Definition and Overview

Visual impairment in children, which affects about 19 million individuals worldwide, is one of World Health Organization’s serious global concerns (WHO). Based on statistics, the majority of sufferers have become visually impaired due to refractive errors – conditions that can easily be treated, if not prevented, through specialised care provided by a paediatric ophthalmologist or paediatric developmental optometrist. The former focuses on the diagnosis and treatment of eye diseases and injuries as well as performs eye surgeries. The latter, on the other hand, focuses more on the visual health of a child and prescribing eyeglasses when and as needed.

A paediatric eye consultation aims to examine the entire visual range of a child to identify any problems early on and understand the child’s risk of developing eyesight disorders.

Who Should Undergo and Expected Results

Children of any age, regardless if they are showing signs of eye problems or not, should be seen by a paediatric eye specialist on a regular basis to ensure the overall health of their eyes.

The eyes develop from infancy through the late teenage years. The American Public Health Association recommends that children undergo an eye examination when they reach six months old, two years of age and when they turn four years old. They would then be scheduled for follow-up consultations based on their specific needs. These consultations can be performed to diagnose and treat certain eye conditions or simply as a preventive measure.

Paediatric eye consultation becomes more important if the child is displaying signs of vision problems, such as:

  • Frequent squinting, eye rubbing, headaches, nausea and tearing
  • Feels the need to get closer to an object to see it better
  • Avoids activities that require clear eye sight
  • Poor school performance due to reading difficulties
  • Poor hand-eye coordination
  • Below average comprehension skills


It’s important to understand that many vision-related problems don’t just involve the eyes, but the brain as well. In fact, brain development relies heavily on the child’s ability to see well. This also includes psychological factors, such as emotional stability or self-esteem.

If a child has learning or development problems that are not attributed to a known disease or disorder, it is possible that he has vision problems that require immediate medical attention.

Categories of Common Vision Problems

  • Refractive problems can be described as difficulties in recognising objects at a certain distance. Under this category are nearsightedness (myopia), farsightedness (hyperopia) and astigmatism.

  • Functional problems encompass disorders that affect the function of the eyes, such as the ability of both eyes to focus on a certain object simultaneously.

  • Perceptual problems lean more towards neurological conditions, which means that the problem involves the way the brain interprets and processes the signals sent by the eyes. In some cases, the brain finds it difficult to store information, which makes it difficult for a child to recognise objects that he or she just saw or encountered.

How Does the Procedure Work?

The exact procedure on how paediatric eye consultation is performed depends on the type of specialist. If a paediatric developmental optometrist is consulted, the consultation will usually begin with a short interview where the child’s medical history, vision-related problems, the list of medications that he is currently taking and any information on past surgical procedures or drug allergies are discussed. If the child is currently undergoing treatment for any medical condition, the optometrist may collaborate with the child’s attending physician to determine if the medical condition is related to the patient’s eye problems or symptoms.

Depending on the symptoms being experienced, children will be examined for three types of vision problems: myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (vision distortion). Diagnostic tests may also include a cover test and retinoscopy.

Should the optometrist determine that a child’s vision problems are due to a certain disease or injury, a referral to a paediatric ophthalmologist will be performed. If not, the optometrist will prescribe eyeglasses to help the child see normally.

A paediatric ophthalmologist consultation, on the other hand, focuses on checking signs of diseases or injury to the eyes. After the examination, the ophthalmologist will discuss the findings with the child’s parents or guardian and recommend a treatment method.

Possible Risks and Complications

The risks associated with a paediatric eye consultation are very minimal. There is a slim possibility of accidental damage to the eye during an examination, but this rarely occurs and would be considered as negligence on the part of the attending eye doctor.

The risks are greater if the child does not undergo regular eye examinations or if any symptoms are neglected. It’s important to remember that the child’s eyes are still in the developmental stage. Any problems can lead to poor eyesight or hamper a child’s psychological development.

Reference:

  • Goldstein HP, Scott AB. Ocular motility. In: Tasman W, Jaeger EA, eds. Duane's Foundations of Clinical Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012:vol 2, chap 23.
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