2025-12-03
Earlier Than You Think
Here is a statistic that surprises most parents: the Canadian Association of Optometrists recommends a first eye exam between 6 and 9 months old. Not 6 years. 6 months. And yet most Canadian kids do not see an optometrist until they are 5 or 6 — usually because a teacher noticed them squinting at the board.
By that point, they may have spent years with an undetected vision problem that affected everything from learning to read to hand-eye coordination. And some issues, like amblyopia (lazy eye), have a critical window for treatment that starts closing around age 7.
The Schedule That Optometrists Recommend
First Exam: 6 to 9 Months
This is a quick, non-invasive check. The baby does not need to read a chart or even cooperate much. The optometrist checks:
- Eye alignment — Are both eyes pointing in the same direction? Crossed eyes (strabismus) at this age need early intervention.
- Pupil response — Do the pupils react normally to light?
- Focusing ability — Can each eye focus on a target?
- Eye health — Are the structures of the eye developing normally?
Most babies pass with no issues. But for the ones who do not, catching problems at this age gives the best treatment outcomes. In Alberta, this exam is covered by Alberta Health — there is no cost to parents.
Second Exam: Age 2 to 5
Preschool-age children can cooperate with simple tests — matching shapes, identifying pictures on a chart. This exam checks for:
- Refractive errors — Nearsightedness, farsightedness, and astigmatism. Some degree of farsightedness is normal in young children, but significant errors need correction.
- Amblyopia (lazy eye) — One eye is weaker than the other. The brain starts ignoring the weaker eye, and without treatment, vision loss becomes permanent. Patching therapy and glasses work well before age 7, less well after.
- Strabismus (eye turn) — Misaligned eyes. Can be constant or intermittent. Affects depth perception and can lead to amblyopia.
- Eye coordination — Can both eyes work together to track a moving object?
This exam is critical and still covered by Alberta Health. If your child has never been to an optometrist by age 3, make it a priority.
School Age: Annual Exams
Once kids start school, annual eye exams are recommended. Vision demands increase dramatically — reading, board work, computers, sports. Myopia (nearsightedness) often develops between ages 6 and 14 and can progress quickly during growth spurts.
Annual exams catch prescription changes before they affect school performance. A child who cannot see the board clearly may not tell you — they do not know what "normal" vision looks like because they have nothing to compare it to.
Why School Vision Screenings Are Not Enough
Most schools in Alberta offer basic vision screenings, and many parents assume this is the same as an eye exam. It is not. A school screening typically tests distance vision with a wall chart. That is it. It does not check:
- Near vision (reading distance)
- Eye teaming and coordination
- Focusing flexibility
- Eye health
- Astigmatism
- Colour vision
A child can pass a school screening with 20/20 distance vision and still have a significant focusing or coordination problem that makes reading exhausting. These kids often get misidentified as having learning disabilities or attention issues when the real problem is their eyes.
Signs Your Child Might Have a Vision Problem
Kids rarely complain about their vision because they assume everyone sees the way they do. Watch for these behaviours:
- Sitting very close to the TV or holding books/tablets close to the face
- Squinting, tilting, or turning the head to see
- Rubbing eyes frequently (not related to tiredness)
- Losing place when reading or using a finger to track
- Avoiding reading or close-up work
- Complaints of headaches, especially after school
- One eye turning in or out, even occasionally
- Difficulty catching or hitting balls (depth perception)
None of these definitively means a vision problem, but any of them is worth investigating with a proper eye exam.
Myopia in Kids: Why It Matters Now
Myopia rates in children have increased dramatically worldwide over the past 20 years. More screen time and less outdoor time are the primary suspected factors. In Canada, roughly 30% of children are now myopic.
Why it matters beyond needing glasses: high myopia (above -6.00) significantly increases the risk of serious eye diseases later in life — retinal detachment, glaucoma, and myopic maculopathy. Slowing myopia progression during childhood reduces these long-term risks.
Myopia management strategies that optometrists can offer include:
- Atropine drops — Low-dose drops that slow eye growth
- Orthokeratology (Ortho-K) — Overnight contact lenses that temporarily reshape the cornea
- Specialty contact lenses — MiSight and similar lenses designed to slow myopia progression
- More outdoor time — Studies show 90+ minutes of outdoor time daily reduces myopia risk and progression. Natural light exposure appears to be the key factor.
Cost in Alberta
Children's eye exams are fully covered by Alberta Health, once per year. There is zero cost to parents. Given that the exam is free, takes 20-30 minutes, and can catch problems that affect your child's learning and development, there is really no reason to skip it.
If your child needs glasses, that cost is out of pocket — but most family benefits plans cover children's eyewear. Many plans offer $150-300 per child every 12 months for frames and lenses.
The bottom line: book the first exam way earlier than you think you need to, keep up with annual exams once school starts, and do not rely on school screenings to catch everything. Your child's vision is too important to leave to a wall chart in the gym.