What Parents Should Know Before They Bring Their Child to an Eye Exam
As children enter kindergarten and elementary school, good vision will become an important part of learning. Here are some key facts parents should know about pediatric eye exams, and the important role they play in a child’s overall health and development.
- Vision screening for kids isn’t one and done. Because kids’ vision can change over time, child vision screenings should be done at least once a year. Some vision problems, such as nearsightedness, may not emerge until kids are older, around age 8 or 9, and growth spurts can also contribute to a rapid change in vision.
- Many parents may not even be aware that their child is experiencing vision problems until a problem is detected by a vision screening.Vision screenings are important because young children often don’t realize what is or isn’t normal, and are not likely to speak up if they’re not seeing as well as they should.
- The signs that your child may be experiencing vision problems can be subtle and can include squinting; tilting or turning the head to see something; eye misalignment (strabismus); complaining of headaches when doing visual tasks; inability to see things that are far away as well as peers/parents; trouble concentrating or fatigue in school; and having a persistent, unusual spot in his eyes in photos taken with a flash (a white spot, for example, instead of the common red eyes), which can indicate nearsightedness or in some cases, a more serious eye disease.
- Sitting close to the TV or holding things such as books very close to the face could also indicate a vision problem, but since these are common kid behaviors in all kids, parents should look for these symptoms in combination with the other signs that their child is having trouble seeing well, says Mae Millicent W. Peterseim, MD, a pediatric ophthalmologist at the Storm Eye Institute/Medical University of South Carolina.
- It is very important to catch vision problems early. Some conditions, such as amblyopia, or “lazy eye,” are most treatable when caught at a young age, and are difficult to fix if it’s diagnosed when a child is older, around age 7 or more. For instance, a child may have poor vision in one eye but see well enough with both so that the problem isn’t detected; only a vision screening that tests a child’s vision one eye at a time would detect such a problem. (Amblyopia is usually treated with glasses and sometimes patching.) “It’s heartbreaking to hear a child say, ‘I thought everyone could see better with one eye,” says Dr. Peterseim.
- Once a problem is detected, a child should undergo a comprehensive eye exam. If a screening exam indicates a vision problem, a child will be referred to an ophthalmologist or optometrist for a complete eye exam. “At an eye exam, at the eye doctor’s office, the technician will check vision and should do a test of depth perception,” says Dr. Peterseim. The doctor will check to see how well the eyes track something and how well they move and focus on objects (looking at each eye independently by covering one first and then the other). She will also examine the retina and optic nerve and check the eyes for any signs of infection or disease.
- There are exciting new screening tests for children. “Newer instrument-based screening works well and can pick up problems in children earlier,” says Dr. Peterseim. “A child looks at the device with a twinkling light and the machine detects abnormalities in a moment, like a camera, so minimal cooperation is needed.” This method is a bit more expensive, but it’s fast, easy, and effective. New AAP policy is recommending instrument-based screenings for children as young as 12 months old, says Dr. Peterseim.
- Eye exams are particularly important for school-age children. Children learn a lot visually in the classroom, and poor vision can have a negative effect on how a child does in school. That’s why it’s particularly important for school-age children to continue to get regular vision screenings, whether at school or at the doctor’s office.
- Parents play an important role in protecting kids’ vision. Follow up on screening test results and/or if you spot any signs your child may have a vision problem. Look for a pediatric ophthalmologist or optometrist, or a doctor who is comfortable with children and is experienced in caring for kids’ eyes. For instance, kids tend to peek when asked to cover one eye, so a doctor should know to use a patch or cover an eye well during the exam. Doctors should also dilate pupils during an eye exam. “It is important that the child have drops to dilate the pupils to determine if he really needs glasses,” says Dr. Peterseim. “Some doctors skip this step. If your child’s eye doctor doesn’t do this, a parent should ask, or go somewhere else.”
Eye-Opening Study: Relationship Between Glaucoma and Poor Sleep
Glaucoma is a disease of the optic nerve. Damage to this nerve—which is responsible for sending signals from the eye to the brain so you can see—often goes unnoticed until an eye exam reveals the nerve damage and related vision loss caused by glaucoma.
The study examined data from the 2005-2008 National Health and Nutrition Examination Survey. The study participants were glaucoma patients with evidence of optic nerve damage and vision loss in some portions of their visual field. Participants were examined using fundus photography to see the optic nerve and automated visual field testing to check for areas of vision loss.
Respondents to the sleep questions of the survey reported their experiences with the following:
- Amount of time slept
- Difficulties falling asleep
- Sleep disturbances (waking up during sleep)
- Having diagnosed sleep disorders, including sleep apnea
- Use of sleep medication
- Problems with sleepiness during the day
The study found an association between having glaucoma and having various sleep problems. Among the findings:
- People who slept for 10 or more hours a night were three times more likely to have glaucoma-related optic nerve damage than those who slept 7 hours a night.
- People who fell asleep in 9 minutes or less, or those who needed 30 minutes or more to fall asleep, were twice as likely to have glaucoma than those who took 10-29 minutes to fall asleep.
- The odds of having missing vision were three times higher among people who got 3 or fewer or 10 or more hours of sleep per night, compared with those who got 7 hours a night.
- People who said they had trouble remembering things because of daytime sleepiness were twice as likely to have visual field loss than those who said they were not sleepy during the day and did not notice memory problems.
- People who said they had difficulty working on a hobby because they were sleepy during the day were three times more likely to have vision loss than people who reported no problems working on hobbies and no daytime sleepiness.
“This study is interesting in that it adds to other research looking at the association between glaucoma and sleep problems,” says Michael Boland, MD, PhD, one of the study’s authors and a glaucoma specialist at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine in Baltimore, MD.
“We already know that doctors should talk with their patients about the importance of healthy sleep for good overall health. With studies like this, we can add that glaucoma may be related to sleep health issues,” says Dr. Boland.
The American Academy of Ophthalmology recommends that everyone should see an ophthalmologist for a baseline medical eye exam at age 40. This is the age when early signs of eye disease (like glaucoma) and vision changes can begin.
Seniors who are worried about the cost of an exam can visit the American Academy of Ophthalmology’s EyeCare America program page to see if they are eligible for a no-cost eye exam.
Vision Facts and Myths
Reviewed by: Jonathan H. Salvin, MD
Old wives’ tales abound about the eyes. From watching TV to eating carrots, here’s the lowdown on some vision facts and fiction.
Myth: If you cross your eyes, they’ll stay that way.
Fact: Contrary to the old saying, eyes will not stay that way if you cross them. If your child is crossing one eye constantly, schedule an evaluation by an ophthalmologist.
Myth: Sitting too close to the TV is bad for the eyes.
Fact: Although parents have been saying this ever since TVs first found their way into our homes, there’s no evidence that plunking down right in front of the TV set damages someone’s eyes. The American Academy of Ophthalmology (AAO) says that kids can actually focus up close without eyestrain better than adults, so they often develop the habit of sitting right in front of the television or holding reading material close to their eyes. However, sitting close to a TV may be a sign of nearsightedness.
Myth: If parents have poor eyesight, their kids will inherit that trait.
Fact: Unfortunately, this one is sometimes true. If you need glasses for good vision or have developed an eye condition (such as cataracts), your kids might inherit that same trait. Discuss your family’s visual history with your doctor.
Myth: Eating carrots can improve vision.
Fact: Although it’s true that carrots are rich in vitamin A, which is essential for sight, so are many other foods (asparagus, apricots, nectarines, and milk, for example). A well-balanced diet can provide the vitamin A needed for good vision, says the AAO.
Myth: Computer use can damage the eyes.
Fact: According to the AAO, computer use won’t harm the eyes. However, when using a computer for long periods of time, the eyes blink less than normal (like they do when reading or performing other close work). This makes the eyes dry, which may lead to a feeling of eyestrain or fatigue. So encourage your kids to take frequent breaks from Internet surfing or video games.
Myth: Two blue-eyed parents can’t produce a child with brown eyes.
Fact: Two blue-eyed parents can have a child with brown eyes, although it’s very rare. Likewise, two brown-eyed parents can have a child with blue eyes, although this is also uncommon.
Myth: Only boys can be color-blind.
Fact: It’s estimated that up to 8% of boys have some degree of color blindness, whereas less than 1% of girls do.
Myth: The eye is full size at birth.
Fact: The eye is NOT full size at birth but continues to grow with your child. This growth partially accounts for refractive (glasses) changes that occur during childhood.
Myth: Wearing glasses too much will make the eyes “dependent” on them.
Fact: Refractive errors (near-sightedness, far-sightedness, or astigmatism) change as kids get older. Many variables come into play, but most of this change is likely due to genetics and continues despite wearing glasses earlier or later or more or less. Wearing glasses does not make the eyes get worse.
An incredible 1.6 billion people worldwide suffer from some form of nearsightedness (myopia), which can vary from being mild to severe.
Myopia is the world’s most common eyesight problem, but in the last two decades there has been a significant increase in the number of children being diagnosed with the condition.
Recent research suggests that a quarter of children now need glasses to correct blurred distance vision caused by myopia.
A study carried out has found that a lack of outdoor activity (less than 45 minutes a day) and a general increase in the amount of time (more than 2 hours a day) spent using near vision (video games, computers) can affect eye development in children.
Reducing the risk of myopia
There is a genetic link to the development of myopia, with those who have a familial history of the eye condition being more likely to suffer from it too.
For children who are predisposed to developing myopia, it was suggested that they spend at least 15 hours a week outside and minimize the amount of time doing long stints of activities that require near vision.
Simple changes, such as increasing the amount of time outdoors and limiting the use of liquid crystal monitors at close range (laptops, computer games etc) can help reduce the risk of developing myopia.
According to the Centers for Disease Control, there are nearly 800,000 work-related eye injuries each year. Every day, approximately 2,000 U.S. workers receive medical treatment for eye injuries related to or sustained at work. While vision loss is one of the 10 most common disabilities, 90 percent of eye injuries are preventable.
By Amy Hellem; reviewed by Gary Heiting, OD
Eye drops are used to treat a wide variety of conditions — from glaucoma and eye infections to allergies and dry eyes. In many cases, eye drops (or “eyedrops”) are essential to preserving your vision and protecting your eyes.
To get the greatest benefit from eye drops, you must use them properly. Whether you need one drop per day or 10, there’s a right way and a wrong way to put eye drops in your eyes.
Your eye doctor or pharmacist may give you instructions that are specific to the prescription eye drops you need. But in most cases, the proper technique for applying eye drops is the same, whether you are using prescription or over-the-counter formulas that you can purchase without a prescription.
Failing to learn how to correctly put drops in your eyes not only can defeat the purpose of having them, it also can get expensive. Each time you miss your eye and have to use more drops than you should, it costs you money — potentially a lot of money in the case of some prescription eye drops.
Step-By-Step Approach ToPutting In Eye Drops
- Wash your hands with soap and water; then dry them with a clean towel.
- If you are wearing contact lenses, remove them. The only exception is if you are using eye drops that are specifically formulated to remoisten your contacts or if your doctor advised you to use the drops in this manner.
- Remove the dropper cap and look closely at the tip to make sure it’s not cracked or otherwise damaged. Do not touch the tip.
- Either lie down or tilt your head back, and look up at the ceiling. Concentrate on a point on the ceiling, keeping your eye wide open.
- Place one or two fingers on your face about an inch below your eye; gently pull down to create a pocket between your lower eyelid and your eyeball.
- Use your other hand to hold the eye drop bottle, pointing the tip downward. Resting your hand on your forehead may help steady it.
- Hold the bottle close to your eye (about an inch away). Be careful not to let the dropper touch your eye or eyelashes, since this can introduce bacteria and other organisms into the eye drops in the bottle.
- Squeeze lightly to instill one drop inside your lower lid.
- Remove your hands from your face, gently close your eyes and tilt your head down for a few seconds. Try not to blink, as this can force some of the drop out of your eye before it has had a chance to be absorbed.
Knowing how to apply eye drops properly will save you time, aggravation and, especially in the case of prescription drops, quite a bit of money.
- To keep as much of the drop on your eye as possible, press lightly on the inner corner of your eyelid, next to your nose. A small duct that drains tears away from your eye and into your nose is located here. By pressing at this point, you close down the opening of this drainage duct, allowing the eye drop to remain on the surface of your eye longer.
This technique also minimizes the funny taste you may get in your mouth after applying certain eye drops.
- Use a clean tissue to absorb and wipe away any drops that spill out of your eye and onto your eyelids and face.
- If you are using eye drops on both eyes, repeat this procedure for the second eye.
- Replace the cap of the bottle and screw it on securely. Never wipe the dropper tip with anything, as this may contaminate the drops.
- Wash your hands to clean away any stray eye drops.
What ToDo If You Need To Use More Than One Eye Drop
Sometimes, you may be prescribed more than one type of medicated eye drop. But if you apply the drops too quickly in succession, they may drip out of the eye and not be absorbed properly, reducing the therapeutic effect.
If you need to put a second eye drop in the same eye, wait at least five minutes. This will give time for the first drop to be fully absorbed and create more space for the second drop on the eye.
If you use both a medicated eye drop and a lubricating eye drop on the same eye, many doctors prefer that you start with the prescription (medicinal) eye drop first and save over-the-counter products, such as artificial tears, for later.
Practice With Artificial Tears
If you aren’t comfortable putting drops in your eyes, a little practice can help you master the task quickly.
Purchase a package of preservative-free artificial tears to use for practice. (Don’t practice with prescription eye drops — you don’t want to risk over-medicating.) Using a preservative-free formula eliminates the risk of you being allergic to preservatives found in many artificial tears. Also, choose a product formulated for mild dry eyes — these drops aren’t as thick as those made for moderate or severe dry eyes, so they won’t cause any temporary blurred vision.
Ask a friend to coach you while you are practicing. In particular, have them help you position the applicator at the proper distance and location above your eye so the drops fall directly on the surface of your eye or in the space between your eye and your pulled-down lower lid.
In less time than you might think, you will become a pro at applying eye drops. Also, it’s a good idea to keep a supply of preservative-free artificial tears on hand. These drops can help relieve discomfort associated with computer eye strain and are soothing at other times when your eyes are tired or dry.