When Should My Child Have Their First Eye Test?

This is a common question asked by parents walking by our optometry practice.  And it is a good question to ask.  An eye exam for an infant is different to an eye exam for a school age student and the signs and symptoms an optometrist will look for are different as well.  It’s never a good idea to assume your child can see well and most times, detecting a potential problem earlier, allows your optometrist to monitor developmental changes closely and then treat at the appropriate time.”

First eye test allows to diagnose potential vision problems earlier rather than later’– Dr SooJin Nam, Behavioural Optometrist

This is what the Australia Optometry recommends

  • First eye test of your child should be done before the age of 6 months.
  • This has to be followed by one eye exam at the age of 3 years and another at the age of 6 years.
  • Once the first eye examination is done, the child’s eyes should be tested annually if a treatment was suggested by the practitioner or once in two years if no treatment has been suggested by the practitioner.

Some of the common problems picked up in infants include eye turns, significant prescriptions like short-sightedness (myopia) and long-sightedness (hyperopia), conjunctivitis and allergy conditions.  Very rarely optometrists may also diagnose life-threatening conditions which may be picked up as an eye health problem.

Sometimes pre-school children are screened for visual acuity.   This screening service checks to see how clearly your child can see for distance and if it’s blurry, they are referred either to an optometrist or an ophthalmologist.  This service is valuable for children who may have an uncorrected prescription or if they have a lazy eye.  However, studies have shown that an acuity-based screening test FAILS to detect at least 50% of children who will go on to have learning difficulties at school because of their vision.  The problem with an acuity screening test is that is can provide a false sense of security that your child’s vision is okay when really, there are many other tests that needs to be done to check their focusing, teaming, tracking and vision processing skills.

Every 7 year child when going to school should take along a certificate from an optometrist that says I’ve had my eyes tested and I can see.  Every 11 year old going to secondary school should do the same’ – the late Prof Brien Holden, Brien Holden Institute

Not all optometrists are comfortable in testing children and parents should not assume that all optometry practices are equipped to see children.  Optometry, like any other medical profession, requires additional skill tests and equipment to get the right results.  You want children to feel comfortable in the testing room – it can be rather intimidating after all and sometimes our chair and equipment can look a little scary.  You also want optometrists who can engage well with your child so that they can get the most of the test on the day.  Some of the tests might look like games and some of them might be done of the floor as they follow them around the room – after all, you can’t expect little kids to sit on the chair for a long time when there are so many new things to look at!

Tests For An Infant

Can you test a baby when they can’t read a chart?  Easy, they don’t need to!  Many of our tests don’t require a child to respond back and tell us what they see.  They are observational tests and they are best done with equipment like a retinoscope.   A retinoscope requires skill and experience to be able to do this quickly and accurately.  Sometimes eyedrops are used to stabilise their focusing ability if your optometrist suspects a prescription problem.  Additional tests include checking:

  • Pupil responses to make sure the infant is reacting to light normally.
  • The ability of a child to fixate and follow an object to determine if the vision is developing as expected. Normally a child should be able to fixate and follow objects by the age of 3 months.
  • How clearly they can potentially see through Preferential Looking Tests: These tests are performed by showing a card which is blank on one side and stripped on the other side.

Tests For Toddlers & Pre-Schoolers:

Some of the tests that can be used for the visual examination of pre-schoolers and toddlers are listed below:

  • LEA symbols: This is vision chart that shows shapes instead of letters or numbers:  Shapes are of a house, apple, square and a circle.  Most 2 year olds can do this well
  • Retinoscopy: It is an objective method to find out if the child needs glasses to see clearly.  Our optometrists won’t be asking them which one is better… 1 or 2?
  • Waggoner Colour Test: Children don’t need to know numbers to do this colour test which is based on shapes likes circles, triangles and square instead
  • Randot stereopsis: This test is used to find out if the child is using both eyes simultaneously to perceive depth. Failing in this test is a trigger to test for lazy eyes
  • Cover/uncover test: It is a simple test used to examine the misalignment of a child’s eye. Commonly called as eye turn, misalignment of a child’s eye can lead to lazy eye.

These are just some examples of how the tests for young children differ to tests for school age students and again for an adult.  A referral to an ophthalmologist (eye specialist) is only warranted when medical intervention for an eye disease is required.  What parents should know is that sometimes young children are referred to an ophthalmologist because the referring optometrist may not have the necessary skill-set to confidently test them at their clinic.  An experienced children’s optometrist will know the difference and can help guide the parents with the options available.

Test your child’s eyes as possible.  There is simply no need to overlook this test before they start schoo’ – Dr SooJin Nam, Behavioural Optometrist