Stages of vision problems

An Overview

A child’s vision is a complex combination of the brain, the eyes and the vast array of nerves that connect them. At birth, this visual system is still immature and continues to develop throughout the child’s early years. The process of “vision” starts when light rays enter the eye and ends with visually-guided behavior. This process goes through three main stages:

1. The optical stage focuses an image on the retina.
2. In the receptor stage , photoreceptor cells convert the light energy striking your retina into nerve impulses which are then be processed by your nervous system.
3. Neural processing, the final stage, processes the nerve impulses, leading to our consciously perceiving,to recognizing object and to guiding in real time the actions that we direct at objects in the visual world.

As children progress through their school-age years, the American Optometric Association recommends an eye exam every year, regardless of whether a vision problem is present. If the person performing a vision screening suspects a problem with your child’s eyes or eyesight, such as a refractive error or eye teaming condition, they will refer your child to an optometrist or ophthalmologist for a complete, pediatric eye exam.
If you prefer to see a doctor who specializes in the diagnosis and treatment of children’s eye conditions, look for a pediatric optometrist or pediatric ophthalmologist. These doctors are specially trained in the diagnosis, management and treatment.

Passing a vision screening can give parents a false sense of security. Many preschool vision screenings only assess one or two areas of vision. They may not evaluate how well the child can focus his or her eyes or how well the eyes work together. Generally, color vision, which is important to the use of color-coded learning materials, is not tested.

Types of vision problems

Most Common Adult Vision Problems

Blurred vision (called refractive errors)
• Age-related macular degeneration
• Glaucoma
• Cataract
• Diabetic retinopathy

Most Common Childhood Vision Problems

Blurred vision (called refractive errors)
• Crossed eyes (called strabismus)
• Lazy eye (called amblyopia)

Between the ages of 3 and 5, your child should have a thorough, in-person optometric eye examination to make sure his or her vision is developing properly and there is no evidence of eye disease. If needed, your doctor of optometry can prescribe treatment, including eyeglasses and/or vision therapy, to correct a vision development problem.

When should a child have an eye exam?

An infant’s eyes are examined by the neonatal pediatrician soon after birth to rule out any of the common postpartum eye diseases such as cataracts, infantile glaucoma and eye tumors.
The recommended schedule of eye exams for children includes:

One visit between 6-12 months
• One visit between 2-3 years old
• One visit between 4-5 years old
• Annual visit, from 6 years and up

Stages of vision problems

Birth to 1 month

At birth, an infant is very sensitive to bright light. You may notice how small theirpupils look, limiting how much light enters their eyes. A newborn baby can see something next to them with their peripheral (side) vision, but their central vision is still developing.
• Blinks in response to bright light
• Uncoordinated eye movements— may appear “crossed-eyed”
• Ability to stare at an object 8-10 inches away
• Stares at light or face
• Begins to track or follow moving objects

1 to 2 months

For their first 2 months, babies’ eyes often do not work together very well. You might notice your baby’s eyes appear to be crossed or they may seem to wander out to the sides. In most cases, this is normal and they will eventually correct themselves. But if one of your baby’s eyes constantly turns in toward their nose or outward away from the nose, talk with your pediatrician.
• Clear vision only for objects 10-12 inches away
• Stares at faces and black and white images
• Follows an object up to 90 degrees
• Watches parent closely
• Begins to develop tears

2 to 3 months

• Begins to notice familiar objects up to 12 inches away
• Examines own hands
• Follows faces, objects, and light

4 to 5 months

• Begins to reach for nearby objects, such as a hanging mobile
• Recognizes objects such as a bottle or pacifier
• Looks at self in mirror

5 to 7 months

At around 5 months old, a baby’s ability to see how far an object is from them (called depth perception) has developed more fully. They are seeing the world in 3 dimensions (3-D) more completely. They get better at reaching for objects both near and far. They also have good color vision at this point, though not quite as fully developed as an adult’s.
• Develops full color vision
• Ability to see images and objects from few feet away
• Turns head to view objects
• Favors certain colors
• Touches mirror image of self

7 to 12 months

At about 9 months old, babies can generally judge distance pretty well. This is about when they start to pull themselves up to stand. Your baby’s eyes are probably their final color now. However, it is not uncommon to see some slight changes later.
• Development of independent eye movements
• Sees smaller objects
• Development of depth perception
• Crawls to reach distant objects
• Plays peek-a-boo
• Watches and follows fast moving objects

12 to 18 months (1 to 1.5 years)

• Clear distance vision
• Depth perception for objects further than 2 feet away
• Refinement of eye movements
• Recognizes images of familiar objects
• Walks to interact with interesting items
• Recognizes self in mirror

18 to 24 months (1.5 to 2 years)

• Begins to focus on objects closer than 2 feet
• Clear distance vision
• Development of fine-motor skills
• Colors with crayons— attempting to draw straight lines or circles
• Identifies body parts —mouth, eyes, and hair, etc.

24 to 36 months (2 to 3 years)

• Improvement of close vision skills: convergence and focusing
• Development of binocular vision at all distances
• Can change focus from distance to near
• Improvement of depth perception
• Uses focusing to recognize shapes and objects

36 to 48 months (preschool)

• Distance vision nearing 20/20
• Clear and single vision up to few inches from face
• Development of gross-motor coordination
• Recognizes complex visual shapes and letters
• Identifies colors

48 to 72 months (school)

• Knows letters and some words
• Recognizes orientation of letters
• Begins reading
• Possesses a matured sense of depth perception
• Clear, single and comfortable vision at all distances

Young children may not report if they feel that something is wrong simply because they don’t realize that something is wrong.

Here are several tips to make your child’s eye examination a positive experience:

1. Make an appointment early in the day and allow about one hour.
2. Talk about the examination in advance and encourage your child’s questions.
3. Explain the examination in terms your child can understand, comparing the E chart to a puzzle and the instruments to tiny flashlights and a kaleidoscope.

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