Vision Birth to Three
The visual system at birth is very immature. After all, our newborn has been a dark environment since conception! Acuity develops over time as does the accuracy of eye movements.
| Age (months) | Skill |
| 1 to 4 | acuity is 20/200 to 20/400, follow slow moving object intermittently, basic eye movements present |
| 5 to 8 | developing color vision, not as good as an adult yet |
| 9 to 12 | improving acuity, responds to faces |
| 12 to 24 | acuity improved to 20/50, developing eye-hand coordination, depth perception |
| 24 to 36 | acuity is 20/20, begins exploring the environment |
| 36 to 48 | using vision for fine motor coordination. At 48 months, refined eye movements with decreased head movement. |
Assessment of eye movements before the age of three should focus on the full range of motion understanding that the accuracy of these movements is still developing and will demonstrate poor accuracy and excess head movement.
“When should their head be still??”
This separation of head and eye movements should begin at about 4 years old with no head movement observed during an assessment at age 10 and tapering in between. This going to be tied to the development of the proprioceptive and vestibular system as well as the development of the overall brain. These systems are closely linked and delay in any of them will cause a delay in ocular motor skill development as well.
When should a baby get their first eye exam?
The first eye exam should be at 6-12 months old. Infantsee, a public health program developed by the American Optometry Association, provides this first eye exam at no charge. It is vital to detect any problem that could limit the development of the visual system. The next eye exam at 3 years, then annually from ages 6-18. Just as the child is growing a changing during these years, their vision could be changing as well. With the visual demands placed on our children during these years, an annual exam makes sure they are ready to meet those demands.
Common Birth to 3 vision problems
The below table is just a few pathologies that could limit the development of the visual system.
| Common Birth to 3 Eye problems | Pathology | Acuity | Prognosis | Functional Problems | Modification |
| Coloboma | failure of the halves of the eye to join completely inutreo may affect pupil, retina or lid | varies depending on retinal damage | stable condition | glare problems if the pupil is affected and retina is functional, reduced binocular depth perception | sunglasses, motor practice |
| Optic Nerve Hypoplasia | decreased development of the optic nerve, usually associated with midbrain/endocrine problems | varies from minimal effect to near blindness, possible field cut, possible nystagmus | stable condition | Delayed motor development due to reduced visual input. Refer to TVI at 3 yrs old. | vestibular and motor facilitation tasks. |
| Retinopathy of Pre-Maturity | scarring related to excessive blood vessel growth during prolonged O2 exposure in premature infants | varies by the amount of scarring | stable condition | depends on the level of scarring, may be no delays related to vision | based on acuity |
| Corticol Visual Impairment | lack of vision due to visual pathway damage/failure to develop | Usually not 100% blind | stable condition | near blindness, refer to TVI, | use contrasting colors, movment and work peripheral to central to investigate amount of vision. Referal to TVI is important for school readiness. |
| Accommodative Esotropia | medial eye turn due to extreme farsightedness | 20/20 with glasses in place, eye turn also corrects with glasses | improves, but the child will remain in glasses throughout life | none with early correction, amblyopia without correction | glasses should be comfortable and worn at all times. |
| Infantile Esotropia | medial eye turn not related to | generally reduced due to amblyopia, may improve with correction | varies, tx by surgery vs VT vs Botox | reduced motor development | per doctors order concerning patching, facillitate motor improvement |
| Amblyopia | reduced acuity due to decreased visual pathway development due to prolonged suppression or lack of stimulation to the visual pathway | varies, 20/200 or worse to 20/50 depending on patching compliance and glasses wear compliance. | may improve with compliance of tx and glasses wear, binocular vision therapy | reduced motor dev., head turns, decrease binocular depth perception. Brain with compensating in time | motor dev facilitation, exercise amblyopic eye if currently patching, binocular vision activities |
| Strabismus | eye misalignment at rest, corrected with surgery vs VT vs Botox | varies, generally reduced due to amblyopia | varies greatly. Long term, the brain adapts to suppression of the turned eye | reduced motor dev, self-esteem, self-conscious of the turned eye, reduced binocular depth perception | eye exercises per doctors order, facilitate motor development |