Chidlren's eye exam - child with a perspective optometry ocluder and an eye chart


Children's eye exams at our Vancouver vision therapy clinic


How common are children's vision problems?


Approximately 1 in 4 school-aged kids have an undiagnosed vision problem. Vision problems in children include blurry vision caused by hyperopia, astigmatism or myopia. Myopia is a progressive disease that gets worse over time and must be controlled; it could lead to permanent vision loss.


Other problems could include eye movement disorders like convergence insufficiency and problems with accomodation, stereo-blindness (the in abilty to see in three dementions) and ablyopia and strabismus (also called "eye-turn" or "cross-eyes". Any of these issues can damage a child's learning abilty, cause behavioural or discipline problems and damage confidence and self-esteem. Problems like strabismus have even been shown to lead to lower educational and vocational attainment in adulthood. Childhood vision problems need to be addressed by an optometrist as early as possible because they become harder to fix as the patient ages.




There is also a type of eye cancer that most commonly affects children and is often first caught during a routine childhood eye exam. This cancer, called Retinoblastoma, begins in the retina, the membrane at the back of the eye. Retinoblastoma can lead to loss of they eye or even death.


Will my child tell me if she has a vision problem?


It can be difficult for parents to notice vision problems in their children because children are not necessarily aware that they do not see the world as others do. An emotional example of this is in the video below about Dr. Randhawa's "inspirational children's eye exam".


Children's vision is important for development and learning


Children's eye exams are critical for child development and educational attainment. Most learning happens through the visual system, approximately 80%. In school, reading, writing, viewing the smart board or chalk-board, playing games that demand eye-hand coordination require a child's eyes and visual system to work perfectly. All of those tasks involve the ability of the eyes to shift focus rapidly, track objects in motion or, scan words on the page line-by line. If any of these visual abilities is not functioning properly, a child's learning and sports can suffer.


The visual demands of school increase as a child progresses. The amount of reading, studying and writing increase and the size of print decreases. Increased workload and homework put significant demands on a child's visual system, which needs to function well so that the child can keep up in an increasingly complex, increasingly visual and competitive world.


Because vision is so important for learning we recommend that an exam be part of the child's back-to-school routine.


A proper children's eye exam includes special tests


Visual acuity


When we talk about seeing 20/20, we are talking about clear vision in the distance and up close. This is called "visual acuity". It is measured by reading lines on an eye chart. Visual acuity is just one component of vision. It is necessary to assess visual acuity but If that is the only component of your child's vision that is being tested, the examination is not adequate. Vision screenings performed in schools fall into this category.


As the video below illustrates, life demands more the 20/20:



Patient history, including developmental history


Childhood development can provide important clues in relation to vision problems, particularly skipping or missing developmental milestones. That's why its important for eye doctors to take a patient history that includes a a focus on developmental milestones.


Measurement of refractive errors like myopia, hyperopia and astigmatism


Myopia, hyperopia and astigmatism cause blurry vision. The blurry vision can be corrected with glasses, contact lenses or orthokeratology. Myopia is of particular concern because it is cause by the abnormal elongation of the eyeball, which can lead to blindness. There are effective techniques to slow or stop the progression of myopia that our doctors will discuss with you if myopia is found.


Eye focusing, eye movement and eye teaming


At our clinic, we conduct an assessment of eye focusing, eye teaming and eye movement abilities. This are generally referred to a binocular vision skills and include convergence insufficiency, accommodation, tracking, saccades and others. Problems in these areas can make life in the classroom difficult and can interfere with learning. For example, eye movement control involves the ability to move both eyes together in focus and point them at a target and follow the target along a path, like reading lines of text in a book..


An examination of the health of the eyes


We also examine the health of the eyes. We use special equipment to image the interior of the eye, the ocular surface, the tear film and the glands that produce tears. We also check the pressure inside the eye. Diseases that are diagnosed during an eye exam include glaucoma, eye cancer, skin cancer, diabetes, cataracts, macular degeneration, high bood pressure, high cholesterol, and more. Many diseases diagnosed during a routine eye exam are most easily treated if caught early, so it is not advisable to miss your regular eye exam


Depth perception should be tested in a child's eye exam


If a child is unable to see in 3D, this points to underlying eye problems like binocular vision issues, eye misalignment, amblyopia or strabismus.. Amblyopia and strabismus are best treated at an early age. If they are not caught until later in youth, they are much more difficult to fix.


Testing for convergence insufficiency is a feature of our children's eye examinations


Convergence insufficiency (CI) is a common vision disorder that affects 15% of the population. It interferes with a person's ability to see, read, learn and work at close distances. In CI, the two eyes don't work together in unison as they should and they have a tendency to drift outward when doing near work. Vision Therapy is the best treatment for CI.


Perspective Optometry also tests for visual perceptual abilities


Depending on the results of these evaluations, additional tests of visual development and visual perceptual abilities may be needed to effectively assess a patient's total visual status. The components ogf visual perception include, visual cognition, visual memory, patter recognition, scanning and visual attention.


What happens after a child's eye exam is over?


Any reading or learning difficulties experienced by you or your child should be brought to Dr. Randhawa' s attention. Request an evaluation to detect whether learning-related vision problems are present.

Once testing is completed, Dr. Randhawa will review all findings with the patient or parent and provide consultation and recommendations regarding any needed treatment.


Children's glasses


If eye-glasses are needed, we have an excellent selection of children's frames for your convenience with brands like Safilo Kids, Puma, Converse, Lacoste, Superflex and small, kid-friendly sizes in major brands like Kate Spade, Hugo Boss and Burberry.


Child wearing stylish eye glasses in front of a a selection of children's eye-glass frames


Watch Dr. M.K. Randhawa talk about an inspirational children's eye exam


While it can be shocking that a 5 year-old girl had uncorrected vision problems likey since birth, this story of when she saw her parent's faces for the first time in Dr. Randhawa's exam room is inspirational. This story highlights the need to bring your child in for an eye exam starting at six months of age and regularly thereafter. The silver lining in this story is that the child's vision problem was caught just as the child was about to start school. While the child likely missed out on considerable visual learning prior to her first eye exam, that problem has been fixed going forward and her vision will no longer be an obstacle to her learning.




A children's eye exam uncovered ambloyopia



A children's eye exam at age 3 found that Kelly's eye was not working properly.

Thanks to vision therapy, she now sees, learns and plays as well as she should.







Dr. M.K. Randhawa on vision therapy and children's vision care