Vision is a complex process which develops gradually in children. By three months, your baby can probably follow a moving object with his eyes but he won't see a full range of colors until four months. Depth perception comes after that and 20/20 vision isn't attained until the age of 5. But experts say many young children need glasses to ensure normal development of sight and vision before they start school.

The American Public Health Association reports that 10 percent of young children have vision problems. In fact, a study reported by the American Association for Pediatric Ophthalmology and Strabismus found 1 in 20 preschoolers should wear glasses, yet only 1 in 100 do.

It's not that these children have negligent parents; it's more a matter of no one detecting a problem. Toddlers and preschoolers rarely complain about their vision. They don't understand that their vision is impaired since the way they view the world is all they've ever experienced. And some problems, like uncorrected acuity, aren't obvious. Without a comprehensive vision test, some children are at risk of permanent damage to their eyes and sight.

Wearing glasses can correct a host of vision-related issues so it's important for parents to look out (excuse the pun) for signs of compromised vision- especially when there is a family history of needing glasses at an early age.

The American Optometric Association (AOA) recommends a full eye exam by 1 year if you and/or your spouse is far sighted (hyperopic), near sighted (myopic) or has another vision-related issue such as dyslexia, double vision, focusing problems, or astigmatism (misshapen eye curvature).

There is a difference between a comprehensive vision exam and a routine vision screening typically performed by the child's pediatrician at the yearly check up beginning at the age of 3. Additionally, the AOA points out that many well-meaning parents mistakenly believe that passing a routine vision screening means their child has perfect vision.

Vision screenings typically assess only one or two areas of vision (there are several more). These simple screenings do not reveal important information about the child's ability to focus or how well her two eyes work together. As a result, these screenings can miss as many as 60 percent of kids with vision problems. "Most young children come in because a parent notices an eye turning in or out or because mom and dad both wore glasses at an early age," says Allison Ashbeck, OD, an optometrist and mother of three in the Baltimore area. Another common reason she see patients is because the child failed a vision screening test at school.

Spotting Poor Vision/What to Look For

Here, some signs that may indicate a child is struggling to see:

  • Squinting
  • Having an eye that wanders or turns in or out (also known as strabismus)
  • Sitting too close to the TV, a book or computer
  • Avoids coloring, puzzles or other activities that require close attention to detail
  • Tilting his head when focusing on something (possibly an attempt to minimize double vision)
  • Difficulty with eye/hand/body coordination
  • Eyes that tear excessively (sometimes the result of eyelids that don't completely close during sleep, which dries the eyes)
  • Covering one eye to watch TV
  • Rubbing eyes frequently (a sign of uncorrected visual acuity or allergies)

If you notice any of these signs, make an appointment with your pediatrician and discuss your concerns. Early detection and correction of vision problems can ensure normal development, which is essential for school success. When the brain is overly focused on the motor movements (for instance, focusing on printed words and tracking across a page), it can't also handle the comprehension piece. Learning to read then becomes a challenging task.

Your pediatrician may refer you to a pediatric ophthalmologist or optometrist who will dilate the child's pupils with drops and use an instrument called a retinoscope to formulate an accurate prescription. Good vision requires both eyes to see the same clear image. Amblyopia, or lazy eye, happens when one eye has weaker vision prompting the child to rely on the "good" eye for sight. Wearing a patch over the stronger eye for a temporary period (months or years depending on the severity of the problem), forces her to use and strengthen the weaker eye. If the condition is not diagnosed and treated the brain will ignore the eye that sees poorly which can lead to permanent vision loss.

Talking to your child about what to expect will help prepare him for the eye exam and ensure it is a positive experience. If the diagnosis of glasses is made, getting your toddler to wear them usually isn't a problem, assures Ashbeck. "Most young children happily comply since seeing more clearly with the aid of glasses makes an enormous and immediate difference for them."

Allison Ashbeck, OD, reviewed this article.




American Optometric Association

The American Academy of Pediatrics

Interview with Allison Ashbeck, OD
Optometrist with South River Eye Care in Edgewater, MD