A Letter to Parents: What to Expect at your Child's Eye Exam
August is Children's Eye Health and Safety Month and (not coincidentaly) also a great time to have your kiddos' eyes checked.
Here are a few key points to consider:
Good vision is subjective and not always indicative of good eye health
Eye care providers can detect conditions beyond a need for glasses, such as lazy eye (amblyopia), crossed eyes (strabismus), drooping of the lid (ptosis) and color blindness before they lead to long term complications
Although rare, an eye examination can also detect eye cancers - whether benign or malignant, like retinoblastoma
School or well child vision screenings, although beneficial, do not substitute a comprehensive eye exam
Eye safety is also at the forefront of children's eye health because eye injuries are the leading cause of vision loss in children.
Ways you can be proactive about their eye health include:
Sport goggles (prescription available) should be worn to help protect their eyes from blunt trauma during sports
Toys with sharp or protruding objects should be eliminated and age appropriate toys chosen
Safety glasses should be worn during woodworking or any other activity which uses tools (our kids love to "dig for dinosaurs" by chipping away at frozen ice in summer)
If you've never had your child's eyes examined or it's been a while, I've written a letter to let you know what you can expect at your child's next (or first) eye exam...
I know you are curious about your child's first eye exam. Here is what will take place:
I will introduce myself as Dr. Herring, then welcome you and your child into my exam room. I’ll ask if you have any concerns regarding their eyes or vision that you’d like addressed today and we’ll chat about it for a few minutes.
I will ask about their eye and overall health history, including any medications, allergies. family medical and eye histories, so bring any old pairs of glasses they've worn in the past.
Then, we will discuss their developmental and educational milestones, as well as any daily habits including digital device use and amount of time spent doing near work.
I will also ask you whether they get enough water, sleep and outdoor play time, in addition to their nutritional patterns. It is my job as a primary care provider to inquire and discuss these aspects of your child’s health as they can each affect their visual system and overall eye health.
I will then begin with my assessment of their visual system by checking both near and far acuities and perform a few preliminary tests. These "games" include assessment of their eye movements, tracking patterns and natural postures, ability to focus, peripheral vision, pupillary assessment, color vision and depth perception.
I may then perform what’s called an ‘objective refraction’ behind the phoropter depending on their age. You know the piece of equipment I’m referring to - the bulky, outer space-like contraption? The phoropter will be placed in front of your child’s face to determine whether a refractive error exists.
I will do this by shining a light from a black, rod-like instrument called a retinoscope in their eyes while turning dials on the phoropter, all the while encouraging your child to sit still and stare at a large letter on a screen across the room.
Your child can sit still, right?
That’s when the fun begins. Depending on how active your child is, my time is limited or I will lose their attention and focus. I also get to decode what your child’s responses mean as I present lens options to them, while encouraging them further down the eye chart to the 20/20 line, (which, by the way, refers to what an average person sees at 20 feet as being the same size object that your child can see at 20 feet.)
By then, I will have a pretty good idea of whether or not your child may need glasses.
Up next, I will assess their binocular vision status, (how well their eyes work together), through the phoropter. Did you know that some children’s difficulties in school can be attributed to poor vision or eye teaming skills?
I will then move on to the health evaluation part of the exam and look at their eyes under a giant microscope called a slit lamp. I can tell identify any ocular allergies, blepharitis or dry eyes. I may need your help holding their head firmly in place and can even show you their eyes through the slit lamp if you are interested.
Dilation of their pupils comes next, and I will do this by gently instilling drops into their eyes. Don’t worry, I have a few tricks up my sleeve, including 'magic drops' and the 'closed eye' method. They don’t hurt but will make their eyes feel numb for a few minutes and blurry for a few hours after the exam.
Oh, and please don’t ask if this is necessary because they have soccer practice right after the exam or you will probably have to bring them back to finish their exam. Although I am a fan of the retinal photos you had taken at the beginning of the exam, they do not substitute the dilation, in your child’s case. This is because I perform a stronger dilation (aka cycloplegic dilation) necessary for me to fully assess their visual system and finalize their prescription.
You may choose to wait in the waiting area, or try on frames while your child’s eyes dilate. I will call him or her back in 15-20 minutes.
After your child’s eyes are blurry and the pupils are the size of dimes, it’s time for part 2 of the exam, where I will repeat the “better 1, or 2?” test.
I will then have the data I need to recommend or not to recommend glasses, patching or vision therapy.
Onto the final health assessment, where I will take one last look through the giant microscope at the back of their eyes with a small lens. I am not expecting to find anything, but am trained to look for congenital abnormalities, retinal holes or tears and cancerous tumors. I finalize this part with a larger lens and a science-y looking contraption on my head. Very fancy.
And that will conclude your child's total eye check. I will go over any treatment recommendations and we will discuss any questions you have before making their personalized eye care plan.
Of course we save the best for last as your child will receive a pair of ever-fashionable, disposable dark out shades as you leave. And maybe a sticker ;)
Thank you for entrusting me in the care of your child's eye health.