As parents, we track our children's milestones: first steps, first words, first loose tooth. But what about their vision? It’s easy to assume that if a child isn’t bumping into things, everything is fine. In reality, a child’s visual system is still developing, and many eye conditions have no obvious symptoms to a casual observer.
That’s why a comprehensive children’s (paediatric) eye exam is so important. It’s much more than reading letters off a chart, it’s a specialised, age-appropriate assessment designed to make sure your child’s eyes are healthy, developing properly, and working together as a team.
So, what actually happens during one of these important appointments at Illume Eye Care? Let’s take a look.
Why a Paediatric Eye Exam is Different (And So Important!)
Children aren’t just small adults. Their eyes are still growing, and they can’t always explain what they’re seeing (or not seeing). At Illume Eye Care, our optometrists use gentle, child-friendly techniques and equipment to assess vision and eye health, often without needing children to give verbal responses.
Early detection of issues like amblyopia ("lazy eye"), strabismus (eye turn), significant refractive errors (nearsightedness/myopia, farsightedness/hyperopia, astigmatism), and even rare but serious conditions like congenital cataracts and retinoblastoma is critical. The earlier we diagnose, the easier and more effective treatment can be.
What to Expect: A Step-by-Step Look
Every exam is tailored to your child’s age and developmental stage, but most comprehensive children’s eye exams include:
1. Detailed History & Parent Concerns
We begin by getting to know you and your child. Your optometrist will ask about:
- Your child's birth history (premature birth can increase eye risks).
- Developmental milestones and any developmental delays.
- Family history of eye conditions (e.g., "lazy eye," strong glasses prescriptions, strabismus).
- Any symptoms you’ve noticed or are concerned about including squinting, rubbing eyes, head tilting, holding things close, eye turns
- Performance in school or sports.
- Behavioural signs that may relate to vision
2. Visual Acuity Testing (How Well They See)
This is where the "E" chart comes in, but it's not the only method!
- Older Children: Will read letters, numbers, or shapes off a chart.
- Younger Children (or Non-Verbal): The optometrist might use special charts with pictures or tumbling "E"s where the child indicates the direction of the "E" legs. Alternatively, preferential looking tests use cards with stripes on one side and a blank on the other; infants naturally prefer to look at patterns, allowing the optometrist to estimate visual acuity.
These methods allow us to estimate clarity of vision at any age.
3. Eye Movement & Alignment Tests (How Eyes Work Together)
This assesses for strabismus (eye turns) and how well the eyes track objects.
- Cover Test: The optometrist will have your child focus on a target, then briefly cover one eye, looking for any movement in the uncovered eye as it tries to fixate. This reveals subtle eye turns. From here we may do a range of tests to explore eye alignment further.
- Tracking: The optometrist uses a target or light to see if your child can smoothly follow an object with both eyes.
4. Stereopsis (3D Vision) Testing
Using special 3D glasses and child-friendly patterns, we assess how well both eyes work together. Good stereopsis is vital for depth perception, hand-eye coordination, and sport.
5. Refraction (Would they benefit from Glasses?)
We use several tools to accurately measure your child’s prescription. This determines if your child would benefit from glasses for nearsightedness, farsightedness, or astigmatism.
- Autorefractor: A quick, automated machine that measures refractive error.
- Retinoscopy: This is the gold standard method for children. The optometrist will shine a light into the eye and uses a series of lenses to neutralise the light's reflection off the retina. This allows for an objective measurement of the prescription without requiring verbal feedback from the child.
- Cycloplegic refraction: This is a crucial step for many children, especially younger ones or those with suspected farsightedness or shortsightedness. Special eye drops are instilled to temporarily paralyse the eye's focusing muscle (the ciliary muscle). Why is this important? Children have very strong focusing abilities, which can mask significant amounts of farsightedness or induce pseudo-nearsightedness. By relaxing this muscle, the optometrist can get a truly accurate and objective measurement of the child's full refractive error using instruments like a retinoscope.
6. Eye Health Assessment (A Look Inside the Eye)
This is a vital part of the exam to check for any diseases or abnormalities of the eye:
- Slit Lamp Examination: Using a special microscope with a bright light, the optometrist examines the front structures of the eye: eyelids, lashes, cornea, iris, and lens.
- Ophthalmoscopy: The optometrist sometimes uses an ophthalmoscope to look at the retina, optic nerve, and blood vessels inside the eye.
- Axial Length Measurement: As part of modern myopia management, we also measure axial length - the physical length of the eye. This is one of the most important indicators of myopia progression. Even small increases in axial length can signal a growing risk of future eye disease. Measuring it regularly allows us to detect early changes, guide treatment decisions, and closely monitor any progression, ensuring your child receives the most up-to-date, evidence-based care.
- Pupil Dilation: We may use eye drops to temporarily widen your child's pupils. This allows the optometrist to get the clearest view of the retina and the optic nerve. It also relaxes the focusing muscles, allowing for a more accurate prescription measurement, especially in younger children who can "over-focus".
7. Eye Pressure Measurement (If needed)
While glaucoma is rare in children, eye pressure might be checked, with a hand-held device for younger children.
8. Diagnosis & Discussion
After all the tests, the optometrist will discuss their findings with you, explain any diagnoses, and outline a treatment plan if necessary. This could include:
- Glasses - for full or part-time wear
- Myopia Management with glasses, contact lenses, atropine or red-light therapy
- Patching or atropine drops for amblyopia.
- Vision Therapy for Binocular Vision Conditions
- Contact Lenses for sports or myopia management
- Therapeutic Management of any eye allergies, blepharitis, styes or infections
- Referral to an ophthalmologist for surgical intervention (e.g., strabismus surgery).
- A schedule for follow-up visits.
You’ll always leave with a clear understanding of your child’s vision and what to expect next.
When Should My Child Have Their First Eye Exam?
In New Zealand, its recommended children have comprehensive eye exams at these ages:
- First exam: Between 6 and 12 months of age.
- Preschool exam: Between 3 and 5 years of age.
- School-age exam: Annually from age 6 onward.
Your optometrist will also recommend longer or shorter intervals between exams based on your child's eyes.
Good vision underpins so much of a child’s world - learning to read, concentrating in class, hand–eye coordination in sport, and overall confidence. That’s why it’s important not to rely solely on Before School Checks or school vision screenings. These quick screenings are designed to pick up only significant distance blur and obvious eye turns. They don’t assess eye health, focusing accuracy, depth perception, near vision, or how well the eyes work together, all essential skills for comfortable reading, effective learning, and success on the sports field.
A comprehensive paediatric eye exam gives a complete picture of your child’s vision and eye health, ensuring they have the visual foundation they need to thrive. Many vision problems are silent, but easily treatable if identified early. Prioritise your child’s visual health, it’s a vital part of their development, learning, and everyday wellbeing.