We often hear the question “Does my child need an eye exam?” The US Preventive Services Task Force (USPSTF) just released a statement recommending that children 3 to 5 years of age should undergo a vision screening at least once to detect amblyopia (“lazy eye”) or its risk factors. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) has a more extensive set of guidelines for vision screening from newborns to children 5 years of age and older. Click here for the AAPOS recommendations. Many doctors (pediatricians and ophthalmologists) believe that children should be referred with even more strict guidelines.
Many of the eye conditions that affect children are not obvious to parents, teachers, or to the kids themselves. Some examples of these conditions are amblyopia (“lazy eye”), strabismus (eye crossing/wandering), increased optic nerve cupping (resulting in suspicion for glaucoma), and inflammation inside the eye due to an underlying systemic autoimmune or inflammatory condition.
Any child with a family history of amblyopia, strabismus, glaucoma (at a young age), or any other hereditary eye disease should undergo a baseline eye exam by age 3 to 5 years. Children may need repeat eye exams anywhere from every few months to every 1 to 2 years to monitor response to treatments or for any changes depending on what the preliminary eye exam reveals.
Certain medical conditions and genetic syndromes can also affect the health of a child’s eye just as they can affect the adult eye. For example, any child with diabetes should undergo a dilated eye exam at least once a year. Children with Down Syndrome, autism and certain learning disorders should have a complete eye exam by a pediatric ophthalmologist at least as a baseline. Ultimately, any changes to eye health resulting from these conditions may result in permanent reduction/loss of vision if not detected early and treated appropriately.
Most children are undergoing vision screening on a regular basis at their pediatrician’s office and/or at school. Although there may not be an obvious problem with the eyes or vision at home, it is important to follow through with a recommendation to undergo a complete eye exam if the results of a vision screening are abnormal. We certainly do see false positives (and thus a normal eye exam), but any abnormality detected early and monitored closely has a higher chance of resulting in good binocular vision, healthy eyes and excellent life long vision.