"Most children are born with slate grey or light brown eyes, which tend to darken over the first year as pigment develops," says Dr. Lee S. Friedman of the Florida Eye Microsurgical Institute. "Babies born with very light blue or green eyes frequently retain the color throughout."
Dr. Stephanie Goei, a pediatric ophthalmologist at MCGHealth in Augusta, Georgia, explains that eyes are lightest at birth because the cells that make color pigment are not fully developed yet. Final eye color is determined by genetics.
"Babies are born without any vision experience, so their brain is like a blank slate," Dr. Friedman says. "As the baby develops and begins seeing the world, images become imprinted on the visual cortex and the neural inputs develop."
Dr. Goei explains that "a newborn infant usually sees very high-contrast shapes and movement and color such as black, white, and red," she says. "Usually by 1 or 2 months the parents will notice a child is able to track bright toys and even some lights without noises."
"When the majority of babies are born, their eyes move in different directions," Dr. Goei says. "By 3 to 6 months of age, babies are using their eyes together very nicely. If the eyes seem to cross all the time, that's not normal. It should be very apparent that the child can use both eyes simultaneously."
"Children with vision problems may crawl or walk late and may be clumsy when they do walk," Dr. Friedman says. "Parents should look for squinting of the eyes, which could signal high refractive errors, refractive symmetry or strabismus, which is crossed eyes."
Dr. Jeffrey Kenyon, an optometrist specializing in pediatrics with the Michigan Optometric Association, says parents should also take note if their child has a specific head tilt or rubs the eyes a lot, which can be a sign of a vision problem.
According to Dr. Friedman, the leading cause of childhood blindness is amblyopia, a "lazy eye" that affects an estimated 500,000 preschoolers and causes permanent vision impairment if it is untreated or insufficiently treated in early childhood. "This needs to be detected early on because it is 100 percent treatable," Dr. Goei says. "You can have it in one eye or both eyes. Sometimes it is correctable with glasses, a patch, or sometimes surgery."
Another thing parents need to consider is the role that family history plays in an infant's eye development and potential problems. "A family history of eye problems is an indication for early evaluation as it is not uncommon for multiple family members to suffer from the same condition," Dr. Friedman says.
For the first six months of life, pediatricians typically provide base-level eye screening for infants during the regularly scheduled well visits. But Dr. Kenyon recommends a more thorough eye screening for infants starting at age 6 months.
Dr. Kenyon says a typical exam lasts about 20 minutes and the infant usually sits on a parent's lap. Tools such as gray cards with various sized stripes or pictures may be used to determine at which objects the baby prefers to look, and at what distances. The doctor may also use lenses and light from a small hand-held instrument to assess how the eye responds to particular targets. Some doctors use photographic testing to analyze the pupil reflex in the photo.
If you have any additional questions or concerns with your child's vision development, be sure to bring them up with your pediatrician during well visits. Your child's pediatrician's office can help with referrals when the time comes for your child to begin visiting a pediatric optometrist or ophthalmogist on a regular basis.