RX for Your Health: Children’s Eye Care


Courtesy of NewYork-Presbyterian/Lower Manhattan hospital, some of the finest doctors in the city provide us with great health-related tips and general things to know or look out for on different topics on a regular basis.  This week, we spoke to Dr. Erica Oltra, a pediatric ophthalmologist at the hospital.

Ophthalmologist Dr. Erica Oltra
Ophthalmologist Dr. Erica Oltra

What do you hope to bring to this community and what do you like about downtown?

As a pediatric ophthalmologist, I see children of all ages for both routine exams as well as medical and surgical eye care. With the number of young families in downtown Manhattan, my adult ophthalmology colleagues and I strive to provide quality comprehensive eye care for the entire family. The diversity and energy downtown make for an unparalleled workplace – not to mention the delicious food!

What can we expect from your practice?

You can expect high quality and compassionate care from everyone you interact with at our office. As a mother, I know that bringing your child to the doctor for any reason can be stressful. We aim to make the experience fun while gathering all the important information necessary to assess your child’s vision and eye health.

How much can my baby see? When is vision fully developed?

We are not born with fully developed visual systems. At birth, babies can typically see for approximately 8-10 inches in front of them, but beyond that is quite blurry. A child’s vision develops over the first few years of life and continues to develop through 4-5 years of age. Vision then develops rapidly, though development of perfect 20/20 vision occurs anywhere between 6 months and 6 years of age.

Babies are not born with good color vision, but it develops over the first 6 months. This is why newborns are more attracted to black and white patterns and will slowly become more interested in bright colors. Newborns are also learning how to use their eyes together; so occasional eye crossing can be normal for the first 2-3 months of infancy. After this point, an ophthalmologist should evaluate any eye misalignment.

Is too much TV or iPad bad for my child’s eyes?

While limiting screen time may be best for a child from a developmental standpoint, the truth is that it is not damaging to their eyes or vision. However, too much screen time can make our eyes feel tired for two reasons. First, we blink less while watching television or using a computer, causing our eyes to dry out quickly. Second, our eyes may feel strained from over accommodating or “over focusing” when looking at something up close like a computer, iPad or phone. It is therefore recommended to blink frequently and take breaks after long sessions of screen time. I recommend to my patients and parents that they follow the 20-20-20 rule: after every 20 minutes of screen time, take 20 seconds to focus on an object 20 feet away. While many parents may expect me to tell their child to limit their screen time for the health of their eyes, it is simply a myth that too much TV or iPad will cause long-term damage to the eyes.

However, I always encourage parents to consult with their pediatrician for information on how too much screen time can affect their child from a cognitive and developmental standpoint.

When and how often should my child have their eyes examined?

The current guidelines agreed upon by the American Academy of Pediatrics and the American Academy of Ophthalmology are for primary care doctors to perform age-appropriate routine eye examinations. This includes testing for a red reflex in the newborn nursery, checking the movement and alignment of the eyes at subsequent well-child visits, and a vision screening around 3-4 years of age. A child is referred to a pediatric ophthalmologist if there are any concerns from the pediatrician and/or parent. Although there are no current guidelines that suggest every infant or child have a comprehensive eye exam by an eye care professional, I am always happy to examine a child if parents have any concerns or there is a family history of eye problems.

Children over the age of 4 years should have their vision checked at least once a year, either at their pediatrician’s office or in school. These vision screenings are important because early detection of any vision problems is key. On average 1 in 20 pre-school aged children have a vision problem that can cause permanent blindness if left untreated. The earlier the detection of a vision problem, the more successfully it can be treated.

How important is it for my child to wear sunglasses while outdoors?

Wearing sunglasses while outdoors should start when the child is old enough to cooperate and wear them at their own will. Before this, a wide brimmed hat can block 50 percent of the sun’s UV rays. Too much sun exposure can set a child up for potential vision problems later in life such as eyelid skin cancers, cataracts and macular degeneration. UV eye damage is cumulative over time, so it’s important to protect their eyes starting at a young age. That said, there is no way I can get my one year old to wear sunglasses! I advise parents to do the best they can and don’t stress too much about forcing their child to wear sunglasses before they’re ready. Sun visors on strollers, wide-brimmed hats and sun shades on car windows are a simple and easy way to start.

I’ve heard that a white reflex in my child’s eyes on a photo could mean cancer, is this true?

A white pupillary reflex on a photograph might scare a lot of parents, because they’ve heard this could mean an eye cancer called retinoblastoma. A white reflex is most likely due to light reflecting off of the optic nerve which is white, though rarely it can be a sign of something more serious like retinoblastoma or a cataract. A dilated eye exam by an ophthalmologist is a reasonable consideration when a white pupillary reflex is detected in a photograph.

What is the difference between an optometrist and an ophthalmologist? Who should my child see?

An optometrist is a doctor who has received a Doctor of Optometry degree (OD). They perform routine eye exams and prescribe eyeglasses and contact lenses. An ophthalmologist is a doctor who has received a medical degree (MD or DO) and additional training in a surgical ophthalmology residency after medical school in order to treat medical conditions involving the eye and perform eye surgery. Whichever doctor you see, it is important to make sure they have experience in children’s eye conditions. If there is any issue detected that requires medical or surgical treatment, you will be referred to a pediatric ophthalmologist.

To make an appointment, contact Dr. Oltra at (646) 962-2020