Don’t Forget Your Preschooler’s Eyes!

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When is the last time you had your toddler’s eyes checked?  If you answered, “Never,” you are not alone. Many parents have not been educated on the importance of having an eye exam for their two to five year old. However, the preschool checkup is necessary to determine whether glasses are needed and to evaluate binocular vision, color vision, and ocular health – and especially to look for amblyopia (lazy eye) and strabismus (eye turn).

Evaluating Vision

A preschooler will usually not tell you if his/her vision is blurry. This is because they interpret how they see as normal and does not have a frame of reference to expect any differently. Other times, they will be able see well with one eye, but blurry with the other. The “good” eye will compensate for the “bad” eye, so they will not realize that one eye is blurred until the eye exam. If the blurred eye has a high enough prescrip­tion and is not corrected, the brain and eye will not form a strong connection, so the eye can become lazy. Once the eye becomes lazy, it will not be able to see normally even with glasses. The brain is most adaptable before the age of six, so lazy eye is easiest to treat if addressed before this age. Once the child becomes school-aged, it is much more difficult.

Your eye doctor can test two year olds by showing them two shape cards and having them point to or look at the correct shape. Three and four year olds can match pictures. Five year olds can either match or name a restricted set of let­ters. Your eye doctor can even determine your preschooler’ s glasses prescription without your preschooler stating which choice is clearer. And yes, your eye doctor MUST dilate to get an accurate prescription.

Evaluating Binocular Vision

Binocular refers to how we combine images from the right and left eye to interpret our world. Healthy binocular vision is what allows us to have depth perception. The lack of depth perception can indicate an eye turn. Some eye turns are so subtle that you cannot see it by simply looking at the child; however, it will show up on the depth perception test. Eye turns are important to catch early, because, like the eye with a high prescription, a turned eye and the brain will not form a strong connection, so the eye can become lazy. If the turned eye is treated early, you may be able to avoid lazy eye and even develop depth perception. A turned eye treated later has a worse prognosis. Your eye doctor can test depth perception by showing your child an age-appropriate stereogram (think Magic Eye). If the child has depth perception, he will look intently at the picture and may even try to grab the image popping out. These tests can even be performed on infants as young as six months.

Evaluating Color Vision

A preschooler should also have his/her color vision checked. Many teachers use color coding to help their students learn. A child who is color-blind is at a distinct disadvantage if the teacher is unaware of the color-blindness. Your eye doctor can test color vision by showing your child shapes that blend into the background for color-blind individuals. Younger children can either point to or trace the shape with their fin­gers, and older preschoolers can identify the shape.

When should I bring in my child?

The American Optometric Association recommends that the first exam be done at age one, then three, then five, and then yearly thereafter. According to the American Public Health Association, about 10% of preschoolers have an eye or vision problem. If your child is one of those 10%, you want it ad­dressed sooner rather than later.

How do I tell if something is wrong?

Many times, children will not show symptoms. However, if you observe any of the following signs or symptoms, your child may have a vision problem:

  • Sitting abnormally close to the TV or holding reading material too close
  • Closing or covering an eye
  • Complaining of blurred vision, eyestrain, or headaches
  • Squinting
  • Tilting their head
  • Rubbing their eyes often
  • Inattentiveness or requiring breaks more often than is age appropriate
  • Turning in or out of an eye, even if it only happens occasionally
  • Clumsiness – lack of eye, hand, and body coordination
  • Avoiding detailed activities

If you observe any of the below symptoms, your child may have an infection or ocular disease, so contact your eye doc­tor immediately:

  • Red, swollen, or encrusted eye or lid
  • Excessive watering
  • Extreme sensitivity to light
  • White pupil

How can I make the most of my preschooler’s eye appointment?

Schedule your preschooler’s appointment when he/she is the most alert and the least hungry. Usually morning appointments are better. Don’t schedule an appointment for another family member on the same day; otherwise, your preschooler’ s atten­tion span will be used up and your doctor will have difficulty getting good results. Schedule the appointment when you are not in a rush. Young children having varying levels of coop­eration that require more time. Talk to your child in advance about dilation, so they won’t be scared during the exam. Bring a few small toys with you to the exam. Your doctor can incorporate them into the eye exam. Together, you and your eye doctor can give your preschooler a positive experience that will set the stage for healthy vision and eye health for years to come.

Picture of Lisa Januskey

Lisa Januskey

Dr. Januskey '02 is the owner and developmental optometrist at Precision Eye Care. Her goal is to provide others with the eye health and vision they need to be successful and improve the lives of others. She especially enjoys treating binocular vision disorders and pediatric optometry.