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Eye test for kids: what a children's eye check-up involves at each age

Parents usually come for one of two reasons: a note from school saying the child did not pass the vision screening, or a wish to know that a young child's eyes are developing as they should. This guide explains what a children's eye check-up at ReNew Vision in Vasco involves and how to get your child ready for it. For the wider picture, see children's eye care and squint treatment.

What does an eye test for kids actually check?

Reading a chart is only one part of it. A complete children's eye examination looks at five things:

1. Sight in each eye on its own. A child with one good eye manages well, so a weak second eye can go unnoticed for years.
2. Spectacle power. Short sight, long sight and astigmatism, and whether the two eyes need very different powers, which is a common hidden cause of a lazy eye.
3. Alignment and movement. In the cover test, the eye doctor covers one eye and then the other while the child looks at a toy, watching whether the uncovered eye shifts. This picks up squints too small for a parent to see.
4. How the two eyes work together, including depth (3D) vision and focusing at reading distance.
5. Eye health. The front of the eye is examined under a microscope, and the retina and optic nerve at the back, usually after drops.

A colour vision test is added when a parent, a school or a form asks for one.

What is checked at each age?

The methods change with age, while the aim stays the same.

• Newborn to six months. The baby's doctor shines a light into both eyes and looks for an even orange-red glow in each pupil (the red reflex). Babies born early also need retina screening for ROP, explained on the children's eye care page.
• Six months to two years. No chart is used. The eye doctor watches the child look at and follow a toy, and notices whether the child protests more when one particular eye is covered. A strong protest when the same eye is covered every time can be the first clue that the other eye sees poorly. Spectacle power is measured with a hand-held light after drops, so the child does not need to answer anything.
• Two to four years. Vision is tested as a matching game. The child points to or names simple pictures or shapes, or matches them on a card held in the lap. A three-year-old is not expected to see the smallest line that an adult sees, so the result is judged against what is usual for the age and against the other eye.
• Four to six years. Most children can now manage a letter or symbol chart, matching letters if they cannot yet read them. A lazy eye or unequal power is often found for the first time at this age, while treatment still has years in which to work.
• Six years and above. A letter chart for distance and a reading card for near, with questions about the board, headaches, screen time and time outdoors. For a child who is already short-sighted, the eye doctor also tracks how fast the power is changing; see myopia control for children.
• Teenagers. Much like an adult examination, plus any eye fitness certificate a school or college form needs.

School eye screening or a full eye examination: what is the difference?

Many schools hold a vision screening, often once a year, and some families receive a referral note after it. A screening is a quick sieve: each child reads a chart from a set distance, one eye at a time, and any child who cannot read down to a certain line is referred. It checks a whole school in a short time, and does that job well.

A full examination at the hospital is different in almost every way:

• Who does it: the eye doctor, rather than a screener.
• What is tested: vision, spectacle power measured after drops, alignment, 3D vision and the health of the front and back of the eyes, not distance vision alone.
• What you leave with: a diagnosis and a plan, rather than a pass or a referral.

Screening can miss long sight, because a child's strong focusing hides it at a distance chart. It can also miss a small squint, a mild lazy eye and eye problems that do not affect the chart. A referral note is not a diagnosis either: sometimes the child was simply nervous. Either way, bring the note, because the reading it records helps the eye doctor.

Why are dilating drops used, and are they safe for children?

The drops relax the focusing muscle inside the eye and widen the pupil. Children focus so strongly that a long-sighted child can appear to see normally, or a short-sighted child can appear to need more minus power than is really the case, so a power measured without drops can be wrong. The wide pupil also gives the eye doctor a clear view of the retina.

• Putting them in: the drops sting for a few seconds and may be repeated once or twice. They take a while to work, often half an hour or more.
• Afterwards: near vision is blurred and bright light is uncomfortable for several hours. Depending on the drop used, this can last into the next day, and occasionally longer.
• Side effects: uncommon and usually short-lived, such as a flushed face or crankiness. Tell the eye doctor about any health condition, medicines or earlier reaction to eye drops, and tell us at once if your child seems unwell.

The effect of the drops wears off completely. They do not weaken the eyes or change the child's spectacle power.

How do I prepare my child for an eye test?

For toddlers and pre-school children:

• Talk about the visit a day ahead as a game of pictures and lights. Nothing in the check-up involves a needle.
• Practise at home: cover one eye with a palm and name pictures in a book, then swap eyes.
• Choose a time after a nap and a meal.
• Pack a small toy, a snack and water for the wait while the drops work.

For school children:

• Be honest that the drops sting briefly.
• Tell them it is fine to say "I cannot see that one." Children who guess or peep around the cover to pass can hide a real problem.
• Avoid the day before an exam, because of the blur from the drops.

What to bring, at any age:

• the child's current spectacles and any old prescriptions
• the school screening note or the teacher's comments
• phone photos that show an eye turning, or a white glow in a pupil
• a list of the child's medicines, and birth details if the baby was born early
• the family's eye history: squint, lazy eye, high spectacle power, or cataract or glaucoma in childhood
• sunglasses or a cap for the journey home

A parent stays in the room for the whole examination.

How long does a children's eye check-up take?

Longer than an adult's power check, mainly because of the wait while the drops work. Allow at least an hour. The Eye OPD runs from 4 pm to 7 pm, so coming early in those hours leaves time for the drops, and most children do not need to miss school.

What happens after the eye test?

The eye doctor explains the findings in plain words and writes down the plan:

• Healthy eyes, no spectacles needed: you are told when to come back for the next check.
• Spectacles needed: you receive the prescription. The Vision Correction Centre in the same hospital makes children's spectacles to it; see spectacles for children: a parent's guide.
• A lazy eye: spectacles come first, often with patching of the stronger eye; see lazy eye (amblyopia) and patching.
• A squint: spectacles, patching or surgery, depending on the type; see squint surgery: when it is needed.
• Something else: infections, allergies and lid lumps are treated here; anything not done at ReNew Vision is referred.

Some answers take a second visit, for example after a child has worn new spectacles for some weeks. The eye doctor then sets the gap to the next check. If you are unsure whether to come sooner, see signs your child needs an eye test or glasses.

Who examines children at ReNew Vision?

Children's eye care (paediatric ophthalmology) is one of the special interests of our consultant ophthalmologist, who examines the child and plans any treatment with the parents.

How do I book a children's eye check-up in Vasco?

• Where: ReNew Vision Eye Hospital, 2nd floor, Pai Hospital building, Vaddem Merces Road, Vaddem, Vasco da Gama, Goa 403802. See timings and directions.
• When: Eye OPD Monday to Saturday, 4 pm to 7 pm. Sunday OPD closed. For an eye injury or a sudden problem, emergency eye care is available 24 hours; see eye emergency.
• Call or WhatsApp: 072489 88039. Tell us the child's age and whether there is a school note, so that enough time is kept for the drops.

Questions patients ask

At what age can a child have an eye test?

At any age, from a newborn upwards. A child does not need to read or even talk, because vision and spectacle power can be measured with pictures, toys and a hand-held light. A full examination before starting school is advised for every child.

My child did not pass the school eye screening. What should I do?

Book a full eye examination and bring the screening note. A referral is not a diagnosis: the child may need spectacles, may have a lazy eye or squint, or may simply have been nervous on the day. The examination finds out which.

Can my child's eyes be tested if they cannot read yet?

Yes. Young children match or name pictures and shapes instead of letters, and babies are tested by watching how they look at and follow a toy. Spectacle power is measured after drops without the child having to answer.

How long does the blur from the eye drops last?

Usually several hours, and with some drops into the next day or occasionally longer. Near vision is blurred and light feels bright until the effect wears off completely. Avoid exam days.

Can I check my child's eyes with a phone app or an online test?

An app can sometimes show that one eye sees less well, but it cannot measure spectacle power accurately in a child, check alignment properly or look inside the eyes. Passing an app test does not rule out a problem, so it does not replace an examination.

What does 6/6 mean on my child's eye report?

It is a measure of sharpness. 6/6 means the child reads at 6 metres the line a person with standard vision reads at 6 metres. 6/12 means the child has to be at 6 metres to read what standard vision reads at 12. Young children are judged against what is usual for their age.

This page is general eye-health information, not personal medical advice. Your eye doctor advises you after examining your eyes.