Children's Eye Tests

Sight vs. Vision:

• Eyesight measures how well you see a certain-sized object at optical infinity.
• Vision involves the brain and body's ability to interpret light signals and create an image in the brain of the world we see. Awareness of this distinction is crucial for understanding eye and vision health.

Vision and Learning:

• Vision is involved in up to 80% of learning and develops through physical interactions with the environment. Think of a child who is well aware of their surroundings to the one who is always clumsy, and often bumps into things suffering from minor/major injuries. 

The Visual System:

• The brain and body evolve together. 
  • For example, myopia (short-sightedness) isn’t simply due to an eye growing too long, as some optometrists will make you believe. This is far from the truth and evidence-based myopia control guidelines recommend at least two hours of outdoor time, supported by statistics from countries like Taiwan, where indoor lifestyles contribute to higher rates of myopia.
• Yes, genetics play a role in myopia, but epigenetic factors can mitigate it.   
  • For example, a child may become myopic not because of their genes but due to NEGATIVE BEHAVIOURAL changes. Perhaps a year or two earlier, they were gifted a new iPhone, PlayStation, or Xbox (even Wii Sports). If you want to play tennis, play real tennis; where your mind and body use vision to learn to judge the ball's speed, the required force to hit it, and the timing. Instead of a loose arm that causes the ball off course because you misjudged any of the above factors. Therefore, virtual play is far inferior in sensory and motor experience.

Behavioural optometrists assess these vision aspects, emphasising real-world training over virtual alternatives. While devices can be helpful as a starting point, usage must be supervised and limited. 

This page discusses an example of a common refractive error Myopia to show the comparison in the testing protocol, management, and understanding of the condition.

The same comparison can be applied to many other types of vision problems. For example, Visual Information Processing skills are not commonly tested in mainstream optometry (See table at top of page).

• A child previously engaged in outdoor play may become sedentary, addicted to screens, and socially withdrawn. This can lead to myopia, as prolonged screen use in poor posture alters eye shape.
• Screen time rewires the brain for short bursts of focus, impairing longer attention spans that are critical for classroom success.  The child, though intelligent, may struggle to sit still in class, and lose interest in education. 
• Exposure to inappropriate or insufficient knowledge further hampers development. For example, premature exposure to violence shapes the brain differently than discovering physical fitness passions that may lead to a career in boxing or martial arts. This also applies to an abundance of inferior knowledge levels and a lack of age-appropriate knowledge. A child staring at a screen misses age-appropriate learning and valuable real-world exposure. 

• Compare the above in-depth understanding you have gained with just being told your child is short-sighted and needs glasses in a 15-minute eye test. While we now have effective myopia control options, some optometrists still choose to prescribe single-vision glasses, which allow the eyesight to worsen over time and offer no control. This may be due to financial incentives, as prescription changes mean ongoing updates to the glasses.
• Some optometrists will claim to be performing children's eye tests. As an informed parent, I urge you to show them the table at the top of the page and confirm they will be performing testing that assesses the complete range vision tests listed in the table as age-appropriate. If not, it might be worth finding someone who does to get a full understanding of the child's visual system's performance.
• Many patients are unaware of better options for myopia control because their optometrist doesn’t discuss these alternatives.
  • In my clinic, I’ve consulted with many patients whose myopia progressed because neither they nor their parents were informed of better options. Awareness requires a detailed discussion of the condition, treatment options, and their effects. This ensures informed decision-making for you as a patient, whether to act or not. However, achieving this understanding takes time—often close to an hour—not the 10-20 minutes of a mainstream eye test.

So what is behavioural optometry doing differently in an hour compared to a regular eye test that may only take 15 minutes?

See the table at the top of the page that shows the areas of vision tested in a regular eye test vs a behavioural vision test.

It is evident that all the additional tests and the observations the trained paediatric optometrist makes during these tests influence the overall result of the report you receive. Yes, you receive a comprehensive report detailing all the tests, their outcomes and their impact on learning. 

Frankly, this often leads to doubt in parents’ minds as a regular report may state 

• "the child has 20/20 eyesight & normal eye health"

compared to more than one page of report outlining 

• "the visual information processing difficulties and what they mean and how they affect learning" & "the child has 20/20 eyesight & normal eye health"

Additionally, some optometrists may test for some of these aspects of vision but have nothing more to offer in terms of how to manage or treat the issue.

Behavioural optometrists spend additional years after graduating to continuously spend time learning about the visual system and the neurological aspects of vision training that are constantly evolving with new research. 

•  You may have already heard or experienced, that it is much easier to change a habit or learn a new skill or language when you are younger versus older. The younger the easier and the older the harder. This is the exact reason why behavioural optometrists prefer to see the children for school readiness assessments to ensure that the children are ready to use their vision efficiently to learn. 
• Something that they will be using 80% of the time when in a classroom. It is then much easier to treat and manage any vision disorders, or deficits due to the higher amount of neuroplasticity in the brain.  
• Just as a soldier wouldn’t go to war unarmed, we shouldn’t send our children to school without proper vision. Similarly, sending a child with a pencil who doesn't know how to use it, is the same as relying solely on an eyesight test without assessing the functional visual skills that might be insufficient for learning in school.

If in doubt, Pratap will check it out! 

• If you have already had an eye test and don't feel like you understand the outcome or feel unsure, try and seek a second opinion. Ideally, one that is from an Independent Behavioural optometrist who can give you an honest and comprehensive assessment that is not biased by any pressures of meeting sales targets or KPI figures. Pratap our friendly optometrist welcomes new patients even it is just for a second opinion. No obligations or pressure to purchase glasses!