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Children’s Vision – FAQ’s

Q:  How often should children have their eyes examined?

A:  According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. After that, children should have a full eye examination at age 3 and again at age 5.  They need to be visually ready to learn.

Vision is a major way that we input visual information and we learn.  It is therefore important that all school-aged children have an examination yearly to identify small issues before they can adversely impact learning.

Q:  My 5-year-old daughter just had a vision screening at school and she passed. Does she still need an eye exam?

A:  Yes. A school vision screening or a vision screening at the pediatrician's office is often confused as being a full eye examination.  The two are not the same and a screening is not an eye examination.

School vision screenings are designed to detect gross vision problems or eye health problems.  Most school screenings consist of reading letters on a chart that measures distance acuity.  Typically it is done one eye at a time.  Think about where a child does most of his or her learning.  Is it at distance?  No!  It is at near, usually using two eyes.

  • When we look at distance, for example, the blackboard, the eyes are pointing straight.  When we read, the eyes have to point in (converge).
  • When we look at distance, the focusing mechanism is in its relaxed position, but when we read, at arm's length, we much physically focus the lens in the eye.  Further, when we read, we need to be able to sustain that position, meaning that we need to hold our eyes pointing in and focusing, for the duration of the reading assignment.  These are just some of the skills that we must have.  To see and read about all of the visual skills needed, click here.

A child may pass a screening at school and still have vision problems that can affect their learning and school performance. A comprehensive eye exam by an optometrist can detect vision problems a school screening may miss.  Also, a comprehensive eye exam includes an evaluation of your child's eye health, which is not part of a school vision screening.

Q:  What is Vision Therapy?

A:  Vision Therapy (at times called vision training or eye therapy) is an individualized program of building visual skills and other methods to correct vision problems that are beyond what eyeglasses can do.  Eyeglasses address nearsightedness, farsightedness and astigmatism.  Problems treated with vision therapy include amblyopia (‘lazy eye"), eye movement and alignment problems, focusing problems, and certain visual-perceptual disorders. Vision Therapy is performed in an optometrist's office, complemented by home therapy as being part of the treatment plan.

Q:  Can Vision Therapy cure learning disabilities?

A:  Vision Therapy addresses the foundation skills that make it difficult to input visual information and to learn.  It does not correct learning disabilities.  A child has difficulty learning because they also have vision issues (that may not be an eyeglass issue).  By correcting the underlying vision problems that is contributing to or making the child's difficult to learn, the child can now more easily learn because the underlying vision issue that is contributing to the child's learning problems is eliminated.

Q:  Our active 1-year-old son needs glasses to correct his farsightedness and the tendency for his eyes to cross, but he pulls them off the second they go on. We've tried an elastic band, holding his arms, tape... He just struggles and cries. How do we get him to wear his glasses?

A:  This is very common.  Most children do not like to wear something on their face.  Some might even be sensitive to wearing a hat, for example.  Some children may need to be desensitized and we can discuss the various methods when you are in the office.

At times, contact lenses are indicated, and for some, this may actually be the best option.  Many parents are surprised that contact lenses might be an option and are taken aback by the thought of inserting and removing a contact lens for a child.  Consider this; does the parent of a child with diabetes really WANT to inject their child with insulin?  Every parent has experienced the need to give medication to a child.  Most of us don't like the thought of having to do that, but it is in the best interest of your child.  Removing a splinter that is painful is not something that we like to do, but it needs to get done.  As parents, our obligation is to teach our child not to run into the middle of the road because of the potential/likely consequences.  At times, contact lenses may be the best option for vision development.  Contact lenses for adults are often about freedom from wearing glasses.  Contact lenses for children are about enabling and facilitating vision development.

It is important that the eyeglasses are made correctly and are fitting properly. Today, there are many styles of frames for young children, including some that come with an integrated elastic band to help keep them comfortably on the child's head. Please bring in the eyeglasses that had been prescribed.  Even if you had not purchased the glasses from us, we will be happy to give you our opinion about why your son is having a tough time wearing them and what you can do about it.

Q:  Our 3-year-old daughter was just diagnosed with strabismus and amblyopia. What are the percentages of a cure at this age?

A:  With proper treatment and the right type of advice, the odds are extremely good, even when surgery to “correct” the yes has not been successful.  It is common for Ophthalmologists to suggest a second or third surgery, although this is not likely to address the underlying problem.

Many doctors still believe that the visual system can only develop up to about age 8 to 10.  Research has demonstrated that the brain can learn at any age.  This applies to even adults!  The technical term for this is neural plasticity.  Surgery is rarely indicated and most often we are able to help children and adults who have an eye turn (strabismus) or amblyopia (or "lazy eye").  We have found that many pediatric ophthalmologists have given parents incorrect information about surgery and discredit Vision Therapy.  They may give suggestions such as patching, although patching has been shown not to work and is really old thinking.  Be aware that when you get the opinion of a pediatiric ophthalmologist, you are getting the opinion of someone who is expert is surgery but does not necessarily understand how the visual system develops and functions.

Q:  My daughter (age 10) is farsighted and has been wearing glasses since age two.  We think she may have problems with depth perception. How can she be tested for this, and if there is a problem, can it be treated?

A:  There are a number of tests that determine stereopsis, the ability to see in depth.  In one of these test, she wears "3-D glasses" and looks at objects in a special book or on a chart across the room. There are other ways that we can test for the ability to use the two eyes together as a team.  If she has reduced stereopsis then a program of Vision Therapy will enable her to develop depth perception.

Q:  We have an 11-year-old son who first became nearsighted when he was 7. Every year, his eyes get worse. Is there anything that can be done to prevent this?

A:  Yes!  In our office, we see many children and parents who have visited other doctors with that concern.  Gas permeable (GP) contact lenses have been demonstrated to slow or stop the progression of nearsightedness.  A special technique with GP lenses, called orthokeratology (or "ortho-k") can reverse myopia.  Correctly prescribed bifocals and/or reading glasses slow down the progression of myopia in most children, and is often the first step in starting to solve the problem.  Please see our page on orthokeratology for more information on this.

Q:  My 7-year-old son's teacher thinks he has "convergence insufficiency." What is this, and what can I do about it?

A:  Convergence Insufficiency (CI) is a common learning-related vision problem where a person's eyes don't stay comfortably aligned when they are reading or doing close work. For reading and other close-up tasks, our eyes need to be pointed slightly inward (converged). A person with convergence insufficiency has difficulty doing this.  This leads to eyestrain, headaches, fatigue, blurred vision and reading problems. The Convergence Insufficiency Treatment Trial, a study funded by the National Eye Institute, which is a part of the National Institute of Health, proved that Vision Therapy is the effective method to treat CI and reduce or eliminate these problems. At times, special reading glasses or bifocal lenses may be prescribed as well.

Q:  My son is 5 years old and has 20/40 vision in both eyes. Should I be concerned, or could this improve with time?

A:  Usually, 5-year-olds can see 20/25 or better but realize that visual acuity testing is a subjective matter and is a factor of not only the patient (child) but also the examiner’s ability to extract that information.

A child may be asked to identify letters, pictures, or special instruments that we can determine what someone’s acuity is even without having to say anything.

Some children want eyeglasses and may actually say that they cannot see even though they actually are able to

A school vision screening is not the same as an eye examination.  An eye examination tests for eye health, if eyeglasses are needed, if the two eyes are working together as a team, and if someone is able to use their visual system effectively for school and for learning.

During the comprehensive examination, the doctor does not rely only on what the child verbalizes (subjectively).  Objective measures such as manual retinoscopy, using a special instrument called an autorefractor, tests such as Monocular Estimation Method, etc. enable to doctor to determine what the acuity is, and if eyeglasses or other means are needed.

Q:  Does my child need to know their letters in order to have an examination?

A:  No.  Infant examinations, and young children examinations, as well as adults who are developmentally delayed, or who cannot speak, or have dementia, can still be evaluated, and a correct prescription determined.

Q: My daughter has been diagnosed with refractive amblyopia due to severe farsightedness in one eye. She just got her glasses and the lens for her bad eye is much thicker than the other lens. She complains that the glasses make her dizzy and she refuses to wear them. Can anything be done about this?

A: In situations like this, where one eye needs a much stronger correction than the other, contact lenses are a better option. With glasses, the unequal lens powers cause an unequal magnification effect, so the two eyes form images in the brain that are different in size. This can cause nausea and dizziness because the brain may not be able to blend the two separate images into a single, three-dimensional one. When this occurs, glasses are usually unattractive because one lens will be much thicker than the other.

Even if your child is quite young, she can probably handle contact lens wear. Contact lenses don't cause the differences in image magnification that glasses do. Continuous wear lenses (worn day and night for up to 30 days, then discarded) or one-day disposable lenses may be good options.

Keep in mind that amblyopia is a condition where one eye doesn't see as well as the other, even with the best possible correction lens in place. Simply wearing the contacts may not improve the vision in her weak eye. Usually, a program of Vision Therapy will also be needed.