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October 30, 2013

Published in Calgary Child’s Magazine: infant vision

As a new mother and optometrist, I understand the important role parents play in the eye and vision development of their infant. Healthy eyes and good vision contribute to helping infants see well and prevent developmental delays. There are three steps I encourage parents to take when it comes to vision. Firstly, parents should watch for signs of eye and vision problems early on. Secondly, they should have their child’s eyes examined by an optometrist at six months of age. Early detection leads to better treatment outcomes. Thirdly, engaging in age-appropriate activities helps to stimulate the eyes and vision. Similar to walking and talking, a baby learns to see over time. Visual abilities such as focusing (accommodation); moving the eyes accurately (eye tracking); using the eyes together (eye teaming); and the brain processing what it sees (visual processing) are learned skills. In fact, 80 per cent of learning occurs through vision, so why not give your infant the best chance at life?


The following are eye and vision milestones to watch for from birth to 12 months. Note: Every child is not the same, and some may reach certain milestones at different ages.

Birth to six months

  • Studies indicate the sharpness of vision or visual acuity begins around 20/400 at birth to approximately 20/25 (adult-like) at six months of age.
  • At birth, an infant sees in black and white and shades of grey as nerve cells in their retina are not fully developed. By six months of age, color vision should be similar to that of an adult in that all colors are seen.
  • The eyes are able to focus on objects placed within 20 to 30 centimetres of an infant’s face. Babies are drawn to highly contrasted targets, such as the face of their mother. By eight weeks, babies begin to focus with more ease.
  • The eyes are not well-coordinated at birth and one eye may appear to wander upward, downward, inward (crossed) or outward. If the eyes have a large or constant misalignment, notify your optometrist right away. By six months of age, the eyes work together and depth perception is established.
  • The eyes begin to follow moving objects at three months of age.
  • At three months of age, an infant’s ability to detect light is 10 times that of an adult. Diming the light for naps and bedtime is recommended.
  • Babies have better hand-eye coordination by four to six months allowing them to accurately locate and pick up objects, such as their feeding bottle.
  • Mark it on your calendar! At six months of age, book your child’s first eye exam with an optometrist.

Seven to 12 months

  • Control of eye movements continues to improve.
  • Between nine and 12 months, infants develop better awareness of their body and learn to coordinate vision with body movements. Parents should encourage crawling rather than early walking to help the child develop better eye-hand-foot-body coordination.
  • Infants are better at judging distances and more accurate at grasping and throwing objects.
  • Eyes can change color as more dark pigment is produced in the iris changing the eye color from blue to brown, green, grey or a mixture of colors.


The following are suggested activities for visual development by the American Optometric Association and my own personal experience:

Birth to six months

  • Use a night light to provide visual stimulation when the infant is awake in their crib at night.
  • Add new items to their room, change the location of their crib and your infant’s position in it, and change the location of existing items in the room.
  • Keep reachable toys within your infant’s focus (20 to 30 centimetres). Have your infant watch a brightly colored object (balloon, ribbons, and pinwheel) and move the object from side to side and up and down to help strengthen the eye muscles, track objects and focus at different distances.
  • Your voices and various noise makers (squeaky toys) help your infant develop visual tracking and auditory location skills. Dangling objects will sharpen your infant’s auditory and visual discrimination skills.
  • Talk to your infant as you walk around the room.
  • Faces are very important to infants. Use facial expressions such as a smile, an opened mouth, raised eyebrows, a stuck-out tongue or simply saying their name while maintaining eye contact helps stimulate vision and bonding. Having the infant gaze into a mirror or showing them a book with various facial expressions helps the infant’s eyes to focus and track and explore the social nature of faces.
  • Alternate right and left sides with each feeding.
  • Building blocks, a small plush toy or a teething ring attached to a brightly colored ribbon dangled in front of an infant can help boost fine motor skills and small muscle development as they try to reach for the toy.

Seven to 12 months

  • Hang a mobile or line art with various objects across the crib for the infant to grab, pull and kick. Having you standing close by and talking about the objects captures the infant’s attention and provides a chance for both of you to interact.
  • Becoming dexterous requires fine control of the wrist, palm and fingers, as well as the ability to judge distances and shapes. Plastic measuring cups and spoons are great toys as they are easy to grasp and have different surfaces.
  • Play patty cake and other games, moving the infant’s hands through the motions while saying the words aloud.
  • Play hide-and-seek games with toys or your face to help the infant develop visual memory.
  • Name objects to encourage the infant’s word association and vocabulary development skills.
  • Give the infant plenty of time to play and explore on the floor. Encourage crawling.
  • To stimulate eye-hand-body-coordination, place a toy on the floor and encourage them to get it. Provide plenty of objects and toys that they can take apart and put together helping with hand-eye coordination and visual discrimination.
  • Emptying and filling containers helps develop spatial awareness such as big, small, empty or full. It also exercises fine and gross motor skills.


Although your infant cannot read the wall chart in an optometrist’s office nor can they tell you if they are seeing well, your optometrist is able to provide an accurate and complete eye examination using non-verbal testing to check the level of vision (visual acuity); excessive or unequal amounts of nearsightedness, farsightedness or astigmatism; eye focusing, tracking and eye teaming; and eye health problems.

Schedule the eye exam at a time when baby is relaxed and happy. Fill out any required paperwork at home and bring in on the day of the exam. Bring along a familiar toy to calm your baby if they start getting fussy as the initial eye exam can take up to 30 minutes. Further examination such as a dilated fundus examination may be required to check the posterior structures of the eye (the retina) and/or verify if a prescription for glasses is needed. Be proactive about your infant’s eye and vision development, it will pay off for their lifetime.

Dr. Farrah Sunderji, OD, completed her Optometry degree from the New England College of Optometry followed by a residency in Pediatrics and Vision Therapy. Her practice EyedeologyTM is located at #245, 520 – 3 Avenue SW. For more information on children’s vision, check out her website at


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