Infant and Toddler Eye Exams

By Anna Griffith, OD

Getting an eye exam for your baby or toddler may be one of the most important things you do. A baby’s eyes continue to develop after they are born. As the eyes see the world around them, they develop the ability to see clearly, track moving objects, and see depth in our 3-D world. These visual skills are critical for motor development and learning. Poor eye alignment or significant nearsightedness, farsightedness, and astigmatism, not corrected with glasses, can impact development during infancy and early childhood.

Amblyopia, also called “lazy eye,” is one of the most important conditions to catch early.  An eye exam is necessary because in some cases there are not any warning signs for a parent to see.  Amblyopia can occur when there is an eye turn, but can also be present when the amount of farsightedness, astigmatism and less frequently, nearsightedness, is very high or unequal between the two eyes. If one eye sees well and the other does not, a child can appear to function fairly normally, but the other eye will not develop good vision or depth perception without glasses. In some cases, patching of the good eye and vision therapy can also improve vision.

Naturally, infant and toddler exams are very different from adult exams.  Rather than the infamous, “Which is better, 1 or 2?” other techniques are used to examine an infant or toddler’s eyes. At Family Eye Care in Chico, for a toddler who does not know letters, vision can be determined with the Lea eye chart which has shapes (a circle, square, house, and apple).  If the child is too young to know the names of the shapes, a matching card is used on the child’s lap, so they can point to the shape.  A pirate patch is worn so the vision is measured in each eye.

Children have fun wearing special “3-D glasses,” while their depth perception is tested. They look at colorful stickers or moving colored lights while their eye alignment, focusing ability up close, eye movements, and the ability to use their eyes well together is evaluated.  Neurological and eye muscle problems are ruled out at this time.  Color vision is also tested if the child is old enough.

Dilation of the eyes is an important part of an infant or child eye exam.  Dilation enables the optometrist to most accurately measure the amount of farsightedness, nearsightedness, and astigmatism.  Children watch a movie like Finding Nemo while the optometrist holds lenses in front of one eye at a time and uses another instrument to  take measurements. Dilation also enlarges the pupils so more can be seen inside the eyes to make sure they are healthy. Though rare, serious eye conditions need to be ruled out.

A toy with spinning colored lights in a dark room keeps an infant’s interest and directs their gaze. Eye health and eye movements are evaluated to rule out any muscular, neurological, eye coordination, or eye alignment problems. Eye alignment is evaluated several ways. A special stereo test can also be used to see if an infant has depth perception. Just as with a toddler, an infant’s refractive error (farsightedness,  nearsightedness, and/or astigmatism) can be measured after the eyes are dilated. Very high, or unequal amounts of refractive error will impact the development of good vision, depth perception, motor development and learning.

The American Optometric Association recommends eye exams at 6 months and again at 3 and 5 years. Eye exams are also important for school-aged children. Especially, if your child is struggling in school, an exam that evaluates visual skills beyond seeing 20/20 is important. Difficulties with eye focusing, coordination, tracking, the ability of the eyes to work well together, and visual processing can be roadblocks to reading and learning.  For more information see the article “Good Vision Is More Than 20/20, How Vision Therapy Can Help” in Growing Up Chico’s April 2013 issue, or online at

*Dr. Griffith of Family Eye Care is residency trained in pediatrics and vision therapy and is accepting patients 6 months old and older.

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