Y is for Youngsters’ Eye Examinations

There are many common misnomers amongst parents.

  • Children have eye examinations at school
  • Children can’t have an eye examination until they can read
  • Children don’t need an eye examination until their teens
  • My child will tell me if they have any problems with their eyes

In the UK children do not have an eye examination at school.  In the days that they did the “examination” consisted of showing the child a letter chart and asking them to read it.  This may well detect simple problems like short-sightedness (although many patients have told me that they cheated!), but omits a huge number of tests that comprise an eye examination (see my O is for Optometry post).  Crucially though, it does not check the health of the eyes.  Many ocular health problems do not have any symptoms, and are detected at the time of an eye examination.  A health check is absolutely vital.

A child (or adult for that matter) does not need to be able to read for an eye examination.  In my favourite consulting room, I have a projector chart, which gives me a vast array of charts to use.   I have traditional letters, numbers, illiterate Es, Landolt Cs, and Kay pictures.  If I have a small and nervous child to examine I turn all the tests into games, and particularly love the pictures for this, and have great success with children as young as two.  In one of my favourite examination moments, I pointed to the tree picture and on asking my young patient what the picture was, received the reply “Broccoli”.  Too cute!!

In actual fact, a patient does not even need to be able to speak for me to perform an eye examination.  I can’t measure their vision, but I can perform the rest of my arsenal of tests, and have a pretty good idea of exactly how well they would manage could they read the chart.

Whilst children will sometimes complain that they can’t read the board at school, all too frequently I pick up a problem that both child and parent were unaware of.  Vision can change gradually so that changes aren’t apparent, or the child can have a problem with one eye that goes unnoticed.  The earlier your child has an eye examination, the better.  There are certain eye problems that cannot be fixed beyond 7-8 years of age.  This is devastating for both child and parent and makes me want to cry and scream with frustration.

At birth the connections between the eye and the brain have not finished developing.  If one eye has a squint or has much poorer vision than the other, the brain decides to ignore it, and concentrate entirely on the good eye.  The connections between the brain and the weaker eye never develop properly, and vision remains poor as a result., even if the initial problem is solved.  This is essentially what a lazy eye is, and patching is prescribed – covering the good eye for several hours per day to force the weaker eye to work, and the connections to develop.  By 7-8 years of age, those connections have finished developing and there is nothing I can do, no spectacles or treatment I can give to improve the lazy eye.

I vividly remember 2 young patients I saw during my pre-registration year.  They had almost identical prescriptions, having no prescription at all in one eye, and being very long-sighted in the other (+6.50, for any optical friends reading).  The first was a young boy of 6 years of age who could only read the top letter of the chart with his weaker eye.  I prescribed a quite aggressive regime of patching, and by the end of it he could manage the penultimate line of the chart.  That eye will always remain a little weaker, but he will still be legal to drive if he ever has a problem with his good eye, and there are now no professions ruled out due to not having good enough vision.

The second patient was a girl of 14 years of age.  With her weaker eye she could only manage the top line of the letter chart from 1 meter away.  She had never noticed one eye was weaker, and was far too old for patching.  She is practically blind in that one eye, and there is absolutely nothing that can be done about it.  I could have cried with frustration.

The moral of the story?  Please, please, please take your child for an eye examination, and the younger the better.  Not all Optometrists will be happy to see very young children, as the examination presents much more of a challenge, but by phoning around you’ll find a practice quite happy to care for your little one’s eyes.  My oldest patient to date was 108 and my youngest 5 ½ months old!

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10 Responses to Y is for Youngsters’ Eye Examinations

  1. Very useful post. I had patching when I was younger. Hate to think what I would have been like without it!!

  2. Stacey says:

    Didn’t realise all this – perhaps I’ll bring mine to see you!

  3. Ric Tedeschi says:

    Great post Jay.

    • Jay says:

      Thanks hun. Was hoping it wasn’t boring, cause I waffled on for longer than I meant to. Although that seems to be standard procedure for my blog posts!

  4. Cath says:

    Isaac had his first test at age 2, and absolutely loved it, he thought it was a great game, and loved being centre of attention!
    So many people have no idea of the importance of the pre-7 test, and it’s so sad when a kid effectively loses vision because their problems weren’t detected in time.

  5. Oooh, so should I take DD, just turning 4, for a test?

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