Can my child see?
Did you ever wonder how well your child sees? Are images clear in both eyes? Does your child use both eyes to see together? These are important questions. Many parents (and unfortunately some doctors) believe that until a child is in school or complains of bad vision, that he/she is too young for glasses. Your pediatrician or family practice doctor should be checking your child’s eyes and vision from the day he/she is born. This if often difficult, and it is important that this is done correctly. Many eye problems can present in early childhood, and can result in irreversible blindness in one or both eyes if not detected in time.
Amblyopia (lazy eye, in which one eye does not see well regardless of glasses) occurs in 3-5% of adults. It is one of the most common causes of permanent vision loss in an adult and often develops in childhood before the child is 5 years old. Crossed eyes or drifting eyes (also known as strabismus) is another leading cause of visual loss. Both of these conditions can often be treated if caught in time, usually in the first few years of life. Cataracts, eye tumors, retinal diseases, and ptosis (drooping eyelids) can also be present in children. Treatment for many of these conditions varies but can include glasses, patching and/or surgery.
How old must a child be to first be seen?
It is possible to examine and give glasses to newborn babies. In fact, most premature babies are seen in the hospital before discharge and up to 60% end up needing glasses before 1 year of age. Their proper development is often dependent on glasses. In addition, children born to parents who wore glasses at an early age are more likely to require glasses at an early age. Even if your child appears to have good vision, there are other reasons to have your child’s eyes checked. Children who have other underlying medical proiblems or a family history of eye problems should be checked by an ophthalmologist regularly. Some medical problems requiring ophthalmological exams include, but are not limited to, arthritis, diabetes, HIV/AIDS, leukemia, steroid dependent asthma, transplant patients, and patients on certain chronic medications In addition, children with the following disorders should have a baseline eye screening by an ophthalmologist: seizures, developmental delay, learning disabilities, squinting, head turn or tilt, irregular eye movements, or any other concerning problem. A child who has ANY crossing of one or both eyes either turning in or out, closes one eye to see, appears not to see or recognize near or distant images well should be seen by an appropriate eye care specialist.
Who are the different people who provide eye and vision care and who should my child see?
Here is a list:
Ophthalmologist: A medical doctor (MD) who has gone to medical school and has completed an internship and an ophthalmology residency at an accredited medical school program. This involves around 12 years of training after high school. They have been trained to diagnose and treat eye disease, perform surgery, and prescribe all necessary medicines and glasses. They are accredited by the American Academy of Ophthalmology.
Pediatric Ophthalmologist: An ophthalmologist who has done extra fellowship training to treat children and eye misalignment. They have extra expertise in working with and treating children. They can prescribe glasses, recognize and treat eye disease, and perform all necessary eye surgery. They are accredited by the American Academy of Pediatric Ophthalmology and Strabismus.
Optometrist: An optometrist has gone to optometry school and has been trained in recognizing eye disease and providing basic treatment and glasses. This involves around 8 years of training after high school. They are not able to perform surgery, but can prescribe some medications. It is important that an optometrist is comfortable with children and does a full dilated exam prior to prescribing glasses.
Vision therapist: A vision therapist is an optometrist who uses eye exercises to strengthen visual tasks. This is a form of eye exercise, just as a personal trainer helps an athlete. It will not treat dyslexia or cure learning disabilities. When used in conjunction with school related tasks in a team approach with tutors and educational skills, it may improve school function. Vision therapy has also been shown to be effective in certain types of strabismus (crossed eyes) and preventing double vision. While some of these exercises have benefit, many are very controversial and may not be approved by insurance companies or American Academy of Ophthalmology. Therefore, before any patient undergoes vision therapy or exercises, a thorough ophthalmological exam by a pediatric ophthalmologist should be performed.
Optician: An optician is an individual licensed to make and fit glasses. Not all workers at optical shops are opticians, so be careful with who you let fit your child with glasses.
How do you get the care your child needs?
Your child’s vision is important, but unfortunately many insurance plans don’t realize that poor vision as a child may lead to permanent irreversible vision loss when the child becomes an adult. Understanding your insurance is important. If you have private insurance, a PPO or straight Medi-cal you may see a pediatric ophthalmologist directly by making an appointment yourself. Many people do not realize that an eye exam is covered by medical insurance (not vision insurance) if there is any medical problem. Unfortunately, if you have an HMO insurance, it is not so easy. An HMO requires your primary doctor to refer you to an eye care professional if he or she thinks there is an eye problem. This may require you to first see an optometrist and then an opthalmologist and then a pediatric ophthalmologist.
Primary care doctors have an average of less than 24 hours of opthalmology training. Thus, their ability to detect eye or vision problems is fairly limited. In addition, many optometrists and ophthalmologists are not trained or comfortable with children, and may not get an accurate exam. Even if you request an eye exam by a specialized doctor, it is up to you and your HMO plan to see that it gets done. In some cases, waiting even a month or two for appropriate authorization may result in irreversible vision loss. Many children have gone blind as their parents fght through the insurance system. The final care of your child rests with you. If you are concerned and feel your child may have an eye disease or poor vision, it is important you bring them to an appropriate health care specialist.
Click here for a list of accepted medical insurance at Children’s Eye Institute.