The Complete Guide for Parents Eye Exams for Children
Eye Exams for Children – A Guide for Parents: Ophthalmologist, Optometrist, When to Get Checked and What's Important to Know
Children can't tell you they don't see well – a timely exam makes the difference
Ophthalmologist or Optometrist – What's the Difference?
An ophthalmologist diagnoses and treats eye diseases, and an optometrist tests visual acuity and fits glasses and lenses. Both are important, and in most cases they complement each other.
| Ophthalmologist | Optometrist | |
| Training | A physician specializing in ophthalmology (for children – sometimes a sub-specialty in pediatric ophthalmology) | An academic degree in optometry and a license from the Ministry of Health |
| What they check | The health of the whole eye: eye structure, retina, optic nerve, intraocular pressure, strabismus and diseases | Visual acuity, glasses prescription, coordination between the eyes and near vision |
| What they provide | Medical diagnosis, drops and medication, surgery, referrals for further treatment | Prescriptions for glasses and contact lenses, vision exercises, referral to a doctor when a problem is suspected |
| Where | Health fund clinics, hospitals, private clinics | Optical chains, institutes, some health fund clinics |
Rule of thumb:For a young child's first exam, and for any suspicion of strabismus, disease or injury, go to an ophthalmologist. For fitting glasses and routine follow-up of a healthy child, an optometrist is the right address.
Who Is It For?
An eye exam is right for every child, even without complaints, because children almost never say they don't see well. Some children need an earlier exam or closer follow-up. Better to start with an ophthalmologist:
- Premature babies, especially those born very early or with low birth weight.
- Children with strabismus, lazy eye or a pupil that looks white or different.
- Children with a family history of eye diseases, such as cataracts or glaucoma at a young age.
- Children with genetic syndromes, diabetes, juvenile arthritis or developmental delay.
- Children after a blow or injury to the eye.
An optometrist is especially suitable:
- For school-age children who were examined in the past and appear healthy.
- For fitting and renewing glasses and contact lenses.
- For children who complain of difficulty reading or seeing the board, to check vision and coordination.
When Should a Child Be Examined?
A first full eye exam is recommended at age 3–4, and another exam before first grade. Before that, screening checks at the pediatrician and the well-baby clinic look for early signs.
| Age | What's checked | By whom |
| Birth – one year | Red reflex, gaze and following objects | Pediatrician, well-baby clinic; premature babies – ophthalmologist |
| 3–4 | First full eye exam, even without complaints | Ophthalmologist |
| Before first grade | Visual acuity, glasses prescription and coordination | Ophthalmologist or optometrist |
| School age | An exam every one to two years; a child with glasses – as instructed by the examiner | Optometrist or ophthalmologist |
Signs that justify an early exam at any age:
- Strabismus, a wandering eye or a constant head tilt.
- Getting close to the TV, a book or a screen.
- Frequent blinking, squinting or rubbing.
- Headaches, especially after school or reading.
- Difficulty copying from the board or a drop in school performance.
- Red, watery eyes or strong sensitivity to light.
- A white pupil in a photo or a blow to the eye – see an ophthalmologist without delay.
Vision Problems That Require an Ophthalmologist
Any problem related to the health of the eye, and not only to visual acuity, requires an ophthalmologist. Some of these problems are urgent, and early detection changes the outcome.
| Problem | Possible signs | Why an ophthalmologist |
| Strabismus | An eye that turns in, out, up or down | Diagnosing the cause, treatment with patching or drops, and sometimes surgery |
| Lazy eye (amblyopia) | Usually no external sign | Diagnosis and treatment, preferably at a young age |
| Congenital cataract | A white or grayish pupil, an unfocused gaze | Requires urgent evaluation and sometimes surgery |
| Glaucoma in children | A large eye, corneal clouding, tearing and sensitivity to light | Measuring intraocular pressure and urgent treatment |
| Retinopathy of prematurity | No signs; detected only in an exam | Regular screening in premature babies according to guidelines |
| Inflammations and infections | Redness, discharge, swelling, pain | Diagnosis and treatment with drops or medication |
| Blocked tear duct | Constant tearing and discharge in a baby | Follow-up, and sometimes opening with a simple procedure |
| Drooping eyelid (ptosis) | An eyelid that covers part of the pupil | May block vision and cause lazy eye |
| Eye injury | A blow, a foreign object, a chemical | Go to an eye emergency room immediately |
In addition, children with fast-progressing nearsightedness are referred to an ophthalmologist to consider treatment to slow the progression, such as low-dose atropine drops or specialized lenses.
Vision Problems the Optometrist Checks
The optometrist specializes in problems where the eye is healthy but vision is not sharp or comfortable. If a medical problem is suspected, they refer to an ophthalmologist.
| Problem | What it is | How it looks in the child |
| Nearsightedness (myopia) | Blurry distance vision | Gets close to the TV, has difficulty seeing the board, squints |
| Farsightedness (hyperopia) | Strain when seeing up close, and with a high prescription also at distance | Headaches, fatigue when reading, sometimes an inward squint |
| Astigmatism | Distorted or blurry vision at all distances | Head tilting, confusing similar letters |
| Prescription difference between the eyes | One eye needs stronger correction | Usually no sign; may lead to lazy eye |
| Difficulty with coordination and convergence | The eyes don't work well together up close | Skipping lines, double vision, avoiding reading |
| Difficulty focusing (accommodation) | Difficulty switching focus between far and near | Fatigue when copying from the board, blurring after screen time |
