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Does Your Preschooler Need Glasses?

Blog Does Your Preschooler Need Glasses?

“Kids under age four often aren’t really old enough to complain,” says David Plager, M.D., director of pediatric ophthalmology at Riley Hospital for Children at Indiana University Health. “To them, being unable to see clearly may seem normal and yet this is a critical time for catching eyesight problems."


It’s not hard to figure out if a school-age kid can’t see well: She’ll squint, report she can’t read the blackboard at school, perhaps complain of headaches or say her eyes feel tired. But with younger children, focusing in on a vision problem often isn’t so easy.

“Kids under age four often aren’t really old enough to complain,” says David Plager, M.D., director of pediatric ophthalmology at Riley Hospital for Children at Indiana University Health. “To them, being unable to see clearly may seem normal and yet this is a critical time for catching eyesight problems. The visual part of the brain develops during the first seven or eight years of life — especially the early part of that time period.”

What’s more, trouble seeing isn’t the only reason a young child may need to wear glasses. Here are some of the main ones, according to the American Association for Pediatric Ophthalmology and Strabismus (AAPOS):

  • To correct myopia (near-sightedness), hyperopia (far-sightedness), or astigmatism. The AAPOS says myopia is most common in school-age kids, but younger ones can be affected. Most of the time, myopia runs in families. Children who are far-sighted only need glasses if their hyperopia is excessive enough to cause blurred vision or discomfort. The same is true of astigmatism, in which the eye is shaped more like a football than a perfect sphere, explains Dr. Plager. If a child has a significant astigmatism, fine details may look blurred or distorted, in which case corrective lenses can help.
  • To help straighten eyes that are misaligned, or “crossed,” a condition called strabismus. Some children are born with strabismus, in which they need corrective surgery. More often, it develops between the ages of 2 and 4, according to Dr. Plager — often due to a difference in prescription between the two eyes (anisometropia). One eye may have normal vision, for instance, while the other is significantly near-sighted or far-sighted. (Extreme hyperopia also sometimes causes eyes to cross, according to the AAPOS.)

    “It’s important to catch this discrepancy early,” says Dr. Plager, “because a child often will rely on the eye with the better vision to do most of work of seeing, causing the other eye to become ‘lazy’ and preventing it from developing normally.” The medical term for lazy eye is amblyopia. Glasses (and sometimes patching or eye drops) can be used to force the weaker eye to work harder.
  • To protect one eye if the other has poor vision.

Since very young children aren’t likely to speak up if their eyesight is poor (or even notice something is wrong), screening them is key to discovering vision problems, says Dr. Plager. Fortunately, pediatricians and family doctors typically screen at yearly check-ups.

And the old-fashioned eye chart is still the gold standard for catching potential issues. “It indicates exactly what a kid is seeing, unlike machines that don’t require feedback from a child.”

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