Eye tests for children 

Introduction 

Routine eye tests are offered to newborn babies and children to identify any problems early on in their development.

Although serious vision problems during childhood are rare, early testing ensures that any problems are picked up and managed as early as possible.

This page covers:

Why eye tests are important

When will my child's eyes be checked?

What eye tests may be carried out?

Causes of eye problems in babies and children

Spotting signs of an eye problem

Why eye tests are important

Routine eye tests offered soon after birth can detect some eye problems immediately, and tests offered later on can help identify any problems that were missed or develop as your child gets older.

Children may not realise they have a vision problem, so without routine tests there is a risk that any problems could go undiagnosed for months or years.

It's important for eye problems to be identified as early as possible, because they can have a significant impact on a child's development and education.

Eye problems are often much easier to treat if detected while a child's vision is still developing (usually up to about seven or eight years of age). An early diagnosis will help to ensure that you and your child have access to any special support services you may need.

When will my child's eyes be checked?

Your child's eyes may be checked:

• within 72 hours of birth – this is known as the newborn physical examination and it can be used to check for obvious physical problems
• between six and eight weeks old – this is a follow-up physical examination to check for any obvious problems that weren't detected soon after birth
• at around one year old or between two and two-and-a-half years old – you may be asked whether you have any concerns about your child's eyesight as part of a review of your child's health and development; eye tests can be arranged, if necessary
• at around four or five years old – some children will have an eye test when they start school, although this varies, depending on where you live

It's also recommended that children have regular eye tests at least once every two years. These tests can be done at a high street opticians and are free for all children under 16 years old (and those under 19 years old in full-time education).

Speak to your GP or health visitor if you have any concerns about your child's vision at any stage (see spotting vision problems below).

What eye tests may be carried out?

A number of tests may be carried out to check for vision or eye problems in babies and children. Some of these are described below.

The red reflex test

The red reflex test is usually carried out alongside a general examination of your baby's eyes, as part of newborn checks. It involves using an instrument called an ophthalmoscope, which magnifies the eyes and produces a light that allows the eyes to be examined clearly.

When light is shone into your baby's eyes, a red reflection should be seen as it's reflected back. If a white reflection is seen, it could be a sign of an eye problem.

The pupil reflex test

The pupil reflex test involves shining a light into each of your baby’s eyes to check how their pupils (black dots at the centre of the eyes) react to light.

Your baby's pupils should automatically shrink in response to the light. If they don't, it could be a sign of a problem with their eyes.

Attention to visual objects

This is a simple test to check whether a newborn baby pays attention to visual objects. A midwife or doctor will try to catch your baby's attention with an interesting object. They then move it to see if the child's eyes follow.

These sorts of tests can also be used to check the eyesight of older babies and young children who are not yet able to speak. If your child can speak, but is not yet able to recognise letters, pictures may be used instead of objects.

Snellen and LogMAR charts

When your child can recognise or match letters, their vision is tested using charts that have rows of letters and numbers of decreasing sizes. Your child will be asked to read out or match the letters they can see from a specific distance. These charts are called Snellen or LogMAR charts.

For younger children, a similar test using pictures or symbols may be carried out instead.

Range of movement tests

To test the range of movement of each eye, a child's attention will be drawn to an interesting object, which is then moved to eight different positions: up, down, left, right, and halfway between each of these points. This tests how well the eye muscles work.

Refraction test

A refraction test is carried out by an optometrist at a high street opticians and is used to determine if your child needs glasses and what prescription they need.

Before the test, your child may be given special eye drops that widen their pupils, so the back of their eyes can be examined more clearly. Your child will be asked to look at a light, or read letters on a chart if they're old enough, while different lenses are placed in front of their eyes.

Colour vision deficiency test

Colour vision deficiency tests, also known as colour blindness tests, are usually carried out in older children if a problem is suspected.

One of the tests used to check for colour blindness is the Ishihara test. This involves looking at images that are made up of dots in two different colours. If a child's colour vision is normal, they'll be able to recognise a letter or number within the image.

A child who can't tell the difference between two colours won't be able to see the number or letter, which means they may have a colour vision problem. Read more about diagnosing colour vision deficiency.

Causes of eye problems in babies and children

There are a number of different eye problems affecting babies and children that can be detected during eye tests, including:

• childhood cataracts – cloudy patches in the lens of the eye that are present from birth
• lazy eye (amblyopia) – where the vision in one eye does not develop properly
• squint (strabismus) – where the eyes look in different directions
• short-sightedness (myopia) – where distant objects appear blurred, while close objects can be seen clearly
• long-sightedness (hyperopia) – where you can see distant objects clearly, but nearby objects are out of focus
• astigmatism – where the cornea (transparent layer at the front of the eye) is not perfectly curved
• colour vision deficiency (colour blindness) – difficulty seeing colours or distinguishing between different colours; this is more common in boys than girls

Spotting signs of an eye problem

Although your child should have regular eye tests as they grow up, it's still important to look out for signs of any problems and seek advice if you have any concerns.

For babies, the checklist in your baby's personal child health record (red book) can be used to help you check if your child's vision is developing normally.

In older children, signs of a possible eye problem can include:

• the eyes not pointing in the same direction
• complaining of headaches or eye strain
• problems reading – for example, they may need to hold books close to their face and they may lose their place regularly
• problems with hand-eye co-ordination – for example, they may struggle to play ball games
• being unusually clumsy
• regularly rubbing their eyes

Speak to your GP or health visitor if you have any concerns about your child's eyes or vision. They can have an eye test at any age.