When should my child have his/her first eye exam?
This is probably one of the most common questions I receive. First it is helpful to understand how vision develops:
Newborn to 6 months: infants should start tracking objects, responding to visual stimuli, and making eye contact during this time. Occasional misalignment (crossing or wandering) may be normal during this time, but should not be constant and should improve over time. Infants may also have some tearing or crusting on their eyelids due to a blocked tear duct—this should improve spontaneously but if it is excessive the pediatrician should be consulted. Any anatomic abnormalities of the eye—droopy eyelid, cloudy appearance to the eyes, abnormal eye movements—should be examined by a pediatric ophthalmologist (a medical doctor or MD who is trained in both ophthalmology and pediatric ophthalmology). Children who were born prematurely especially earlier than 30 weeks are at much higher risk of developing visual problems and should be referred to a pediatric ophthalmologist for a baseline exam.
6-12 months: infant should be visually engaged, following well with his/her eyes, responding to lights and brightly colored toys; misalignment should not be seen. Persistent tearing or discharge may require consultation with a pediatric ophthalmologist.
1-4 years: child should have a pediatric ophthalmologic exam if any of the following are noticed: Misalignment of the eyes (strabismus); closing one eye frequently or covering one eye with a hand; holding objects close to the face; excessive blinking/squinting; abnormal screen by the pediatrician (poor red reflex or difficult reading the eye chart in older children); strong family history of strabismus, amblyopia (lazy eye), or early glasses wear.
5 years + : In Maryland, all children should receive a vision screening exam in their first year of entry into school and again in 1st grade , and 8th or 9th grade. Children who complain of difficulty seeing in school should have a complete ophthalmologic examination. Children who are struggling in school or who suffer from headaches are often referred to a pediatric ophthalmologist as well to rule out a visual cause.
At any time a parent or pediatrician suspects a problem, the child should be evaluated regardless of age. Otherwise, the child should be screened regularly by the pediatrician and the schools and referred if there are any issues. Parents are most familiar with their own children and are often the first to detect a problem. If you suspect your child is having any difficulty seeing or any other eye problem, then a full pediatric ophthalmologic examination should be performed. Most pediatric eye disorders respond best when treated early, so age 3-4 years would be ideal for a first routine examination.