Eye health is critically important for children’s development. Eye problems that are not diagnosed at an early age can lead to academic failure, social developmental delay, and permanent vision problems in later ages. Therefore, a pediatric eye examination should be performed at regular intervals, and parents should be aware of eye health issues.
In this blog post, we will cover topics such as pediatric eye examination, eye tests for infants, eye measurement values, and at-home eye examination in detail.
Table of Contents
Eye Examination in Infants
Eye examination in infants should begin from birth and be repeated at regular intervals. While newborn babies’ eyes are assessed with a basic eye screening immediately after birth, more detailed examinations should continue regularly in the following months and years. Pediatric ophthalmologists recommend that the first eye examination for infants be performed within the first 6 months after birth. These early examinations ensure the early diagnosis of congenital diseases, refractive errors, and other eye disorders that may affect eye health.
Infants’ visual development begins at birth and reaches its highest level in the first five years. Babies do not have fully clear vision when they are born, and their visual abilities mature over time. Visual skills depend on the development of nerve connections between the brain and the eyes. If there is any obstacle in this process, permanent vision problems such as lazy eye (amblyopia) may arise.
Early eye examinations performed on infants help in the early diagnosis of serious eye conditions such as strabismus, congenital cataract, lazy eye, and glaucoma (eye pressure). Eye problems diagnosed early can be corrected with appropriate treatment, and future vision loss can be prevented.
The following conditions are checked during an eye examination performed on infants:
- Congenital Cataract: Can prevent the baby from seeing clearly due to clouding of the eye lens.
- Strabismus (Eye Misalignment): A condition where the eyes are misaligned. If not treated early, permanent visual impairment may develop.
- Glaucoma (Eye Pressure): A rare disease in infants that can lead to permanent vision loss if left untreated.
- Retinopathy of Prematurity (ROP): Occurs in premature babies due to abnormal development of retinal vessels and can lead to vision loss.
- Hereditary retinal diseases
- CVI (= Central Visual Impairment): This condition, also called CVI, is especially seen in infants who are born prematurely or need to stay in intensive care for a long time after birth. It affects visual development.
Pediatric Eye Examination
Regular eye examinations from infancy ensure the early diagnosis of potential eye diseases. The answer to the question, When is a pediatric eye examination performed?, is as follows:
- At 1 year of age: The first detailed eye examination should be performed.
- At 3 years of age: Visual acuity, eye alignment, and lazy eye are evaluated.
- At 5 years of age: A pre-school vision examination must be performed.
- School age: It is recommended to visit the ophthalmologist regularly every year.
How is a Pediatric Eye Examination Performed?
The following tests are applied in a pediatric eye examination:
- Eye measurement values: Checking for myopia, hyperopia, and astigmatism.
- Vision screening test: Determining whether glasses are needed.
- Fundus examination: Evaluating the health of the retina and nerves with an eye fundus examination.
- Pediatric ophthalmologist: Checking for conditions such as lazy eye and strabismus.
Pediatric eye examinations should not be neglected, and an ophthalmologist should be visited at the specified periods.
Eye Tests in Children
Eye examination in children is very important for assessing eye health, detecting eye diseases, and starting necessary treatments in time. Refractive errors such as myopia, hyperopia, and astigmatism, as well as conditions like lazy eye (amblyopia), strabismus (eye misalignment), and retinal diseases, can cause permanent vision problems if not detected at an early age.
Regular eye examinations are recommended to protect children’s eye health. Let’s examine the tests performed to give a detailed answer to the question: How is a pediatric eye examination performed?
1. Vision Test
Children’s eyes are evaluated for refractive errors such as myopia, hyperopia, and astigmatism.
- Myopia: The child’s inability to see far clearly. It manifests with symptoms such as blurred vision of the board, sitting too close to the television, or reading books too closely.
- Hyperopia: The inability to see near objects clearly. There may be complaints of squinting or headaches during reading.
- Astigmatism: A condition that causes images to be seen blurred or distorted. The child may see objects double or blurry and experience headaches.
Vision Test Process:
- The child looks into a special machine (autorefractometer) to measure refractive errors.
- The eyes’ focusing power is determined in all children using the eye measurement test with drops (skiascopy).
- If a refractive error is detected, glasses are prescribed and followed up with regular check-ups.
2. Vision Screening Test (Glasses Need Determination Test)
Visual acuity measurement is applied to determine whether children need glasses.
- Snellen Test: Visual acuity is measured by having the child read letters or symbols from a certain distance.
- Lea Symbol Test: A test that uses shapes instead of letters for younger children.
- One Eye Test: The child is asked to read with one eye covered. This test helps determine if there is hidden lazy eye in one eye.
Vision Screening Test Process:
- The child reads letters or symbols from a certain distance.
- If the child has difficulty reading the letters, whether they need glasses is determined.
- If myopia, hyperopia, or astigmatism is detected according to the test results, glasses are recommended.
3. Fundus Examination (Eye Fundus Examination)
Fundus examination is a detailed examination performed to examine the inner part of the eye, especially the retina and the optic nerve.
- Retinal diseases and congenital eye problems are diagnosed early.
- Premature babies are used to assess retinal vessel development.
- It helps determine serious eye diseases such as glaucoma (eye pressure).
Fundus Examination Process:
- The child’s pupil is dilated with the help of drops.
- The ophthalmologist examines the internal structure of the eye in detail using a special light and lens.
- The retina, optic nerve, and intraocular vessels are evaluated, and any abnormalities are checked.
4. Eye Alignment and Strabismus Tests
Strabismus (eye misalignment) is a common eye problem in children. If left untreated, it can lead to permanent lazy eye.
- Hirschberg Test: Light is shone into the child’s eyes, and the way the light reflects in the pupil is examined. If the light reflections are not symmetrical, strabismus may be present.
- Cover Test: One eye is covered, and the movements of the other eye are observed. If the covered eye deviates when uncovered, lazy eye or strabismus may be present.
Eye Movements and Strabismus Test Processes:
- Eye movements are checked individually or together in various directions of gaze.
- If strabismus is detected, glasses, exercises to strengthen eye muscles, or surgical treatment are planned.
5. Color Blindness Test
Some children cannot distinguish colors from birth. A color blindness test is performed to detect this condition.
- Ishihara Test: Special cards with numbers in different colors are used.
- If the child cannot distinguish the numbers or shapes, color blindness may be diagnosed.
Normal Eye Measurement Values
Eye measurement values vary in children depending on their age. Normal eye measurement values in children are as follows:
| Age | Normal Refractive Error (Diopter) |
|---|---|
| 0-6 Months | Hyperopia up to +3.00 diopters is normal. |
| 1-3 Years | Hyperopia starts to decrease. |
| 3-6 Years | Eyes approach adult levels, refractive errors may be detected. |
| After 6 Years | Myopia or astigmatism is evaluated. |
If the child’s eye measurement values fall outside the normal range, early intervention may be required. Glasses may be recommended if there are signs of myopia or hyperopia.
At-Home Eye Examination
Children’s eye health is of great importance for their overall development and academic success. Vision problems that are not diagnosed early can lead to learning difficulties and challenges in social interaction. Therefore, it is necessary for parents to regularly monitor their children’s eye health and take them to an ophthalmologist at specific intervals.
However, it may not always be possible to visit an ophthalmologist. Simple at-home eye examination methods can help you detect vision problems in children early. These methods do not replace a visit to the ophthalmologist but can help you take the first step to understand if there is an issue with your child’s eye health.
How to Perform an At-Home Eye Examination?
Parents can apply the following tests to determine their children’s eye health:
1. Distance Reading Test (Visual Acuity Test)
This test is performed to determine how clearly the child can see at distant and near ranges. It is an effective method for detecting signs of myopia (inability to see far clearly) or hyperopia (inability to see near clearly).
How is the Test Performed?
- Select a text containing large letters or symbols. For example, you can use a Snellen chart or a large-print newspaper headline.
- Ask your child to read the text from a near distance (30 cm), a middle distance (1 meter), and a far distance (3-5 meters).
- If the child sees distant text blurry, it may be a sign of myopia; if they cannot see near text clearly, it may be a sign of hyperopia.
- If the child struggles to read the text or if they tilt their head or squint, an ophthalmologist should be consulted.
Note: If your child rubs their eyes during reading, blinks frequently, and complains of headaches, or struggles to see the board, these symptoms suggest a possible vision problem.
2. One Eye Test (Lazy Eye or Astigmatism Check)
This test is performed to determine whether both of the child’s eyes see at an equal level. It is beneficial for early detection of conditions like lazy eye (amblyopia).
How is the Test Performed?
- Cover the child’s right eye first, then the left eye, with their hand or a piece of paper.
Ask them to focus on a near and far object with the uncovered eye. - If conditions such as the child seeing blurry, being unable to see clearly without squinting, or struggling to focus occur when looking with a single eye, this may be a sign of lazy eye.
- If the child experiences headaches or frequently rubs their eye while looking with one eye, an ophthalmologist should be consulted.
Note: Lazy eye, if not detected and treated at an early age, can lead to permanent vision loss. Therefore, if there is a noticeable difference in the child’s ability to see with one eye, an ophthalmologist should be visited without delay.
3. Color Blindness Test (Color Perception Check)
Color blindness is a congenital condition in some children, manifesting as the inability to distinguish certain colors. Conditions such as mixing up green and red or being unable to distinguish pale colors may indicate color blindness.
How is the Test Performed?
- Select objects or toys in different colors (e.g., red, green, blue, yellow blocks).
Ask your child to name the colors. If they mix up certain colors or name them incorrectly, there may be a possibility of color blindness. - Use Ishihara color blindness test plates to check whether the child can correctly distinguish the numbers or shapes.
- If the child has difficulty distinguishing certain colors or names them incorrectly, an ophthalmologist should be consulted.
Note: Color blindness is a hereditary condition and is more common in boys. If there is a family history of color blindness, it is important to test the child at an early age.
Extra At-Home Eye Health Checks
Other eye checks that can be done at home include:
- Eye Drift or Strabismus Check: Check whether the child’s eyes are aligned when focusing on an object. If one eye drifts compared to the other, it may be a sign of strabismus.
- Habit of Blinking and Eye Rubbing: If the child frequently rubs their eyes, they may have a vision problem.
- Redness in Eyes or Sensitivity to Light: If the child shows sensitivity to light or their eyes water frequently, an ophthalmologist should be consulted.
- Habit of Head Tilting and Squinting: If the child tilts their head or squints while watching television, this may be a sign of astigmatism or a need for glasses.
- One of the most important checks is checking the light reflected from the baby’s pupil. If a yellowish-white glare is seen in the eye when light is shone, a doctor should be consulted immediately.
Is the At-Home Eye Examination Sufficient?
At-home eye tests only provide preliminary information to understand if your child has a possible vision problem. However, these tests do not replace a professional eye examination.
For the definitive diagnosis and treatment of serious conditions such as eye diseases, refractive errors, or retinal problems, an ophthalmologist should be consulted.
- Parents should visit an ophthalmologist without delay if the following symptoms are present:
- If the child frequently experiences headaches and eye strain
- If their eyes are rubbed frequently or watery
- If eye drift or strabismus is noticed
- If they watch television from up close or read books too closely
- If they squint while studying or writing
The at-home eye examination is a great way to monitor your child’s eye health and detect potential vision problems early. Thanks to simple methods like the distance reading test, one-eye test, and color blindness test, you can determine whether your child has a vision problem.
However, it should be noted that these tests are only a preliminary assessment, and children must be taken to an ophthalmologist regularly for a definitive diagnosis. Do not neglect to have an eye examination at least once a year and consult a pediatric ophthalmologist to protect your child’s eye health!
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