When Should My Child Have Their First Eye Exam?

Novel Eye Care, Downtown Nashville. 

I'm Dr. Julianne Koch, owner of Novel Eye Care, and my passion for pediatric eye care began with my own story.

I started wearing glasses when I was just two years old. My aunt noticed I was constantly squinting and suggested to my mom that I should have my eyes checked. Sure enough, I had significant astigmatism and needed glasses. My first pair was bright red with confetti and, honestly, pretty clunky. If you visit our office, I'll happily show you the picture!

Growing up, regular eye exams became part of my life. I started wearing contact lenses at eleven years old, and by the time I was in college, I knew I wanted to become an optometrist.

While attending Southern College of Optometry, I discovered my passion for pediatric eye care. During my clinical training, I completed rotations at Mercy Children's Hospital in Kansas City and at a family practice with a strong pediatric focus. After graduation, I joined an ophthalmology practice where I was able to care for many children while also treating patients with dry eye disease, glaucoma, corneal conditions, and other eye diseases. Those experiences helped shape the comprehensive approach I bring to patient care today.

Now, after more than 13 years of practice—and as a mom myself—I understand firsthand how difficult it can be to fit another appointment into a busy family schedule. My oldest daughter is now five years old and has been wearing glasses for the past year. Convincing a young child to wear and care for glasses isn't always easy. It takes consistency, patience, and teamwork from everyone who helps care for them.

When Is the Right Time for My Child's First Eye Exam?

As both an optometrist and a parent, I screened both of my children for eye disease and refractive error when they were about eight months old. That's how I knew my daughter would likely need glasses when she reached preschool age.

One of the techniques optometrists are trained to perform is called retinoscopy. This allows us to accurately estimate a child's glasses prescription—even if they're too young to tell us whether "one or two" looks better. Combined with a dilated eye exam, we can evaluate the health of the retina, check the structures inside the eye, and identify eye diseases that young children cannot describe.

After their infant screenings, I re-examined my children around three to four years of age. My son was about three and a half, and my daughter was four.

Many parents are surprised to learn that eye doctors don't prescribe glasses for every child with a small prescription. There are well-established pediatric prescribing guidelines designed to prevent amblyopia (lazy eye) while avoiding unnecessary treatment. The decision depends on a child's age, prescription, vision, and how both eyes work together.

My daughter has significantly more astigmatism in one eye than the other. Without glasses, her brain naturally favors her stronger eye, increasing her risk of developing lazy eye. She'll often tell me she can "see just fine" without her glasses—and she's not entirely wrong. But wearing them allows
both eyes to work together properly, helping her visual system develop normally and protecting the vision in her weaker eye.

Getting her to understand that? That's a different challenge!

What Do I Recommend?

Even if your child's vision screening at the pediatrician's office is normal, I recommend scheduling a comprehensive eye exam around age five, before they start kindergarten.

Vision screenings are valuable, but they aren't designed to detect every vision or eye health problem. A comprehensive eye exam allows us to evaluate eye alignment, focusing ability, depth perception, prescription, and the overall health of the eyes.

For most children under 12, I recommend dilating the eyes during their first comprehensive exam. Dilating the pupils allows us to obtain the most accurate prescription and thoroughly examine the back of the eye. If everything remains stable, dilation may only be needed every couple of years after that.

Glasses Can Change a Child's Life

Unfortunately, there's still a stigma around children wearing glasses. I hope we continue to change that.

The right pair of glasses can improve learning, confidence, athletic performance, comfort, and overall quality of life. Early detection and treatment of vision problems can make a lasting difference in how a child's visual system develops.

I know it certainly changed my life.

If you have questions about your child's vision or you're wondering whether it's time for their first eye exam, we'd love to help. At Novel Eye Care, we're committed to making eye exams comfortable, educational, and even fun—for both kids and parents.