What to Expect at Your Child’s Eye Exam

A lot of essential development happens as your child grows up, including eyesight. Your child gets vision screenings at well visits and eventually at school. But these tests aren’t complete exams and can miss possible eye problems.

“We need to pick up on anything that’s potentially harmful to children’s vision early on in life,” emphasizes Melanie Kazlas, MD. As a Mass General Brigham pediatric ophthalmologist (eye specialist), Dr. Kazlas helps prevent lifelong vision problems in children. She treats patients at Mass Eye and Ear.

When should your child have an eye exam?

“Most kids should have their first eye exam with a pediatric eye care provider between ages 3 and 5, and then once every 2 years,” says Dr. Kazlas. This age range gives eye doctors enough time to identify and treat eye problems before they become permanent.

But you can schedule an appointment at any age for your child, even as a baby or a 2-year-old. You should get an eye exam for your child earlier if:

• You have concerns about your child’s vision.
• Your child fails their vision screening at pediatrician checkups or school.
• Your child was born prematurely (at 32 weeks or less of gestation), which increases the risk for eye problems.
• You have a family history of eye problems in childhood, such as strabismus (crossed eyes), amblyopia (blurry vision in one eye), or the need for glasses.

Signs of eye problems in children

Your child can’t always tell you if something’s wrong, especially as a baby or young toddler. However, you can watch for early signs of eye problems.

“I call it the good Mom and Dad wisdom, where you have this gut feeling about your child,” says Dr. Kazlas. “You have to trust your instincts.”

She highlights the main reasons to see an eye specialist right away:

• Your child doesn’t make good eye contact with you or look at your face.
• Your child responds to sounds instead of things in their field of vision.
• Your child’s eyes don’t look like they’re moving together; one eye looks crossed or wanders.
• One of your child’s eyes looks larger than the other.
• One of your child’s eyelids looks droopy.
• You see a white spot in your child’s eye in photographs of them.

Tests performed at your child's eye exam

“We try to make eye exams a fun experience for kids as much as possible,” says Dr. Kazlas. “We know they can be stressful for both children and parents.”

Eye specialists tailor each visit to your child’s age and developmental stage. Dr. Kazlas involves toys, stickers, colorful lights, and cartoons in eye exams for younger children. She also uses kid-friendly names for eye tests and tools, which make the exam feel more exciting.

The doctor will check your child’s eyes for proper alignment, depth perception, and eye pressure. “We also use special lenses and instruments to look at the retina (back of the eye) and the optic nerve (which sends information from the eyes to the brain),” explains Dr. Kazlas.

"We want to identify conditions that could lead to amblyopia, or permanent blurry vision in one eye,” she emphasizes. “Amblyopia occurs in about 5% of the population, and there’s a small time frame when we can treat it.”

How do doctors test children's eyesight?

Vision tests, which check how well your child can see, are also part of a comprehensive eye exam. “We use different vision tests depending on whether the child is a baby, a toddler, a preschooler, or older,” explains Dr. Kazlas.

If your child is:

• Younger than 2 months old: Eye specialists will look at your baby’s gaze and eye movements. They will also use a flashlight to check your baby’s pupils.
• Between 2 and 4 months old: Most babies start to follow toys with their eyes at this age. Doctors will check how your child looks at toys with both eyes and with each individual eye.
• 6 months to 3 years old: Research has shown that children at this age would rather look at a black and white striped pattern than a simple gray background. Doctors use tests that include this pattern to check children’s eyesight.
• 3 to 6 years old: By this age, most kids can tell the eye doctor what they see. Matching games that use symbols and shapes help check children’s vision.
• In kindergarten or older: Once your child knows their ABCs, doctors use conventional eye charts with letters from the alphabet.

“Sometimes as children grow, their eyes change, too,” says Dr. Kazlas. “Be prepared that your child’s eyesight may differ every time we check their eyes and vision.”

Do kids need to get their eyes dilated?

The short answer is yes. “The drops let us see the structures in the back of the eye. They also allow us to accurately check for glasses,” says Dr. Kazlas. “When the pupils are dilated (enlarged), we can determine if your child is nearsighted, farsighted, or has astigmatism without your child needing to tell us anything.”

Dr. Kazlas compares the drops to getting water in your eyes in the bathtub or pool. If dilating eye drops really scare your child or cause emotional distress, ask your doctor about at-home eye drops. You can put them in your child’s eyes the night before their eye exam.

Choosing a pediatric eye doctor

When you’re ready to schedule an appointment for your child, what kind of eye specialist should you see? If your child is 10 years old or younger, Dr. Kazlas recommends going to a pediatric ophthalmologist. These medical doctors specialize in the full spectrum of eye conditions and treatments, including exams, glasses, and surgeries.

“Children’s eye problems are unique because their vision is still developing. There are specific conditions that only happen in kids,” says Dr. Kazlas. “Pediatric ophthalmologists have specialized training in children’s eyesight that goes above and beyond other eye care providers.”