Should My Child Be Seen?

How early is too early for testing my child’s vision?

A newborn baby’s vision can be tested almost immediately after its birth. A baby who sees will follow a human face, especially the face of the mother. As focusing ability is not developed yet, a newborn’s vision is best at 8 to 15 inches. So feeding time provides an ideal opportunity to observe your baby’s visual attentiveness.

How can you test the vision of a baby?

It is really quite easy, although most testing will not be able to give you an actual measurement (for example, 20/20). However, a good examiner will be able to tell if vision is essentially equal in each eye. The examiner will cover one of the baby’s eyes with a hand and then observe how the baby reacts to an interesting object. This target could be the examiner’s face or a small toy, such as a brightly colored finger puppet. The baby’s attention to the target, and reaction to having each eye covered, indicates the presence and quality of vision in the tested eye. It is very important that the examiner not use a target that issues noise into the testing situation, such as a set of keys, as it then may be difficult to determine if the baby saw or heard the keys.

My child’s eye keeps tearing.

Many children are born with an underdeveloped tear-duct system, a problem that can lead to tear-duct blockage, excess tearing, and infection. Blocked tear ducts are a fairly common problem in infants; as many as one third may be born with this condition. Fortunately, more than 90% of all cases resolve by the time kids are 1 year old with little or no treatment. The earlier that blocked tear ducts are discovered, the less likely it is that infection will result or that surgery will be necessary.

How is vision tested in my 2 year old?

Once a toddler begins to talk, he/she can actively participate in the vision testing process. The Lea Pictures, Wright Pictures or Allen cards utilize familiar objects, such as a birthday cake, car, horse, train, house, circle, square or apple imprinted on plastic cards. The child is asked to identify the picture that is presented. Each eye should be tested separately, with a patch that adheres to the skin, as this is the best way to accurately determine if there is a difference in vision.

What if my child refuses to wear a patch or talk to the examiner?

Little ones may be initially resistant to having one eye covered with a patch, so the parent’s hand or a paddle occluder may be used, but the examiner must be careful to ensure that the eye not being tested remains completely covered. Young children who are too shy to speak to an unfamiliar person may prefer to participate in a matching game, where the examiner presents a picture and the child points to its match on a printed sheet of paper.

I received a notice that my 3-1/2 year old failed a vision screening twice at the preschool.

Failure on the first school screening test is not uncommon. However, if the child doesn’t pass a repeat screening, then it may indicate the presence of a vision problem. Referral to an eye care professional, such as a pediatric ophthalmologist or optometrist, is necessary to determine if a visual problem exists. Early diagnosis of a vision problem is the key to its improvement or elimination.

My child is now in kindergarten. What vision test should be used?

As the child grows older, more advanced vision tests should be used. Age-appropriate tests for a pre-school age child include the HOTV, a matching game using the four letters; the “E” game, where the child points his hand in the direction of the legs; numbers; or Snellen letters, which are considered to be the gold standard in vision testing.

What are some of the warning signs that may indicate that my baby may not be seeing well?

Back and forth movements of the eyes, no eye closure when in bright sunlight, or a lack of a consistent response to the mother’s face are “red flags” and usually mean that the baby has a problem seeing with both eyes. A transparent or white reflex in one or both pupils is not normal. An examination by a trained eye care professional is advised if any of these signs are present – your pediatrician can refer you. Early detection of any visual problem is essential, because certain conditions may be vision, or life, threatening.