About eyesight / Nearsightedness, strabismus and 'lazy eye': first visit as early as 3 years old to take care of your child's vision

Let’s talk about eyesight. Myopia, strabismus and ‘lazy eye’: at birth, our eyes are fully formed, but our visual capacity is still immature

Then day after day, we learn to look at the world thanks to the correct stimulation and tricks we learn in early childhood.

In the first five to six years of life, the development of visual function in children takes place in progressive stages: it is therefore important to intercept in time problems or pathologies that could jeopardise the development of a complete and correct visual function.

Eyesight: when is it advisable to have the first eye examination?

The first eye examination (ophthalmic and orthoptic) should be carried out between the ages of 3 and 4, generally speaking around 3½ years.

At this age, in fact, the child is in most cases sufficiently cooperative to carry out the required tests, first and foremost the assessment of visual acuity using graphic characters (stylised shapes and drawings of familiar objects) and those proposed by the orthoptist to assess the correct development of motor functions.

So a visit before the age of 3 is not necessary?

No. An examination should be brought forward if the parents notice that the child, perhaps at the age of 1 or 2, “twists an eye” or assumes an abnormal head position when looking at objects.

The examination should also be brought forward in children born prematurely and if there is a family history of strabismus and amblyopia.

How is the first eye examination carried out?

The first eye examination is an important moment in which various tests are carried out.

The paediatric ophthalmologist checks both the ‘health of the eye’ from an anatomical point of view (e.g. evaluation of the adnexa, structures of the anterior segment and fundus examination) and functional aspects (e.g. visual acuity, ocular motility, presence of stereopsis).

Finally, for a complete examination it is necessary to instill a few drops of eye drops, which may sting a little, but which are essential for performing the refraction examination in cycloplegia, a test that assesses any refractive defect, i.e. the inability of the eye to focus images sharply on the retina (blurred vision).

Speaking about eyesight: what problems can be detected in a young child?

High refractive defects (especially astigmatism and hypermetropia) and slight strabismus (microtropia and small-angle strabismus) can be diagnosed at the age of 3-4 years. High refractive defects, especially if they are asymmetrical in both eyes, and strabismus are dangerous, because they can cause amblyopia, the so-called “lazy eye”.

Prompt correction of these defects is essential.

If amblyopia is found is there a chance of cure?


In most cases, glasses are prescribed as a first step and very often after some time the rehabilitation treatment is started, which consists of ‘bandaging/covering’ the eye that does not have refractive defects or has better visual function, thus stimulating the other eye.

If started early, rehabilitation treatment is usually well accepted by the child and gives better and faster results.

It is also important to follow the instructions given by ophthalmologists and orthoptists scrupulously, and to respect the deadlines for check-ups so as not to undo what has been done.

If everything goes well at the first screening appointment, when is the second appointment?

The second screening visit should be carried out in pre-school age.

Older children are able to read the smallest letters or graphic symbols, which means that the visual function is fully mature (the famous 10/10).

At this age, it is also possible to diagnose childhood-onset myopia and prescribe spectacles so that the child has no learning difficulties related to the visual defect when entering primary school.

In this connection, it should be noted that most children, even up to the age of 8-10, tend not to report their visual difficulties.

What steps are important to take to ensure healthy vision in older children and young adults?

Definitely limit the use of tablets and other electronic devices, especially at close range.

At the same time, encourage and promote outdoor activities and sports.

A large body of scientific literature now shows that proper exposure to natural light reduces the progression of myopia, an increasingly common condition that is becoming an epidemic in some countries.

It is also important to get children and young people used to wearing sunglasses with good quality UV filters on particularly sunny days and hours, especially where there is a lot of glare (e.g. at the beach or swimming pool in summer and in the mountains in the snow).

To protect the eyes of children who find it difficult to keep their sunglasses on from the sun, it is also useful to use caps with a visor, while for the youngest children, don’t forget to use sunshades for prams.


With regard to glasses, any advice on how to make children accept them better?

It is necessary to rely on the expertise of an optician who is an expert in the paediatric age and who has a wide range of frames suitable for children’s faces in terms of materials and shape (usually in non-toxic rubber, without nose pads and with elastic arms) and, why not, in bright colours.

Never use metal frames, as they can be dangerous if children fall.

The same applies to sunglasses, where particular attention should be paid to the quality of the lenses.

Finally, any final tips for detecting vision problems at the start of primary school?

It can happen that at school the child, usually boys, becomes aware that he does not see colours correctly, especially shades.

The most frequent forms of impaired colour vision (colour blindness) affect green and red, the genes for which are located on the X chromosome, which explains why the disease mainly affects boys.

This alteration can have varying degrees of severity, ranging from absolute insensitivity to colour vision (black, white or grey vision with the presence of only one or two colours), which occurs rarely, to an inability to fully grasp nuances.

The diagnosis of colour blindness is not difficult: there are special visual tests, the so-called Ishihara tables, which make it possible to detect any difficulties in colour perception even in very young children, as young as 4-6 years old.

Although there is currently no treatment for these defects, it must be remembered that colour blindness does not affect visual acuity at all and the child can carry out most daily activities without any problems: learning to read and write and, in due course, obtaining a driving licence.

However, it is important that teachers and educators are informed about the disease so that they avoid learning methods based on recognising and comparing colours for that child.

Read Also:

What Is Ocular Pressure And How Is It Measured?

Opening The Eyes Of The World, CUAMM’s “ForeSeeing Inclusion” Project To Combat Blindness In Uganda

What Is Ocular Myasthenia Gravis And How Is It Treated?


Policlinico di Milano – sito ufficiale

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