What to Expect During the Exam

In over three decades of caring for children’s eyes, we have strived to create a warm, friendly environment designed to be enjoyable and comforting for our patients and their parents. We want children to learn that visiting the eye doctor can be a fun, rewarding experience.

The exams themselves incorporate picture games, colored flashlights, and 3-D pictures. Through the use of these items and other more sophisticated equipment, the exam can be performed in a thorough and non-threatening fashion.

Our approach to your child’s care is a team approach, with our board certified ophthalmologists, optometrists, orthoptists and opticians all working together in the evaluation, diagnosis, and treatment of your child. Our Young Eyes Optical Department works closely with our medical staff to assure that each patient is properly fitted with high-quality frames and precisely crafted lenses.

In order for our doctors to conduct a complete eye exam with dilation and thoroughly explain any findings from the visit, please allow 90 minutes for the first appointment (which includes the 30 minutes of waiting for the dilation drops to sink in). We suggest that you have snacks and other necessities for your child on hand. If you or your child’s eyes are dilated, they will be sensitive to light, so we suggest that you bring sunglasses to wear after your visit. The eye drops will make your or your child’s near vision blurry. Depending on the drops that are given, the dilation can last anywhere from 4 to 24 hours.

Treatment

Refractive errors (optical focusing issue): Myopia, hyperopia, and astigmatism are the main types of refractive errors.  A small amount of a refractive error may be normal depending on the child’s age. Or, our measurement may reveal that he/she will need glasses soon but it may be ok to wait to start with glasses.  On the other hand, sometimes even a baby needs to wear glasses.  Your doctor will help you decide if glasses are necessary.

Amblyopia (“lazy eye”): Amblyopia refers to when proper vision does not develop in the visual system of a young child. There can be several causes of amblyopia, the most common one being a refractive error (need for glasses) that is either high in both eyes or asymmetric between the two eyes. Eye alignment problems can also cause the brain to develop worse vision on one side. There are other causes as well.  But whatever the cause, the treatment often includes patching the better seeing eye for a few hours each day to force the brain to use the “weaker” eye.  The patch is, in effect, helping to rewire the brain’s visual system.  Amblyopia is often not picked up by parents since many children can seem to function fine by just using the better-seeing eye. The best chance for success is early detection, since a child’s brain becomes less “flexible” with each passing year.  Sometimes alternatives to an adhesive patch are possible, such as a slide-on patch over glasses, a filter on the glasses, or even an eye drop. Your doctor will discuss which option might work best for your child.

Strabismus (eye alignment problems): Many eye alignment problems can be successfully treated by in-office and non-surgical techniques, such as glasses, patching, orthoptic exercises, and prisms. If the need arises for surgical correction, our ophthalmologists are experts in this surgery, and operate at Greater Baltimore Medical Center (GBMC), a wonderful hospital with an excellent pediatric anesthesia team. Pediatricians and referring ophthalmologists in Maryland know that we welcome complex problems such as cyclovertical deviations, nystagmus, and prior strabismus surgery elsewhere and that we also can perform an “adjustable suture” technique if indicated.

Other problems: There are obviously many other problems that can affect the eye, including injuries, infections, and allergies. Tear duct obstructions and problems affecting the eyelids or eyebrows are also often seen in our office.  While rare, even children can sometimes have cataracts, glaucoma, or retina issues. We see premature babies who may be at risk for retinopathy of prematurity.  Often a child has a systemic health problem such as diabetes or juvenile arthritis that requires an eye exam. Sometimes a genetic workup is being done and we are asked to evaluate a child for eye problems that may be associated.  Whatever the concern about your child’s eyes, our ophthalmologists have extensive experience evaluating and treating even rare conditions. Before you leave our office, you will have a clear plan about treatment and the next steps to take.

Practice the eye chart: If your child is too young or otherwise unwilling to read standard letters on the eye chart, try practicing one of the other types of figures we use in the office, below.  When they come in for an exam, these pictures will be on a screen at the end of the room and they can either name them or match them to a corresponding card that they can hold on their lap. Just gaining familiarity with the pictures before your visit can increase the likelihood they will do it during the exam.  (And if they can’t do its don’t worry! We can still figure out whether or not they need glasses).

The first set are called “Lea” figures. It does not matter if they call the circle a “circle”, or a “ball”, or an “O”.  The figure at lower right is often called an “apple” or a “heart”, but any answer is fine as long as it is clear what they are describing.

The next set of pictures are called “Allen” figures.  (You can skip the phone).  The car/jeep is sometimes confusing too. Some of our offices also have a tree, airplane, and bear if they can at least get the cake, hand, bird, and horse, that should be enough to

Finally, we have the “HOTV” optotypes. When you think about it, letters are really just shapes. By simplifying to just a few letters that are fairly distinct, we find even kids who don’t know their letters yet can match these “pictures” to corresponding H,O,T, V figures we will have on a card in front of them: