One of the most delicate questions to answer from a parent is “could my child fake their way into glasses?” Before we get to the answer, I think it’s important to point out why this is such a delicate subject in the exam room.
Clinical experience has taught me there can be two extremes of parental perspectives on glasses for children. Usually, parents don’t fall into the far extremes, but most parents rightly have rational concerns across the spectrum. One extreme perspective is that a child’s vision must be fine so any indications they need glasses must be due to the child faking during the eye exam. The opposite extreme is that since the child complains of vision issues any exam indicating the child doesn’t need glasses must be the mistake of the examiner and not indicative of a child who may not be fully forthright.
With any degree of these perspectives, most eye doctors would caution parents against prejudging any vision or eye related complaints before the child undergoes a comprehensive eye examination. Vision screenings at schools or pediatrician offices do not count! A full eye exam by an experienced eye doctor is essential for accurate diagnosis and treatment.
But back to the question: can a child fake their way into glasses? I’d also add on the question, can a child fake their way out of glasses? Both questions are valid! The answer to both should be no.
There are two categories of vision tests in an eye exam: objective and subjective testing.
Objective testing does not rely on the response of the patient. This includes the use of an autorefractor, which is a machine that scans the eye to estimate the amount of vision prescription. While not 100% accurate, it is very good in screening and estimating the presence and amounts of glasses prescription in a patient. Retinoscopy is another objective test of vision error whereby the doctor scopes a light across the pupil and uses lenses to measure the response and determine the amount of prescription present. Other objective tests exist to aid in this process.
Subjective testing relies heavily on patient response. Subjective testing includes checking vision on a vision chart. When a child says they can see letters of one size but not letters of another size, that is a subjective test that relies on the patient’s input. Subjective testing also includes refraction. This is the typical “better one or better two” testing that most patients are familiar with during their eye exams.
The eye doctor who is experienced in pediatric care will be attuned to weighing the results of objective and subjective testing to make sure they are cohesive with each other and make sens-- especially in light of the child’s complaints and the parents’ observations of the child. If things don’t match, objective testing is given priority in case the child is attempting to get into or out of glasses. If the doctor is concerned, there are some “tricks of the trade” that may identify children that are attempting to manipulate the outcome of the testing.
Whatever the outcome, it’s important for parents to know that the testing by an eye doctor experienced in pediatric care is designed to give the most accurate possible assessment of a child’s vision needs and issues at that moment in time. Despite any prejudgments, glasses are not for every child that complains of vision issues; and, glasses may be indicated for children who don’t loudly voice vision complaints.
Dr. Beach.