In Kentucky where I practice, we have a law that requires children to have a complete eye examination with an eye doctor before starting school. I get to see lots and lots of kids. I am always amazed at the number of children that have significant vision issues that could affect their ability to perform optimally in school. Often, their parents don’t notice anything is wrong. Studies in Kentucky have shown that about 18 percent of children ages 3 to 6 suffer from significant vision problems. Many vision issues can be difficult to detect and frequently are undiagnosed by the typical pediatrician’s screenings. Vision screenings at school where a child is asked to identify letters or pictures on a wall chart often don’t detect the issue either. Unfortunately, many children with undetected vision problems struggle at school and can be misdiagnosed with attention, behavioral, or reading issues. Often all they really need is correction to give them clear, comfortable vision. Here are some signs to watch out for that may indicate your child has a vision problem:
Squinting the eyes helps to make vision a little clearer for a child who is nearsighted. Nearsighted children can see things that are near to them, but have a harder time seeing things far away, like the TV across the room. Squinting can also help clear up some of the distorted vision that can be caused by having astigmatism. Children learn to squint at an early age as a compensating mechanism to help clear up their blurry vision.
Another compensating mechanism that children learn is to tilt or turn their heads when they have a muscle imbalance in their eyes. By tilting or turning, they can use their head position to alleviate straining their eye muscles to focus together.
Many children who have significant amounts of farsightedness will have very limited tolerance for near focused activities like reading, coloring or puzzles. Farsightedness means that the child has an easier time seeing things that are far away, but has to work much harder to see things that are close up. Farsightedness is tricky to diagnose, because farsighted kids usually can see 20/20 (the small letters or pictures on the eye chart). They can usually even see things clearly close up, but have to strain their eyes to do it. This focusing strain is not something that a child would typically complain about or even realize that they are doing, but it will make them want to push away a book pretty fast and move on to something else.
Some kids are just clumsy. If a child has a muscle balance issue that causes the eyes to not want to work together however, this can lead to a decrease in depth perception which can make it harder for a child to judge distances. I saw a 5 year old recently that was really struggling to ride his bike. When he would approach a curb or any obstacle, he would stop and walk his bike around it. He was also frequently bumping into things. After treating his condition with glasses, his Mom brought him in several weeks later, amazed that he was riding his bike everywhere and no longer had to push his bike around obstacles as he could better judge distances.
When one eye works significantly better than the other, or has clearer vision, a child may have a tendency to cover the bad eye. This could be an indication of a condition called amblyopia, which is sometimes referred to as “lazy eye.” When the two eyes do not work well together, the brain likes to use the better eye and tries to ignore the lazy eye. This can result in permanent vision loss in one eye if not corrected early on.
A frequent sign of eye strain in a child is when they rub their eyes a lot. Eye rubbing can be caused by a muscle balance or focusing issue that causes the eyes to fatigue easily. Rubbing the eyes can also be related to eye allergies.
Frequent headaches in a child can indicate an issue with eye strain or difficulty focusing. Though less frequent, headaches can also be a sign of more serious issues causing pressure or swelling behind the eyes. If you notice any of these signs in your child, be sure to schedule them to have a complete eye examination with an eye doctor (an optometrist or pediatric ophthalmologist). Be sure to find a doctor who is comfortable seeing children and who has the tools and tricks of the trade to work with kids.
An eye examination on a child is much different than an eye examination on an adult. We rely much more on the measurements that we take and our clinical findings than we do on what a child is able to tell us. An eye doctor who works with children a lot will have specialized equipment and diagnostic tools, as well as toys and games to keep the child’s attention to get the information that they need. They also need a personality that is part doctor and part circus clown to make the experience fun and interesting for a child. Even if a child will not speak or respond, or if they try to convince us that they really need those cool pair of Sponge Bob glasses like their friend just got, we can very accurately determine the status of their vision and eye health.
Updated Sep 22nd, 2017
Clay Mattson, O.D. has been practicing optometry at EyeMax in Nicholasville and Lexington, KY since 2000. Dr. Mattson also serves as a consultant, lecturer, author and advisor to the eye care industry and to other eye doctors.