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When Should My Child’s First Eye Exam Be?

When it comes to your child’s health, it seems like there are hundreds of recommendations and doctors to visit—but when should your child begin to see an eye doctor?

The Eyes and Human Development

As noted before, we know there are many different recommendations out there. With our friend Dr. Google it can be hard to determine what exactly is the best schedule to follow and when to go to what doctor.

However, when you think about it more closely, proper eye health is required for good vision—if vision is poor it can make life quite difficult.

If your child has poor eyesight from birth—they likely will not be able to recognize that his or her vision is poor, as it is what they have always known. He or she will not be able to tell you that they cannot see well, but instead will think that is simply how the world looks.

Poor vision, therefore, can cause a child to struggle in more aspects in life than just school work. Thus, it is important to have a first eye exam prior to entering school-aged years.

Think about a toddler learning to walk. If he or she cannot see where they are going—this toddler may be afraid to walk around and ultimately come to avoid the task. The same can be applied to other aspects of life as well. If a young child cannot see effectively, they may not be able to recognize family members, feed themselves, play with toys, etc.

Essentially, your baby could be trying to learn how to encounter the world for the first time through extreme blur—this would be a difficult task for anyone to overcome, let alone a baby! This could prolong their developmental milestone track and cause parental stress and worry.

While you might think the most appropriate doctor to see is a developmental therapist, the solution could be as simple as your baby just needing a pair of glasses.

Pediatricians and Eye Exams

A common statement heard from many parents is that they take their children regularly to see pediatricians and the pediatrician performs a vision screening—so why is it recommended to take my child to see an eye doctor?

This is a very fair question. Pediatricians go through schooling to learn about the human body in its entirety. They go through medical school first, and then at least three additional years of schooling to specialize in patient care for the younger population.

The human body is extremely complex with many different moving parts that must be evaluated within a 20 minute exam slot. Thus, when your child sees a pediatrician, the doctor is doing a simple screening looking for major eye health problems (cancers, malformations, obvious eye turns, infections, etc.), and then moving on to the next test.

This of course is not to say that pediatricians are not doing enough—they are experts in children medical care of course! However, the eye is so complex that doctors of optometry spend 4 years studying just eyes, and look at so much more than just a glasses prescription! Why not leave the vision examination to a specialist who is trained to pick up on subtleties and has the proper equipment to conduct various tests specific solely to the eyes?

What do Eye Doctors do Special During Pediatric Eye Exams?

Eye doctors not only have more advanced and specialized equipment to evaluate children’s eyes, but they also go through special schooling to assess children’s eyes.

An infant eye exam begins with your typical history questions—asking about length of pregnancy, complications that occurred during birth, and if applicable, developmental milestones. It is important to come prepared with this information as this information is crucial for eye development timelines and can lead your eye doctor to watch more closely for subtle signs and changes in your baby’s eyes.

For example, a baby that was born prior to 37 weeks (pre-mature) is at higher risk for eye turns (called strabismus), refractive errors (i.e. will need correctional glasses), and other eye health problems. This is not absolute—so do not panic reading this! It is just another reason as to why it is important to visit an eye doctor early in life rather than waiting until school-aged years.

After the history, your eye doctor will look at your child’s eye alignment to evaluate if he or she has an eye turn and ensure the eye muscles are working properly.

Next, the eye doctor will look at your child’s light reflex. This is how eye doctors can look into a patient’s eyes and determine if he or she needs a glasses prescription without verbal feedback.

The eye doctor will hold some lenses in front of your child’s eyes while shining a light into them quickly. The light is reflected off the back surface of the eye. With lenses, the eye doctor is able to neutralize this light reflex to come up with the appropriate glasses prescription (if needed).

The last major test during an eye exam is dilation. Dilation is important because it allows the doctor to use a special magnifying lens to look into the back structures of the eye and ensure everything is healthy and has developed properly.

It is important to catch any disease early, while it may be unlikely for a major problem to be uncovered in your child, it is always better to be safe when it comes to your child’s health.

What are Abnormalities Eye Doctors May Find During the Eye Exam?

A large majority of children will get the all-clear and be perfectly healthy with no treatment necessary from their first eye exam. Your eye doctor will then give you an updated timeframe and likely will not need to see your child again until reaching the school-aged years, unless another concern comes up in the meantime.

There are, however, several different abnormalities that may be detected during your child’s initial eye exam—initiating treatment for said abnormalities will be a lifechanging improvement for your child.

One such abnormality could be the need for glasses. A child who cannot see well may lash out, anger easily, or appear to be developmentally delayed. This could simply be out of frustration due to seeing the world as a blurry mess.

Many children need glasses—especially in today’s world with a drastic rise in myopia (near-sightedness). If your child needs glasses it is nothing to panic about, and there are many great options for flexible, comfortable glasses even for babies!

Another reason as to why eye exams are crucial for your young ones is due to a problem called amblyopia. In short, amblyopia is caused by the brain “shutting off” one eye. It can be caused from one eye seeing well and the other eye seeing poorly, an eye turn, or a structural abnormality such as an excessively droopy eyelid or trauma.

The crucial years for eye development range from birth to about 7 years of age. During this time, if amblyopia is caught, there is a much better likelihood of treatment working to “turn the eye back on” and prevent permanent decreased vision in the problem eye.

Amblyopia can be tricky to detect because your child might appear to see well, as their good eye is taking lead and allowing them to see “alright”. Eye doctors are trained to watch very closely for this problem; the earlier it is caught the better the outcome is for your child.

Other problems eye doctors watch for are eye turns, cancers, glaucoma, and other retinal diseases (the retina is the back most structure of the eye responsible for transmitting vision from the eye to the brain).

At What Age is the Eye Exam Recommended for my Child?

A safe recommendation is for your child to have his or her first eye exam around 6 months of age. If the eye doctor sees a concern it is easy to initiate treatment at that time, or if it is something that should be monitored they may recommend you bring your child back in to see them every year.

If everything looks good at this initial visit, your doctor will likely recommend you return for your child’s next visit when they get closer to starting school—around the age of 4-5 years.

Once reaching school-age, it is recommended to bring your child in for an eye exam yearly. This is to watch for changes and initiate any necessary treatment as early as possible to prevent the issue from progressing.

Is There Anything I Should Watch for in my Child Before the Eye Exam?

As a parent we know you have many concerns and are quite busy. However, the following is a list of signs that indicate you should make an appointment with your local eye doctor:

  • Excessive squinting
  • Inability to focus on a target (toy, bottle, face, etc.)
  • Visible eye turn (can be constant or only seen sometimes)
  • Excessively droopy eyelids
  • If the black part of your child’s eye appears white (especially in pictures)

If you notice one or more of these signs in your child, it does not necessarily mean something is wrong, but could be a sign of something more serious going on. Your local eye doctor would be more than happy to see your little-one and make sure he or she is setup to live their happiest, most-successful life.

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses and diagnosis of various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to learn more about a pediatric eye exam.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services and eye exams in the Midtown, Downtown, Museum District, Montrose, East Downtown, and Southside Commons (Southside Place) vicinities of Houston, Texas.

Eye Problems and Down’s Syndrome

Down’s syndrome is a condition in which chromosome 21 is duplicated, resulting in three copies rather than just two. It is associated with intellectual, developmental, and physical changes.

The eyes are one component and there are a variety of conditions that individuals diagnosed with Down syndrome may be affected by or more susceptible to. Read on to learn about some of the most common ocular findings.

 

Refractive Error and Glasses

This refers to an individual’s prescription in corrective eyewear such as glasses or contact lenses in order to see as clearly as possible. Patients with Down syndrome are more likely to need corrective eyewear whether for nearsightedness, farsightedness, or astigmatism.

 

Strabismus is a Common Feature in Down Syndrome

Strabismus refers to an eye turn that the individual may have. This could be one eye turning in and out, or both eyes turning and switching back and forth. It could also be present at all times or only at some points in the day and associated with certain activities.

An eye more often turns inward, but in either case amblyopia or lazy eye may develop. This means that because the turned eye is not being used as frequently, it will not receive as much visual stimuli and its pathways to the brain will not fully develop, leading to permanent vision reduction in that eye if the eye turn is not fixed in childhood.

 

Down’s Syndrome Can Cause Keratoconus

At the very front of the eye is the clear cornea, which is thinned in this condition, causing the fluid from inside the eye to push outwards. This causes the cornea to bulge outwards into a cone shape and distorts the curvature, affecting vision. This condition has been shown to be associated with eye rubbing and our optometrist will check to make sure that there are no underlying causes inducing this.

Cataracts

A cataract refers to the clouding of the lens within the eye, causing blurry vision or a spot in vision. If noted, our optometrist will assess to see how severe the cataract is and, if needed, refer the patient to receive surgical treatment to replace the lens. Patients with Down syndrome are at higher risk for either congenital cataracts (present at birth) or developing cataracts as they age earlier than the general population.

Glaucoma

This is a group of disorders that refer to the death of the nerve cells at the back of the eye, which are responsible for providing peripheral vision. This is often associated with higher eye pressure but this is not the only variable.

Treatment includes eye drops, instilled everyday, to lower eye pressure or certain laser procedures that help with outflow of the fluid within the eye to lower the pressure. Individuals with Down syndrome are at higher risk for higher eye pressures and glaucoma.

Blepharitis

This is a condition that leads to inflammation of the eyelids and the glands within them. It is often associated with a dry or burning feeling in the eyes and redness. Eyelid hygiene is an important component for this condition and it can be treated with eyelid cleaning, warm compresses, steroids, or antibiotics.

 

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses and various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to learn more about how Down’s syndrome can affect the eyes.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services and eye exams in the Midtown, Downtown, Museum District, Montrose, East Downtown, and Southside Commons (Southside Place) vicinities of Houston, Texas.

Can Smoking Affect My Eyes?

Smoking has a variety of adverse effects on the body and the eyes are no exception. It is often a risk factor for developing several diseases or exacerbates existing conditions. Here are some of the interactions that smoking has with the health of your eyes.

Smoking Worsens Macular Degeneration (ARMD)

Smoking is one of the main modifiable changes to prevent age-related macular degeneration (ARMD) development and progression. In ARMD, the nerve fiber at the back of the eye, the retina, is damaged. Specifically, this disease involves damage to the macula, the portion of the area on the retina that is responsible for your central vision. This results in loss of vision centrally and currently, there is no treatment that can reverse this disease. Various studies have shown that smokers are more likely to develop ARMD compared to non-smokers.

Smoking Can Cause Cataracts

A cataract is the clouding and yellowing of the lens within your eye. This lens is responsible for focusing light on the nerve fiber layer at the back of the eye. The clouding causes people to experience blurry vision, glare, and a dimming effect with a diminished ability to distinguish colors. The change occurs gradually and the treatment includes cataract surgery to remove and replace the lens within the eye. Smoking increases the risk of developing cataracts and increases the likelihood that surgery will be needed sooner.

 

Glaucoma

Smoking is a risk factor for developing glaucoma as well. Glaucoma involves the loss of peripheral vision due to changes to the optic nerve at the back of the eye. The optic nerve transmits information from the eye to the brain and thus damage to this area will have detrimental effects on vision.

 

Diabetic Retinopathy and Cigarettes

Diabetic retinopathy (DR) refers to damage to the back of the eye as a result of diabetes. In DR, the blood vessels at the back of the eye are damaged and are leaky. This can result in hemorrhages and can cause swelling. This can blur and distort vision, ultimately leading to blindness if left untreated. Cigarette smoke can increase the likelihood of blockages in the blood vessels and the dysfunction of the vessel walls. This can in turn increase the chance of leakage of blood or the formation of excess and weak blood vessels that can cause permanent damage to the eye.

Dry Eye Disease is Exacerbated by Smoking

Dry eye disease could easily be exacerbated by the smoke produced by cigarettes. The smoke contains many chemicals and debris that can enter the eye, irritating and drying out the tear film that lubricates the front surface of the eye. Secondhand smokers will often also be consistently affected by this and unfortunately can develop dry eye disease as well. Symptoms include irritated, red, gritty, and itchy eyes.

 

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses, and various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to learn more about how smoking can affect your eyes.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services and eye exams in the Midtown, Downtown, Museum District, and Southside Commons (Southside Place) vicinities of Houston, Texas.

Glaucoma and Eye Pressure Testing

One of the most common tests completed at the optometry office is the Non-Contact Tonometer (NCT), more often known as the “air puff test” or “glaucoma test”. To many patients, it is a mystery what this test is truly measuring but here is a quick run-down of the purpose of this test and its importance. 

 

Eye Pressure and Glaucoma

At your eye exam, our optometrist will often want to keep a record of your eye pressure, which is the pressure exerted in the eye from the fluids acting within/ around it. The importance of this measure is that, like other parts of the body, it is important to maintain a normal value. 

Eye pressure can have small fluctuations in the short term due to a variety of factors (i.e. body posture, exercise, eye movement, time of day) that do not have a detrimental effect on the body. The most important change that your optometrist would find significant would be a large increase or decrease in eye pressure. Low pressure could indicate leakage of internal fluid or intraocular inflammation. A pressure that is too high could indicate changes in blood pressure, disease, or injury. High IOP is also a strong risk factor for glaucoma, a disease that can decrease the size of your visual world slowly without your awareness.  

 

There are a variety of ways that your eye pressure can be measured: 

 

Indentation Tonometry

This refers to a method of indenting a small area on the cornea, the front surface of the eye. The amount of force needed to indent a specific amount of the cornea is measured, but this technique is rarely done today.

 

Applanation Tonometry

This method uses a force (air or physical pushing) to applanate (or flatten) a specific small area of the cornea. The force and area flattened is measured and used to determine the pressure. 

The Goldmann Applanation Tonometer, Perkins Tonometer, Tonopen and i-Care are all instruments that utilize a probe to physically push into the cornea a small depth. Our optometrist will be looking to see how much pressure needs to be exerted on the front surface in order to flatten the cornea a specific amount. Our optometrist may instill an eye drop prior to the procedure to numb the eye so you will not feel any sensation of the probe. This also does not affect the health of the eye.

The Non-Contact Computerized Tonometer is commonly used for assessing eye pressures. This is an automated test that produces a puff of air that flattens the cornea. The value that is measured is the amount of time it takes for the cornea to be flattened a specific amount, meaning that the longer it takes for the air puff to flatten the eye, the higher the internal pressure. The thickness of the cornea can affect the measurement of the eye pressure so this is often automatically accounted for after the air puff is delivered and the final IOP is calculated.

 

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses and various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to learn more about how we use eye pressure to assess your risk of glaucoma.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services  and eye exams in the Midtown, Downtown, Museum District, and Southside Commons (Southside Place) vicinities of Houston, Texas.