the eye blog
EYE CARE INFO & UPDATES
Parents often wonder how accurate children's eye tests are.
That's understandable because young children often don't respond the same way as adults do during an eye examination. Children can find it harder to tell the difference between lenses presented to them when the optometrist asks, "Which is better? 1 or 2?".
But an optometrist with experience and expertise in testing young children will be able to test children's eyes accurately. Paediatric eye examinations require a different set of skills and equipment than regular adult eye tests, and also more patience on the part of the optometrist. Being able to maintain a child's interest and attention are important to getting the most from their eye test.
At Eyecare Concepts Optometry, we take the following steps to ensure that children who come to us for their eye care are well looked after and that their eye tests are as accurate as possible:
LONGER CONSULTATION TIMES
As an independent optometrist we can choose to spend more time with our patients. For children we allocate 40 minutes for their eye test. This gives the child time to settle in an unfamiliar environment, feel more comfortable, and to allow the time to perform all necessary tests without rushing the child. We also spend time explaining our findings to the parents in detail.
ACCURATE DIAGNOSTIC INSTRUMENTS
Adults' eye test results are determined by subjective responses (what the patient says during the test) and in a child's eye test more weight is placed on accurate objective findings (what the optometrist sees). Objective results, and the interpretation of these results by a skilled optometrist, are a vital part of children's eye tests. That means we can measure a child's eyesight and prescription without needing 'correct' responses from the child. To do that our clinic is equipped with advanced instruments that are highly accurate, and our optometrist cross-references the findings between different instruments to give the best possible assessment of a child's vision.
CHILDREN'S EYE TEST CHART
For children who are still learning their alphabet, we have a range of children's eye test charts to assess their vision. These include paediatric symbols (Lea symbols chart), numbers, 'Tumbling E' and 'Landolt C' eye charts designed specifically for testing younger children.
ALL TESTING BY THE OPTOMETRIST
The optometrist is the best person to carry out all tests in a child's eye examination. This includes preliminary testing and eye imaging tests that many optical chain stores delegate to their support staff. By being involved in the entire eye test journey, an experienced optometrist can pick up on subtle signs and issues that may otherwise be missed.
NO CHILD IS TOO YOUNG TO BE TESTED
Some parents tell us they were sent away by other optometrists saying their child is too young to be tested. Our optometrist can assess children of any age, even infants as young as 6 months. All children should have a comprehensive eye test by the age 3 to ensure that any vision issues that may interfere with normal vision development are detected early.
THE USE OF EYE DROPS WHEN NEEDED
While eye drops are generally not required in a child's eye test, they are occasionally necessary to make a definitive diagnosis of a child's eye condition. We will let you know if eye drops are recommended during your child's eye test. This is a called a cycloplegic examination, when we temporarily numb the eyes' focusing muscles. This in-depth examination is helpful when a child's focusing varies significantly during testing, or when the possibility of a very high prescription or lazy eye is detected, or when it is necessary to check the back of the eye in greater detail through dilated pupils.
BULK BILLING CLINIC
Our clinic's eye tests are bulk billed. That means there are no out-of-pocket costs to have your child's eyes comprehensively tested by us. And we also welcome parents bringing their children here for a second opinion if they have been tested elsewhere but are unsure of the results or have doubts about the recommendations given. It's one of many reasons why families across Melbourne are choosing Eyecare Concepts for their children's eye care.
If you have any questions about our children's eye test services here at Eyecare Concepts Melbourne, please contact us on (03) 9819 7695 to speak with our children's optometrist.
Here at Eyecare Concepts, a family optometry practice with a focus on children's vision, I test a lot of kids' eyes. Kids of all ages and from different family backgrounds. Many children come in for their routine eye checkups and have normal eyesight and healthy eyes, which is always great to see. Some children’s cases are more challenging, but it’s very satisfying and professionally rewarding when I'm able to help them and enhance their lives with better vision.
Lazy eye is a condition that most parents have heard of and are often concerned about. Sometimes the term ‘lazy eye’ gets confused with a turned eye or crossed eye. In optometry speak, lazy eye is called amblyopia, while a turned eye is called strabismus. They are often related, but quite different conditions. A lazy eye is usually a healthy eye but the eye and the brain are not working together properly. The visual processing system and nerve pathway associated with this eye is under-developed, from the brain becoming accustomed to 'ignoring' this eye in favour of the stronger eye. Without proper neural stimulation, the suppressed eye falls behind the good eye in eye-to-brain development.
The majority of cases of lazy eyes in Australian children are associated with long-sightedness (hyperopia). Some children are born highly long-sighted in one or both of their eyes. A long-sighted eye is an eye that is physically shorter in length than normal, or has a lens that is too powerful, so that light entering the eye is focused behind the retina instead of on it. Most children are mildly long-sighted when young, that is perfectly normal, but when an eye is significantly long-sighted (usually +4.00 or above) the eye is unable to fully compensate for this and the result is blurred vision both in the distance and up close. Normal development of the visual system is hindered by blurred vision from the affected eye/s. A lazy eye can also result if a child has one eye that is significantly more short-sighted (myopic) than the other, or has a high degree of astigmatism (uneven eye surface shape).
It is important to diagnose lazy eye in a child from an early age. Amblyopia occurs in around 2-3 in every 100 children, so it's not a rare condition. Some children have mild forms of amblyopia, and some have more severe forms. If a lazy eye is not detected, corrected or treated before age 8, permanently reduced vision in the affected eye can result and which will affect the child for the rest of his or her life. Lazy eyes are usually not treatable, or are extremely difficult to treat, in adulthood. Loss of vision in one eye means the child has impaired stereo (3D) vision and depth perception, and can affect potential future career ambitions as an adult, as some professions require good vision from both eyes.
One tell-tale sign that your child may have a lazy eye is a turned eye (strabismus). An eye that is highly long-sighted will have a greater tendency to turn inwards toward the nose (termed esotropia), especially when the child is tired. Some children may have an eye that turns outwards (termed exotropia). An inward-turning strabismus is more common in Caucasian children, while an outward eye turn is more common in kids from Asian backgrounds. If you suspect your child may have a eye that turns or wanders, whether it affects one eye or both eyes, turns inwards or outwards, and even if it happens only occasionally, you should have your child examined by an eye care practitioner — an optometrist or an ophthalmologist — as soon as possible.
With some infants and toddlers their eyes may give the appearance of being turned or crossed but are in fact straight. This is an optical illusion called pseudostrabismus caused by facial features and eyelids that are not yet fully developed. As trained professionals, we can differentiate between a true strabismus and a pseudostrabismus. We suggest seeking a professional opinion if you have any concerns at all about your child's eyes.
Our recommendation is that all parents should bring their children to an optometrist for their first eye test by the age of 3, even if they show no signs or symptoms and seem to be perfectly fine. Young children do not realise anything is wrong with their sight, they are not aware of what blurred vision is, and can appear to be functioning perfectly, especially when a problem affects only one eye. Often it's only at their first eye test that significant issues are discovered.
Children will usually have a basic vision screening test by their maternity nurse when they reach 3.5 years of age. This test is called the Melbourne Initial Screening Test (MIST). While these tests are helpful they are not always reliable and are not a substitute for a proper comprehensive eye examination. We believe all kids should be tested by an optometrist even if they have passed their screening test, for a more in-depth assessment of their eyesight, visual functions and eye health.
In our children's clinic we have special instruments and sophisticated eye measuring equipment to test young children, and objective tests that do not require any responses from the child if they are too young to read letters, identify symbols or give reliable responses. We also use dilating eye drops to more thoroughly assess your child's eyes and focusing. The presence of a lazy eye, turned eye, long-sightedness, short-sightedness and astigmatism can be detected. Where a lazy eye is found we can diagnose the cause of it and implement a treatment plan to gradually build up the vision in this eye and to make both eyes work together as a team. This usually involves glasses (sometimes contact lenses), eye patching or eye drops, and vision therapy. With timely and appropriate treatment the visual outcome for a child with a lazy eye is usually very good.
As an eye care professional, to see a child's face light up and smile when given glasses for the first time and being able to see better is always such a delight. And I'm reminded of what a privilege it is to have the opportunity, and to be entrusted with this responsibility, of looking after young children's eyes and enhancing their lives through eye care.
FAMILY & CHILDREN'S OPTOMETRIST — KEW, BALWYN, BALWYN NORTH
All children should have their first eye test by an optometrist by the age of 3, and reviewed at least every year as they grow up.
Good vision is vital for a child's growth and development, as most of what a young child learns about the world comes from their eyesight. Poor eyesight in kids, which they often are not aware of and do not complain about, can lead to behavioural issues, delayed social development and learning difficulties.
While young children will have an eyesight screening test by the Maturnal & Child Health Service, these are typically very basic tests that may not reliably detect all vision issues. It is recommended that all children by the age of 3 have a comprehensive, professional vision and eye health assessment by a children's optometrist.
HOW WE TEST YOUNGER KIDS' EYES
At Eyecare Concepts, our paediatric optometrist routinely tests children as young as 2, and sometimes even younger. Children's eye tests are different from adults' eye tests, requiring a different set of skills and equipment. We tailor the eye test to your child's age, maturity level and responses. Many tests are objective, meaning we can obtain reliable results without necessarily needing a response from your child. Our kids-friendly clinic is equipped to test younger children's eyes more thoroughly than most general retail optometrists.
We schedule 40 minutes for a children's vision assessment to allow ample time for children to settle and feel comfortable in our spacious consulting room. As it may be their first eye test, some children can be understandably a little nervous and anxious in new surroundings. Our aim is to make their eye test a fun and enjoyable experience, and as always, to provide the best eye care.
In a typical eye test for a preschool child, we check their eyesight with our children's eye test chart (picture matching), measure any potential focusing issues with a special light or a computerised vision tester, check eye movements, look for signs of a turned eye or lazy eye, check stereo acuity (ability to see 3D), colour vision, and the health of the front and back of their eyes. Eye drops are sometimes required to allow us to check the child's vision status and eye health in more detail.
KIDS' VISION PROBLEMS
Young children can have myopia (short-sightedness), hyperopia (long-sightedness) and astigmatism (irregularly shaped eye) just like adults can. Many eye problems actually run in families, so if you have an eye condition there's a good chance that your child may also have it, or may develop it. It is of even greater importance that vision problems are detected early in children, as delayed treatment can potentially affect their vision for life.
By having their first eye test before the age of 3, we have a baseline to compare and monitor any vision changes as they grow up. It also allows for us to predict when your child may begin to have eyesight problems and to make recommendations to help prevent or delay the onset of these problems.
Children who are already short-sighted before 5 have a very high risk of developing high myopia, which has lifelong eye health implications. More Australian children today are becoming short-sighted, and at an earlier age, than before. We have a specialised myopia treatment program to control childhood eyesight deterioration that occurs with progressive myopia. Our optometrist has successfully treated many young children to slow down their rate of myopia progression.
Below are two other examples of childhood eye problems that require urgent attention:
If you come across a photo of your child with a white reflex in one eye (like the image below), you should seek medical attention immediately as it may be a very serious problem. An opacity in the eye, a cataract, retinal detachment or a retinal tumour (retinoblastoma) can cause this white reflex phenomenon. Retinoblastoma is a rare eye cancer found in younger children (usually before age of 5, and more commonly before 2) that, if not detected and treated, may spread and become life-threatening.
EYES NOT STRAIGHT
If you have noticed that your child's eyes are not straight, whether it's subtle or obvious, sometimes or all the time, your child needs a detailed eye examination. A turned eye or strabismus (also called a 'squint') may involve one eye turning inwards or outwards relative to the other eye. It is caused by a misalignment, imbalance or weakness in the muscles that move the eyes. Strabismus occurs in about 2-4% of all children.
Many cases of strabismus are caused by a high degree of long-sightedness (hyperopia) in one eye and can be corrected with glasses without needing surgery. Failing to diagnose and treat strabismus from an early age can lead to the development of amblyopia ('lazy eye') which is permanent vision loss in one eye that cannot be treated or corrected in adulthood. Amblyopia needs to be treated early — typically before age of 8 — for best results. We can treat childhood amblyopia with glasses correction, patching and atropine eye drop therapy.
Where necessary we can also refer your child to a paediatric ophthalmologist (an eye specialist) for further assessment and management.
If you have a concern about your child's eyes, book an appointment to see our paediatric optometrist as soon as possible. We can test children as young as 6 months with advanced technology specific for assessing children's eyes.
FAMILY & CHILDREN'S OPTOMETRIST — KEW EAST, MELBOURNE
Has your child just started school or is about to start school? Have they recently had a school vision screening test that flagged potential areas of concern about their eyesight?
This is a good time to bring your child to see an optometrist for a comprehensive eyesight and eye health assessment. This will ensure your child has optimum vision for reading, learning and participating in all their school activities. Many children are unaware of blur, focusing difficulties or changes in their eyesight, and as many as 1 in 5 kids have undetected vision issues that can affect their learning and attention span.
A detailed baseline eye test by the age of 5 is recommended even a child appears to have no eyesight-related symptoms or has passed a basic screening test by the school nurse. A child's eyesight can often change quickly as they grow and our baseline findings can help us predict potential changes before they occur.
As a leading children's optometrist in the Kew, Kew East and Balwyn North area, we will thoroughly assess your child's eyesight and visual functions in readiness for them to start their primary schooling. Our spacious, full size consulting room was designed with kids in mind to make their eye test a fun and enjoyable one. With 40 minutes allocated for each consultation (compared to just 15-20 minutes at a typical retail optical store) it means we have time to do more tests and your child can relax and won't feel rushed.
Our comprehensive children's eye test includes:
· Sight test (letter chart and children's eye test chart are available).
· Detection of any focusing issues (long-sightedness, short-sightedness, astigmatism).
· Eye movement and eye tracking.
· Binocular vision testing to check that both eyes are working well together as a team.
· Stereo acuity (ability to see 3D).
· Colour vision testing.
· Eye health examination including digital retinal imaging.
· A written report will be provided to you and your child's school.
Ensure your child is ready for school - book a bulk billed eye test today.
Eyecare Concepts Optometry — Family & Children's Optometrist in Kew East.
Philip Cheng - B.Optom (Melb) Ocular Therapeutics (GCOT). Optometrist at Eyecare Concepts Kew East, Melbourne. An experienced eye care & contact lens practitioner with expertise in myopia control & orthokeratology.