“Be careful, Mya, or they might stay that way!” That’s what Toronto mom of three Kelly Ross* told her then-five-year-old daughter when she was purposely making her eyes cross. A few days later, Ross noticed Mya’s eyes were, in fact, not aligning.
After a trip to the optometrist, Ross discovered Mya has strabismus, or crossed eyes. It’s one of the conditions doctors and optometrists look for when they shine that little light into your child’s eye — and it can be helped, even cured completely, if it’s caught and treated before age seven.
Mya now wears corrective glasses and goes for regular appointments to check her progress. There are no signs of strabismus when she has her glasses on, but when they’re off, her eyes cross immediately. Since the diagnosis, Ross has discovered the condition runs in her family and holds hope that, like her own sister, her daughter will outgrow her need for glasses as she gets older. For now, Mya isn’t the least bit self-conscious about wearing them, according to her mom. She even has an American Girl doll with pretty pink glasses just like hers.
It begs the question: Did crossing her eyes cause Mya’s strabismus? No, insists Saint John, NB, optometrist JoAnne Henderson. But, interestingly, Halloween brings out the strabismus cases. “Kids who have worn pirate patches may reveal an eye turn,” she says. “The condition was already present — the costume just sped up the process of discovery, which is a good thing for treatment!”
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Baby's first checkup
You may be surprised to discover your newborn had an eye exam right there in the hospital or, if you’ve had a home birth, at his first baby checkup. Doctors look for anything unusual, or eye diseases that must be treated immediately. “In a lot of cases, if a new baby has an issue, he will have an underlying syndrome or pathology, like Down syndrome or cerebral palsy,” says Henderson.
The exam itself is a piece of cake. “The doctor looks through an ophthalmoscope, shines the light into the baby’s pupil, and checks for the red-eye reflex, or the reflection of light from the eye’s retina. It should be symmetrical, and it should light up red in both eyes, like when you take a picture and see red in the subject’s pupils,” explains Raphael Sharon, associate clinical professor in the Department of Pediatrics at the University of Alberta in Edmonton. You’ll get the all-clear on your child’s exam, or be alerted to any issues, right there.
The next visit
The Canadian Association of Optometrists (CAO) recommends that you take your baby for her first visit to the optometrist between six and nine months, again at age two, and then once a year up to age 19. (Thankfully, kids’ yearly optometrist checkups are covered by most provincial health plans.)
However, your paediatrician or family doctor will likely recommend a less rigorous schedule, since he or she is also checking your child’s eyes at physicals. As long as there’s no family history of issues and nothing seems out of the ordinary, Sharon tells his patients to take their kids to the optometrist by age three, and after that, every two years if their eyesight is good, or more often if indicated by an optometrist.
Why by age three? Kids’ eyes are still developing, so many issues can be helped at this point. Also, children are heading to school. According to the CAO, 75 to 80 percent of all school learning is visual, so an eye exam to identify or rule out any problems will help give kids the best possible start. School or public health screenings, while better than nothing, are not good enough, says Henderson, because there’s a lot they can’t check for. Some kids may have 20/20 vision, for example, but they can’t sustain their focus or track objects well. “Too often, kids are thought to have a mental focusing issue, such as ADHD, when they have a physical focusing issue that a pair of glasses can fix,” Henderson explains. Annual visits to an optometrist will ensure the eyes are healthy and that everything’s on track.
What to expect at the appointment
What if your child doesn’t know her letters yet? No problem. Eye exams for kids aren’t like ours. Among other fun stuff, your child will get to look at pictures through 3-D glasses and cross her eyes on purpose. Kids who are shy will often sit on their parent’s lap during the exam, or ride up and down on the chair to get comfortable. “It’s a lot easier than going to the dentist, that’s for sure,” Henderson says. “There are no needles, and there’s a little bit of light at the end, but a lot of it is really fun.”
While your child enjoys her eye exam, the optometrist tests for things like:
•Binocular vision: Are the images from both eyes blending well into one? •Depth perception: How good is her 3-D vision? •Tracking: Do her eyes move smoothly from one image to another? •Focus: Is she able to refocus her eyes from one distance to another and maintain focus? •Visual acuity: How sharp is her eyesight at near and far distances? •Astigmatism: Is her vision distorted or blurred? •Strabismus: Do both eyes appear to be looking at the same object? •Amblyopia: Does she see better in one eye than the other?
Amblyopia, or “lazy eye,” is a major focus of the exam because it must be caught and corrected early, or your child may always have one eye that doesn’t see well. “If one eye isn’t clear, then the brain won’t pay attention to the blurry image, so the connection between the good eye and the visual cortex in the brain will be completely dominant, and vision will become impaired in the other eye,” Henderson explains. About two to four percent of children younger than age six have amblyopia, and while that seems rare, it’s the biggest cause of children’s unilateral vision loss among all eye injuries and diseases combined. *Names have been changed.
A version of this article appeared in our August 2013 issue with the headline "Do you see what I see?" pp. 34-36.
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