Understanding the Results of a Pediatric Refraction Eye Exam

What Is a Refraction Test for Pediatric Patients?

A refraction test is typically included in a pediatric eye exam. These tests evaluate how clearly young children can see by measuring how much light hits their retina—the nerve layer at the back of the eye. The test results help determine if a patient needs an eyeglasses prescription or another type of vision correction. There are a few different types of refraction tests that your child's eye doctor may perform, including:

• A computerized test that uses a machine to determine how much light is moving through your child's eyes. 

• A manual light reflex test where the doctor shines light into each eye and measures how much light is reflected by the retina. 

• A phoropter test, in which your child's face is positioned against a mask-like device called a phoropter. They will be asked to look through the device at an eye chart 20 feet away and identify the pictures or letters on it if they are able. The idea is to find the smallest row of items that the child can see. 

Dilatation is commonly used in these tests because children tend to focus on nearby visuals instead of the distant visuals needed for the examination. Optometrists will often perform a cycloplegic refraction, temporally relaxing the focus muscles in the eye with eye drops. This allows the eye doctor to measure farsightedness and get a true measure of refractive errors. 

How Often Your Child Should Get an Eye Exam

In the first year of your child’s life, they should visit the eye doctor once between 6 and 12 months to confirm their eyes are properly aligned and to rule out congenital cataracts, excessive farsightedness, and early-onset amblyopia. Their next exam should occur between age 3 and early kindergarten, where the eye doctor can detect uncorrected refractive errors, binocular vision problems, and amblyopia at the time when treatment will be most effective.

After they start school and receive a baseline exam for school, which ensures clear, comfortable vision for reading and near work and establishes a pre-school prescription baseline, your child should visit the eye doctor once a year. These annual exams keep their prescriptions current during their most rapid growth years, monitor myopia progression, and screen for computer vision strain. 

How Are Refractive Errors Diagnosed in Young Children?

If you're told that your child has 20/20 acuity, this means there is no refractive error to correct. When looking at your child's chart, you will see a zero, which means that there is no issue with their vision. It is not uncommon for your child to have some type of refractive error, it just means that light passing through the eye is not hitting the retina in the right spot. The most common refractive errors include:

• Myopia (nearsightedness), which involves difficulty clearly seeing things in the distance, such as the board in the classroom. With nearsightedness, light is focused in front of the retina instead of directly on it. 

• Hyperopia (farsightedness), which means objects that are closer tend to be out of focus. In this case, light is focused behind the retina. Keep in mind that some children can have slight hyperopia early on that resolves on its own by adolescence. 

• Astigmatism, which causes blurred vision and difficulty seeing both up close and far away. This happens when the cornea is an unusual shape. Instead of being shaped like a sphere, it may be egg-shaped. Instead of focusing light to just one point, the unusually shaped cornea may refract it to several points. Your child may be born with astigmatism or it may develop later from an injury or eye disease. Keep in mind, your child can have astigmatism along with either myopia or hyperopia. 

Common Parental Worries

Taking your child to see an eye doctor can be a stressful experience, especially when you don’t know what to expect. Here are some of the most common concerns parents have when scheduling eye exams for their children.

Does my child really need this test?

If you’ve noticed your little one squinting at the TV, holding tablets inches from their face, or complaining of headaches after school, those behaviors can all point to an uncorrected refractive error. A pediatric refraction pinpoints whether the eyes are focusing light properly so problems like nearsightedness, farsightedness, or astigmatism don’t sneak up on learning and play.

What actually happens in the exam room?

The whole process only takes about 15 minutes and is totally painless. Here’s a quick, simple rundown of what will occur:

1. Retinoscopy/Autorefractor – The doctor shines a light or uses a hand‑held device while your child looks at a target; no answers required. 

2. Phoropter choices – Older kids look through the familiar lens dials and simply pick “Which is clearer, 1 or 2?” 

3. Cycloplegic drops (if needed) – A mild, temporary eyedrop keeps the focusing muscles from “cheating,” giving the most accurate prescription for fast‑changing young eyes 

What do the numbers on the Rx slip mean?

The terms on your child’s prescription can be confusing. We’ve provided a short list to help you, but you can always bring the slip to any Clarkson Eyecare location and we’ll translate it again, no judgment.

• Sphere (SPH): How strong the lens must be to sharpen vision. Negative means nearsighted, while positive means farsighted. 

• Cylinder (CYL): Extra power to correct astigmatism (football-shaped cornea). 

• Axis: The direction the astigmatism correction sits in the lens. 

• OD / OS / OU: Right eye / left eye / both. 

What Happens After Your Child’s Results Are In

Before you leave the exam room, the optometrist will walk you through the prescription in plain language—what the numbers mean, how they affect distance vs. near vision, and whether any urgency exists. Feel free to snap a photo of the chart or ask for a printed copy to share with teachers or caregivers. If a refractive error is identified, you’ll likely choose eyeglasses first. Your eye doctor will likely recommend kid-proof frames and impact-resistant polycarbonate lenses for longevity.

As your kid ages, they may want to explore contact lenses. Daily disposables can be an option as early as 8–10 years old for sports or self‑esteem, but there are many options available. Your eye doctor will walk you through the available types of contact lenses and recommend the best option for your child’s lifestyle.

Finally, you’ll schedule a follow-up visit (likely a year later) to continue monitoring your child’s vision and refractive error. These visits will be essential to ensure your child always has the right prescription and is set up to succeed in school, sports, and social interactions.