Pediatric eye care is a crucial aspect of development in children.

Vision problems in children is a major cause of developmental delays and learning disabilities. Often these vision problems are missed during school screenings and vision screenings by pediatricians.

Learning related vision problems can’t be ruled out just by reading an eye chart.

  • Eye movement dysfunction (Oculomotor dysfunction or OMD) is a problem with muscle coordination that interferes with reading due to poor tracking and use of side vision to track from word to word and line to line.
  • Accommodative insufficiency– When looking at near tasks, the lens in the eye shifts like a camera lens to bring near print in focus. This lens is typically effective at focusing at near until we reach age 40. Then the lens begins to harden and gradually loses the ability to shift focus causing the need for reading glasses. However, some patients struggle with a weak focusing system and difficulty keeping print clear when reading.
  • Accommodative infacility– this is often related to accommodative insufficiency, but is most noticeable when trying to shift focus from far to near and back to far again.
    • In the classroom, copying from the board to their paper, kids with infacility copy the wrong thing and lose their place.
  • Convergence insufficiency– another important part of reading is the ability of the eyes to turn inward and point at the print in the same spot. When the eyes struggle to turn inward, the eyes become slightly misaligned.
  • Exophoria/Esophoria– this is a “tendency” for the eyes to want to turn outward (exophoria) or inward (esophoria). This is not as extreme as a true eye turn, but it can cause difficulty focusing, reading, and other symptoms associated with learning problems.
  • Exotropia/Esotropia– this is when one eye turns outward (exotropia) or inward (esotropia). Esotropia is commonly referred to as “crossed-eyes” and can cause double vision and amblyopia.
    • A new onset of exotropia or esotropia causes double vision. Sometimes this can be “intermittent” (comes and goes), or this can become constant.
    • Longstanding exotropia or esotropia leads to “suppression” of vision of the eye that is turning. This is the way the brain adapts and is able to eliminate the double vision. Suppression is effectively like closing that eye. The brain shuts off the central vision of that eye and uses only the eye that is looking in the right direction.
  • Amblyopia– Commonly known as “lazy eye”, but often misunderstood. Sometimes amblyopia can also be associated with an eye turn (exotropia or esotropia). Sometimes amblyopia does not involve an eye turn, but an eye with a much higher prescription (refractive error) than the other eye.
    • Strabismic Amblyopia– strabismus is a general term for “eye turn” (either inward OR outward). When one eye turns in or out constantly, the brain suppresses the vision in that eye, and over time, the eye loses the ability to see 20/20 even with glasses. As a child ages, the chances of correcting the vision to 20/20 become less and less. Once in their teenage years, the reduced vision becomes permanent loss of vision.
    • Refractive Amblyopia– generally occurs when one eye is extremely far-sighted or has a high amount of astigmatism. This large prescription or “refractive error” makes the vision very blurry in that eye. If the other eye has little to no refractive error (or is near-sighted), then the brain will choose to use the better eye and “suppress” or shut off the vision in the poor seeing eye. Over time, the eye will not develop the ability to see 20/20 even with the best prescription in glasses. Once in their teenage years, the reduced vision becomes permanent vision loss.
  • Aneisometropia– this refers to a large difference in prescription between the two eyes. When one eye is very far-sighted, near-sighted, or has a high amount of astigmatism compared to the other eye, this is too difficult for the brain to put the two images together. Even if glasses are worn full time, one eye sends an image to the brain that is much larger or smaller than the image sent to the brain by the other eye. This causes confusion and the brain will “suppress” the vision in the weaker eye leading to amblyopia.

All of the above problems can develop at any time during childhood, school age years, and adulthood. Unfortunately, some of these learning related vision problems can be missed during school screenings and pediatrician vision screenings. Even a vision exam by some optometrists or ophthalmologists not adept at pediatric vision care can miss some of these issues.

If your child suffers from the following symptoms, a comprehensive pediatric eye exam is highly recommended:

  • Headaches
  • Eye fatigue
  • Learning disabilities
  • Dyslexia
  • Attention deficit disorders (ADD/ADHD)
  • Low attention span
  • Behavioral problems
  • Avoidance of near tasks
  • Losing ones place when reading
  • Reversals of letters and words
  • Eye strain
  • Blurry vision
  • Poor reading skills
  • Double vision
  • Skipping words
  • Clumsiness
  • Sitting close to the TV
  • Holding reading material unusually close
  • A visible eye turn
  • Rubbing the eyes more often than usual


  • We do FREE INFANT exams on kids ages 0-3 years old
  • All school age children qualify for the “Lets Go See” program for a FREE EYE EXAM AND GLASSES EVERY SCHOOL YEAR.