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What does a children's eye test involve?
July 19, 2022
A question that I often get asked comes from parents that want to know what a children's eye test involves and when they should take them to get their eyes tested. A huge amount of visual development occurs in the first few years of your child's life, especially when they’re babies. Their visual system is undergoing a lot of change in a relatively short period, so it's important to monitor these changes and keep an eye on them (pun well intended).
The tricky thing as a parent is how to detect if one of your child's eyes is not seeing as well as the other. If one of their eyes seems to be misaligned and the child is 12 months old or older, then they should have further assessment, and need to be taken to your GP for a paediatric referral for treatment. If your child is verbal and can communicate to you that one eye is “fuzzy” etc., then they should be taken to the GP for further referral for possible amblyopia - meaning that for some reason one eye is not seeing as well as the other. If you’re able to detect this as early as possible, or you have suspicions, then it’s essential that you have the child referred via their GP as early as possible. This is because the visual system of the child is most responsive to treatment the younger they are - particularly below 4.5 years old. This is known as the plastic period, and is the window of opportunity we have to treat amblyopia. The further away in age that the child is from 4 years old, the less effective any required treatment is likely to be.
That is all to say, if you notice a concerning or unusual change with your baby or child’s eyes under the age of 4, they should be taken to the GP for a paediatric referral.
If you have any immediate questions and would like to consult with one of our optometrists, you can book a remote consultation right here on Eyebou.
Once your child reaches 4 to 4.5 years old, they can be taken to the local optometrist for assessment. The first visit to the optometrist can be daunting for the child, as there is so much unfamiliar equipment around, and of course, this is the first time they’re meeting the optometrist. Rest assured that the optometrist will usually be aiming to make the child as comfortable as possible during this first visit, and will only conduct a couple of very simple checks as the child gets used to the environment. They will be looking to assess a couple of key things initially:
1. Can the child see relatively equally with both eyes?
This will usually be checked by covering each of the child's eyes (sometimes with a little patch), and asking them to identify what shape they can see on the screen. When the child is confident with letters, this will change to letters. If the child has failed a visual screening check at school or nursery, the parent will be asked to make an appointment for the child to have their vision checked by an optometrist.
You can also do a vision screener for your child's eye health with a quick strabismus check on the Eyebou iOS app.
2. Is there any misalignment of the eyes?
The optometrist will ask the child to look at a little toy or something that grabs their attention and assess how the eyes are moving together.
3. Do their eyes appear healthy?
If the child seems happy and calm, the optometrist may also have a peek in the child's eyes with a small torch to assess if their optic nerves appear normal and healthy.
If all of the above is normal, the optometrist may request that the child returns for their routine sight test again in 12 or 24 months. If the child has struggled to cooperate, or has been feeling overwhelmed, they’ll schedule a follow up assessment for the child to try again.
Sometimes, there can be a concern that the child is not seeing well with one or both of the eyes, and drops might need to be applied to relax the focussing system of the eyes, and allow the optometrist to measure their prescription with a little torch. These drops do briefly sting, and so the optometrist will discuss with the accompanying parent if they feel it best to apply these drops at home ahead of a follow up appointment (to reduce the risk of a breakdown of trust between the child and the optometrist), or if the parent wishes the optometrist to proceed with the drops and assessment that day.
If possible on the day, the optometrist will also aim to obtain a photo of the child’s retinas (at the back of the eyes), to be able to build a historic record of the child's retinal health. This allows the optometrist to become very familiar with what is normal or not over time for your child.
As the child gets older and becomes more relaxed with the environment of the examination room and the optometrist, they will look at assessing the child’s colour vision and depth perception, and will conduct a more in depth assessment of the front and back of the eyes.
It’s becoming increasingly more common for children to develop myopia (short-sightedness). If this is the case with your child, the optometrist will assess them more often and will discuss with you management strategies to slow the progression of myopia. If you have any questions about this, please contact your local optometrist or book a remote appointment with one of our optometrists at Eyebou.
If your child is seeing well, and seems to have healthy normal eyes, then either an annual or 24 month review is sufficient, depending on any risk factors being present e.g. both parents having myopia. However if you notice any changes, or your child reports visual issues or more frequent headaches, then you should book an assessment with your local optometrist.
In the UK, sight tests for children are covered by the NHS and the NHS will subsidise the costs of any spectacles required. Not all practices offer completely free spectacles however, so if this is a concern, please speak to the practice ahead of booking your child for an eye examination.
This article was written by Mai Monavar, Eyebou's lead optometrist.