If you missed our last pediatric eye care blog, check out “Your Child's First Eye Examination”. Both the American Academy of Ophthalmology and American Optometric Association (AOA) recommend comprehensive eye exams in early life. The first eye exam should occur between 6 and 12 months of age and should be performed by a Residency-Trained Pediatric Optometrist or Pediatric Ophthalmologist. This is an important consideration for parents because the vast majority of eye doctors do not specialize in pediatric eye care. In fact, in the Treasure Valley there are only 3 pediatric eye care specialists; one Residency-Trained Pediatric Optometrist and two Pediatric Ophthalmologists. These three doctors have the specialized training required to see infants, toddlers and young children.
Your young child is developing at a rapid rate, and their eyes and visual system are changing too. This is why the second eye examination is recommended at 3-years-old if the first eye exam revealed no concerns.
What is important about the second examination?
The second examination is designed to assess visual developmental milestones and ocular health. A child's visual skills have really progressed from infancy! Not only has a child developed new ocular skills but they are refining previously developed skills. A properly working visual system makes a positive difference in skills like coordinated movements and mobility.
What are some of the skills that have been refined from infancy?
Visual acuity: Visual acuity is a measure of visual ability (20/20). An infant is unable to appreciate 20/20 vision because the macula (retinal structure responsible for fine detail vision as well as color vision) isn't fully developed until 3 years of age.
Oculomotility (eye-movements): Eye movements entail saccades, pursuits, and fixations. Saccades are responsible for making accurate jumps between two targets. Pursuits are smooth movements across targets. Fixations are prolonged viewing of a stationary target. All of these skills are important for activities involving eye-hand coordination as well as education activities such as reading.
Depth perception: Around 5 months of age an infant can appreciate depth (3D vision). As a child's binocular skills improve their depth perception will improve so they can appreciate finer disparities.
Accommodation: Accommodation is the skill that allows the eyes to accurately focus on objects at near and in the distance.
Convergence: Convergence is the eyes' ability to turn inward together in a controlled manner to view objects at near.
NOTE: The development of these skills contributes to noticeable changes in the child's eyes and vision. Many children will develop an eye turn (strabismus) around 2 or 3-years-old. These cases warrant an immediate examination by a Residency-Trained Pediatric Optometrist or Pediatric Ophthalmologist. Many parents are relieved to learn that these eye turns can be successfully managed; often times without the need for surgery.
What are some of the newly developed skills?
If a child is having difficulty with skills that their peers seem to excel at such at recognition of shapes, colors, etc. they may have some areas of difficulty that should be addressed before entering kindergarten.
Of course there are other things that can inhibit learning besides visual perceptual difficulties. The Vision in Preschoolers research group released a study that indicates if a child has a high hyperopic (far-sighted) prescription that is associated with decreased near visual acuity and stereopsis (3D vision) they perform more poorly than their peers.
A strabismus (eye-turn) may also occur at this time that was not present during their previous examination. A strabismus may not always be cosmetically noticeable and can be easily missed during a vision screening. Keep in mind that vision screenings do not assess the previously mentioned skills except for visual acuity.
Remember that eye examinations are preventative care and should be considered part of a child's primary care routine. A brief visual screening at the pediatrician or school does not replace a comprehensive eye exam. Children rarely complain about their vision as they assume they see just like everyone else. A proactive approach to vision care will keep your child's eyes healthy and seeing well.