All babies are examined for any obvious problems such as cross-eyes, cloudiness (a sign of cataracts) and redness.
A light is shone into the baby’s eyes to check pupil reflex. The midwife, or your doctor, will also check the baby pays attention and his or her eyes follow an object which is passed in front of them.
An ophthalmoscope (a magnifying instrument with a light on the end) is shone in the baby’s eye to check there is a red reflection. If the reflection is white the baby will be referred to a specialist who will check for signs of cataracts and other eye conditions.
If you have concerns about your child’s vision you can ask your GP or child’s paediatrician to refer them for an eye test.
Make time to sit down and explain to your child what will happen during their eye test. Make sure your child knows that he or she will be asked to look at and identify objects for the eye doctor with both eyes and also one eye at a time (with the other covered). These could be random pictures, letters or shapes of light on the wall. Also explain that the eye doctor may put drops in his or her eyes but that although it may sting initially it will not hurt. After the drops are put into the eyes you will have to wait for around 15 minutes for them to take effect and after this they will make everything go blurry. Some children do find that the drops make their eyes over-sensitive to light for around 24 hours afterwards so you may want to bring some sunglasses or a hat with you.
Depending on your child's age, the optician will use different techniques to test their eyes. But however old they are, your child will have the vision in each eye tested separately and then tested together to see if they work properly. If the optician thinks your child needs glasses he or she will then test out lenses of different strengths on your child. Your child will then be asked to either read the standard letters chart (Snellen charts or logMAR cards) or read a special chart with shapes on it instead. This is especially useful for younger children or those that are not sure of their alphabet. The optician will also use picture books and other visual materials to how clearly your child can see. If your child cannot really explain which lenses have improved their vision, the optician will use an instrument called a retinoscope. This shines a light on the retina at the back of the eye and enables the optician to measure the eye's ability to focus.
Your child will also be checked for the range of movement they have in each eye and how well their eyes follow a moving object.
Your child is usually not tested for colour-blindness until they are 11 or if a problem is suspected. Typically, the Ishihara colour vision tests will be used and involve images made up of two different colours of dots. If your child’s colour vision is normal, they will be able to recognise the letter or number that is highlighted. If they cannot tell the difference between two colours (such as red and green) and so cannot see the picture, they may have a colour vision problem.
NHS optician is still the term most of us associate with an eyecare professional. However, the term is being used less and less within the profession. When you visit an optician, your child will have their sight tested by an ophthalmic practitioner, which can mean either an optometrist or an ophthalmic medical practitioner.
Previously known as ophthalmic opticians, optometrists are primary health care specialists trained to examine the eyes to detect defects in vision, signs of injury, ocular diseases or abnormality and problems with general health. They may also test a person's ability to focus and coordinate the eyes and see depth and colours accurately.
A detailed examination of the eye can reveal conditions such as high blood pressure or diabetes. Optometrists make a diagnosis, offer advice and when necessary prescribe, fit and supply contact lenses or glasses. Optometrists do not perform surgery. If necessary, the optometrist will refer you on to a specialised doctor or eye surgeon for treatment.
Optometrists can prescribe and fit glasses, contact lenses and low vision aids. They can also prescribe eye exercises, undertake vision therapy, and, if trained to do so, prescribe medication to treat eye diseases. An optometrist can also prescribe coloured or photochromic glasses (darkened lenses) to reduce light sensitivity or visual distortions.
Ophthalmic medical practitioners (OMPs)
Ophthalmic medical practitioners are medical doctors specialising in eye care. Like optometrists, they examine eyes, test sight, diagnose abnormalities and prescribe suitable corrective lenses.
Dispensing opticians advise on, fit and supply spectacle frames and lenses working from the prescriptions written by optometrists and ophthalmologists. They also fit and dispense low vision aids such as magnifying glasses or telescopic spectacles. They don't test eyes. A dispensing optician can give you advice on types of lenses, such as single-vision or bifocal and help you to choose frames and other optical aids. They also advise patients on how to wear and care for their spectacles.
Ophthalmologists (eye surgeons) are doctors that specialise in the medical and surgical care of your eyes and the visual system. They mainly work in eye hospitals and hospital eye departments. They also look into the prevention of eye disease and injury. An ophthalmologist treats patients of all ages, from premature babies to the elderly. The conditions dealt with in ophthalmology can range from eye trauma to cataracts, diabetic eye diseases, such as diabetic retinopathy, congenital and genetic eye problems.
Orthoptists generally work with ophthalmologists in hospitals and in the community. Their main role is to investigate and identify problems relating to the development of the visual system such as eye problems relating to eye movements and the inability of the eyes to work together. Examples of these problems are squint (strabismus), lazy eye (amblyopia) and double vision (diplopia).
Orthoptists also investigate, diagnose and assist in the treatment of conditions such as glaucoma, cataract, retinal disease, stroke and other neurological disorders. Some Orthoptists perform vis>hools and community health centres.
A Behavioural Optometrist is a specialised Optometrist, with a specialist interest in how vision affects human performance. They explore and examine how the visual input at the eye is dealt with in the brain and how it integrates with other brain processes e.g. hearing, movement, touch etc. It’s a branch of optometric practice that uses a holistic approach to the treatment of vision and vision information processing problems. This service is not available on the NHS at the current time but private treatment is available in the UK. More information is available from The British Association of Behavioural Optometrists.