Which eye examinations are useful for children?
At birth, children are already equipped with two highly developed sensory organs with which they discover and conquer the world: their eyes. By the time they are born, the anatomical development of the retina is largely complete. Immediately after birth, the eyes usually remain closed - because good vision requires practice. Full vision develops in the first six months of life. Most parents are familiar with these developmental stages, but very few know how important early preventive examinations by an ophthalmologist are. Reason enough to take a closer look at the most important ones.
A girl looks into the camera and squints her eyes
Classic preventive eye examinations at the pediatrician
The eyes normally accompany a person throughout their entire life. And protecting them is also important in every phase of life - even in children. The examination is usually part of the so-called U examinations, which are covered by health insurance companies. Since 2017, the children's guidelines for these examinations have also included a new regulation for the detection of visual impairments. As early as the U2 examination (3rd to 10th day of life), the doctor asks about hereditary eye diseases in the family. He also checks for physiological abnormalities of the eyeballs, eyelids and pupils. In the following examinations, further test features are continually added. The test of the eye reaction to movements and light (U3 in the fourth week of life), a test for squinting or cataracts (U3 in the fourth month of life) and the test of visual acuity and spatial vision (U6 in the 10th to 12th month of life), and later (U7, 8 and 9 from the 24th month of life). If there is a suspicion of visual impairment, the pediatrician will refer the child to an ophthalmologist who can make a final diagnosis and begin treatment.
Why one-sided impairments can lead to damage
Nature has adapted the human eye to its needs: Just as the human hand is universally applicable, the eye is superbly developed for the conditions of human life: It can be focused both near and far. It is well fitted and rotatably mounted in the eye socket to protect it from injury and is well protected by the eyelids. The adjustment to all levels of light is done roughly via an iris diaphragm and finely adjusted using sophisticated "software" in the retina and brain. There are even two of these highly developed sensory organs in order to be able to accurately judge spatial distances. The slightly different images from the two eyes are combined in the brain to form one image with information about the depth ratios. A one-sided visual impairment is considered particularly dangerous for visual development: if you do not intervene in time, this eye becomes weak-sighted (amblyopic); it is virtually switched off by the visual center in the brain. Amblyopia of this kind can occur in all of the developmental stages described below.
Premature babies: checking retinal development
In premature babies born before the eighth month of pregnancy, the retina has not yet fully developed, so it must be monitored weekly. Insufficient blood vessel development in the retina can lead to vascular proliferations that mistakenly grow into the vitreous body of the eye and can lead to retinal detachment (retinopathy of prematurity). Premature babies born before the 32nd week of pregnancy and weighing less than one and a half kilograms are particularly at risk of retinal detachment. If the damage is discovered early, the ophthalmologist can counteract it with laser therapy - this can preserve eyesight in over 90% of cases.
Immediately after birth: Detecting lens opacities
Even in babies who wait until their due date to be born, a doctor can identify possible congenital abnormalities and, ideally, correct them. Occasionally, for example, a congenital clouding of the lens - a childhood cataract - can hinder development. Although the disease occurs much more frequently in older people, small children can also suffer from congenital clouding of the lens: around three out of 10,000 births have a so-called cataract. The trigger for this can be an infection in the womb, such as rubella or herpes viruses, or there is a genetic predisposition to cataracts. Surgical treatment is usually the only option. This usually involves inserting artificial lenses (intraocular lenses) into the eye to ensure that the development of the retina's performance is not hindered. Since the refractive power of the eye changes significantly in the first few years of life, it may be necessary to insert a new lens at a later date. For this reason, some ophthalmologists used to avoid using artificial lenses in the first few years and instead initially used contact lenses. The appropriate approach in each individual case should be discussed with the treating ophthalmologist.
A little boy looks skeptical during the eye examination.
Eye misalignment should be corrected by the sixth birthday
Amblyopia can also develop in the following years, when the two eyes cannot be positioned even close to parallel. In the first few weeks, it is completely normal for a baby to be unable to align its eyes in parallel. If after six months there is still a misalignment of the eyes (strabismus), the ophthalmologist should begin treatment. Without treatment, around 80 to 90 percent of all cases result in amblyopia - for the affected child, this can have a significant impact on their quality of life. If the misalignment of the eyes is not corrected, treatment is no longer possible after around the sixth birthday. Before that, however, it is very simple: strabismus is often treated with what is known as occlusion therapy, in other words by closing it. This is done using an eye patch that is stuck in phases on the eye that is not squinting or does not have any visual impairment. This trains the weaker, squinting eye. Sometimes, however, just glasses are enough to correct the visual defect.
School enrollment: Visual ability at the school entrance examination
The school cone is packed, the serious business of life begins... at least a little. When they start school, children are also asked to take an eye test, because in order to read, write and do arithmetic they need to be able to see the dots on the board and in the textbook. In all federal states, the eyesight test is part of the standard school entrance examination. The pediatrician checks all children's visual acuity, spatial vision and color vision - after all, they should be able to follow the learning material as well as possible. If there is a suspicion of impaired vision, an ophthalmologist is also called in for this examination, who can make a more precise diagnosis and decide on visual aids or treatment options.
Controlling school myopia early
Learning can be tiring - also for the eyes. Added to this is the increasing use of smartphones and digital media, even among very young children. This leads to an increasing number of students with short-sightedness (myopia). But genetic factors also play a role: if the mother or father is short-sighted, the offspring has a three times higher risk of becoming short-sighted themselves. If both parents are affected by myopia, the probability is even six times higher. Studies have shown that children who spend at least two hours outdoors (without a cell phone) are less likely to develop short-sightedness. If the diagnosis is confirmed, a short-sighted child should wear glasses or contact lenses. This does not eliminate the visual impairment, but it can correct it so that further eye development can proceed normally. It is important to have regular checks by an ophthalmologist to see whether and to what extent the short-sightedness is developing.
A boy with one eye covered.
Do health insurance companies pay for eye examinations for children?
Many health insurance companies cover the cost of examining children. The U examinations in particular are covered by the insurance companies. The first youth health examination, which is carried out from the age of 12, is also covered by the insurance company. The situation is different for the voluntary examinations U10 (seven to eight years), U11 (nine to ten years) and J2 (16 to 17 years): Many health insurance companies contribute to the costs, but this is not a mandatory service. Parents can simply call the health insurance companies and ask whether the costs for certain treatments are covered. This is especially true for examination costs at the eye doctor, which are not part of the U examinations. The treatment is always covered by the health insurance companies.
How do I recognize eye diseases in my child?
Small children cannot tell for themselves that their eyesight is poor - they simply have no comparison. And because poor vision does not hurt, they have no reason to cry or complain at first. It is therefore not easy for parents to recognize reduced vision in their children: visual impairments are often discovered late - sometimes too late. The only real certainty is a visit to the ophthalmologist, but there are some signs that parents should take seriously: if children squint their eyes noticeably often, tilt their heads or move uncertainly around the room, this can indicate reduced vision. Particularly pronounced sensitivity to light, watery eyes or frequent inflammation of the eyelids should also be a reason to see an ophthalmologist. It is also noticeable if the red pupil reflex in the child's eyes is not the same when looking at pictures with a flash. With older children, it is particularly noticeable that they get headaches when reading or tend to copy content from the person sitting next to them rather than from the board. However, when children from the neighbouring house copy things that are not written on the board, it is generally not due to their eyes…
Early prevention for lifelong vision
Cataracts, squinting, short-sightedness - parents understandably want to protect their children from eye diseases. The normal U examinations are an important starting point for good preventive care, but a visit to the ophthalmologist is not just for adults. The early detection of possible eye diseases opens up a life for children in which good binocular vision and access to all professions is possible. A visit to the ophthalmologist is therefore also useful for the very young explorers and conquerors.
