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No matter how the vision is tested, it is important to check each eye separately. Two to five percent of children have one eye which does not see as well as the other--a condition called amblyopia or "lazy eye."
For older children who can talk but who do not yet know their numbers or the alphabet, special charts are used which have pictures common in a child's world such as birds, birthday cakes, and stars. Some tests may require the child to point to a letter which matches a letter on a chart. All of these tests show a child smaller and smaller items in order to get an idea of the child's best visual acuity.
Testing for binocular vision (the ability to use both eyes together) and depth perception can also be done early in childhood.
In some special situations, the measurements may be made of a young child's vision based on brain wave measurements while the child watches striped patterns or by observing the way the child looks at black and white stripes on flash cards.
Lights, lights, and more lights. Lights are used to examine the pupils to see if the eyes are working properly. During this portion of the examination the areas around the eyes such as the eyelids and the tear canals are also examined.
The tiny flashlight can also be used to see if a child's eyes are straight or turned. If a child is looking straight at the flashlight, the reflection off the front of the child's eyes allows the ophthalmologist to tell whether the eyes are turned or straight. This is important in infants because their wide noses may make their straight eyes look crossed.
Sometimes, the ophthalmologist will cover one eye and then the other. If the eyes are not aligned properly, they will jump back and forth when looking at the light or a toy. Wedge-shaped pieces of clear plastic called prisms can be used to measure the amount of misalignment of the eyes.