Children’s vision: How do I know if my child needs glasses?

While vision issues tend to be obvious in adults — you have trouble seeing road signs while driving or reading a menu at your favorite restaurant — they can be harder to diagnose among children. What’s frustrating for parents is that many children show no outward symptoms of vision problems, even when they’re experiencing them, says Sarah Guillette, O.D. She’s a pediatric optometrist at Akron Children’s Hospital in Ohio.

That’s why getting children to the eye doctor early is a must. “Even if a parent thinks there is nothing wrong with their child’s vision, children should have their first eye exam between the ages of 3 and 5 years old to ensure that they are seeing clearly and that their eyes are healthy,” says Guillette. “Good vision is essential in preparing a child to go through school and life with as little difficulty as possible. Visual barriers can reduce their quality of life.”

Fortunately, children’s vision problems are highly treatable if you catch them early enough. Follow these steps to find out if your child may need glasses and help cover the costs if so.

Already know that your child needs glasses? Talk to a licensed insurance agent at (800) 827-9990 about vision plans that can help cover the costs of exams and glasses, or browse plans online.

Step 1: Find the right vision insurance

The right vision insurance for your needs and circumstances can help you save money when it comes to exams, treatment, and even equipment like glasses and contacts. Pediatric vision care is considered an essential health benefit under the Affordable Care Act (ACA). That means the insurance you buy on the federal marketplace or from a state exchange must provide vision coverage for children younger than 19.

Besides an ACA plan, if you already have medical and/or vision coverage through your employer, you can add your child to both policies. If they don’t offer vision insurance, you can purchase a supplemental vision plan that can cover your entire family.

But it’s worth noting that coverage and insurance costs can vary from plan to plan, depending on the medical issues or eye conditions your child may have. The diagnosis will determine whether your child’s eye exam gets billed through your medical insurance or vision insurance, explains Guillette. “Vision insurance should, at minimum, cover a yearly comprehensive eye exam,” says Guillette. That exam will include:

• Dilation, which allows the doctor to better see inside your child’s eye
• Checking for refractive errors, which happen when the shape of your child’s eyes keeps light from focusing correctly on their retina (a light-sensitive layer of tissue in the back of their eye)
• Checking for other health or eye conditions that could be causing their symptoms

“If a child is referred for a failed vision screening, most medical insurance plans will cover the exam minus any copay or deductible,” says Jamie Ikeda, M.D., a pediatric ophthalmologist at Nemours Children’s Hospital in Florida. “Vision insurance can sometimes help pay for glasses, if needed, and sometimes for an exam — within network providers.”

Some private insurance companies do offer free eye exams and glasses for kids, so check with your provider. Medicaid and the Children’s Health Insurance Program (CHIP), which are available for families with limited income, also cover vision care for kids. And if you don’t have health insurance, the U.S. Department of Health and Human Services suggests checking with government or nonprofit organizations such as Financial Aid for Eye Care, Sight for Students, and InfantSEE for free or low-cost eye care programs for children.

Want a way to find vision coverage but need a little help? Call a licensed insurance agent at (800) 827-9990.

Step 2: Schedule a pediatrician appointment focused on your children’s vision

If you think your child may be having vision problems, or you just want to get their overall health checked, the first step is to get them evaluated by their pediatrician. “Most pediatrician offices now offer photoscreening to determine if the child has risk factors for an eye problem,” says Dr. Ikeda. (Photoscreening is a type of test that uses a camera to check kids’ eyes for refractive errors and risk factors for developing amblyopia, or lazy eye.)

Dr. Ikeda explains that in the pediatrician’s office, children may also undergo a test of their vision by looking at a wall chart.  “If the child fails the vision screening at the pediatrician’s office, then a referral can be initiated to an appropriate eye care provider,” adds Dr. Ikeda. That usually means seeing an optometrist who can help pinpoint what might be causing the issue.

Step 3: Schedule an eye exam

It may feel like your kid is the only one on the block having vision issues, but they’re relatively common. Vision issues affect millions of kids in the United States. In fact, more than 25% of children ages 2 to 17 wore glasses or contacts in 2019, according to the Centers for Disease Control and Prevention. And that number increased among both boys and girls as they got older.⁴

Additionally, a visit to the eye doctor can be about more than just getting your child’s first pair of glasses or being fitted for contact lenses. An eye exam may reveal several vision issues in your child. But according to Robert Layman, O.D., an optometrist and president of the American Optometric Association, the most common vision problems in school-aged children are caused by how their eyes bend or refract light — known as refractive errors.

Normally, the corneas and lenses in a child’s eyes help them focus on things like books or blackboards at school. Refractive errors happen when the shape of the eye keeps light from focusing correctly on the retina. The cause could be the length of the child’s eyeball (longer or shorter), changes in the shape of their cornea, or how the lens is aging. “However, a child who sees clearly can still have a vision problem related to eye focusing, eye tracking, and eye coordination,” says Layman.

If your child has any of the following conditions, they will likely need glasses:

• Nearsightedness (myopia): Kids can see things that are up close but not far away. It develops when the eyes grow longer than normal. “This causes light rays to not be focused correctly on the back of the eye, which leads to blurred vision at distance,” says Dr. Ikeda. “Risk factors include a family history of myopia and not enough time spent outdoors in sunlight.”

Research shows that getting your child outdoors regularly can help protect them from developing myopia. Exposing them to sunlight — their bodies create vitamin D when it hits their skin — helps reduce the risk of glaucoma, macular degeneration, and cataracts (clouded vision). Also, exposing them to brighter light helps their eyes maintain the distance between their retina and lens.

Dr. Ikeda adds that the most common symptom a parent might notice is squinting to try to see things that are farther away. “School-aged children will typically report difficulty seeing the board at school,” she says.

• Farsightedness (hyperopia): Farsightedness is a refractive error that makes objects your child looks at up close appear blurry. It happens when the shape of the eye makes light focus behind the retina, instead of on it. “In general, children are typically mildly farsighted, and most can see well at any distance, since the young, healthy eye is able to focus well,” says Dr. Ikeda. A common symptom of farsightedness is a disinterest in reading. Ikeda notes that parents may notice farsightedness in their kids if one or both eyes start to turn in toward their nose — also called strabismus (or crossed eyes). This happens in kids when their eyes are not both directed or focused on the same object.

“Some eye turns require the use of glasses to keep the eyes straight,” explains Guillette. “You may see one of your child’s eyes turn inward or outward seemingly of its own accord. The child may close one eye when trying to focus, rub their eyes, or complain that their eyes hurt.” Glasses or patching (placing a patch over the stronger of the two eyes) can help strengthen the weaker eye, helping to gradually straighten it out.

• Astigmatism: “Astigmatism is an irregularly shaped cornea or lens that prevents light from focusing properly on the retina,” explains Layman. “The surface of the cornea is shaped more like a football, instead of being round like a basketball, and the eye is unable to focus light rays to a single point.” The shape of the cornea or lens makes light bend differently as it enters the eye, causing a refractive error. Doctors, however, don’t know what causes astigmatism, and there’s no way to prevent it.

With this condition, your child will have trouble seeing things at any distance, Layman adds. “In addition, the curvature of the lens inside the eye can change, resulting in an increase or decrease in astigmatism,” he says. Symptoms of this condition include blurred vision, eye discomfort, and headaches.

• Lazy eye (amblyopia): One of the most common eye conditions among children, 3% of American children have a lazy eye, according to the National Eye Institute.⁹ If your child has a high refractive error, an eye turn, or another condition, the affected eye (or eyes) may become weaker, according to Dr. Ikeda.

“A child may squint, rub their eyes, say that they can’t see as well out of one of their eyes, or have a short attention span for near tasks such as reading,” says Dr. Ikeda. She adds that it’s very treatable most of the time, but early detection is key. Treatments include glasses that correct refractive errors (like nearsightedness and farsightedness), patching (see above), and eye drops (which can temporarily make it more difficult for the stronger eye to see properly, so the weaker one works harder and gets stronger).

Additionally, if your child has been diagnosed with diabetes, it’s a good idea to get them checked for diabetic retinopathy, which involves issues with the blood vessels in the back of the eyes and can lead to blindness. Your child will likely get a dilated eye test to check for this within a year of their diabetes diagnosis.

One way to help your child get checked regularly for potential eye conditions affordably is by having the right vision insurance plan for your needs. You can call a licensed insurance agent at (800) 827-9990, or visit explore your options online, for more information.