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Who should check my baby's eyes?
Your baby's doctor should examine his eyes at each well-baby visit. She'll check them for problems, just as she examines his back, ears, breathing, and heart, to make sure that all's well.
If the doctor spots a health problem with your baby's eyes, such as a minor infection, she'll treat it. If the problem is more serious, she'll refer you to a medical eye specialist, or ophthalmologist. She should also refer you to a specialist if she notices any other signs of vision trouble or if your baby has a strong family history of eye problems in childhood.
What happens during an eye exam at a well-baby visit?
At every well-baby visit, the doctor should check for signs of congenital eye conditions and other problems. She should also examine the structure and alignment of your baby's eyes and his ability to move them correctly. If the doctor does the following things, you can rest assured she's doing a thorough job:
- She asks you about your family's vision history (or your child's birth family's history if he was adopted or conceived through a surrogate).
- Using a penlight, she examines the outside of your baby's eyes, including the eyelids and the eyeball, looking for discharge and other signs of infection, allergy, disease, or blocked tear ducts. She checks to see that the pupils are equal size, round, and reactive to light. She looks to see that the lids don't droop and checks the position of your baby's eyes, lids, and lashes.
- The doctor checks your baby's eye movement by watching his ability to fix on an object (like a toy) and follow it as she moves it into different positions. She'll do this with each eye and with both eyes together. Your baby should be able to follow these movements by the time he's 2 or 3 months old.
- To test your baby's vision, she'll watch how he follows an object with one eye and then the other eye (covering one eye at a time). If your baby follows the object with one eye but consistently doesn't follow it with the other eye, it's a sign that his vision is worse in the eye that's not responding.
- Although most doctors are trained to screen children for eye problems, some have more training than others. A good pediatrician or family doctor will refer you to a specialist if she notices a potential problem or believes something is out of her area of expertise.
Should I take my baby to an optometrist, too?
That's something medical doctors and optometrists tend to disagree about, so you'll have to decide for yourself. Most medical doctors who deal with children's eyes say that vision screening at well-child visits, if done properly, is all that's needed to monitor your child's vision. (The American Academy of Pediatrics, the American Academy of Family Physicians, and the American Association for Pediatric Ophthalmology and Strabismus say that primary care physicians should be the ones to screen for vision problems.)
According to medical doctors, taking your child to an optometrist for a separate screening is time-consuming and expensive. In addition, some eye care providers both prescribe and dispense glasses, which may present a conflict of interest.
But optometrists (and the American Optometric Association) say that because some primary care doctors aren't properly trained, aren't comfortable giving eye exams, or don't have the time to do complete eye exams, many children don't receive thorough examinations.
Medical doctors and optometrists may disagree about who should check your baby's eyes, but there's no argument on one point: It's crucial to have your baby's eyes checked for problems early on. Good eyesight helps your child do his best in everything from schoolwork to sports. And early detection of certain eye problems, such as lazy eye (amblyopia), makes treatment much more likely to be successful.
The American Academy of Pediatrics and the American Academy of Ophthalmology recommend that your child's eyes be screened for problems at birth, by 6 months of age, at 3 to 4 years of age, at 5 years of age, and every following year. The recommended schedule set by the American Optometric Association is similar: at age 6 months, at age 3 years, and before first grade, followed by routine exams every two years.
In addition, if your child has an increased risk of eye disease, his eye care provider might suggest that his eyes be checked more often. Factors that might put him at higher risk include premature birth, developmental delay, family history of eye disease, previous serious eye injury or eye disease, use of certain medications, and a chronic condition such as diabetes.
How can I make sure my baby's eyes and vision are monitored and cared for properly?
Your first strategy should be to make sure your baby's eyes are checked thoroughly at regular doctor visits, as described above. If you're not satisfied, talk with your child's doctor. And if you're still not happy with the level of care, by all means get a second opinion from someone you trust, whether that's another doctor, an ophthalmologist, or an optometrist.
Even if you're satisfied with the eye exam your baby receives during regular checkups, you can get a more thorough exam by an optometrist for free through the InfantSee program. Any baby between the age of 6 and 12 months can get a free exam. Check the organization's website to find a participating optometrist near you.
Between regular checkups, observe your baby's developing vision at home, and if you think something might be wrong, have it checked out. For pointers on what to look for, see our list of that there might be a problem with your child's eyes.
What's the difference between an ophthalmologist, a pediatric ophthalmologist, an optometrist, and an optician?
Ophthalmologists are medical doctors who have graduated from medical school and completed, at minimum, an internship and a three-year residency. In addition to doing eye exams and prescribing eyeglasses and contact lenses, ophthalmologists diagnose and treat eye diseases, prescribe medications, and perform surgery.
Pediatric ophthalmologists complete a yearlong fellowship in the surgical and medical treatment of eye disease in children after finishing a residency in ophthalmology.
Optometrists are not medical doctors but doctors of optometry. They are trained and licensed to examine the eyes and diagnose and treat vision problems with glasses, contacts, and therapy. Optometrists can also prescribe some medications.
Opticians make and dispense glasses and other optical items. They're trained to fill the lens prescription provided by the ophthalmologist or the optometrist, in much the same way that pharmacists fill doctors' prescriptions.