A Visit to the Eye Doctor

A Visit to the Eye Doctor

When should your child see an eye doctor? Kid Stuff asks White River Family & Hanover Eyecare.

By Laura Jean Whitcomb

An eyechart isn’t enough, says Dr. Eugene (Rusty) Bernal of White River Family & Hanover Eyecare. “We need to get kids in earlier. Young kids should see an optometrist by their first birthday, then again at age 3. The first three or four years are very important for vision development.”

Dr. Bernal would know; he has more than 35 years of experience as an optometrist. He earned his Doctor of Optometry degree from the New England College of Optometry in 1984 and arrived in the Upper Valley that same year, working at the practice of Dr. Thomas Terry. In 1990 Dr. Bernal opened his own private practice, White River Family Eyecare. In 2014, he expanded his practice and bought Hanover Eyecare from Dr. Richard Brennan.

All four doctors — Dr. Bernal, Dr. Shawn Morris, Dr. Jessica Berry and Dr. Han Re — see children at both locations: White River Junction, Vt., and Hanover, N.H. “We make pediatrics a priority,” says Dr. Bernal. “Most of our doctors are parents or parents to be, so we’re used to working with kids.”

The first birthday seems, well, early for an eye exam, but Dr. Bernal says that kids don’t need to know the alphabet to have an eye exam. “We show them pictures, videos and fancy eye charts to keep their attention. We get a good picture of how they are doing, and the earlier we catch a problem, the better.”

School screenings and pediatrician visits are helpful—but they don’t have the same tools and technology that optometrists have. “Local pediatricians know that an eye chart isn’t enough,” says Dr. Bernal. “A screening by an eye professional will pick up things that may not be obvious. Be sure that your kids are seen at least twice by an optometrist before Kindergarten.”

What to Ask the Optometrist

Kid Stuff magazine asked Dr. Morris some questions about a special interest of his: pediatric optometry. He’s been with White River Family Eyecare for six/ten (CHECK) years.

“Hanover Eye Care was long known for the tremendous care that Dr. Brennan had given to the Upper Valley for many years. I came on board after working in White River Junction for a couple years after Dr. Brennan transitioned away from the practice,” says Morris. “We have an incredible staff, and we do a little bit of everything: routine eye exams, contacts and specialty contacts, glasses, medical eye care and everything in between.”

Today Dr. Morris primarily sees patients in the Hanover office. He has a bachelor’s degree in biochemistry from Villanova University in Pennsylvania and received his Doctor of Optometry degree from the Pennsylvania College of Optometry at Salus University. He’s also a father of two, so it was only fitting that we asked him about early eye exams.

Q. At what age (or how) do a child’s eyes develop?
A. Like the rest of us, a child’s eyes don’t come out a finished product. In fact, most kids won’t see that famous “20/20” mark until the age of 6. At birth, kids mostly are receiving a lot of stimulus with their eyes, but can’t discern different objects. They are naturally drawn to high contrast images and faces and see things most clearly about 8 to 10 inches away. As a child grows, so does their ability to resolve images better, track things with their eyes, and reach for things within their range. Around 5 months color vision is present, and by 1 year we get depth perception, or the ability of the eyes to work together.

Q. So when should I take my child to the eye doctor for the first time?
A. Ideally, a child should be seen around 6 months if no other issues have arisen. An exam can be performed at any age. For younger patient we have techniques to see how eyes track and are drawn to certain patterns. Toddler exams have shape and pictures or easy letters like HOTV.

Q. What should we expect during the first exam?
A. Kids generally do great with eye exams, mostly because they are an active participant in the process. I like to ask questions that they know the answer to and start with large shapes or letters to build their confidence. The exam begins with some basic health questions and some instruments that measure the shape of the eye, which we use for finding any possible glasses prescriptions. For kids over 8, we will try to use the infamous “puff of air” test, which is called a non-contact tonometer, to test the eye pressure. If unable, we can use our fingers to roughly gauge the pressure instead. We check the vision, how the eyes are aligned (looking for strabismus, aka, lazy eye), how they move together, color vision, depth perception, we look for how the eyes react to  light to check for neurological issues, and check to see if glasses may help the child. We always end with a comprehensive check of the anatomical health of the eye using the slit lamp, which is like a microscope.

Q. What questions should a parent ask?
A. Parents and guardians should make sure that they understand exactly what they should be doing for their child’s eyes. This includes making sure everyone is on the same page for wearing glasses, using the computer/tablets, or using eye drops for eye infections. I would also always encourage parents and guardians to be an advocate for their child. If you notice something, like strange eye movements when reading/holding things too close, trouble with colors, etc., please bring it up. The more information we have the better care we can give.

Q. How do I know if my child needs glasses?
A. The best way to know if your child needs glasses is to listen to their complaints about school and watch their behaviors. A myopic child (near-sighted) often complains of not seeing the board and parents may not notice excessive squinting or strong preference for reading/near games as opposed to television or movies. A hyperopic (far-sighted) will experience eye pain or strain, complain of headaches, or have trouble focusing in general. Any child with ADHD or attention deficit symptoms should also be checked for possible induced eye strain leading to certain behaviors.

Q. How often should my child have his eyes checked?
A. Once a child starts school, they should have yearly eye exams. Children, and their eyes, tend to grow and change often during these years, so it is important to maintain clear vision to ensure that each child is given every advantage in the classroom. If things change before the year, it is always worth it to check in with us for a quick visit.

Q. Are the eye tests at school enough?
A. School screenings are just that, screening test to catch the majority of kids who have easily identifiable eye issues. They are an important part of detecting eye issues, but they are just an entry point. Every child should have their eyes checked yearly or, at the very least, bi-yearly by an optometrist.

Q. What would you like parents to know about eye exams?
A. They aren’t just for kids or people with eye problems/glasses. The eye is a unique structure that allows us to look at arteries, veins and nerves in their natural state. This means things like hypertension, diabetes, multiple sclerosis, autoimmune diseases and even Leukemia can show up in the eye before the patient has any idea. A yearly dilated fundus exam should be part of everyone’s health care regiment. If you are making an appointment for your kids, you should be coming as well.

Q. What would you like parents to know about White River Family & Hanover Eyecare?
A. A child is never too young for an eye exam and we are always happy to help. We really focus on the whole family. I would also say that we do fit kids for contacts, especially for sports or other activities where glasses just wont work.

Q. Should my child wear sunglasses?
A. Absolutely, the eye can burn like any other part of the skin. If your child is wearing sunscreen, they should be wearing sunglasses. Especially in the winter with the sunlight reflecting off the snow.

PARENT TIPS

  • If a child is wearing glasses, he should have annual checks until his late teens/early 20s. There might be a quiet time for eye development between age 20 and 40, but changes start in the mid-40s.
  • If a child does not wear glasses, they should have an eye exam every two years. If they are age 20 with no visual issues, a screening should be scheduled every two or three years. (This age group tends to stare at screens all day so eyesight may change with eyes under stress.)
  • If you’ve never worn glasses your whole life, you will need readers by age 50. And for adults with diabetes, hypertension or thyroid issues, an annual check-up is recommended.

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