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Vision Development for Kids: When should they have their Eyes Assessed?


As a parent of three kids, I know it can be hard to sift through all the information/ misinformation available to make prudent choices for our kids. When it comes to vision care, I get questions all the time, which indicates that we as eye practitioners could be doing a better job at getting the necessary information to the general public. To that end, I have gathered many of the key pieces of information that a parent, grandparent or other caregiver might need to feel comfortable making some of those decisions, such as when to have a first eye exam or how to recognize indications of vision problems at different ages.

Vision development is a great place to start. Here is a timeline to consider:

Birth to 24 months:
Babies are not born with a fully developed visual system, and they actually learn to see over time. They must learn how to focus, use their eyes together as a team and even how to use the visual information they are receiving. Eye and vision problems at this stage, although uncommon, can cause developmental delays, so schedule their first eye exam between 6 and 8 months of age. Initially, an infant’s eyes are not well coordinated, so intermittent wandering/ crossed eyes can be normal for the first few months. If, however, it is constant or still happening frequently by three months, have an assessment.
A few other important signs of visual problems include excessive tearing, extreme light sensitivity and, very rarely, the appearance of a white pupil. The full range of colors and depth perception won’t be available for them until around the fourth to fifth month. A general timeline of visual development might include following high-contrast targets within 8 to12 inches by 2 months, batting nearby targets at 3 months and beginning to reach and grab around 4 months. From 9 to 12 months, they should be able to judge distances fairly well and be grasping things with thumb and forefinger. By 24 months, hand-eye coordination should be well developed, as should depth perception. Remember, most babies’ visual systems develop without complication, but if you notice anything mentioned or something else that concerns you, bring them in immediately to be assessed.

From ages 2 to 5: Visual development continues with ongoing refinement of the abilities gained during infancy. They are developing fine motor skills, hand-eye coordination and perceptual abilities necessary to be able to succeed in school and beyond. Approximately 25% of preschoolers have a vision problem, yet many go undiagnosed—some with long-term consequences. With visual development ongoing, anything that interferes with this process has the potential to create Amblyopia (in which vision is blurry, usually in one eye, and is not correctable with glasses). Eye coordination issues can also present during this period. One of the most common is Crossed eyes— the eyes do not work together and can be constant or intermittent. Amblyopia can develop from crossed eyes but can also develop without noticeable signs, making it harder for a parent to identify.
With no evidence of visual problems, minimum recommended eye exams would be at 3 and 5 years of age. I advocate for annual assessment in my practice through this developmental period since it is such a crucial period in that problems can be elusive and in many cases have better outcomes if managed early. Some important signs for parents to watch for that might indicate a visual problem include frequent eye rubbing, short attention span, light sensitivity, avoidance of detailed visual tasks (i.e. puzzles), frequent head tilting, squinting or consistently sitting too close to the TV or holding books to close. In addition, pay attention for delays in development that may indicate a vision problem (i.e. delays in recognition of numbers, shapes, letters or colors). If any of these signs are present or if you suspect a vision problem might be present, be conservative, and book an appointment. It is also very important to realize that a vision screening is not an eye exam. Screenings done at school or even screenings at the pediatrician/family doctor’s practice can uncover some vision problems, but they can miss more than they find. This is a concern about vision screening programs, which in some cases create a false sense of security and can delay diagnosis. The solution is simple: include regular eye exams by your optometrist or ophthalmologist to protect your kid’s eye health and visual development.

School Aged Vision: age 6 through teens: One of the most important things to remember is that vision is much more than visual acuity (seeing 20/20 on a chart). Your child’s eyes need to track/follow, work as a team and focus at different distances, which in turn leads to visual perception and related hand-eye coordination. Even small deficiencies can affect school performance, especially as the school years pass and visual demand increases. We estimate as much as 80% of learning is visual, let alone our vision’s role in everyday life tasks, sports etc. It is estimated that 25% of school aged children have a visual problem that if left untreated can affect learning ability and so much more. Signs of vision problems for this group can mirror many of those for the preschoolers but should be expanded to include frequent headaches or complaints of tired eyes, poor comprehension/memory of reading material and/or poor reading ability in general (including losing their place when reading). Exam-frequency recommendations for this group without vision problems is every 2 years or as per your eye doctor’s recommendations if an eye problem exists (i.e. annually if your child is near sighted and needs glasses/contacts).

Learning disabilities
are another concern to discuss that tie into visual development. Approximately 4 to 5% of school age kids have a learning disability. Although this is not a vision problem, it has been shown that kids with certain visual problems were significantly more likely to be diagnosed with a learning disability and/or ADHD. Although the exact relationship between the two is unclear, ensuring proper visual development and managing any visual problems if a diagnosis has been given as part a multidisciplinary treatment makes logical sense.
In closing, remember this: if identified early and managed, most eye problems can be solved. The first step is to educate yourself and bring your kids in for routine assessments. If you have questions or concerns, we are always here to help.

Dr. Peter Roed

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