What to Expect at Your Infant's First Eye Exam

The American Optometric Association (AOA) encourages parents to include a trip to the optometrist in the list of well-baby check-ups. Exams at six to 12 months of age can determine healthy development of vision. Early detection of eye conditions is the best way to ensure your child has healthy vision for successful development, now and in the future.

Pediatricians perform screening eye exams on newborns to check for infections or structural problems with the eyes: malformed eyelids, cataracts, glaucoma, or other abnormalities. Though a baby's eyes are checked at birth, it is a good idea to schedule an eye examination for your baby.

While the AOA recommends that children be checked at six months of age, your pediatrician will help you determine an appropriate time for your child's first visit. It is a good recommendation to have an additional eye exam at three years of age and then again at around five or six, which is usually around the time formal grade school begins.

Even the most astute parents have a hard time judging how good their own child’s vision seems to be. Having an eye exam is much more involved than reading the letters of the eye chart, and babies don’t communicate much at all except when they are hungry and tired. A trained optometrist or ophthalmologist can evaluate your child’s vision sometimes without your child saying a word. Infants and young children need eye exams because those with large problems that may go undetected can be addressed before they turn into something that cannot be fixed. A child's neural system is complex, and still developing until 7-8 years of age. Problems that can be addressed before the age of 7 or 8 can save a lifetime of vision, social or employment problems.

An infant eye examination is similar to that performed on adults. However, it is simplified a bit. There are three goals that the doctor will try to achieve during an infant’s eye exam:

1. Rule out significant amounts of farsightedness, nearsightedness, or astigmatism
2. Rule eye muscle and binocular problems such as strabismus
3. Rule out eye disease including the presence of congenital cataracts, retinal disorders, and tumors

The doctor will evaluate the baby’s medical history, vision, eye muscles, and eye structures. The doctor will observe how the baby focuses, and whether or not both eyes are working together as a team. It is common for babies to not obtain full-time binocularity (both eyes working together) until 4-6 months of age. Occasionally, you may see one eye go out or both eyes crossing. It should be brief and not often. Your doctor will assess this carefully to make sure both eyes fall within normal ranges.

Although a baby can’t provide any "subjective" input at this age, the doctor can perform several tests that will provide information about the child’s sight. 

• The doctor assesses the baby’s vision. Does the infant react to light shone in the eyes? Will the baby look at a face or follow a moving toy? Other, more sophisticated vision tests may be used if needed.
• The doctor temporarily dilates the pupils with dilating drops. The eye doctor will use an instrument to test the baby’s eyes for refractive error, such as nearsightedness, farsightedness or astigmatism without the infant or child saying a word. Most babies are slightly farsighted at birth. This usually goes away by 3-5 years of age. However, a baby can wear glasses if needed. Special eyeglasses are designed to fit very small faces.
• The doctor uses a lighted instrument with a magnifying glass (ophthalmoscope) to look inside the baby's eyes. With the use of an ophthalmoscope, the doctor will be able to assess the overall health of the baby's eyes and detect any early signs of trouble.

He may seem tiny and perfect in every way but your new baby really should have his eyes checked at every checkup during his first year of life. Your baby's pediatrician should check to make sure his eyes are straight and have the ability to focus properly. Catching eye and vision problems early will help ensure a lifetime of seeing his very best.