Schedule an Appointment
Does My Child Need Glasses?
Glasses are prescribed to correct for significant changes in vision such as myopia (nearsightedness or trouble seeing without objects); hyperopia (farsightedness or trouble seeing near objects occasionally resulting in crossing of the eyes in young children); astigmatism (irregularly shaped eyes resulting in blurred vision); and anisometropia (unequal focus between the two eyes which may result in amblyopia or one eye becoming weaker than the other).
Children particularly at risk for requiring glasses are those who were premature, have family members who wear glasses (particularly siblings), have strabismus (crossing of the eyes), or show behavior consistent with poor vision such as squinting.
A child’s requirement for glasses can be checked accurately and painlessly by a pediatric ophthalmologist, at any age (even newborns), using specialized equipment.
Babies have poor vision at birth but can see faces at close range, even in the newborn nursery. At about six weeks a baby’s eyes should follow objects and by four months should work together. Over the first year or two, vision develops rapidly. A two-year-old usually sees around 20/30, nearly the same as an adult.
Parents should be aware of signals of poor vision. If one eye turns or crosses, that eye may not see as well as the other eye. If the child is uninterested in faces or age-appropriate toys, or if the eyes move around or jiggle (nystagmus), poor vision should be suspected. Other signs to watch for are tilting the head and squinting. Babies and toddlers compensate for poor vision rather than complain about it.
Should a baby need glasses, the prescription can be determined fairly accurately by dilating the pupil and analyzing the light reflected through the pupil from the back of the eye.
A baby’s vision can also be tested in a research laboratory where brain waves are recorded as the child looks at stripes or checks on a TV screen. The test is called Visual Evoked Potential (VEP). Another test called preferential looking or Teller Acuity Cards uses simple striped cards to attract the child’s attention. In both tests, as the stripes grow smaller, the child eventually does not respond (with brain waves or by looking at the stripes).
Strabismus refers to misaligned eyes. If the eyes turn inward (crossed), it is called esotropia. If the eyes turn outward (wall-eyed), it is called exotropia. Or, one eye can be higher than the other which is called hypertropia (for the higher eye) or hypotropia (for the lower eye). Strabismus can be subtle or obvious, intermittent (occurring occasionally), or constant. It can affect one eye only or shift between the eyes.
Strabismus usually begins in infancy or childhood. Some toddlers have accommodative esotropia. Their eyes cross because they need glasses for farsightedness. But most cases of strabismus do not have a well-understood cause. It seems to develop because the eye muscles are uncoordinated and do not move the eyes together. Acquired strabismus can occasionally occur because of a problem in the brain, an injury to the eye socket, or thyroid eye disease.
When young children develop strabismus, they typically have mild symptoms. They may hold their heads to one side if they can use their eyes together in that position. Or, they may close or cover one eye when it deviates, especially at first. Adults, on the other hand, have more symptoms when they develop strabismus. They have double vision (see a second image) and may lose depth perception. At all ages, strabismus is disturbing. Studies show school children with significant strabismus have self-image problems.
Amblyopia, or lazy eye, is closely related to strabismus. Children learn to suppress double vision so effectively that the deviating eye gradually loses vision. It may be necessary to patch the good eye and wear glasses before treating the strabismus. Amblyopia does not occur when alternate eyes deviate, and adults do not develop amblyopia.
Strabismus is often treated by surgically adjusting the tension on the eye muscles. The goal of surgery is to get the eyes close enough to perfectly straight that it is hard to see any residual deviation. Surgery usually improves the conditions though the results are rarely perfect. Results are usually better in young children. Surgery can be done with local anesthesia in some adults but requires general anesthesia in children, usually as an outpatient. Prisms and Botox injections of the eye muscles are alternatives to surgery in some cases. Eye exercises are rarely effective.