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Should my baby get an eye exam?

· Happy Eyes

Did you know that eye exams start as early as day 1 of a baby's life? Vision is a key part of our ability to interact with the world, and as health care providers, we take vision screening very seriously. Before leaving the hospital, your baby will have had his or her eyes checked by the pediatrician and hospital team at least once. Your care team checks that there are no obvious abnormalities in the appearance of your baby's eyes. After leaving the hospital, your pediatrician or family practitioner then becomes the main health care professional to regularly examine your baby's eyes as part of each well-child visit. If there are any concerns, your pediatrician or family practitioner may refer you to a pediatric ophthalmologist (an eye doctor with an MD) for a closer look.

What is a pediatric ophthalmologist?

A pediatric ophthalmologist is a trained medical and surgical doctor who specializes in vision problems that affect children. In the United States, a pediatric ophthalmologist is a doctor who has completed college, medical school, a 1-year internship, 3-years of comprehensive ophthalmology training (also known as residency), and a 1-2 year fellowship specifically in pediatric ophthalmology and strabismus.

Pediatric ophthalmologists are experts in treating different eye conditions that affect children. This includes if a child has an eye misalignment (also known as 'strabismus' or 'squint'). Treatments include glasses, patching, and medications to help a child's visual system develop. Treatments may also involve complex eye surgery, which pediatric ophthalmologists are qualified to perform. Many doctors, including other ophthalmologists who do not work extensively with children, will refer their pediatric patients to a pediatric ophthalmologist for treatment because of the unique needs children have for their care. Pediatric ophthalmologists also commonly manage adults who have eye movement disorders because of their expertise in strabismus.

Here are examples of eye conditions that pediatric ophthalmologists manage and treat:

  • Refractive error (a.k.a. needing glasses for far-sightedness or near-sightedness)
  • Abnormal visual development ( a.k.a. 'lazy eye' or amblyopia)
  • Eye misalignment or movement disorders (strabismus, nystagmus)
  • Structural eye problems :
    • Retinopathy of prematurity
    • Eye cancers like retinoblastoma
    • Tumors around the eye
    • Cataracts
    • Glaucoma
    • Infections 
    • Blocked tear ducts
    • Droopy eyelids (ptosis)
  • Genetic syndromes and congenital conditions that involve the eyes
Examples of Strabismus, by . Exotropia, esotropia, hypertropia, hypotropia.

Examples of eye misalignment (strabismus).

What is normal vision?

From birth until about 2 months of age, babies may only blink to light. They will start to look at faces and start to track around 2 to 3 months of age.

From 4 months of age and onward, eye coordination continues to improve. Babies gets better at tracking objects with their eyes. Their ability to look and grasp for objects develops. During this time, babies also begin to develop depth perception. Before 4 months of age, it can be normal to have occasional crossing or drifting out of the eyes as a baby is learning to use both eyes together. By 4-6 months of age, babies should be able to use both eyes together without crossing or drifting out of the eyes. Eye-hand-body coordination develops quickly thereafter as a baby learns to crawl and then walk.

By age 3, a child should be able to read the majority of symbols on the 20/50 line of a vision chart.*

By age 4, a child should be able to read the majority of symbols on the 20/40 line.*
By age 5, a child should be able to read the majority of symbols on the 20/32 line or better.*

When should my baby be seen by a specialist for an eye exam?

Here are some situations when it may be worth considering a visit to the pediatric ophthalmologist:

  • If you are concerned that your baby's vision is not developing appropriately, if you feel he/she is not fixing/tracking or meeting the milestones outlined above, trust your parenting intuition! It doesn't hurt to have this checked out. 
  • If you have concerns for a lazy eye
  • If your baby is constantly squinting to see
  • If one or both eyes are frequently or constantly crossed in
  • If one or both eyes are frequently or constantly drifting out
  • If one eye looks like it gets stuck looking up/down
  • If your baby is constantly tilting his/her head or turning his/her face to the side when looking at objects
  • If the eyes look abnormally large or one eye is larger than the other (or other people comment that your baby's eyes are very large)
  • If one or both eyes look cloudy or white
  • If the eyes are very red and irritated
  • If one or both eyelids are always drooping
  • If you notice that the pupil (center of the eye) of one or both eyes is always white in pictures
  • If the eyes are constantly shaking/shimmering
  • If you notice a growing bump on or both eyes and you are concerned it may be affecting vision
  • If there is excess gunk around one or both eyes that has persisted up until 12 months of age and still hasn’t cleared up
  • If your baby has had a recent eye injury
  • If there is a family history of eye problems that start in childhood (like eye cancers)
  • If your baby has a genetic condition and your pediatrician wants an eye exam to check if your baby's eyes are also involved
  • If your baby was born premature
  • If your child failed a vision screen at your pediatrician's office

If you have any of the above concerns about your baby's eyes, please talk to your pediatrician or family practitioner about getting a referral.; Eye Dogtor Julie

*Source: Vision Screening Guidelines by the American Association of Pediatric Ophthalmology and Strabismus: