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Vision Development and Lazy Eye:: home
Vision Development and Lazy Eye

At birth, vision is not fully developed. In order for vision to develop properly, the eyes need to be stimulated with focused light. If light doesn’t enter a baby’s eye focused, the child will have subnormal vision and be at risk for developing a lazy eye (Amblyopia). Lazy eye is an eye with poor vision and an underdeveloped optic nerve due to lack of use. An eye will not be used if it has excessive refractive error (farsighted, nearsighted, astigmatism), if it is turned in the wrong direction, or has vision blocked by a birth abnormality like a cataract. Consequently, it is critical to have a child’s eyes checked early to make sure they are seeing clearly and that their eyes are straight. When detected and treated early, lazy eye is reversible in most children. When detected late, improvement is possible, but generally more difficult to obtain because the nerve pathway has already grown incorrectly.

Under normal circumstances, a baby’s eyes will develop properly. When born, babies see very blurry. Typically they have both farsightedness and some astigmatism. Within the first 6-12 months of life, vision begins to normalize going from about 20/300 (the top of an eye chart) to almost 20/20 (the bottom of an eye chart). Detection of fine lines, textures, and smaller details gradually progresses from shadows and rough contours. The ability to adjust focus develops around 2-3 months of age. As clarity begins to develop, so does improved color vision. Although babies can see in color at birth, the shades of color they see are different and somewhat muted. More normal color vision occurs closer to a year old. Control of eye muscles is also not well developed at birth. Babies can move their eyes, but cannot accurately coordinate their eye movements until around 3-4 months old. Tracking movements begin as erratic, and then become more accurate as vision gets clearer and the child gets more practice. Around the same time, 3-D perception kicks in allowing better judgment of distance, depth, and speed. Keep in mind that not everyone develops at the same rate and abilities may vary slightly. Overall most infants should have relatively normal eye performance just past 6 months old.

If your child exhibits unusual visual behavior or you suspect that something is wrong, have them examined as soon as possible. Some other key indicators for eye problems in infants include, premature birth, underweight at birth, digestive problems at birth, any abnormal head, facial or eye structure, misaligned eyes, and failure to respond to distant or near objects of interest especially if illuminated or moving. As an infant transitions into a toddler and becomes more mobile, consider no fear of heights or continued clumsiness as red flags for poor eyesight. Also, children from families having a history of eye problems such as high prescriptions, lazy eye, or other vision birth defects are also at greater risk for inheriting eye problems. Children that have examination findings outside the expected norms for their age should be treated with the appropriate measures to avoid poor eye development and/or function.