At what age should I have my kids eyes checked?

Your child’s first exam should be at 6 months of age. During an eye exam for children, the optometrist will assess for the normal development of the eye and visual system. We will also discuss what to expect as your child grows older. All testing at this age is objective, and the exam takes only 10 minutes. As with all children, the cost of the exam is covered by Alberta Health.

Children of school age are seen annually to ensure that their vision is not affecting their learning and school work. In fact, 1 in 4 children diagnosed with a learning disorder actually has a vision problem. Although screenings are conducted in some schools, they are not adequate to detect all vision issues. Alberta Health covers the cost of eye exams until your child turns 19.

If your child is 13 or older, visit our Teen Eye Exam section for further details on what to expect during a routine eye exam.

Your child’s eye health is important. Here are some answers to common questions and concerns, answered by our friendly family optometrists located in our Calgary eye clinic.

How can you do an eye exam at 6 months when they cannot talk, what should I expect?

This is an eye exam for baby wellness that requires no verbal response and generally lasts no more than 5 minutes. We are looking for sight threatening diseases such as congenital cataract, infantile glaucoma, retinoblastoma and anything that could potentially affect normal development of the visual system.

Without any response on their part, we are able to get a good idea of their refractive prescription using an instrument called a retinoscope. We also look into their eyes to assess eye health using an instrument called an ophthalmoscope. We are also looking for eye movement disorders such as an eye turn (lazy eye), high degrees of astigmatism, high near or far-sightedness, inaccurate eye-tracking, and we even screen for proper neurological development as it relates to the eyes. All of this can be done accurately and objectively in a very short time. Unless there is a very high prescription or eye health disorder, there is rarely any treatment at this age.

How often do I have my child’s eyes checked?

If all goes well at the 6-month visit, we schedule another eye exam at age 3. At this visit, your child will be able to see pictures and respond to basic tests for vision, depth perception, color vision, and eyeglass prescription. We generally keep their attention using cartoons and games, and we will use automated equipment to obtain more data. Since the visual system is developing only until about age 8, we must ensure both eyes are receiving clear images and working together in order to prevent a lazy eye (amblyopia). After this age, vision impairment due to inadequate development becomes difficult if not impossible to treat. If your child has any signs of vision impairment, we will talk to you about treatment options that may include eyeglasses, eye exercises and possible eye patching or vision therapy to ensure a lifetime of clear vision. Exams are generally scheduled annually through the school years to ensure they continue to see to their full potential

If my child wears glasses, will their eyes become lazy or get worse?

This is a common misconception. In fact, the opposite is true. We now have reliable studies that demonstrate how near-sightedness (myopia) will actually progress faster if not fully corrected with glasses. Myopia is related to excessive elongation of the eyeball and will not slow down with a reduced or absent eyeglass prescription. Furthermore, inadequate correction of far-sightedness or astigmatism will only lead to eye fatigue, squinting, and blurry vision that may lead to poor school performance and learning. Thankfully, we now have methods to slow the progression of near-sightedness, you can read more about myopia control.

My child can see the smallest details and never complains about vision, why do I need to bring him or her in?

It is important to remember that a child cannot tell you if they have a problem if they do not know any different. This is especially true if one eye sees well, but the other does not. 80% of learning is visual, and up to 40% of children with learning disabilities have an undiagnosed vision problem. Lazy eye (amblyopia) is of particular concern. As noted earlier, if child has a lazy eye that is not corrected before the age of 8, the chances of ever seeing well out of that eye are extremely low. Having both eyes function together allows us to see 40% better, and is important for depth perception and hand-eye coordination. A comprehensive examination is also important to screen for both eye diseases and systemic diseases that may have no symptoms.

Children and Screen Time

The Canadian Association of Optometrists published a position statement in 2017 on the use of digital device screens by children. Here are their recommendations by age:

0–2 years

None, with the possible exception of live video-chatting with parental support, due to its potential for social development, though this needs further investigation.

2–5 years

No more than 1 hour per day. Programming should be age-appropriate, educational, high-quality, and co-viewed, and should be discussed with the child to provide context and help them apply what they are seeing to their 3-dimensional environment.

5–18 years

Ideally no more than 2 hours per day of recreational screen time. Parents and eyecare providers should be aware that children report total screen time use as much higher (more than 7 hours per day in some studies).  This is not unrealistic considering the multitude of device screens children may be exposed to in a day, both at home and at school. Individual screen time plans for children between the ages of 5–18 years should be considered based on their development and needs.

Further Recommendations:

Breaks no later than after 60 minutes of use (after 30 minutes is encouraged). Breaks should include whole-body physical activity. The ideal length of break has not been identified for either children or adults.

Workstation ergonomics: Chair heights should be set such that the child’s feet can lay flat on the floor or on a stool underneath the feet to allow for support. Chairs should not have arm rests unless they fit the child perfectly, as should back rests. Desks should be set at the child’s elbow height or slightly lower. There should be enough depth on the desk to allow for forearm support; this is specifically effective in preventing musculoskeletal strain.

Displays should be set in front of the child. There is no official recommendation for the angle of screen inclination. For computers, it is recommended to place the top of the display or monitor at the child’s eye level, and then allow them to move the screen down into a comfortable viewing position as needed. Official recommendations regarding a screen’s distance from a child do not exist; the computer screen should be placed at arm’s length, and then moved as necessary.

External devices such as keyboards should also be placed in front of the child, with the mouse close to the keyboard and appropriately sized. Workstation lighting should be equal throughout the visual field, so glare and reflections that inhibit screen viewing or cause visual discomfort are inhibited.

The use of screens should be avoided one hour before bedtime. Screens in the bedroom are
not recommended.

Outdoor activity over screen time should be encouraged

Children may or may not complain of electronic screen-associated discomfort. Regular eye
exams, which assess a child’s visual ability to cope with their visual demands and offer treatments for deficiencies (e.g., glasses correction; treatment (other than glasses) of other contributing eye conditions, etc.) are recommended.