What is a Pediatric Eye Exam?

Pediatric Eye Exams vs. Vision Screenings

Young children often receive vision screenings instead of comprehensive eye exams. These are less in-depth than a full-fledged pediatric eye exam and help determine whether further eye testing is needed by an eye doctor. The pediatric ophthalmologists from The American Academy of Ophthalmology recommends getting your child’s vision tested:

• At birth and again between six and 12 months of age

• Between the ages of three and five

• When first entering school, and then every year or two

A vision screening is usually not a replacement for a comprehensive eye exam. In fact, as many as 60% of children with vision issues slip through the screening cracks. Even if the screening goes well, it is still important to schedule a pediatric eye exam, especially if you've noticed symptoms like frequent squinting or trouble focusing, if your child has a developmental disorder, or if you have a family history of eye disease. Even without these symptoms, the American Optometric Association recommends scheduling your child's first full, in-person exam between the ages of three and five.

What to Expect at a Pediatric Eye Exam

What happens at a pediatric eye exam varies depending on your child's age.

Eye Examination for Infants

An exam for infants will not be as regimented as when you have your own eyes examined. In this case, the exam will include using lights and toys to engage the baby and ensure their vision is developing as expected. At this stage the eye doctor will also check for the following:

• Proper eye movement

• Signs of developing nearsightedness (trouble seeing well at distance) or farsightedness (trouble seeing well at close range)

• Signs of the cornea (the clear dome at the front of the eye) developing an irregular shape

• Ability to focus at different distances

• Problems at the back of the eye by testing your child's red reflex. This reflex occurs when light passes through the pupil and is reflected off the back of the eye; it's what causes "red eyes" in pictures taken with a flash.

Eye Examination for Young Children (Ages 3-5)

Those in the preschool age group (ages three to five) can be more active participants in the eye examination even though they likely can't read yet. Instead of the normal chart with letters, the eye doctor will use what's known as a tumbling E chart. With this eye chart, your child will be asked to extend their fingers in the same direction that the E is facing. For young children with stronger vocabularies, the eye doctor may use a chart with symbols such as a house, a square, a circle, or an apple in place of the tumbling E chart. In addition, the eye doctor will likely test for things like:

• Color vision

• Depth perception

• Crossed eyes

• A lazy eye: This can be successfully treated, especially when caught early.

Eye Examination for Teens (Ages 13-17)

By this age, most children can confidently read letters or symbols on a traditional eye chart. Your eye doctor may also use near-vision tests (like reading a handheld card) to evaluate both distance and close-up clarity. The doctor will also use specialized lenses and possibly a phoropter (the machine you look through) to pinpoint any need for glasses or an updated prescription. For children who already wear glasses, this test confirms whether their prescription has changed.

School-aged children rely heavily on their eyes working together properly for reading and classroom activities. The optometrist will check eye alignment and coordination, ensuring both eyes are focusing together and tracking smoothly across a page. Their eye exam will also include an evaluation of the health of their eye’s internal and external structures. To do this, your child may be asked to follow a light or look in certain directions while the doctor observes the pupils, eye movements, and overall eye wellness.

Eye Examination for Teens (Ages 13-17)

Teenagers often experience changes in their vision as they grow. A refraction test helps confirm if glasses or contacts need to be updated, and teens will have more say in which they prefer. For teens interested in contact lenses, the optometrist checks eye shape, tear film quality, and overall eye health to determine the best lens type. They will discuss single-use vs. monthly lenses, proper hygiene, and any potential risks or lifestyle considerations.

With increasing school demands and digital device usage, teens can be prone to eye fatigue or dryness. The exam may include questions about your teen’s daily screen habits, breaks, and any symptoms of digital eye strain like headaches or blurred vision. Your teen’s exam will still involve checking overall eye health, including examining the retina and optic nerve. If there’s a family history of eye diseases, or if your teen experiences any unusual symptoms, the optometrist can perform additional tests.

What Comes Out of a Pediatric Eye Exam?

A comprehensive pediatric eye exam not only checks for current vision problems but also lays the groundwork for your child’s future eye health. Here’s what parents can typically expect to gain from this important appointment: 

Clarity on Visual Acuity

A pediatric eye exam provides a clear understanding of your child’s current vision. You’ll learn whether their eyesight is developing normally or if refractive errors like nearsightedness, farsightedness, or astigmatism are present. If corrective lenses are necessary, your optometrist will discuss the best options, taking into account your child’s activities and sense of responsibility. 

Early Detection of Eye Conditions

One of the greatest benefits of routine pediatric eye care is catching potential problems before they significantly affect vision. Conditions like amblyopia (lazy eye) or strabismus (crossed eyes) respond more effectively to treatment when identified early. By spotting these issues while they’re still subtle, you can often prevent them from escalating into more serious vision challenges. 

Insight into Visual Skills

In addition to checking how well your child sees objects at various distances, the exam also assesses crucial visual skills. These include how both eyes coordinate (binocular vision), the ability to track moving objects (eye-tracking), and depth perception, all of which are important for tasks like reading, sports, and other daily activities. If needed, your optometrist may recommend vision therapy or exercises to strengthen these abilities. 

Actionable Recommendations

By diagnosing vision problems, the eye exam is an opportunity to receive customized guidance about lifestyle factors that influence eye health. Your optometrist may address topics like appropriate screen time, lighting, and posture, as well as preventive measures such as wearing protective eyewear for sports or outdoor activities. By following these suggestions, you can help your child maintain good vision habits long after the appointment. 

Ongoing Monitoring and Future Care

Children’s eyes continue to develop throughout their formative years, which makes regular check-ups essential. These visits establish a baseline that allows your optometrist to identify any changes to your child’s vision over time. Depending on your child’s unique needs, the optometrist will recommend how frequently to schedule exams and whether additional interventions or therapies are necessary.