Although your tot may not see an eye specialist while she's still a toddler, her pint-sized peepers probably get examined more often than yours. That's because her pediatrician is already doing regular vision screenings for your toddler at every well visit.
The eye screenings may vary a bit from doctor to doctor, but they're all designed to check for the same basic abilities and potential toddler eye problems. Here's a look at what goes down during your child's eye checkup.
When should toddlers get their eyes examined?
Both the American Academy of Pediatrics (AAP) and the American Academy of Ophthalmology (AAO) say children should have their eyes checked at their regular well visits — which take place during the first week and months 1, 2, 4, 6, 9, 12, 15, 18 and 24.[1] After your child turns 2, checkups take place on an annual basis.
These early eye screenings are, however, just that — screenings. They're quick glances into your toddler's peepers to look for basic eye health problems, like crossed eyes (strabismus) or lazy eye (amblyopia).
If your pediatrician suspects that your toddler has a vision problem, you'll receive a referral to an eye health specialist — an optometrist or ophthalmologist — for a more comprehensive eye exam (more about that later).
If you suspect your child has trouble recognizing colors, shapes or letters, you may want to have her eyes examined by a specialist, since this can be a sign of an underlying vision problem.
What to expect at your toddler's eye checkup
During well visits, the pediatrician will ask you some questions about your toddler's vision and perform a few tests, such as:
Ocular history
The doctor will ask if you've noticed anything out of the ordinary about your child's eyes, like whether she holds objects close to her face to look at them or if one of her eyelids ever droops.
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The physician may also ask about your family health history and if your child's relatives have any eye problems. If there are hereditary eye conditions, the doc may suggest your toddler see a specialist regularly to check on her vision development, and you'll probably get a recommendation for a kids' eye doctor.
External inspection of the eyes and lids
With the help of a penlight, the doctor will check your child's eyelids, eyelid lining, iris (the colored part of the eye), cornea (the clear outer layer of the eyeball) and everywhere else in eye-land to make sure those peepers are in peak condition.
The doctor will also be on the lookout for excessive tears or discharge, which may point to allergies, an infection or a blocked tear duct. Be sure to speak up if you notice this at home.
Ocular motility assessment
That's the scientific term for a test that ensures your toddler's eyes move properly. The doctor may shine a light in your little one's eyes to see if the reflection from both is the same. If it is — and that's quite likely — her eyes are properly aligned.
He or she may also have your child focus on a toy or object, and then cover each of her eyes alternately (a "cover test") to evaluate the eyes' movement. If her peepers don't work as a perfect pair to fix on or follow an object, she may have a lazy eye (amblyopia).
Usually, a consultation with a kids' eye doctor and a temporary eye patch or special glasses can solve the problem.
Pupil examination
At most checkups, the pediatrician will check your child's pupils, which should look round and respond in the same way to light: widening when it's dim and shrinking when it's bright.
Red-reflex examination
You know how a camera flash can make your child's eyes look red in a photo? That's one indicator of a healthy eye.
A "red reflex test" at the doctor's office looks for cataracts and other potential eye problems. The pediatrician will look for a symmetrical red "flash" across both of your child's pupils. An absent or black reflex can indicate there's an obstruction preventing light from reflecting back to the doctor.
Vision assessment
The doctor may ask your child to fix her gaze on an interesting object, like a toy boat or a rubber duck, and follow it with both eyes and then one eye at a time. He or she may test your child's peripheral vision by having her focus on, say, the duck, and then flashing a light at the very edge of her vision to see if she notices.
For these tests, it's important that your toddler is alert and pays attention — if not, the results may be inaccurate. Pediatricians, in general, are pros at getting their patients' attention, but yours would likely appreciate a heads-up if your little one isn't feeling cooperative that day.
If your pediatrician picks up anything unusual during any of the screening tests, you'll likely need to visit a specialist for a more intensive eye exam. Pediatric ophthalmologists are experts at dealing with pint-sized patients, but you don't necessarily need a kids' eye doctor — many regular ophthalmologists also see children.
What does a toddler eye exam chart look like?
Since your tyke's too young to use a standard eye chart like the ones you see at the eye doctor, the pediatrician will check how well she sees in other ways. Some offices have special charts with pictures or even equipment that takes photos of the eyes and tells the pediatrician when to refer a patient to a specialist.
During an eye exam, a doctor can also use a special type of eye chart called the "Tumbling E" eye chart for toddlers who are too young to know the alphabet. Instead of using different letters, this one uses the letter E facing in different directions. When your tot looks at this chart, she'll use her fingers to show which way the "fingers" of the E are pointing.[2]
How to prepare your toddler for an eye checkup
Your little one may not enjoy staring directly into a flashlight (and let's face it, who does?), but luckily, the vision screening part of the well visit should end quickly. In the meantime, use these tips to make your child more comfortable:
- Schedule the appointment early in the day. This way, she won't be hungry or tired — which should bode well for her mood.
- Make it a game. Play eye doctor with a toy doctor's kit (or a dull flashlight), or read her a book about a character getting her eyes examined by a doctor.
- Prep her for the exam. Tell your child what the pediatrician may do during the appointment. For example, let her know that the doctor may look at her eyes with a special light or ask her to look at a chart with pictures on it. Letting your child know what's likely to happen can take some of the fear out of the visit.
If you're taking your child to an optometrist or ophthalmologist who doesn't see children exclusively, you might want to mention your child's age when you make the appointment — this way there won't be any surprises when you show up.
Vision screenings versus eye exams
Not all eye checkups are created equal. A vision screening done by a pediatrician is a brief exam that's designed to check for potential eye problems — it can't diagnose a child's eye condition.[3]
What's more, vision screenings aren't substitutes for eye exams. The American Optometric Association (AOA) estimates that screenings miss as many as 75 percent of vision problems in children — which is why it's recommended that your child sit for a more thorough eye exam when she's between the ages of 3 and 5.
Eye specialists, like optometrists or ophthalmologists, conduct these eye exams. During the appointment, the doctor will use more specialized equipment to diagnose vision problems or other eye conditions.[4]
If your child does need to see an eye specialist, it's a good idea to make an appointment as soon as possible. The earlier a vision problem is detected, the more likely it is to be treated or corrected.[5]
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