Children's Pediatric Eye Care Exams at The Eye Clinic of Texas in greater Houston & Galveston.

By Allan Fradkin, M.D.

At The Eye Clinic of Texas our doctors provide children’s’ pediatric eye exams and eye care for kids of all ages for patients from throughout greater Houston and Galveston. Parents should familiarize themselves with children’s eye health and vision expectations.

At about 6 weeks of age, a baby should be able to fixate on an object (such as a face) and maintain eye contact. Over a child’s first few years, vision develops rapidly; 20/20 vision can be recorded by 2 or 3 years of age with some techniques. Parents should be aware of signals of poor vision.

If one eye “turns” or “crosses,” that eye may not see as well as the other eye and may be an indication of a vision or developmental problem. If the child is not interested in faces or age-appropriate toys, or if the eyes rove around or jiggle-called nystagmus-you should suspect poor vision. Other signs to watch for are tilting the head and squinting. Babies and toddlers compensate for poor vision rather than complain about it.

Should a baby need eyeglasses, the prescription can be determined fairly accurately by dilating the pupil and analyzing the light reflected through the pupil from the back of the eye. A baby’s vision can also be tested in a research laboratory, where the brainwaves are recorded as the child looks at patterns of stripes or checks on a television screen. This is called a visually evoked potential (VEP) test. Another test, called preferential looking or Teller acuity cards, uses simple, striped cards to attract the child’s attention. In both tests, as the stripes grow smaller and closer together, they become more difficult to see, and the child’s level of visual acuity can be assessed.

Eyeglasses for Infants & Children
Prescriptions for eyeglasses can be measured in even the youngest and most uncooperative children by using a special instrument called a retinoscope to analyze the light reflected through the pupil from the back of the eye. Most lenses for children’s eyeglasses are made of polycarbonate lens material, which is stronger and lighter than glass. It is a good idea to request a scratch-resistant coating on children’s lenses. Children can be rough with glasses and plastic lenses scratch easily. Color tints or tints that respond to changes in light can be incorporated into eyeglass lenses. For children, the tint should not be so dark that the child has trouble seeing indoors.

Frames come in all shapes and sizes. Choose one that fits comfortably but securely. There are devices that keep eyeglasses securely in place, a good idea for active children and young children with flat nasal bridges. Cable temples, which wrap around the back of the ears, are good for toddlers. Infants may require a strap across the top and back of the head instead of earpieces. Flexible hinges hold the eyeglasses in position, allow the glasses to “grow” with the child, and prevent the side arms from breakage. Often children do not like wearing their eyeglasses although the prescription is correct. Distraction, positive reinforcement, and incentives can help children develop the habit of wearing their glasses. If all else fails, we can prescribe an eye drop that blurs vision when the glasses are not in place. This often helps overcomes the child’s initial resistance to wearing glasses.

Many people are confused about the importance of eyeglasses for children. Some believe that if children wear glasses when they are young, they will not need them later. Others think that wearing glasses as a child makes one dependent on them later. Neither is true. Some children need glasses because they are genetically nearsighted, farsighted, or astigmatic. These conditions generally do not go away nor do they get worse because they are not corrected. For people with refractive errors, eyeglasses or contacts are necessary throughout life for good vision.

Nearsightedness (when distant objects appear blurry) typically begins between the ages of eight and fifteen but can start earlier. Farsightedness is actually normal in young children and not a problem as long as it is mild. If a child is too farsighted, vision is blurry or the eyes cross when looking closely at things. This is usually apparent around the age of two. Almost everyone has some amount of astigmatism (oval instead of round cornea). Eyeglasses are required only if the astigmatism is strong.

Unlike adults, children who need glasses may develop a second problem, called amblyopia or lazy eye. Amblyopia means even with the right prescription, one eye (or sometimes both eyes) does not see normally. Amblyopia is more likely to occur if the prescription needed to correct one eye is stronger than the other or if the prescription in both eyes is very strong. Wearing eyeglasses can prevent amblyopia from developing or may treat amblyopia if already present.

Children (and adults) who do not see well with one eye because of amblyopia, or because of any other medical problem that cannot be corrected, should wear safety glasses to protect the normal eye.

Child Eye Safety
Accidents resulting in serious eye injury can happen to anyone, but are particularly common in children and young adults. More than 90% of all eye injuries can be prevented with appropriate supervision and protective eyewear. Goggles and face protection can prevent injuries in sports like baseball, basketball, racket sports, and hockey. It is more difficult to protect against injuries in boxing, although thumbless gloves help.

Children with vision loss in one eye should wear polycarbonate safety glasses all the time and should wear safety goggles for sports and other dangerous activities. Choose frames and lenses that meet the American National Standards Institute (ANSI) standard for safety (Z87.1).

Appropriate adult supervision is an essential part of preventing eye injuries. Children should never be allowed to play with fireworks or BB guns. Sharp and fast-moving objects such as darts, arrows, scissors, knives, and even pencils or pens can be dangerous. Special care should be taken when working around lawn mowers, which can throw rocks and debris, and when banging two pieces of metal together, which can dislodge small shards of metal. Chemicals such as toilet cleaners and drain openers are especially hazardous.

A primary care physician or an emergency room physician can treat minor injuries, such as a foreign body or an abrasion (scratch) on the cornea. Any foreign material will be removed from the eye, an antibiotic eye drop or ointment may be used, and an eye patch may be applied for comfort. More serious injuries, such as blood inside the eye (hyphema), a laceration (cut) of the eye, or rupture of the eye, require examination by an ophthalmologist. Both surgery and hospitalization may be necessary.

Chemicals that burn should be rinsed from the eye immediately. Chemical burns can cause severe damage, so eyes should be flushed immediately. If sterile solutions or eyewashes are readily available, use them to flush the affected eye. If not, flush the eye with liberal amounts of water from the nearest sink, shower, or hose for ten minutes. Be sure water is getting under both the upper and lower eyelids. After they eyes have been flushed for ten minutes, bring the child to the emergency room immediately. The ultimate visual outcome after a chemical burn depends on the severity of the injury, which cannot always be identified in the initial examination.