“But Doctor”, Vivan’s mother protested, “Don’t you think he is too small? Neither can he read the alphabet and nor can he count the dots. How will it help to take him to an eye specialist?” Vivan’s paediatrician smiled. He was used to hearing this. “Madam, that is why I asked you to take him to a pediatric ophthalmologist. They are trained to check baby’s eyes.” “But Doctor, with Vivan no, you can never predict if he is goofing around with his answers or…” his mom continued, still not believing. “Just trust me once and leave that to the eye doctor”, said the paediatrician but he knew that Vivan’s mother was only half convinced.

This is a common query that many parents have – how do doctors check baby’s eyes? You would be surprised to know that there is a lot that a skilled pediatric ophthalmologist can tell about your baby’s eyes without getting a word out of them.

A Thorough History – What happened around your baby’s birth:

To begin with, the child eye specialist will ask you if there are any early childhood eye problems that run in the family – lazy eye, squint, congenital cataract, eye cancer or high spectacle powers? Did you have any troubles during your pregnancy or delivery? How is your baby with regards to his / her developmental milestones? All these aspects will give the eye doctor a fair idea about your baby’s risk factors. Also do share if you have noticed your baby rubbing his/her eyes too frequently or blinking excessively or having poor eye tracking skills.

Preferential Looking – What Babies Love to Look At:

In infants and young kids, large vision differences between the two eyes are more concerning. This is because, if drastically different images are sent by the two eyes to the brain, the brain blocks out the images sent by the defective eye… initially temporarily and later permanently. Once it becomes permanent, nothing much can be done to reverse the blindness in this lazy eye. The doctor will check for this by covering one eye and seeing if it bothers your baby more than the other.

Also, it is a known fact that, when given a choice between looking at something plain versus looking at stripes or an image, babies prefer to look the latter. This fact is used in many cards which have attention catching lines of varying thickness towards one side and are blank on the other end. Seeing where the baby looks help measure the accuracy of a baby’s vision.

Slightly older kids who can identify shapes are also tested for colour vision and depth perception using specific charts.

Muscle Function – What catches your baby’s eye:

Don’t we know how babies fascinatedly look at new toys! Eye doctors have your child look at a light or toy and see how your baby’s eyes fix and follow the toy’s movement. This gives them a fair idea about your baby’s eye alignment and eye muscles.

At what point your baby responds to the toy that is brought into his / her view also tells about their peripheral vision. When the child eye specialist shines a torch in your baby’s eyes he or she is also checking for how the pupils of your baby’s eyes react. This can detect many brain or nerve troubles.

Red Reflex – Shines light on a lot of areas:

Don’t you hate seeing the red eye in your baby’s photos? Eye doctors love it! This very red eye, called the red reflex is actually a reflected light and tells a lot. An instrument called an ophthalmoscope is used to shine a light in the eye and the colour and nature of the reflected light helps detect a number of eye problems. A similar instrument called a retinoscope helps estimating the power of your child’s eye. Studying how the red reflex changes on holding different lenses in front of the eye helps determine prescription numbers.

Sometimes special eye drops called cyclopegic and dilating drops are used to get a better look at the retina or the back of your child’s eye. This test does not depend on eliciting a response from your baby. Apart from this, your pediatric ophthalmologist also looks at your child’s eyelashes, eyelids, internal lens and outer transparent layer (the cornea) of the eye.

So you see, a skilled Pediatric ophthalmologist is very well adept at identifying vision problems even if your child is too young or too shy to talk. All you need to do is take your child to them at the right time!

Dr. Prachi Agashe is a Pediatric Ophthalmologist at Agashe Pediatric SuperSpeciality Care who has specialised in children’s eye problems. She can be contacted at contactus@agashehospital.com via email or on 022 42435000 via phone.