in managing myopia can significantly reduce the progression of myopia and risk of permanent vision loss.

Additional vision disorders seen in children:

Amblyopia is the leading cause of monocular vision loss in children. In amblyopia, the brain begins to favor an eye, preventing the visual fibers from developing appropriately, potentially leading to uncorrectable vision loss. Treatment of amblyopia depends on the cause and is best when diagnosed early to influence visual outcome. Diagnosis and treatment prior to the age of nine is crucial.

Strabismus is the inability of the eyes to work together, leading to an eye turning. Although strabismus can develop at any age it most commonly develops during childhood.

Oculomotor conditions such as convergence insufficiency and convergence excess are associated with symptoms such as eyestrain, headache, blurred vision, double vision, difficulty concentrating, loss of place while reading and loss of comprehension during short periods of reading.

Accommodative disorders may lead to difficulty focusing on near objects, including focusing for long periods of time and transitioning between near and far objects.

Color vision deficiency, whether inherited or acquired, often leads to difficulty discriminating color differences. The most common form of color deficiency is inherited red-green and seen in 8% of males and less than 0.5% of females. The severity of color deficiency can range from mild to severe. There is no cure for color deficiency.