(905) 689-7234
Fax: (905) 689-4285
301 Dundas Street East
Waterdown, ON
L0R 2H0

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PARENT S CHECKLIST OF VISION PROBLEMS Yorkview Optometric Clinic Dr. Robert D. Gole B.Sc. O.D

1100 Davis Drive Suites 1 & 2 Newmarket Ontario L3Y 8W8 905-895-8668


Does your child need an eye exam?

Children may not know that they have a vision problem. They can’t always tell you what they see. One out of six children have a significant eye problem that can interfere with their learning and development. The Ontario Association of Optometrists recommends that every child have a complete eye examination by age 3 and sooner if there is reason to suspect a problem. Babies as young as 6 months can be examined.

Does your child have an unusual appearance to the eyes? : Yes / No -One eye that turns in or out at any time? : Yes / No -Red or swollen eyelids? : Yes / No -Crusty eyelids? : Yes / No -Frequent eyelid infections or styles? : Yes / No -Eyes that water a lot? : Yes / No

Does your child behave in a way that could suggest a vision problem? -Closes or covers one eye? : Yes / No -Squints or frowns when looking far or near? : Yes / No -Rubs the eyes a lot? : Yes / No -Blinks more than usual? : Yes / No -Turns or tilts head when viewing objects? : Yes / No -Holds objects very close to face? : Yes / No -Touches things to help recognize them? : Yes / No -Avoids near tasks/reading? : Yes / No -Loses interest quickly or becomes irritable with close work? : Yes / No -Poor comprehension? : Yes / No

Is there a family history of vision problem? : Yes / No -Parent brother or sister has a turned eye? : Yes / No -Parent brother or sister has a lazy or blind eye? : Yes / No -Parent brother or sister has glasses with high power? : Yes / No -Were there complications with the pregnancy? : Yes / No -Was your child premature at birth? : Yes / No

If you have answered “Yes” to any of these questions please call our office for a complete eye examination.

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