Your Child's Pediatric Ophthalmologist Visit: What to Expect

Many parents wonder how we can check a child’s vision or need for glasses.  At your Pediatric Ophthalmology visit, we can assess vision at any age, check the need for glasses and evaluate the health of the eyes. 

From birth to around 4 to 6 weeks of age, we judge visual behavior with how babies respond to bright lights. From 2 to 3 months of age, infants will start to look at and follow faces, toys, as well as bright colored lights. After 6 months of age to about 2 to 3 years of age, we test their vision by observing their tracking and their fixation patterns, as well as having them match pictures or letters.

When your child is old enough, we start to have them match pictures or letters. This allows us to attach a number value to their vision and can happen as early as 2 years old. By covering your child’s eyes, we can examine eye movements and any misalignment. This can be assessed in children of all ages.  We also test stereo or 3D vision in verbal children to give us basic information on how your child’s eyes work together.

We also evaluate the structural health of the eye. The front portion of the eye is examined with a slit lamp exam. If your child is old enough, they will put their chin in a chin rest and we look through a special microscope with a light to examine the eye. A portable slit lamp can be used on young children. If your child is old enough, they can also sit on your lap or on their knees, during the slit lamp exam.

We can check eye pressure several ways including just touching the eyes through closed eyelids. Some ways require eye drops to numb the eye. Most importantly we don’t use the “puff of air” test, and nothing hurts while we check eye pressure.

Typically, if this is your first visit, we place drops in each of your child’s eyes so they dilate. It generally takes about 30 to 60 minutes for the drops to work. Often we have to hold children still and help them open their eyelids. The drops sting for 10 to 15 seconds, sort of like getting splashed with swimming pool water. During this time, you may be asked to sit in the waiting room or a special dilating area. Expect your child to start having difficulty reading or looking at near targets during this time.

We give drops during our initial and yearly exams to be able to look at the back of eye, including the optic nerve and retina, and to relax your child’s focusing power to get the best idea of their need for glasses. Without dilation, a child can continually adjust their focus power. This is like trying to measure a child’s height while doing jumping jacks!

After dilation, if they are old enough, a special photograph with a machine called an autorefractor is taken to estimate your child’s focus power. Then, using a special flashlight called a retinoscope and a set of handheld lenses, we can determine the “refractive error” in babies and young children without their needing to give any input. We can determine the “refractive error” in older children by using a device called a phoropter.

While almost everyone has a small amount of farsightedness, nearsightedness, or astigmatism, that doesn’t necessarily mean a child needs glasses. Using these results, we can also predict if your child may need glasses in a few years.

Finally, we look at your child’s retina and optic nerves using a lens and a light source.

Generally, you can expect the visit to last from two to two and a half hours. Most places will offer sunglasses on the way out, as bright lights may bother your child’s eyes after the dilating drops. It is safe for your child to return to school after a visit but be sure to tell the teacher their eyes will be blurry for a few hours. The dilating drops can keep the pupils dilated as long as 24 hours, so don’t be alarmed if your child still seems dilated even the next day.