When should a child have their first eye exam?

The first eye exam should really occur in the nursery shortly after the child is born. A pediatrician will look for the red reflex, the normal red glow that the eye has, with an ophthalmoscope. That screens for the most serious, early onset vision problems. The pediatrician will also check that red reflex at well-child visits and will check a number vision: a 20/20, 20/30-type vision, usually around the time the child is three. Then they can have a full routine eye exam, usually before starting school.

We often hear people tell a child they have eyes just like one of their parents. Is eyesight inherited or genetically linked, just like eye color?

That's a good question. It's not just like eye color because eye color has a very predictable way of being inherited. But everything is genetic and your eyesight, if you mean by that whether you need glasses or not, is a complex combination of a number of different genes that you inherit from both parents. Usually kids' eyes are not exactly like either parent as far as their size and shape, and that's what determines whether you need glasses or not. But, suffice it to say that if one or both parents needs glasses, the chance that a child will need glasses goes up several times, although it's not 100 percent. If either or both parents wear glasses, then kids should be followed more closely. Also, there are some genetic eye problems like retinitis pigmentosa and congenital cataracts that are heritable and definitely run in families. Any time there's an eye disorder in the family, kids should be followed from an early age.

Are there signs a parent should watch for that might signal their child is having a hard time seeing? What are they?

Yes, often kids, even before they can express it in words, will rub their eyes, have frequent blinking, squint, an eye will drift outward or cross inward. All of these can be signs that children are having trouble seeing.

Are there signs a teacher might look for in their classroom? What are they?

Often kids may not want to read for long periods of time or may fidget or fuss when they're reading. That has to be carefully evaluated because that can be signs of other things like dyslexia or learning problems. Teachers may also notice that children cover one eye when they're reading, or hold things very close, or squint, or blink their eyes a lot. A lot of the same things parents might notice but even more so in school.

If a child is loosing interest in classes or becoming frustrated with school, is their eyesight something parents should consider checking?

Vision problems should always be ruled out in that situation. A lot of times it's other things that are contributing to that, but certainly if you have a vision problem, that's going to make any other issues even more pronounced. So they should always start with an eye evaluation to rule that out.

How are a child's eyes tested for vision problems?

Adults wonder that because when an adult goes for an eye exam you're asked a lot of questions—is this better; which is better, one or two. We have a lot of objective ways of measuring kids' vision, both what they see and what their prescription is, whether they have any anatomic problems, whether their eyes are formed properly. They don't really have to participate in any way as far as talking. A lot of it seems like a game to them because we use a lot of toys and other things that just seem like they're playing. Even in kids who can't talk yet, we can get a very accurate exam and measure whether they need glasses. The older the child is, the more we do ask them for some input on how things look or what they're seeing. Then we can test more complex things like depth perception and things like that.

How often should a child have their eyes tested?

It depends on different factors:

• Age
• Family history
• An abnormal exam in the past

It's an individual thing for each child.

Is the treatment for children with vision problems always glasses?

No, it depends on what the vision problem is. Age is a big factor. Kids can be born with cataracts, for example, and those have to be removed before three months of age in order for them to get any vision back. There are other problems where the treatment is glasses. There are other problems where the treatment is surgery. There's a very wide range of vision problems that can affect kids and what the treatment is.

If left untreated and the child has a vision problem, how might that reflect on their grades in school or even their ability to do well in sports?

Children's eyes are very different from adults in that children can get amblyopia and that means if they have an untreated vision problem before the age of nine, the brain can basically disconnect with one or both eyes and the vision can never be brought back to normal. That can affect their depth perception, which of course can have an effect on some sports. It can affect their ability to see comfortably and see well in school; and eventually can even affect getting a driver's license. So in kids, there really is a time factor if they have an eye problem.

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University of Iowa Children's Hospital

According to Prevent Blindness America