Pediatric Ophthalmology
Why Children Need Specialized Eye Care
Your child's visual system develops from birth through the teen years. During this time, the brain learns to process images from both eyes and build depth perception. Problems that go undetected during these critical years can cause permanent vision loss that becomes much harder to treat later.
Children often cannot tell you they have a vision problem. A child born with blurry vision in one eye may assume that everyone sees the same way. Specialized testing methods allow pediatric ophthalmologists to detect problems even in babies and toddlers who cannot read an eye chart.
A pediatric ophthalmologist is a medical doctor who completed extra training in diagnosing and treating eye conditions in children. According to the Cleveland Clinic, pediatric ophthalmology covers both medical and surgical eye care for children, along with strabismus (eye misalignment) management for patients of all ages.
These specialists use child-friendly exam techniques, smaller instruments, and age-appropriate communication. They also coordinate with pediatricians, neurologists, and geneticists when eye conditions connect to broader health concerns.
Multiple professional organizations, including the AAO, AAP, AAPOS, and USPSTF (2022), support vision screening in children to identify threats to vision early. Your pediatrician screens your child's eyes at routine well-child visits. If any screening result raises concern, a referral to a pediatric ophthalmologist provides a more thorough evaluation.
According to the AAP (2022), children should be referred to a pediatric ophthalmologist for suspected retinoblastoma, cataracts, glaucoma, congenital ocular defects, systemic syndromes with possible eye involvement, or any suspected eye disease in non-verbal children aged 7 or younger.
Meet Our Pediatric Ophthalmologist
Dr. John P. Donahue is a board-certified ophthalmologist who specializes in pediatric ophthalmology and eye movement disorders. He cares for infants, children, and teens, and also performs strabismus surgery for adults. His practice includes patients with amblyopia, nasolacrimal duct obstruction, retinopathy of prematurity, and other conditions affecting the developing visual system.
Dr. Donahue completed a fellowship in Pediatric Ophthalmology at Children's National Medical Center in Washington, DC. His combined background in clinical ophthalmology and laboratory science informs how he evaluates and treats complex pediatric eye conditions.
Dr. Donahue completed the Medical Scientist Training Program at the University of Colorado, earning both his M.D. and a Ph.D. in Microbiology and Immunology. His undergraduate work included a Department of Energy Nuclear Chemistry Fellowship at San Jose State University and degrees in Biology and Chemistry from Oral Roberts University.
After medical school, he completed an internship in Internal Medicine and a residency in Ophthalmology at the University of Colorado, followed by his pediatric ophthalmology fellowship at Children's National Medical Center. He has been Board Certified in Ophthalmology since November 2000.
Dr. Donahue serves as Clinical Assistant Professor of Surgery (Ophthalmology) at Brown Medical School. He holds active hospital appointments at The Rhode Island Hospital, The Miriam Hospital, Women & Infants' Hospital, Charleton Memorial Hospital, St. Anne's Hospital, and Good Samaritan Medical Center.
He is a member of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), the American Academy of Ophthalmology (AAO), the Costenbader Society, the American Medical Association, and the Rhode Island Medical Society.
Dr. Donahue has contributed to research on the genetics of immune cell development, mitochondrial diseases of the eye, and the electroretinogram in phenylketonuria. He has presented at Neonatal Grand Rounds on retinopathy of prematurity at Women & Infants Hospital and at Pediatric Grand Rounds on mitochondrial diseases of the eye at St. Anne's Hospital.
He received the Brown University and Rhode Island Hospital Department of Ophthalmology award for Outstanding Commitment to Resident Education in 2004, along with Performance and Recruitment Awards from the Pediatric Eye Disease Investigator Group.
Common Pediatric Eye Conditions
Amblyopia occurs when the brain favors one eye over the other during visual development, leading to reduced vision in the weaker eye. According to the AAO, amblyopia affects approximately 2 to 4 percent of children and is the most common cause of decreased vision in a single eye among children and young adults.
Treatment includes patching the stronger eye, atropine eye drops, or corrective glasses. Starting treatment early matters because the visual system is still developing and responsive to change. According to PMC/NCBI (2022), early detection and prompt management of strabismus and amblyogenic factors improve long-term visual and sensorimotor outcomes.
Strabismus means the eyes do not aim in the same direction. One eye may turn inward (esotropia), outward (exotropia), upward, or downward while the other looks straight ahead. Your child may develop double vision, or the brain may learn to ignore the misaligned eye, leading to amblyopia.
Dr. Donahue may recommend glasses, patching, eye exercises, or eye muscle surgery depending on the cause and severity. According to the AAO (2022), early detection and prompt management of strabismus support long-term visual and sensorimotor outcomes.
Nearsightedness (myopia), farsightedness (hyperopia), and astigmatism are common in children. These conditions blur vision and can interfere with learning and play. Your doctor detects refractive errors during a routine exam and prescribes glasses or contact lenses to correct them.
A large difference in prescription between the two eyes (anisometropia) puts your child at risk for amblyopia. Your doctor monitors this closely and may recommend patching along with glasses to strengthen the weaker eye.
Blocked nasolacrimal ducts cause constant watering, sticky discharge, and occasional infections in babies. Most cases clear on their own by 12 months with gentle massage of the tear sac. If the blockage persists, Dr. Donahue may recommend a brief probing procedure to open the duct.
According to the Cleveland Clinic, blocked tear ducts are among the most common conditions treated by pediatric ophthalmologists. Children with recurrent infections or persistent symptoms after age one may need additional procedures.
Children can also develop droopy eyelids (ptosis), unusual eye movements (nystagmus), conjunctivitis (pink eye), styes and chalazia, eye infections, and differences in pupil size. Dr. Donahue evaluates each finding and explains whether it needs treatment, monitoring, or referral to another specialist.
Some of these findings are minor and resolve quickly. Others may signal a deeper issue that needs imaging, laboratory testing, or coordination with your pediatrician. Your doctor walks you through the reasoning behind each step.
Congenital and Complex Eye Conditions
Some babies are born with clouding of the eye's natural lens. A pediatric ophthalmologist may detect a congenital cataract through the red reflex test in the newborn nursery. If the cataract blocks the visual axis, your child may need surgery within the first weeks of life to help prevent deprivation amblyopia.
After cataract removal, your child wears glasses or contact lenses to correct the missing focusing power. Patching therapy and close follow-up continue through childhood to support visual development.
Retinopathy of prematurity (ROP) affects premature babies whose retinal blood vessels have not finished developing. Premature infants receive their first eye exams in the neonatal intensive care unit. If abnormal blood vessel growth occurs, treatment with laser therapy or injections can help prevent retinal detachment and vision loss.
Dr. Donahue cares for infants with retinopathy of prematurity and has presented Grand Rounds on this topic at Women & Infants Hospital. According to the NEI, ongoing research continues to improve screening criteria and treatment options for ROP.
Pediatric glaucoma involves elevated eye pressure that can damage the optic nerve in children. Retinoblastoma is a cancer of the retina that requires urgent evaluation and treatment. Both conditions are time-sensitive, and a pediatric ophthalmologist can recognize the early signs and coordinate care with other specialists.
According to the AAP (2022), children should be referred to a pediatric ophthalmologist for suspected retinoblastoma, cataracts, or glaucoma. Any abnormal red reflex finding in a newborn requires urgent consultation, since this finding can point to several serious conditions.
Some children inherit conditions that affect the retina, optic nerve, or other eye structures. Your pediatric ophthalmologist can coordinate genetic testing to identify the specific condition, guide treatment decisions, and determine whether your child qualifies for clinical trials or gene therapy.
According to the NEI, the Pediatric, Developmental, and Genetic Ophthalmology Section investigates the genetic and molecular bases of inherited eye diseases in children and develops therapies. Advances in gene therapy have already produced FDA-approved treatments for certain retinal dystrophies.
Adult Strabismus Surgery
Strabismus is not only a childhood condition. Adults can develop new eye misalignment from a range of causes, and longstanding childhood strabismus can also resurface later in life. Common symptoms include double vision, eye fatigue, and difficulty with depth perception.
Dr. Donahue performs strabismus surgery for both pediatric and adult patients with eye misalignments. Adult strabismus surgery aims to realign the eyes so they work together more comfortably.
Adult strabismus evaluation includes measurement of the misalignment in different directions of gaze, assessment of double vision, and review of underlying causes. Dr. Donahue plans the surgery based on which eye muscles need adjustment and how much correction the patient needs.
Most adult strabismus procedures are performed on an outpatient basis. Recovery includes prescribed eye drops and follow-up visits to verify alignment and monitor healing.
Treatments and Therapies
Your doctor prescribes corrective lenses when refractive errors, post-surgical needs, or certain conditions require optical correction. Young children adapt to glasses quickly, and flexible frames with strap options help keep them in place during active play. Our optical shops at the Providence and South Kingstown locations carry frames designed for children.
Contact lenses may be recommended for babies after cataract surgery, children with large prescription differences between eyes, or older children who prefer them for sports and activities. Our optometry team fits children's contact lenses with attention to safe handling and proper hygiene.
Patching covers the stronger eye to encourage the brain to use the weaker eye. Your doctor prescribes specific patching hours based on the severity of amblyopia and your child's age. Atropine eye drops blur the stronger eye and serve as an alternative when patching is difficult.
Consistency matters. Your child's vision often improves when they follow the prescribed patching schedule. Your doctor adjusts the plan at follow-up visits based on measured progress.
Your child may need surgery for strabismus, cataracts, glaucoma, blocked tear ducts, or other conditions. Pediatric ophthalmologists perform these procedures using techniques and instruments designed for smaller eyes. Most surgeries are outpatient, meaning your child goes home the same day.
Your doctor discusses the goals, risks, and recovery timeline before any procedure. Post-surgical care often includes eye drops, patching, and regular follow-up exams to track healing and visual development.
Children with progressing nearsightedness benefit from a coordinated approach that may include specialty contact lenses, atropine drops, and lifestyle guidance. Dr. Donahue co-manages these patients with our optometry team, which provides myopia control fittings and ongoing monitoring.
Co-management means more flexibility for families, with visits scheduled across our pediatric ophthalmology and optometry teams as your child's needs change.
What Happens at a Pediatric Eye Exam
Your doctor uses different techniques depending on your child's age. According to the Cleveland Clinic (2022), newborns receive red reflex testing and light response checks. Babies aged 6 to 12 months undergo eye-muscle-movement assessment. Children aged 3 to 5 receive visual acuity testing and color vision screening.
Pediatric ophthalmologists use toys, videos, and engaging interactions to examine children who may not cooperate with a standard adult exam. According to the AAO, many children do not even realize they are being tested during the exam.
Your doctor examines the outside of your child's eyes first. They check eyelid position, pupil size, and how each eye moves in all directions. A cover test helps detect misalignment by observing how the eyes shift when one eye is covered and uncovered.
Your doctor also checks how both eyes work together as a team. Binocular vision problems can affect depth perception, reading, and coordination. Detecting these issues early supports timely treatment.
Dilating drops widen your child's pupils so the doctor can examine the retina, optic nerve, and internal eye structures. The drops blur near vision and increase light sensitivity for several hours. Bring sunglasses for your child and plan for reduced close-up activities afterward.
According to the AAO (2022), the red reflex test performed in the newborn nursery can catch conditions like cataracts or retinoblastoma early. The dilated exam helps detect cataracts, retinal conditions, optic nerve abnormalities, and tumors that cannot be seen without dilation.
Your doctor measures your child's refractive error to determine whether they need glasses. For babies and young children who cannot read a letter chart, the doctor uses a technique called retinoscopy. They shine a light into the eye and observe how it reflects off the retina through different lenses.
Optical coherence tomography (OCT) captures detailed images of the retina when needed. Electroretinography (ERG) tests retinal function when conditions like retinal dystrophies are suspected. Your doctor orders only the tests relevant to your child's situation and explains each test before performing it.
Care for Special Populations
Premature babies receive eye exams in the neonatal intensive care unit to screen for retinopathy of prematurity. Dr. Donahue holds an active appointment at Women & Infants' Hospital, where care for premature infants includes ROP screening and treatment.
Continued follow-up after discharge is part of the care plan to monitor visual development as your baby grows.
Children with Down syndrome, cerebral palsy, and other developmental conditions have higher rates of eye problems and benefit from early specialist evaluation. Our South Kingstown location provides eye care for patients with special needs.
Pediatric ophthalmologists use child-friendly examination techniques to evaluate even the youngest patients and those who may not be able to follow standard exam directions.
Children with a family history of retinoblastoma, congenital cataracts, or genetic eye disease may need screening before symptoms appear. Premature babies and children with a family history of childhood eye conditions may need their first specialist visit during infancy.
The AAO and the Cleveland Clinic recommend that children have their first comprehensive eye exam by a specialist if there is a family history of childhood eye disease, if screening results are abnormal, or if you notice any concerning signs.
Care Across Rhode Island Eye Institute
Dr. Donahue cares for pediatric and adult strabismus patients at our Providence location at 150 East Manning Street. He also sees patients in Fall River, Massachusetts, where Rhode Island Eye Institute serves families across southeastern Massachusetts and nearby Rhode Island communities.
Our Providence office provides on-site optical and frames for children. Our South Kingstown office offers special needs eye care for patients who benefit from a quieter setting and additional support.
Many pediatric eye conditions involve multiple parts of the eye or connect to other health concerns. Rhode Island Eye Institute brings together fellowship-trained subspecialists in retina, cornea, oculoplastics, and glaucoma under one practice. Your child can be evaluated by a pediatric ophthalmologist and a fellowship-trained subspecialist when needed, without traveling to multiple practices.
Dr. Donahue coordinates with our retina specialists for retinopathy of prematurity, with our oculoplastic surgeon for complex eyelid and tear duct issues, and with our optometry team for myopia management and contact lens fitting in children.
Pediatric ophthalmologists work closely with pediatricians, neurologists, geneticists, and other specialists when eye conditions are part of a broader medical picture. Findings are communicated back to your child's primary care team so everyone involved in your child's health stays informed.
Request a written summary of each visit to share with your pediatrician. This keeps your child's full care team aligned on diagnosis, treatment, and follow-up.
Preparing for Your Child's First Visit
Bring any previous glasses or eye patches, a list of current medications, and records from your pediatrician or other eye care providers. If your child had vision screening at school or a doctor's office, bring those results too. If your child wears contact lenses, bring the most recent prescription and lens packaging.
Pack a favorite toy or comfort item for younger children. Snacks can help keep toddlers calm during wait times.
Talk to your child about the appointment in age-appropriate terms. You can explain that the doctor will look at their eyes using a bright light, and that eye drops may make things look blurry for a while. Reassure them that nothing will hurt.
Younger children respond well to role-playing the exam at home. Let them practice holding still while you shine a flashlight near their face. Avoid using words like 'shot' or 'needle,' since the exam does not involve either.
Dilating drops blur near vision and increase light sensitivity for several hours afterward. Bring sunglasses for your child and plan activities that do not require close-up focus for the rest of the day. Most children feel comfortable again within four to six hours.
If the appointment is in the morning, your child may feel more comfortable returning to school in the afternoon. Check with your school about their policy on returning after medical appointments.
Common Questions Parents Ask
Your pediatrician checks your child's eyes at every well-child visit from birth. If they find anything concerning, they refer you to a pediatric ophthalmologist. The AAO (2022) recommends that ocular health be assessed at each well-child visit starting at one month of age. Premature babies and children with a family history of childhood eye conditions may need their first specialist visit during infancy.
Watch for squinting, sitting close to screens, tilting the head, covering one eye, frequent eye rubbing, or complaints about headaches. Babies who do not track objects with their eyes by three months, or who have a white pupil, crossed eyes, or excessive tearing, should be evaluated promptly.
Constant eye misalignment in children older than four months does not resolve on its own. Intermittent crossing in newborns younger than four months is common and may be normal. If the misalignment persists, your child needs evaluation by a pediatric ophthalmologist to help prevent amblyopia.
This depends on the condition. Some children outgrow their refractive errors as their eyes mature. Others need glasses or contact lenses through adulthood. Your doctor reassesses the prescription at each visit and adjusts the plan as your child grows.
Pediatric eye surgery has a strong safety record. Your ophthalmologist and anesthesiologist have specialized training in caring for children. Complications are uncommon, and your doctor explains all potential risks before the procedure.
Extended close-up work, including screen use, is associated with increasing rates of nearsightedness in children. Encourage breaks every 20 minutes, outdoor play for at least one to two hours daily, and appropriate viewing distances. Your eye doctor can provide specific guidance based on your child's age and visual needs.
Plan for about one to two hours. The exam itself takes 30 to 45 minutes, but waiting for eye drops to dilate the pupils adds time. Bring activities to keep your child occupied during the wait.
School screenings check basic visual acuity but can miss conditions like amblyopia, mild strabismus, or eye health problems. If your pediatrician or family doctor recommends a referral, follow through even if the screening appeared normal.
A pediatric ophthalmologist is a medical doctor trained in both medical and surgical treatment of eye conditions. A pediatric optometrist provides vision testing, prescribes glasses, and manages non-surgical eye conditions. Your child may see one or both depending on their needs.
Many pediatric ophthalmologists continue to see patients into their late teens or early twenties. The transition to an adult provider depends on the condition, the patient's maturity, and the availability of adult specialists experienced with the specific diagnosis. Your doctor helps plan the transition.
Building a Foundation for Healthy Vision
Schedule regular eye exams, follow your doctor's treatment plan, and contact a pediatric ophthalmologist if you notice any changes in your child's vision or eye appearance. Early care supports your child's visual development during the years when their vision is most responsive to treatment.
Your child's first eye appointment is the start of a lifetime of eye care. Encourage outdoor play, limit prolonged screen time, and keep up with regular eye exams. Following through on patching, glasses, and follow-up visits supports clear, comfortable vision as your child grows.
Healthy eyesight supports learning, play, and confidence at every stage of childhood. Our pediatric ophthalmology team is honored to partner with you in protecting your child's vision and walking alongside your family from infancy through the teenage years.
If you have questions about your child's vision, eye alignment, or eye health, talk to your pediatrician about whether a referral to a pediatric ophthalmologist makes sense. Early evaluation gives your child a strong foundation for healthy vision development.