Their eyes have it.

A child’s vision can enable them to succeed in school and extracurricular activities, or it can inhibit their progress.

But if a vision problem puts a child at risk of falling behind in school and elsewhere, children aren’t always able to tell — which means they can’t tell their parents something’s wrong.

“The child has no frame of reference,” said Aaron McNulty, a Louisville optometrist and member of the Kentucky Optometric Association board of trustees. “A lot of times we need to be detectives.”

Tailoring exams to kids’ needs

McNulty said children aren’t always as capable of answering the classic “Which is better, one or two?” questions that many adults are accustomed to hearing during exams. But he and other pediatric eye care professionals have tools such as retinoscopes that can help them evaluate a child’s vision without any input from the patient.

“We can see into the eye as clearly as the child can look out,” McNulty said of these kinds of tools.

Doctors have also figured out a way around the challenge of examining a child who’s not yet familiar with the alphabet.

“Even if they don’t know their ABCs, they can still identify pictures,” said Peggy Fishman, a medical doctor who practices pediatric ophthalmology at Eye Care For Kids in Louisville.

At the office of Rahul Bhola, the director of pediatric ophthalmology at University of Louisville Physicians, there’s another layer — or rather, another dimension — to kid-friendly eye examinations. He can check a child’s depth perception using 3-D images, such as a photographic butterfly that a patient might attempt to pinch mid-air.

And that panic many pediatric patients go through when professionals attempt to give them eye-dilating drops? Bhola’s office has found a way around that: Workers can dilate patients’ eyes using a spray they can administer even to children whose eyes are closed.

“It’s a very kid-friendly test,” Bhola said of the examination process.

Warning signs

But innovations in examining children’s vision only help if parents have those eyes examined.

The American Optometric Association recommends that symptom-free children have their eyes examined at 6-months and 3-years of age, before beginning the first grade, and every two years after that. But parents might consider bringing children in sooner if they have a family history of vision problems or the child exhibits certain symptoms.

“No child is ever too young,” Fishman said.

Pediatric optometrist Kelly Borgman, Fishman’s colleague at Eye Care For Kids, said clues that a child might benefit from an examination include overly rubbing their eyes, closing their eyes when they go outside, tilting their head to the side or tilting their chin up or down.

Additionally, McNulty mentioned that parents might consider having a child examined if one or both eyes water excessively. And he said that as children age, eye problems might reveal themselves more subtly: While younger children might hold a book closer to their face, or might close or cover one eye while reading, an older child with vision problems might complain of headaches after reading — or avoid reading altogether.

Multiple doctors said one of the most common symptoms they encounter is a misalignment of the eyes, such as eyes crossing or turning inward or outward. Other signs a child might need an examination include complaints of nausea or dizziness, or a difference in the eyes’ appearance. For example, one eye might be bigger or brighter than the other, or one pupil might show up as red in photographs while the other shows up as white.

The earlier parents get eye concerns checked out, the easier problems are to address. Dr. Farah Ikram of Children’s Eye Specialists said that because eyes develop so quickly in the first 10 years, certain conditions can be difficult — or impossible — to treat effectively if they’re not addressed soon enough.

Awareness campaigns

Visionworks president Jim Eisen said not all parents understand the need to ensure their children’s eyes are healthy.

“There is definitely a national lack of awareness of the need for eye exams,” he said.

That’s why this school year, his company is launching Let’s Go See, a campaign he hopes will address that lack of awareness, as well as any financial struggles that might prevent parents from having their children examined. As part of the push, Visionworks has committed to donate up to 10,000 exams and 10,000 pairs of glasses.

The American Optometric Association is behind another awareness initiative, InfantSEE. That program provides comprehensive eye exams within their first year of a child’s life through participating optometrists.

How to prepare

Once you make that appointment for your child’s eye exam, you can take steps to make the visit less intimidating.

McNulty suggested bringing children along to their parents’ and siblings’ appointments to familiarize them with office beforehand. He advised that parents schedule the child’s exam for a time when they’ll be well rested, such as in the morning or shortly after a nap.

Fishman and Borgman suggested that parents avoid the word “doctor,” saying many children dread doctors’ offices because they associate them with shots. Instead, the doctors said parents should frame the visit as something fun, by telling them something such as, “We’re going to have your eyes examined to see how pretty they are.”

Because so many pediatric offices are designed to appeal to children, the exam process tends to be less intimidating than parents might remember from their own childhoods.

By the time the visit is over, Fishman said of her patients, “A lot of them don’t want to leave.”

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