When Vanessa Rende’s son, Noah, was 3, he started getting headaches and losing his balance. His pediatrician advised that he get his vision examined, but by the time his eye appointment came, “his right eye had turned in, and the left one was beginning to do the same,” says Rende, of Lake City, Florida. He was diagnosed with strabismic amblyopia.
The problem was so severe that it couldn’t be corrected with eyeglasses. “I didn’t want him to get surgery because he was only 3, but his vision problem was affecting his quality of life,” Rende says. Thankfully, the surgery was able to straighten both of Noah’s eyes, and now, at age 8, his vision is nearly perfect.
Having eye problems at such a young age is not a rare occurrence. Nearly 175,000 preschoolers had vision problems in 2015, according to a study in JAMA Ophthalmology. The reason? Genetics and environmental factors might play a role, studies show, but there’s still a lot of research to be done, says Ricardo Silva, O.D., in Miami, Florida.
Plus, according to Jane Edmond, M.D., a pediatric neuro-ophthalmologist at Texas Children's Hospital and Baylor College of Medicine and clinical spokesperson for the American Academy of Ophthalmology, a mom's health during pregnancy can play a pivotal role in their child's eye health. "Good prenatal care, good nutrition, and no smoking can do a lot to prevent eye problems," she says. In fact, children of mothers who smoked during pregnancy had a 1.5 times greater risk for a refractive error (farsightedness or astigmatism), according to a National Institutes of Health study of almost 10,000 children aged 6 months to 6 years old.
As a parent, you should look for signs that your child has trouble seeing. Some vision irregularities do have telltale symptoms, but many don’t—especially in babies and toddlers. Even an older child might not tell you that he can’t see well, because he probably doesn’t know the difference between clear and blurry vision.
Let your pediatrician know if your baby is not tracking and following objects by 4 months of age, or recognizing you from across the room between 6 and 9 months. "A baby may need glasses if she seems visually inattentive compared to other babies her age or if she holds a toy abnormally close to her face," Dr. Edmond says.
The American Optometric Association recommends that kids have their first comprehensive exam by an eye doctor at 6 months, then a repeat at 3 years, and before first grade, and every two years after. If initial screenings shows that your child’s prescription is 20/40 or worse, she should see an ophthalmologist for a full eye exam.
These are the most frequent problems that affect kids’ eyes—and symptoms you might be able to spot yourself.
What you might notice: Your child squints when she’s looking at faraway objects. She might also mention that it’s hard for her to read words on the wall or on the chalkboard at school. If she squints at the TV, she could be having trouble seeing, but sitting close to the screen doesn’t necessarily mean anything, says Susan Day, M.D., a retired pediatric ophthalmologist in Chicago.
The culprit: Eyes that are longer than normal. This causes light to focus incorrectly on the retina, making it hard for your child to see objects at a distance. Although most nearsightedness is inherited, doing lots of near work, such as looking at a computer, can increase the rate at which it develops, Dr. Day says. Spending time outdoors might help keep myopia at bay. Some experts believe that exposing oneself to sunlight and frequently looking at things that are far in the distance—as kids do in big, open spaces—might reduce the chances of developing severe nearsightedness.
When it appears: Fourth or fifth grade, usually. But it sometimes develops in young kids, especially those who were born prematurely. It usually gets worse during the teenage years, but stabilizes between ages 20 and 30.
The treatment: If your child’s vision is starting to affect her work in school or participation in sports, she’ll need glasses. For some kids, sitting at the front of the classroom is enough. Mildly nearsighted kids younger than 4 probably don’t need specs as long as both eyes are the same. “Their world is right in front of them— toys, food, you—so crisp distance vision isn’t necessary,” Dr. Day says.
What you might notice: Your child rubs his eyes often or squints when looking at things up close. His eyes might also get red or teary, and he may complain of headaches or have difficulty focusing on tasks like reading or playing on the computer for long periods of time, Dr. Silva says. Babies and toddlers often show no warning signs at all.
The culprit: An eye that has a shorter diameter than average, or a front surface that’s too flat to bend light sufficiently. These differences keep light rays from creating a clear picture on the retina, so nearby objects appear blurry.
When it appears: Most babies are born slightly farsighted, but their eyes adapt to the condition. If your baby is more farsighted than usual and the condition goes untreated, he could develop crossed eyes or lazy eye.
The treatment: Wearing glasses all the time, possibly for life.
What you might notice: There are often no obvious signs, but in some cases, you may see one eye turn in or out.
The culprit: Eyes that aren’t working in unison because of vision problems such as astigmatism, anisometropia, or crossed eyes. The brain starts to favor the eye that has clearer vision or the one that is aimed in a targeted direction.
When it appears: Lazy eye can start in infancy and usually shows up by age 5 or 6.
The treatment: Many children first need to get glasses to correct vision problems such as farsightedness or astigmatism, says Marjean Taylor Kulp, O.D., distinguished professor at The Ohio State University College of Optometry, in Columbus. Your child might also need to wear a patch over the favored eye for two or more hours a day for a number of months or use eye drops to temporarily create blurred vision in that eye so he’ll use the eye with reduced vision and help it improve. It’s best to catch lazy eye early when treatment is most effective, but some studies have found that older kids and adults also experience improvement with this type of care. New binocular treatments are also being studied.
What you might notice: Your child turns her head to the left or right when she’s watching television.
The culprit: A cornea that’s shaped more like an oval than a ball. Kids have trouble making out details at any distance, making their vision look like a funhouse mirror. It tends to run in families.
When it appears: Most often at birth. Myopia and hyperopia can be combined with astigmatism, or astigmatism can happen on its own. If left untreated, it can lead to lazy eye.
The treatment: Your child will need glasses if the astigmatism is severe or is accompanied by another refractive problem, says Charles Allen, O.D., in Princeton, New Jersey. However, if the astigmatism is mild, she may be able to go without glasses. Astigmatism in infants goes away in many cases but can last into adulthood.
What you might notice: Eyes that are unevenly aligned. When your child looks at you, for example, one eye may point straight at you while the other one turns up, down, in, or out. This lopsided appearance could be constant or subtle, or it might occur only sporadically, which can make it difficult to spot.
The culprit: “Strabismus may be caused by wiring problems in the area of the brain that controls eye movements,” says Michael Repka, M.D., professor of ophthalmology and vice chairman for clinical practice at Johns Hopkins Medicine’s Wilmer Eye Institute, in Baltimore. An eye that turns inward is known as a crossed eye; a common form of strabismus or misaligned eyes is called a walleye (exotropia). It can be inherited, and it can also stem from untreated vision problems or structural problems in the eye or brain. In rare cases, it’s caused by cataracts or a tumor.
When it appears: Usually by age 5, but it can develop in babies and toddlers. Although it’s normal for a newborn to have an occasional wandering eye, tell your pediatrician if you see your child’s eyes cross or wander after 3 months.
The treatment: Glasses will often fix the problem, especially if the strabismus is related to farsightedness. In other cases, like Noah’s, the child will need surgery on the muscles surrounding the eye. Some kids wear glasses just for a few years, while others need them longer.
Three of these vision problems—myopia, hyperopia, and astigmatism—are classified as refractive errors. In order for our eyes to see, light rays are bent (or refracted) by our eye's cornea, lens, and tear film so they can reach back to our retina, which is a layer of light-sensitive cells lining the back of the eye. When light rays form a picture, the retina sends that image to the brain through the optic nerve. But tiny changes or errors in the shape of our eye can alter how those light rays reach the retina—and how clearly we can see that picture.
But according to Edmond, most babies with refractive issues don’t need glasses. "In spite of their eyes having some refractive error, they will usually develop normal vision without specs. Initially, babies only see nearby objects clearly. Their vision improves as they get older and they start seeing objects well around a year of age, as their brain and retinas mature," Dr. Edmond says.
Keep in mind that it's normal for babies to be farsighted with astigmatism because they don't develop distance vision until they are about 1 year old. By age 3, a child's vision should be at least 20/40 and by age 5, at 20/30. Even if your child's prescription is higher, the ophthalmologist may hold off on glasses to encourage his natural focusing mechanism to correct the error.
If a refractive error is severe, causes a child to have trouble in school, or persists past the age of 8, glasses will usually be recommended. Also, if you or your husband wear glasses, it is possible that your kids will need glasses, too (and maybe at around the same age as you were when you got your first pair). Refractive errors that require correction are mostly inherited, but there are a lot of environmental issues that can have an effect that are not well understood.