Your child never complains about her eyes or vision, so is an eye exam really necessary? If so, at what age should this happen?

Many parents assume that if their child passes the vision screening at school or at the pediatrician’s office, he does not need an eye exam. However, these screenings do not replace a comprehensive ocular health and vision exam performed by an eye care professional.

Most children do not complain about their vision if it has always been poor and has not changed.

The American Optometric Association recommends a first exam when a child is about six months old, then again at about 3 years old, then before first grade and every two years thereafter.

Your eye care provider will be looking for conditions such as retinoblastoma, a rare but life-threatening tumor that usually presents before a child’s first birthday.

Other ocular health concerns that can prohibit proper visual development are congenital cataracts, congenital glaucoma and retinopathy of prematurity, among others.

Some signs of eye trouble that a parent should look for are: a misalignment between the eyes, a white or cream colored hue in the pupil, one eye that seems to bulge or open more than the other, extensive eye rubbing when the child is not tired, and squinting, to name a few.

An estimated 25 to 33 percent of school age children have an eye or vision problem, and many of these can prevent development of clear vision.

Amblyopia is a condition that can occur if the brain does not receive a clear image from the eye during development. Amblyopia can cause the child to have permanently poor vision, even with glasses.

Other “binocular” vision concerns relate to the two eyes working together. In these conditions, each eye sees well individually. But the eyes don’t move properly or work together, which decreases the visual system’s efficiency in transmitting and processing the visual signal.

Children who have binocular vision issues will see clearly with each eye individually and thus pass vision screenings in school and at their pediatrician’s office.

If caught early, these conditions often can be treated with vision therapy. Vision therapy results in clearer, more comfortable vision with both eyes working together.

Most children will not explicitly let their parents know about a problem with their eyes or their vision. Regular comprehensive eye exams will detect any issues early, before the child’s academic performance suffers.

Caroline Bundrick, O.D. is an optometrist practicing at Darling Eye Center, with offices in Bluffton and on Hilton Head Island.