Reader note: This is Part 2 of the Kids and Vision Screening series. Part 1 on the obstacles to kids receiving vision screenings can be read here. Come back next week for Part 3
True or false.
A child’s vision can’t be tested until the child is old enough to read from a chart and answer a doctor’s questions.
FALSE.
According to the American Optometric Association, starting around 6 months, babies can be examined for things like
- excessive or unequal amounts of nearsightedness, farsightedness, or astigmatism
- eye movement ability
- eye health problems.
Even as early as birth, children can begin to receive treatment for eye issues. For example, nurses apply erythromycin ointment to prevent ophthalmia neonatorum (ON), an infection caused by viruses. In the 19th century, untreated ON causes blindness.
Medical treatments aside, parents watch for typical infant behavioral development like if the baby follows objects with the eyes and grabs for toys. It’s not always obvious when a baby has vision issues though.
My friend, who is a physical therapist, said her family didn’t notice anything of concern with her second child’s infancy. When he reached 9 months of age, he received a well baby check at the family doctor who, “noticed a difference in reactions with a visual reflex test…and referred us to a pediatric ophthalmologist.” They were slightly skeptical, but followed up with the specialist who confirmed the family doctor’s suspicion.
The child has a difference in acuity, one eye is stronger than the other, and doctors believe the weaker eye developments better with early diagnosis and treatment. In this case, with glasses. My friend’s son was fitted for glasses before he turned one. She reports they are “MiraFlex. They are plastic with a band that goes around the nape of the neck…they need “wrapped” overnight to ensure they do not lose their shape, but this is not a problem.”
The styles vary. She says, “they come in many colors and sizes for infants through to teenagers, and I think they are pretty popular with young kids, or kids with medical/behavioral issues who may have a more difficult time with standard frames–for example, throwing and breaking frames during tantrums, falling down while learning to walk, during seizures. At some point I am sure we will transition him to standard glasses but so far they have worked well for an active kid who climbs, crashes, runs, and otherwise might not be able to keep regular glasses on himself.”
A toddler doesn’t know of our culture’s biases towards glasses-wearers. They know lenses as a tool to see the world more clearly. When I received my first pair at age 18 months, I saw a whole new world with them on like my friend’s son. Except perhaps when a child starts teething. As she admits, “we got him new glasses after about a year, because he had teethed and put the glasses in his mouth at one point (or more) in the car and they were scratched.” He found a soothing solution within reach, just not the least expensive one. Clever kid.
What did the family doctor do to catch the child’s vision issue? He conducted a Red Reflex test. The NIH explains it’s the examination of pupil reflections using an ophthalmoscope in a dimly lit room. The doctor compares the light that reflects back as a child stares into the scope one eye at a time. Now, I know many people tote a bunch of stuff along with them wherever they go, but I doubt an ophthalmoscope is one of the items at the bottom of a diaper bag. The formal diagnosis must be left to the professionals.
And yet, noticing an eye problem could be one click away. Do you have a smartphone with a flash? Have you ever noticed when people in photos have shiny red eyes? That’s light reflecting off the retina in the back of the eye. In th 90s, I remember when personal cameras featured settings called red eye reduction. In healthy eyes, red light is reflected. In a photo taken with flash photography, when only one eye is reflecting red, there may be an issue. Mind you, it depends on things like the location of light sources, where person is looking, etc., so a false positive can occur. But it’s neat to understand why sometimes people reveal red eyes in pictures. Who knew a simple photograph could alert you to a vision issue?
If you suspect a vision issue, whether it’s due to a child’s behavioral development or you notice a difference in a red reflex, follow up with your eye doctor. A friend of mine encourages parents, “to advocate advocate advocate for your children! Doctors don’t know our children the way we do and they could miss things…if we feel like something is off, it’s important that we go with our gut and pursue it!”
Furthermore, if a friend tells you they think their child may have a vision issue, support them. As my friend who teaches homeschool classes told me, “I was talking just this past Monday with a mom about vision screenings and she has noticed her son holding books very close and squinting while looking at the pages. She mentioned that she will be getting him an appointment soon.”
Have you noticed unusual behaviors from the children in your life? Did you already know what the red reflex is? Have you ever notice one red eye in a photo of a loved one? Do you hate staring into bright lights, too? Tell me about it.
Coming next week in Part 3 of the Kids and Vision Screenings series, I’ll share symptoms of vision issues in children as well as where to find affordable vision screenings and more comprehensive exams.
Adventures in Low Vision 
Right on! I had my first eye exam at two months. I had my first glasses before I was two.
That’s great!
I didn’t get my first pair of eyeglasses until I was eight but if I remember correctly I could see okay before that. I think my vision went south around six years old. I didn’t wear them full time because I didn’t want to be teased. I think I didn’t do that until it was impossible to see the blackboard at all. I had a friend that would read it to me and one day she failed to show up at school and it was clear to my teachers that I couldn’t see well.
The lengths we go to blend in and avoid being teased can be pretty far. Our differences can make us resourceful!