Your baby watches every move you make. When she sees you smile, she smiles. This visual interaction teaches your baby how her world works. To make sure your child is able to see all the things her world offers, her doctor should routinely screen her vision during childhood so that problems can be detected early.

The Development of Vision

How does vision develop? These guidelines are useful in judging progress:

Age Early Visual Milestones:

0–1 month Has limited ability to focus on someone’s face or an object; sees light and form
1–3 months Has longer periods of focusing; follows objects; learns to use eyes together
3–5 months Explores environment; reaches for objects
5–8 months Improves hand-eye coordination; shifts focus
8–15 months Looks for hidden objects; imitates faces
2–21⁄2 years Shows improved attention to distant objects and visual memory

These milestones may occur later in premature infants and children with developmental delay. If normal progress is not noted, special tests or treatment may be necessary. If you believe that your child’s visual development is lagging behind, you should talk to her primary care doctor to determine whether vision testing or other evaluation is needed.

Vision Screening Guidelines

The American Academy of Ophthalmology recommends the following schedule for screening vision:

• Newborns should receive a general eye check in the newborn nursery by the primary care doctor (pediatrician or family doctor).
• Premature infants, infants with obvious eye problems, and infants with a family history of eye problems (cataracts, eye tumors) should be examined by an ophthalmologist (doctor specializing in the medical and surgical treatment of eye problems).
• By six months of age, all infants should have an eye screening by the primary care doctor with a referral to an ophthalmologist if a problem is noted.
• At about age three to three and one-half years, children should have an eye screening, including a test for vision by the primary care doctor with a referral to an ophthalmologist if a problem is noted.
• At about age five, children should again have their vision and eye alignment checked by the primary care doctor with a referral to an ophthalmologist if a problem is noted.

Common Eye Problems

Several eye problems may be noticed by parents or discovered at screenings. Here’s an overview of some of the most common problems.

Amblyopia

Amblyopia (or “lazy eye”) is poor vision (usually in one eye) caused when a diminished or different image from each eye is presented to the brain. Because the brain cannot put the different images together, brain cells that work with one of the eyes will shut down to avoid confusion. Crossed eyes or a difference in near- or farsightedness between the two eyes are common causes of this condition. Amblyopia can cause permanent vision loss if not properly treated. It is most easily treated before the age of five or six years, although treatment should be considered up to age nine years. Treatment often includes wearing a patch over one eye temporarily, wearing glasses, or both. Surgery may be necessary if the amblyopia is caused by a droopy eyelid (ptosis) or by lens clouding (cataract).

Strabismus (“Crossed” or Drifting Eyes)

Strabismus is a misalignment of the eyes and can result in amblyopia if it’s chronic. It is common in newborns, but by the time your child is three months old, any crossing of the eyes should be gone. After that age, you should not assume your child will “outgrow” crossed or drifting eyes. Glasses or surgery may be necessary.

Refractive Errors

Refractive errors cause nearsightedness, farsightedness, and astigmatism. These problems result when the eye is improperly shaped, causing a blurry image. Amblyopia and eyestrain can result. Glasses may be needed if the refractive error is significant.

Eye Problems in the Family

Some eye problems are more significant and require immediate attention and treatment. Alert your child’s primary care doctor if there is a family history of any of these eye problems:

• Retinoblastoma is a malignant tumor that develops in the eye during the first few years of life. Loss of vision, drifting of the affected eye, or a white or abnormal appearance of the pupil may be noted. Multiple forms of treatment are available, depending upon the extent of the disease.

• Cataracts are a clouding of the lens of the eye and may be present at birth or develop in early childhood. Observation, patching, glasses, and surgery are possible treatments, depending upon the severity of the lens clouding.

• Congenital glaucoma is a rare condition in which the drainage system of the eye does not develop properly. Poor drainage can result in high pressure in the eye and can damage a child’s vision. Surgery is often necessary, although medications may also be used.

Signs of Vision Trouble

• Poor focusing
• Poor following of objects
• Abnormal alignment or movement of the eyes (such as “crossed”
eyes or a drifting eye) after three months of age
• Constant eye rubbing
• Extreme light sensitivity
• Chronic redness or cloudiness of the eyes
• Chronic tearing of the eyes
• A white pupil instead of black