Your baby's first eye exam occurs right in the hospital nursery when your pediatrician checks for general eye health and problems such as retinoblastoma, a rare cancer affecting the light-sensitive retinal cells that make vision possible.
High-risk newborns, including premature infants and those with a family history of eye problems, should be examined by a pediatric ophthalmologist.
Otherwise, all children are screened at each well-baby visit for eye issues. The doctor checks baby's ability to fixate on and follow a light; the anatomy of the eye; and whether anything is clouding the lens. Then children will have their first complete vision exam around their third birthday, or between 12 months and 18 months if there's a family history of strabismus, says Dr. McKeown. If this is the case, ask your pediatrician for a referral to a pediatric ophthalmologist.
Other vision problems affecting newborns and young children include:
Amblyopia: Good vision requires both eyes to see the same clear image. Amblyopia, also known as "lazy eye," happens when one eye has weak vision, prompting the child to rely on the "good" eye for sight. Amblyopia is caused by anything that blurs vision or results in the eyes being crossed such as strabismus, cataracts, or a droopy eyelid. Typically, a child needs to wear an eye patch over the stronger eye for months or longer in order to force her to use and strengthen the weaker eye. If the condition is not diagnosed and treated, the brain will choose to ignore the eye that sees poorly, and permanent vision loss -- uncorrectable with eyeglasses or contacts -- will eventually result.
Cataracts: Cataracts are not just problems for AARP members. Like older adults, babies can suffer from cataracts, a clouding of the eye's lens, which is normally clear. Early detection and swift treatment are critical so that children don't miss out on the early period of vision development. "The eye is like a camera. If light isn't getting in, then your baby can't see out," says D.M. Alcorn, MD, associate professor of ophthalmology in pediatrics at Stanford University in California. Most cataracts are surgically removed soon after they're discovered.
Glaucoma: A condition in which there's too much pressure inside the eye, glaucoma is relatively rare in children, occurring in about 1 in 25,000 babies in this country. It may be caused by the overproduction or poor drainage of tears. Warning signs include an enlarged eye, excessive tearing, and extreme sensitivity to light. Most children with glaucoma will need surgery. Without it, glaucoma may cause blindness.
Excessive tearing: This may also be a sign of a minor and more common problem, blocked tear ducts, which occur in about 6 percent of babies. It happens when the normal drainage system for tears fails to open or becomes blocked, preventing the flow of tears from the eyes into the nose. Tears accumulate and overflow onto the cheek, even when baby isn't crying. Other symptoms include mucus discharge at the inner corner of the eye and swollen and red eyelids. Consult your pediatrician, who will show you how to massage the tear duct and apply compresses to encourage it to open. He may also prescribe antibiotics if the ducts get infected. Fortunately, 90 percent of babies outgrow this problem by their first birthday, says Dr. McKeown. If the problem doesn't clear up, surgery may be required to open the tear duct.
In fact, any time you suspect your baby has a problem, call your child's doctor. With early treatment so critical to baby's eye and hearing health, it pays to follow your instincts, says Dr. McKeown, who has plenty of stories about moms like Eileen Ryan who correctly noticed something "different" about their baby's eyes. "A good pediatrician will listen to your concerns and take them seriously," he says. Sometimes, Mom really does know best.