Children’s Eye Tests and Eye Health Care in the UK

It’s important for your child to have regular eye examinations. Many are not aware of when to take your child to have their eyes tested or what an eye test really is. We had a chat with optometrist Panos Nicolaou from CrossEyes in Clerkenwell London to find out all you need to know about your child’s eye test.

We take our daughters regularly. It’s part of our health routine; check up at dentist and a regular eye check at the optician.

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When we last tok Miss A for her regular eye test at CrossEyes UK we decided to ask her optometrist a few questions we often hear from other parents. Panos Nicolaou has kindly answered it all and we hope you will find it useful.

From what age should I take my child for an eye test?
A child’s eyes can be checked at any age from birth onwards, at an optometrist or alternatively they can be seen in a paediatric Ophthalmology clinic within the Hospital Eye Service.

Before the age of 3 we are mainly looking to ensure that there is no pathology and that milestones in vision are being achieved. We are looking to satisfy ourselves that the eyes are developing in the correct way. From the age of 3 onwards, but sometimes before, we tend to introduce more tests to measure the power of the eyes to see if the child is, among other things, myopic (short sighted) or hyperopic (long sighted).

Being able to read the letters on the chart is not necessary for the optometrist to be able to examine and measure a child’s eyes effectively there are many other methods (eg. retinoscopy, auto refractors, picture cards) that we use to establish whether the child’s eyes are healthy and vision is developing properly. We use some of the same methods to perform eye tests on adults with specific learning difficulties who in some cases cannot give reliable subjective responses. It is important to note that high street optometrists are professionally qualified and are responsible for their clinical decisions, so if they perform an examination and identify a problem they should either refer the child on to the relevant hospital clinic or manage the child’s eye problem in their practice.

What are the signs of poor eyesight in children?
General signs would include squinting to see, kids can also be very vocal and will sometimes let you know of headaches and visual disturbances. These are not always genuine but once you have the child in for an eye test the optician should be able to differentiate between genuine symptoms and those that are misleading. Sitting close to the tv screen or boards at school can also indicate visual errors. Eye muscle weakness can also be detected in the form of an eye turn which parents are pretty good at picking up on. Sometimes kids may cover one eye or close one eye to obtain better visual comfort which is also worth noting. If of a literate age, kids may also be symptomatic in the form of slow reading speed. Some children or young adults with poor eyesight display behavioural problems, playing up in class, being disruptive, lacking in concentration. Often parents are quick to investigate whether their child has dyslexia or other learning difficulties before even having their eyes tested.

Where can I take my child to have his or hers eyes tested?
All high street optometrists are capable of carrying out a thorough eye test, the profession is very well regulated in the UK. Hospitals have specialist eye clinics where drugs and surgical methods are used to identify and treat problems. I would recommending taking your child for an eye test with an optometrist first, as they should refer you onto the hospital if necessary. We are CrossEyes and have several practices in London and around the country please see our website for details.

Does it cost anything to have my child’s eyes tested?
All children under the age of 16 are entitled to eye tests under the NHS. Young adults in full time education upto the age of 19 are also entitled to eye tests on the NHS, as are over 60’s. So you would book an appointment for your child in the normal way and then when the eye test has been completed you will be given a form to sign. That signed form is then sent to the NHS for the optician to receive payment for the test. If seen privately and not under the NHS the cost of a sight test with us is £30. We deduct all payments received for eye tests from the complete price of our eyewear, currently we receive £21.31 for performing an eye test under the NHS.

What are included in the eye-test?
The eye test is very comprehensive. We take a full medical history and ask questions designed to identify anything that may be of concern, starting with broad questions and then becoming more specific. We then measure the eyesight, both objectively and subjectively using several methods to establish whether spectacles are necessary. We check the extra ocular muscles and the binocular balance of the eyes and prescribe accordingly. We check stereopsis and colour vision. We also check the health of the eyes, starting with the external eye, we then go on to check the internal eye including the anterior chamber, lens, media, optic nerve head, the fundus, the macula, the blood vessels. We also check the intra ocular pressure in order to check for Glaucoma and Often we detect signs related to general health problems, such as high cholesterol, blood pressure, inflammation, tumors. The eye is the only part of the body where clinicians can actually look at the blood vessels and see what they are doing and changes they are going through.

What are the prices for glasses?
Prices in most opticians vary a great deal depending on the lens index, coatings and frame. Generally speaking the less you pay the lower the quality although that is not always the case and you can pay more for a similar quality product. At CrossEyes we deduct all the payments we get from the NHS from our complete prices. We charge a complete price of £145 on most single strength eyewear, customers can choose any of our frames, they come with high quality thin light weight lenses with all the coatings and the eye test is also included. For children the price works out to £85 after the NHS payments of £60 we receive are deducted from the £145.

Why is an eye test so important?
Eyesight is our most developed sense, we are a visual society, poor eyesight can seriously affect the development of a child in terms of education and their psychological well being and so affect their life chances. The eyes are closely connected to the brain and brain function, an eye test is actually a very good neurological test, a problem with the brain can often be detected through an eyes test in the absence of any symptoms. That is why optometry is regulated as a profession in the UK, it is not simply a case of measuring to see if someone needs glasses as it can be in many other countries around the world. It is quite shocking that nationally only 20% of children are having their eyes tested on a yearly basis, this is compared to 80% of children having their teeth checked at the dentist. Perhaps optometrists are to blame for this, they certainly have not invested as much as dentists have in helping the public understand what it is they actually do.

How often should I take my child to the optician?
Attendance under the NHS is at the discretion of the optometrist and is very much based on the observations made during the course of the eye test. Annual eye tests are the norm for any child regardless of whether they are prescribed spectacles or not. There may be instances when we would like to see the child more frequently during the course of the year ie biannually or quarterly, muscle inbalance or rapidly changing prescriptions are two examples of where an optometrist may want to see a child more regularly. The NHS will cover as many sight tests as the patient needs, but the visits need to be justified somehow by the child, the parent or the optometrist. There needs to be a genuine reason if the child is being seen more frequently than once a year.

From what age can a child start wearing contact lenses?
Contact lenses should be suggested to a child who is capable of following instructions competently. Putting lenses into the eye is a serious matter and if not done correctly with the right guidance and hygiene regime in place, you are putting your child’s eyes at risk. Some optometrists will insist that children should only use daily disposable lenses as it is the most hygienic, there are not as many rules to follow and the regime is more straight forward for a child to handle. The risk is infection and some infections can be very serious indeed.

Do you have any general advice to parents on eye health?
A balanced diet full of healthy green vegetables- kale, spinach and broccoli among many other foods are particularly good for the eyes, as they contain beneficial nutrients such as lutein and zeaxanthin.

Sunlight protection against UV is also important. However it is not well known that a lot of the damage that we observe in an older set of eyes such as macular degeneration and cataracts starts from our youth. Therefore educating children about a healthy diet and UV protection is of great importance. Sunglasses, normal spectacles and some contact lenses also offer an built in UV protection.

It’s important to understand that a pair of glasses is an optical correction, it’s physics, bending light so it comes to a focus. Whether they are worn all the time or not at all they don’t affect the health of the eyes, wearing them doesn’t improve the health of your eyes and not wearing them doesn’t lead to pathology (aside from damage caused by Ultra Violet light). Spectacles are all about seeing clearly and comfortably that’s all, there is no big mystery.

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Thank you to CrossEyes optometrist Panos Nicolaou!

From the NHS website they say that it’s important to bring your child in for regular sight tests. Your child should have a check-up at least every two years, as problems can occur at any age.

If you have any further questions or concerns, please contact CrossEyes (with 10 stores in and around London) or your nearest optician.

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