Redgate Children’s Clinic
We provide NHS eye care services to all children aged from 1-16, and 16-18 for those in full time education.
When Should Children be Checked?
Your child’s eyes may be checked:
- within 72 hours of birth –this is known as the newborn physical examination and it can be used to check for obvious physical problems
- between six and eight weeks old – this is a follow-up physical examination to check for any obvious problems that weren’t detected soon after birth
- at around one year old or between two and two-and-a-half years old – you may be asked whether you have any concerns about your child’s eyesight as part of a review of your child’s health and development; eye tests can be arranged, if necessary
- at age 3 – Children should have their first proper eye examination by a specialist Optometrist, such as the ones at Redgate.
Then your child should have a check at least every 2 years.
All babies will have an eye screening at birth and again at about six weeks of age by a GP or health visitor. For more information see, your babies health and development reviews.
During their first year at school many children will have a screening for lazy eye. Whether the screening is available depends on your local CCG, who commission screening services. The screening is to detect whether a child has reduced vision in one or both eyes.
What should I look out for?
Although your child should have regular eye tests as they grow up, it’s still important to look out for signs of any problems and seek advice if you have any concerns.
For babies, the checklist in your baby’s personal child health record (red book) can be used to help you check if your child’s vision is developing normally.
In older children, signs of a possible eye problem can include:
- complaining of headaches or eye strain
- problems reading – for example, they may need to hold books close to their face and they may lose their place regularly
- problems with hand-eye co-ordination – for example, they may struggle to play ball games
- being unusually clumsy
- sitting too close to the TV or insisting on watching TV in the dark
- rubbing their eyes a lot
- blinking a lot
- showing signs of a squint – the eyes don’t look into the same direction. One eye may turn inwards, outwards, upwards or downwards, while the other eye looks forward
- Problems navigating in the dark e.g. entering a tunnel or the cinema
Even if none of the symptoms above is displayed, there could still be an underlying eye condition. If you are worried about your child’s sight or there is a history of squint or lazy eye in the family, do not wait for the vision screening at school. Take your child to an ophthalmic practitioner or optometrist, who will see children of any age.
Don’t worry about the costs, as all NHS sight tests are free for children under the age of 16 at Redgate Opticians.
Children do not have to be able to read to have their eyes examined. It’s possible to see whether the child has a squint or needs glasses without asking them any questions, using age-appropriate tests and equipment.
If the eye test detects any problems, your child will be referred to an Orthoptist, who is part of the eyecare team and generally works alongside ophthalmologists and optometrists. Orthoptists work in local health clinics or hospital eye clinics. Also read the information What eye tests may be carried out.
What are eyedrops used for during an eye test?
Some children, especially younger ones, might need eyedrops for their eye test. This is important because it can ensure that the correct glasses are given and that the optometrist or ophthalmologist can have a clear look at the internal structure of the eye.
Once put in, the drops will need a while before they work (the darker the eyes the longer it takes).
Eyedrops make the pupils larger so the back of the eye can be seen properly. They also relax the focusing mechanism in the eye so the prescription for glasses can be as accurate as possible.
Once the drops start working, your child might become sensitive to light. You could bring sunglasses or a brimmed hat or cap just in in case. Some children may also feel that their vision is blurred or fuzzy. Again, this is because the drops stop the focusing mechanism working. It’s not possible to reverse the effect of the eye drops, but usually they wear off after 6 to 10 hours and are fully gone within 16 to 24 hours.
About 1 in 10,000 children react to the drops with hyperactivity. This effect is only temporary and will wear off as soon as the drops wear off. If your child does have a reaction to the eyedrops, your optometrist, Orthoptist, or ophthalmologist should inform your GP. They will add a note to your child’s medical records so similar medications are not prescribed in the future.
What eye tests may be carried out?
A number of tests may be carried out to check for vision or eye problems in babies and children. Some of these are described below.
The red reflex test
The red reflex test is usually carried out alongside a general examination of your baby’s eyes, as part of newborn checks. It involves using an instrument called an ophthalmoscope, which magnifies the eyes and produces a light that allows the eyes to be examined clearly.
When light is shone into your baby’s eyes, a red reflection should be seen as it’s reflected back. If a white reflection is seen, it could be a sign of an eye problem.
The pupil reflex test
The pupil reflex test involves shining a light into each of your baby’s eyes to check how their pupils (black dots at the centre of the eyes) react to light.
Your baby’s pupils should automatically shrink in response to the light. If they don’t, it could be a sign of a problem with their eyes.
Attention to visual objects
This is a simple test to check whether a newborn baby pays attention to visual objects. A midwife or doctor will try to catch your baby’s attention with an interesting object. They then move it to see if the child’s eyes follow.
These sorts of tests can also be used to check the eyesight of older babies and young children who are not yet able to speak. If your child can speak, but is not yet able to recognise letters, pictures may be used instead of objects.
Snellen and LogMAR charts
When your child can recognise or match letters, their vision is tested using charts that have rows of letters and numbers of decreasing sizes. Your child will be asked to read out or match the letters they can see from a specific distance. These charts are called Snellen or LogMAR charts.
For younger children, a similar test using pictures or symbols may be carried out instead.
Range of movement tests
To test the range of movement of each eye, a child’s attention will be drawn to an interesting object, which is then moved to eight different positions: up, down, left, right, and halfway between each of these points. This tests how well the eye muscles work.
A refraction test is carried out by an optometrist at a high street opticians and is used to determine if your child needs glasses and what prescription they need.
Before the test, your child may be given special eye drops that widen their pupils, so the back of their eyes can be examined more clearly. Your child will be asked to look at a light, or read letters on a chart if they’re old enough, while different lenses are placed in front of their eyes.
Colour vision deficiency test
Colour vision deficiency tests, also known as colour blindness tests, are usually carried out in older children if a problem is suspected.
One of the tests used to check for colour blindness is the Ishihara test. This involves looking at images that are made up of dots in two different colours. If a child’s colour vision is normal, they’ll be able to recognise a letter or number within the image.
A child who can’t tell the difference between two colours won’t be able to see the number or letter, which means they may have a colour vision problem. Read more about diagnosing colour vision deficiency.
Causes of eye problems in babies and children
There are a number of different eye problems affecting babies and children that can be detected during eye tests, including:
- childhood cataracts – cloudy patches in the lens of the eye that are present from birth
- lazy eye (amblyopia) – where the vision in one eye does not develop properly
- squint (strabismus) – where the eyes look in different directions
- short-sightedness (myopia) – where distant objects appear blurred, while close objects can be seen clearly
- long-sightedness (hyperopia) – where you can see distant objects clearly, but nearby objects are out of focus
- astigmatism – where the cornea (transparent layer at the front of the eye) is not perfectly curved
- colour vision deficiency (colour blindness) – difficulty seeing colours or distinguishing between different colours; this is more common in boys than girls
Remember All children over the age of 5 should have a check at least every 2 years. Book your Child into our Free NHS Children’s Clinic by Clicking on this button.