Long before your child can read an eye chart, he or she may need an eye examination. Young children can develop such conditions as impaired vision without a clear cause, nearsightedness or strabismus, the abnormal alignment of the eyes.

Yale Medicine’s pediatric ophthalmologists use state-of-the-art methods to examine the eyes of children. This allows them to diagnose and treat problems early, says Martha Ann Howard, MD, a Yale Medicine ophthalmologist.

Even premature babies in the neonatal intensive care unit can have their eyes checked for the development of retinopathy of prematurity. At Yale Medicine, this is typically done by a retina specialist, who places numbing drops in the infant’s eyes and dilates the pupils to allow for a thorough examination of the retina.

Your pediatrician may refer your newborns or infant to see an ophthalmologist, who can determine how the eyes are functioning. 

“A newborn should respond to bright light,” says Dr. Howard. Then, once they are a few months old, “Babies should look at fixed-and-follow objects moved in front of them,” she says.

Pediatric ophthalmologists keep a drawer full of toys to use when they are examining young children. 

By holding up a colorful small toy, for example, “We can check preverbal children to see if they use both eyes equally or if they tend to prefer one eye over the other,” says Dr. Howard. 

“As they get even older, at about 2-and-a-half years old, they can identify pictures, and match them to pictures on a card so we can measure visual acuity and look for differences between the two eyes," Dr. Howard says. "At about age 4, they can match a limited number of letters; by age 5 or 6, they can identify randomly generated letters on a chart 20 feet away.” 

The doctor will also use other tools for the examination. For example, the child might be asked to put his or her chin on a chin rest and hands on handlebars. “We say, ‘Want to ride a motorcycle?’” Dr. Howard says. That enables the ophthalmologist to use a slit lamp—a light with a microscope—to look into the child’s eyes.

“It's important for us to examine the optic nerve and retina to see if they appear normal or not,” says  Dr. Howard. “We dilate the eyes of every child we examine, but not on every visit.”

Pediatric ophthalmologists at Yale Medicine use compounded eye drops, which combine three medicines to dilate the eyes, so the child only needs one in each eye. “It makes it a whole lot easier on the child than multiple rounds of drops,” Dr. Howard says. She tells her young patients that it will feel like swimming in a pool and getting water in their eye. “But not worse than that,” she says. 

There is no need to worry if the child is preverbal or shy. “We can measure with our tools to determine their glasses prescription,” says Dr. Howard. Ophthalmologists use a special optical tool that resembles a flashlight. 

Even some newborns wear glasses—they have a strap to hold them onto the baby’s head—and most children do very well with them. A child’s improved vision often means improved behavior because they can navigate the world more nimbly. 

Yale Medicine’s pediatric ophthalmologists use state-of-the-art methods to examine children’s eyes and diagnose problems. They also participate in national clinical trials that are helping to define the best practices to care for children.  

“That distinguishes our practice,” says Dr. Howard.  "Clinical trials are useful in cases when the best treatment approach isn’t yet clear. The trials are in place “to define the best treatment options."