Keep an Eye Out

Early detection can make a world of difference for children’s vision

By Dwain Hebda

Kids Eye Health

With the dawning of the school year comes the opportunity for new discoveries and personal growth for Arkansas’s students. Some of these children and youth, however, will struggle to get the most out of their lessons due to problems with their vision.

Sight problems are common among school-age kids. In fact, Prevent Blindness America estimates that one in four school-age children have some form of vision problems. Such issues aren’t just irritating, they make schoolwork markedly more difficult, affect children in sports and activities and can have potentially serious ramifications related to self-esteem, socialization and adjustment in school.

Identifying vision problems actually starts much earlier than the first day of classes; children should have their first eye exam within the first six months of life and where you go for that exam depends on the circumstances.

“For a child who’s healthy, has no family history of eye problems and was full term, that child follows up with the pediatrician for the normal ‘well baby’ exam,” said Dr. Paul Phillips, pediatric ophthalmologist with Children’s Hospital in Little Rock.

“If there’s a family history of any eye problems in childhood, that child should be evaluated by an ophthalmologist, I would say by four or five months of age. If that exam is normal, they can then follow up with their pediatrician like all the other kids.

“The second thing that’s important is if the child was born premature. Children of a premature birth all get eye exams in the hospital for all the problems that prematurity can cause in the eyes. At four to six months of age parents should follow up with an ophthalmologist—even if the child has been discharged from the hospital—and after that they can follow up with their pediatrician.”

Parents also shouldn’t discount their own powers of observation when it comes to their children’s vision. Watching even very young children interact with the world around them can yield a lot of information.

“What the pediatrician should be concerned about is the same thing the parent will want to look for,” Phillips said. “By four to five months of age, the child should be following faces and objects and that’s pretty intuitive for parents. If the child, by four or five months and sometimes even earlier, is not responding [parents] generally get pretty alarmed.”

Two other things for parents to watch for, Phillips said, are eyes that demonstrate a tremor-like shakiness or eyes that are misaligned. (The latter condition is more concerning after three months because babies younger than that commonly display eye misalignment as their brains play catch-up.) If you do observe such signs, Phillips said skip the pediatrician and head straight for a specialist, as these can be symptomatic of one of a number of serious conditions.

“Of the things that show up as problems, one of the most common is the eyes don’t match,” Phillips said. “In other words, the eyes need glasses but the right eye needs one prescription and the left eye needs another. The brain can only use one of the eyes and it ignores the other.

“A less common one, but not rare, are cataracts. It’s a little different than old-age cataracts, but babies can get cataracts. A third one would be optic nerve abnormality, a case where the optic nerve that comes from the brain to the eye did not form properly.”

Phillips said it’s not only important for parents to know what symptoms to look for, but which eye professional to take their children to for help once they notice them. An ophthalmologist is a doctor who specializes in medical and surgical care of eye disease while an optometrist provides primary vision care but does not have a medical degree.

“Optometrists know relevant things in their field, indeed we have one at Children’s,” he said. “But for diagnosing and treating these conditions, the child should be evaluated by an ophthalmologist and possibly even a pediatric ophthalmologist who, in addition to specializing in the eye, specializes in diseases that involve children.”

Assuming none of the above-described problems are present, children should receive their second eye exam at around age 3 and then again right before starting school. From there, have your kids’ eyes checked every year if they wear glasses, every two years if they don’t. And make sure they're getting a comprehensive eye exam, which, as notes, is different than vision screenings.

“Keep in mind that a vision screening performed by your pediatrician or the school nurse is not a comprehensive eye exam. These screenings are designed to alert parents to the possibility of a visual problem, but not take the place of a visit to an eye care practitioner,” writes website senior editor Dr. Gary Heiting, OD. “Vision screenings are helpful, but they can miss serious vision problems that your eye care practitioner would catch. Studies have found that up to 11 percent of children who pass a vision screening actually have a vision problem that needs treatment.

“Also, children who fail vision screenings often don't get the vision care they need. Two studies published by the American Academy of Ophthalmology found that 40 to 67 percent of children who fail a vision screening do not receive the recommended follow-up care by an eye doctor.”


How to Choose the Right Children’s Glasses

Glasses are the most common appliance for improving vision in children and youth, but the range of available options (and prices) can be intimidating. The following are some recommendations for getting the right pair.

 1. Lens first, frame second

Your child may want to skip ahead to the cosmetics of their new specs, but you should keep in mind the primary function of glasses is how they make a person see, not how they make them look and that starts with the lens.

 Stronger prescriptions mean thicker lenses and thicker lenses should be in the smallest frames possible. This reduces overall eyeglass thickness and blurring at the edges, which is more prevalent with larger lenses and affects peripheral vision. Opt for lenses made out of polycarbonate or Trivex, which are significantly more impact-resistant and considerably lighter than regular plastic lenses or glass lenses. Make sure lenses offer protection against ultraviolet (UV) rays and scratches; some materials have this built-in and some are coatings.

 2. Frame material

Plastic frames used to be the go-to for durability and cost, but today’s metal frames are lightweight and stand up to abuse, often for the same money. Just be sure to ask for hypoallergenic materials if your child has shown sensitivity to certain substances.  Spring hinges, while costing extra, are highly recommended for kids’ glasses. These hinges allow the temples to flex outward without damaging them, which is a nice feature in the hands of a toddler, during sports or activities or until a child learns to handle their glasses carefully.

3. Construction

To keep glasses in place, assess the proper fit on the nose which means no space between the bridge of the frame and the bridge of the nose. Otherwise the weight of the lenses will cause the glasses to slide. Adjustable nosepads, which are fairly standard, also help in this regard.

 However, very young children’s noses have yet to develop a bridge, so must rely on the correct temple (earstem) to keep glasses on. For babies and toddlers look for a feature called a “cable temple,” which wrap all the way around the back of the ear to keep the glasses in place. Cable temples are a feature of some metal styles for older children as well, but they are not preferable for part-time eyeglass wearers due to being more awkward to put on or remove.

 4. Warranties and Back-up pair

Kids are rough on glasses, so warranties and/or backup glasses are a good strategy. Be sure to check the fine print on warranties to know exactly what the policy covers. For backups, ask the optician if there are any discounts for buying more than one pair. Don’t however, hold onto old glasses and use them as backups; kids’ facial structure and lens prescriptions change a lot and an old pair likely won’t provide the proper vision correction or fit.

Liz DeFranco and master optician Mark Mattison-Shupnick for


InfantSEE® Program helps all children get a good start on eye health

While it’s easy to understand the importance of good vision to a person’s quality of life, many children in the United States today do not have access to quality eye care. Many of these children are at risk from undiagnosed vision problems—as many as one in 10 according to some sources—including severe near-and far-sightedness, amblyopia (lazy eye), strabismus (crossed-eyes) and even glaucoma and cancer.

Meanwhile, early detection has shown to be a key factor in curtailing some of the more common eye diseases; one study showed intensive screening performed six times between age 8 months and 37 months reduced amblyopia by 75 percent.

To combat this problem, Optometry Cares: The AOA Foundation and The Vision Care Institute, a Johnson & Johnson company, have partnered to create InfantSEE, a no-cost public health program that provides professional eye care for infants nationwide. Participating optometrists provide a one-time, comprehensive eye assessment to infants in their first year of life, offering early detection of potential eye and vision problems at no cost, regardless of income. To learn more and to access providers in Arkansas, please visit