Pediatric and Binocular Vision Service



It is important to have your child's eyes examined early in life. Rapid development of many aspects of vision occurs between birth and 6 months of age. Successful treatment of vision anomalies can be obtained more quickly with early detection and correction of vision problems and may prevent the occurrence of a more serious vision anomaly.

  • The American Optometric Association recommends that a child's first complete vision examination take place during infancy, approximately at 6 months of age.
  • If there is any complication during the pregnancy or delivery or if there are any other developmental risk factors, we recommend your child be examined by 3 months of age.
  • Even if there are no recognized vision problems, we recommend subsequent comprehensive vision examinations at 3 years of age and again before school (5 years of age).
  • Vision Screenings, such as those provided in elementary schools, frequently miss significant vision problems. A comprehensive vision examination will identify vision problems, inform the parents about the condition and determine the most appropriate treatment. The benefits of a comprehensive vision examination have been well documented by the Infants' and Children's Vision Coalition. Click here for more details.
  • Repeated eye examinations every year or two, sooner if there are any known vision problems, serve to monitor the continuing development of your child's vision status and reduces the risk of vision loss.

The Pediatric and Binocular Vision Service serves the entire West Michigan community. Primary care vision examinations are provided at the Big Rapids campus. Specialty diagnosis and treatment for severe and rare visual problems is also available. The Michigan College of Optometry is committed to supporting doctors statewide through consultation and co-management, go here for referral information.

The Pediatric and Binocular Vision Service is staffed by pediatric optometrists. Student doctors in their third or fourth year of optometry school conduct the examinations under direct supervision of one of the pediatric faculty.

Types of Vision Examinations

Well Baby / Child Examination

(birth to preschool)
Comprehensive vision examinations are available for this special group of patients. The Michigan College of Optometry has comfortable non-threatening examination rooms specially equipped to assist in the examination of infants and small children. Extra time is scheduled for these appointments to assure comprehensive examination and consultation regarding the findings. Remember 1, 3, & 5 - First exam in the first year of life then at age 3 and again at age 5.

Annual Back to School Checkup

(preschool to late teens)
A high percentage of early education and learning involves visual materials, therefore, good vision is essential to good school performance. Children with vision problems often do not know that the world is different from the way they see it. A comprehensive vision examination will evaluate several components of the child's visual system and make sure they are able to meet the special visual requirements of school and recreation.

Learning Difficulties / Developmental Examination

(any age) By referral only. If you do not have a referral from a teacher or other doctor, please ask to speak with one of the pediatric faculty. It may be necessary to order past records or complete a questionnaire before an appointment can be made. This policy has been put in place to avoid performing duplicate or unnecessary procedures.

The Learning Difficulties / Developmental Examination serves patients who have learning problems that can not be explained by lack of intelligence and children who have been identified as having Dyslexia or Attention Deficit / Hyperactivity Disorder. It is comprised of vision, perception, intelligence, and achievement testing resulting in counseling/education, treatment, and/or teaching recommendations

Visual Information Processing Assessment - By referral only.

Binocular Vision Examination

(any age) By referral only. If you do not have a referral from a teacher or other doctor, please ask to speak with one of the pediatric faculty. It may be necessary to order past records or complete a questionnaire before an appointment can be made. This policy has been put in place to avoid performing duplicate or unnecessary procedures.

The Binocular Vision Examination is designed to thoroughly assess the coordinated control of the two eyes. Most commonly this is associated with strabismus (misaligned eyes) or amblyopia (lazy eye). However, there are several less severe causes of poor eye coordination which may impact on a child's or adult's comfort and quality of vision. The goal of this clinic is to provide special glasses or contact lens correction, eye movement exercises, and/or co-management with a strabismus surgeon. Counseling for the patient and parents and informative reports for teachers and other health care providers are also provided.

Special Needs Examination

The staff of our clinic is prepared to provide comprehensive vision exams for children and adults with special needs. This would include those with other sensory impairments such as hearing loss, as well as people with significant physical or mental handicaps, including persons with cerebral palsy or non-verbal patients.

Referring Patients to PBVS and Pre-Appointment Forms


(birth to 18 years of age)
  • Evaluate the functional status of the eyes and visual system
  • Assess ocular health and related systemic health conditions
  • Counsel and educate the parents and patient regarding the status of the visual system and possible associations with overall health and development.


    Although children may not be able to communicate at an adult level, there are many procedures that can be used to determine how well their visual system is functioning. Game-like activities using special figures allow the pediatric optometrist to observe visual reflexes and even communicate with infants and young children. There are also several procedures that are simple measurements of the eye and vision that do not require input from the patient.

    Patient History - Information about the child's and parent's general health can provide clues about the potential risk for vision anomalies. If there is a strong history of a particular vision problem that runs in the family, more frequent examinations or special procedures may be required.

    Visual Acuity - Determines how well the child sees. There are several ways to estimate the child's visual abilities. Although they are not precise for infants they are very good at determining if there is significant vision loss, especially a difference between the two eyes.

    Refraction - Measures the focusing power of the eyes. There is a small range of incorrect focusing power that is acceptable and this can easily be identified with several procedures. Again, a difference between the two eyes is more important than a small amount of near- or far-sightedness. Eye drops are often used to make this procedure even more precise.

    Eye Movements, Binocular Coordination, and Accommodation - There are 14 different muscles that the child must learn to control in order to see the world single, clear and comfortably. For infants, it is common to have minor, occasional lapses in control. Careful observation by the pediatric optometrist can determine if the child is developing appropriate eye movement control for their age.

    Ocular and Systemic Health Screening - Bright lights and magnifying instruments are used to view the different structures of the eyes and supporting tissues. Usually dilating drops are used to temporarily enlarge the pupil so the internal eye structures can be viewed. The lights and drops do not cause any damage but are occasionally uncomfortable and resisted by children. Most of the time a little persistence and consoling will provide the examiner enough time and cooperation to complete the procedure.

    Perceptual Testing - Visual Perception is a broad term that describes how the brain organizes and interprets the information sent by the eyes and other sense organs. This is a very important skill for young learners. Information from the history or examination may indicate the need to examine the child's visual perceptual skills. A screening procedure may be administered during the eye examination or a comprehensive developmental assessment can be scheduled for another day.

    Things for parents to consider to make the exam go efficiently.

    • Set a good example, get your eyes tested and allow the child to observe that there is nothing to fear.
    • Bring props, favorite blanket, comfort toy, extra snacks/bottle.
    • Try to schedule the appointment soon after their typical nap time.
    • Don't bribe, children quickly learn to associate unpleasant activities with, "If you do ______, we will go to McDonalds". Their natural "stranger anxiety" often becomes heightened.
    • An extra set of hands is often very helpful. Having to care for another child may limit your ability to aid and comfort the child being examined and often serves as a distraction to the task at hand.


    There are several factors that place an infant or child at risk for visual impairment and development problems.


    Prescription Lenses

    The Michigan College of Optometry Clinic operates an optical dispensary. Should a patient of the Pediatrics and Binocular Vision Service require spectacles as part of their care, the their spectacle prescription can be filled at the University Eyewear. Additionally, the College of Optometry has a full Cornea - Contact Lens Service, should that mode of treatment be preferred.


    Therapeutic Pharmaceuticals

    In those rare instances when a child may have, for example, a bacterial eye infection or "pink eye," our staff doctors can both diagnose the problem and prescribe the medications necessary to treat the condition.

    Vision Therapy

    Many of the types of vision problems encountered by patients cannot be resolved solely with lenses and will not satisfactorily resolve on their own over time. For these reasons, the Pediatric and Binocular Vision Service provides comprehensive vision therapy services. To optimize visual skills, a prescribed program of appropriately selected and coordinated visual activities, usually performed both at home and in our clinic, is often necessary. This treatment approach is effective for a variety of diagnosed visual problems, including strabismus and amblyopia, accommodative or focusing problems, difficulties maintaining comfortable alignment of the eyes, and problems with visual information processing (visual perceptual) skills such as visual memory or visual-motor integration (eye-hand coordination). Many of these same vision therapy activities are also utilized to enhance the visual abilities of persons who desire improved sports or occupational skills.


    For an appointment call (231) 591-2020


    Avesh Raghunandan, OD, FAAO, Ph.D.
    Mark Swan, OD, MEd, FAAO
    Daniel Wrubel, OD
    Sarah Hinkley, OD, FCOVD
    Paula McDowell, OD. FAAO Chief of Pediatrics
    Amy Dinardo, OD, MBA, FAAO
    Alison Jenerou, OD