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Infant Eye Care

When do infants begin to see?

We used to think that infants did not obtain normal vision until six years of age. This was because we didn’t know how to test them. In the last twenty years using sophisticated techniques we have learned a lot about the way infants see. Infants develop normal vision by age six months. Yes that is right 6 mos. not 6 years of age. Normal vision means they have 20/20 in each eye; they have coordinated binocular vision (both eyes work together without any evidence of an eye turn); color vision is normal; and eye movements are normal. During the next two years the visual system undergoes fine tuning is most liable to be affected by adverse conditions. This short period of time when the neural system (the eyes and brain) are plastic is known as the critical period. The critical period is the time in which lazy eyes (amblyopia) and strabismus need to be diagnosed and treated. It is the time when we have the best chance of obtaining a cure.

At What Age Should My Baby Have Their First Examination?

Since normal vision is not developed until 6 mos. we recommend that the first eye examination should be at age 9 mos. At this age infants are easy to examine and should have normal eyes. If a child appears to have a problem before this age, by all means bring your baby in. We are adept in examining infants from birth on. At 9 months of age babies are very reflexive. They will stare or look at objects interesting to them. Thus, its easy to have them track an object and evaluate eye movement skills. It is easy to determine if a strabismus (eye turn) is present. We are able to inspect the front of the eye to make sure the cornea is clear, the lacrimal system is normal (tearing) and there are no cataracts. We also make sure that there is no glaucoma.

At this point of the examination drops are put in to dilate the pupil and to temporarily stop the eyes from focusing. Twenty minutes later we re-examine your infant. With a special light we can determine if your child is nearsighted, farsighted, or astigmatic. Correction at this age may be important in preventing amblyopia which is present in 4% of all children. With appropriate glasses and patching this condition can be corrected at this young age. Lastly, we use a special instrument to look at your infants retina.

Doesn’t My Pediatrician Examine My Child’s Eyes?

Yes, but your pediatrician will not pick anything other than grossly observable problems. The subtle problems like amblyopia, which causes more visual loss in the under 40 than all the diseases combined is often missed. If an eye turn is so small that it is cosmetically un-noticeable then neither you nor the pediatrician will see it. However, that eye turn may cause a lack of development of normal depth perception and visual acuity. Lastly, visual acuity is not assessed until the child can read, too late to fully correct many of the visual problems.

Isn’t Two Years of Age a Better Time?

There is a reason why they call them "terrible twos". At that age the visual system is developed and your child knows they don’t want to be in the doctor’s office. They are less cooperative and more difficult to examine.

After the First Examination When Should My Child Be Examined Again?

Six years of age is another milestone. Children need to see well, have good eye muscle coordination, and have reached the normal visual developmental milestones to have unimpeded academic growth. If there are no problems at age 6 the next examination should be at age 21 unless there are problems. You may monitor vision in each eye using an interactive visual acuity chart. If you choose to do so, be sure to test your vision or your child’s vision, one eye at a time (cover the eye not being tested).

What is 20/20 Vision?

20/20 vision means that you see at 20 feet what the average person sees at 20 feet. 20/200 means that you see at 20 feet what the average person sees at 200 feet. Many young patients have better than 20/20, e.g., 20/15. Only a few people have 20/10.