What is a Comprehensive Eye Exam and Does My Child Need One?

I literally knew nothing about vision issues prior to my son being diagnosed with one. I naively thought, people either see things clearly or they don't. If they don't, they get prescription glasses and problem solved!

I couldn't have been more off-base.

Visual acuity, which is measured during a standard eye exam, tells us how clearly we see at certain distances. If we have trouble seeing things clearly, we're told we're either nearsighted (can see clearly close up but not far away) or farsighted (harder to see clearly close up).

While visual acuity gives us important information about the quality of our eyesight, it tells us very little about the quality of our vision.

If you're like me, before my son was diagnosed with a vision issue, you're probably thinking, hold on a minute, aren't eyesight and vision the same thing?

Nope! They're actually quite different.

Eyesight takes place in the eye and refers solely to visual acuity. Light enters the eye and then an image is formed on the retina. If the structure of the eye is A-OK and everything is working properly, then you have 20/20 eyesight. If not, you have trouble seeing things clearly at certain distances and you'll most likely need corrective lenses.

Vision, on the other hand, takes place in the brain. It's the process of understanding and analyzing what you're seeing through a complex interplay of more than a dozen visual skills that "incorporate subtle forms of movement within the eyes and the eye muscles that coordinate with other movement systems of the body."

Yep, just a wee bit more complicated than my intial understanding!

News Flash: the standard vision screening your child receives from his pediatrician or school nurse tests solely for eyesight (visual acuity) and only identifies five percent of vision problems.

Shocking, right?

Even more shocking is the fact that a child can have "healthy" eyes and "perfect" 20/20 "vision" and still have a vision problem. It's estimated that more than 70 percent of classroom "underachievers" have an undiagnosed visual processing issue despite having 20/20 eyesight.

In order to properly assess a child's vision and truly rule out a vision issue, he needs a comprehensive eye exam from a developmental/ behavioral optometrist.

The difference? In addition to assessing visual acuity, a comprehensive eye exam tests for:

  • eye movement skills
  • vergence
  • eye teaming
  • focusing skills
  • eye tracking
  • binocular vision
  • depth perception
  • color vision
  • visual memory
  • visual spatial skills
  • peripheral vision
  • visual motor integration
  • amblyopia (lazy eye)
  • hyperopia
  • visual motor integration
  • visual spatial memory
  • visual perceptual skills

Now you know why it's called a comprehensive eye exam!

The American Optometric Association recommends that children receive a comprehensive eye exam first at six months, then at three years and again before entering kindergarten. Sadly, only 14 percent of children receive one by the time the enter first grade, which is why it's estimated that one in four children have an undetected vision problem that's interfering with their ability to learn.

Here are some of the warning signs of eye and vision problems in children:

  • Sitting close to the TV or holding a book too close
  • Squinting
  • Tilting their head
  • Covering an eye
  • Frequently rubbing their eyes and/or squinting
  • Short attention span for the child's age
  • Turning of an eye in or out
  • Sensitivity to light
  • Difficulty with eye-hand-body coordination when playing ball or bike riding
  • Avoiding coloring activities, puzzles and other detailed activities
  • Difficulty initiating or holding eye contact
  • Increased fear of being in the dark
  • Difficulty discriminating between shapes and letters
  • Difficulty with handwriting
  • Frequently loses place while reading or copying from the board
  • Often bumps into things
  • Slow or hesitant climbing up or down stairs
  • Difficulty with visually stimulating activities (puzzles, locating objects in pictures, completing mazes, word searches)
  • Complains that reading and writing make him "tired"

If you've noticed some of these warning signs in your child, ask your pediatrician to refer you to a developmental optometrist or CLICK HERE to find one in your area.

If you live in the San Diego area, Dr. Carl Hillier at San Deigo Center for Vision Care is phenomenal. If you're in the Los Angeles area, I highly recommend Dr. Alan Brodney

All children should receive a comprehensive eye exam, but for children with sensory processing issues it's a MUST, especially if they have vestibular processing issues. Our vestibular and visual systems are intricately linked, if there's a problem with one, often the other is impacted as well.

If you have a child with a vision issue, getting it properly diagnosed and treated will be a game-changer!

Stay tuned for more information on visual processing disorders as well as the benefits of vision therapy.

Please leave your questions and/or comments below and CLICK HERE if you need guidance on how to best address your child's developmental challenges. I've been through and heard it all and can point you in the right direction.


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Hi! I'm Cameron, mom of two incredible, "differently-wired" boys who have sensory processing challenges, wife of a nerdy surfer, mindfulness practitioner and Parenting Coach with master's degrees in education and psychology.