What Can My Baby See? Vision in the First Year

“What can my baby actually see?” is one of the questions we hear most often at Vision & Learning Center. It is easy to picture a newborn going from the warm darkness of the womb into a loud, bright, blurry world and being overwhelmed by it. The research paints a calmer picture. Babies arrive with a small but working set of visual skills, and they start using them right away. How a baby uses those skills — whether they look, follow and hold a gaze — is one of the first things we pay attention to.

Here is what the first twelve months actually look like, and what is worth a phone call along the way.

Key takeaways

• Newborns see light, motion and bold light-dark patterns, and they follow face-shaped patterns from the first minutes of life.
• Detail vision is poor at birth and improves fast, reaching close to adult levels of grating resolution by around 8 months on some measures.
• Color discrimination builds gradually across the first three months.
• Depth perception from the two eyes working together (stereopsis) appears around 4 months and keeps refining for years.
• Most babies are not born with blue eyes, and most babies are farsighted, not nearsighted.
• The AOA recommends a first comprehensive eye examination between 6 and 12 months.

The newborn weeks: light, contrast and faces

A newborn detects light, gross shapes and movement. Fine detail is not there yet, and neither is much contrast sensitivity — which is exactly why babies stare at bold black-and-white patterns and at the high-contrast outline of a face against hair. Both resolution and contrast sensitivity climb steeply over the first three months (Banks & Salapatek, 1978).

Faces get special treatment from the very start. In a classic study, forty newborns with a median age of nine minutes turned their eyes and heads to follow a proper face pattern more than they followed scrambled versions of the same features (Goren et al., 1975). Your face, held close, is the most interesting thing in the room.

How a scene looks as acuity develops over the first year

How sharp is newborn vision, really?

Acuity in a baby is measured in one of two ways. One records the brain’s response to striped patterns. The other simply watches which way a baby chooses to look.

Those brain recordings put grating acuity at roughly 4.5 cycles per degree in the first month. Cycles per degree describes how fine a striped pattern the visual system can still make out, and a bigger number means finer stripes: at 4.5, only bold wide bars register; at 20, the pattern can be far finer. By 8 to 13 months babies reached about 20 cycles per degree — and by 8 months they were statistically indistinguishable from adults tested on the same equipment (Norcia & Tyler, 1985). Behavioral looking tests are the clinical counterpart. Teller Acuity Cards, which we use to check babies who cannot read a chart, have published norms running from 1 month to 4 years of age (Mayer et al., 1995). Whichever method is used, the direction is the same: blurry at birth, dramatically better within months.

One correction to a very common claim. Babies are usually farsighted, not nearsighted. In 514 healthy term-born children, hyperopia (farsightedness) was the norm and declined steadily with age. Myopia turned up in only 3%, and astigmatism of a diopter or more was most common in infancy (Mayer et al., 2001). Early blur is mostly an immature retina and visual brain, not a mismatched eyeball.

Focusing is imprecise early on too. In 1- to 3-month-olds the limits come mainly from sensory immaturity and a wide depth of focus, not from a weak focusing muscle (Banks, 1980). In practice that means a broad range of near distances all look about the same to a young baby. Holding your face close is still good advice; it is just not a precise eight-inch rule.

Two to four months: eyes team up, hands join in

Now a baby holds gaze longer, follows moving faces and objects with both eyes together, scans between several targets, and starts moving the eyes independently of the head. The American Optometric Association puts the milestone plainly. Babies should begin to follow moving objects with their eyes, and reach for things, at around three months. Eye-hand coordination develops as the infant tracks a moving object and reaches for it (AOA, Infant Vision). The aim is poor at first — that is normal. Looking, reaching and grasping train each other.

Alignment matters here. The American Academy of Ophthalmology notes that for the first two months the eyes often do not work together well, and may appear to cross or wander. By three months they should be working together to focus on and track an object (AAO, Vision Development: Newborn to 12 Months). A drift that persists after about four months, or an eye that always turns, is worth checking rather than waiting out.

Color arrives gradually

Color vision is not a switch that flips. Researchers test it with habituation: a baby is shown one color until interest fades, then shown a new one, and the researchers watch whether the change wins that attention back. The colors are matched for brightness so a baby cannot pass by noticing that one patch is simply lighter or darker. Tested this way, one-month-olds could tell red from green, but not either of those from yellow. Two-month-olds added green from yellow, and only at three months did red from yellow appear (Adams & Courage, 1995). A broader review concluded that color vision improves greatly across the first three postnatal months, and that most typical three-month-olds have at least some color vision. Much of the early limitation comes down to general insensitivity to contrast rather than to color itself (Brown, 1990).

Four to six months: depth perception arrives

Two eyes pointing at the same spot give the brain the small disparity it needs to build a three-dimensional view. Stereopsis first became demonstrable at a mean age of 16 weeks. By a mean of 21 weeks, stereoacuity reached 1 minute of arc or better (Held et al., 1980). A minute of arc is one sixtieth of a degree: a very small mismatch between what the two eyes see. On this scale, a smaller number means a finer sense of depth. The AOA puts it similarly: depth perception is not present at birth, and it is around the fifth month that the eyes become capable of a three-dimensional view (AOA, Infant Vision).

The visual cliff, the classic laboratory test of infant depth perception

The famous visual cliff is often described as showing that babies “learn” depth once they crawl. The stronger finding is the opposite. Infants younger than crawling age produced reliable heart-rate deceleration when placed on the deep side, and not on the shallow side (Campos et al., 1970). In other words, they could already tell the two sides apart. They simply had no way to crawl away from the drop yet.

Depth perception is not finished in infancy, either. Stereoacuity keeps sharpening from about 100 arcseconds at age 3 to 40 arcseconds by age 7 (Birch et al., 2008). An arcsecond is one sixtieth of a minute of arc, so the average 7-year-old is picking up depth differences about two and a half times smaller than the average 3-year-old. Better stereoacuity also tracks with better fine-motor performance on tasks such as pegboards and bead threading (O’Connor et al., 2010). That is one reason we care how the two eyes work together, not only how each one reads a chart.

Six to twelve months: seeing to move

In the second half of the first year, vision becomes a whole-body activity. To look at something a baby has to orient the trunk, turn the head and point the eyes. Sitting, crawling and walking each change what is reachable and what is visible — eye height and head mobility literally change the view. The AOA marks the same shift: crawling at about 8 months “helps further develop eye-hand-foot-body coordination,” and by 9 to 12 months babies “can now judge distances fairly well and throw things with precision” (AOA, Infant Vision). This is where vision, balance and movement begin negotiating with each other, and it is the foundation for the visual-motor skills we assess later in childhood (more in our post on visual milestones).

About those blue eyes

Here is the myth we correct most often: babies are not all born blue-eyed. Among 192 healthy full-term newborns photographed with a standardized camera, 63.0% had brown irises, 20.8% blue, 5.7% green or hazel and 9.9% indeterminate (Ludwig et al., 2016).

The same baby’s eyes from four days old to five months

What is true is that iris color can change over the first months as melanin is laid down. The AAO’s newborn-to-12-months guide says that at about 9 months a baby’s eye color is probably final, while adding that slight changes later are not uncommon (AAO, Vision Development). Longitudinal data adds a larger caveat. Most people had stable eye color by age 6, but 10 to 15% of the white subjects in the Louisville Twin Study changed further through adolescence and adulthood (Bito et al., 1997). And the old “two blue-eyed parents can’t have a brown-eyed child” rule is not how the genetics work. Iris color is polygenic, with roughly 74% of the variance traced to a single region of chromosome 15 (Sturm & Larsson, 2009). We go deeper in the evolution of eye color in babies.

When should a baby’s eyes be examined?

Two schedules coexist, and it helps to know which is which.

• Pediatrician screening. Under AAP policy, visual assessment starts in the nursery with external inspection and the red reflex. Instrument-based screening is then attempted between 12 months and 3 years and at annual well-child visits, and a child who fails is referred on (Donahue & Nixon, 2016). The US Preventive Services Task Force recommends screening at least once at ages 3 to 5 for amblyopia and its risk factors. It found the evidence insufficient to recommend screening under age 3 (USPSTF, 2017).
• Comprehensive examination. The AOA recommends a first comprehensive eye and vision examination between 6 and 12 months. After that it recommends another between 3 and 5 years, one before first grade, and annual exams from then on (AOA pediatric guideline, 2017).

Our clinical perspective at Vision & Learning Center is that both belong in a child’s life. Screening catches a great deal, and a full examination looks at things a screening is not designed to find. A baby exam does not require reading a chart. We check fixation and following, eye alignment, pupil responses and eye health, and we measure the focus of each eye with retinoscopy while the child sits on a parent’s lap.

Signs worth a call before the next milestone

• A white, dull or unusual reflection in the pupil in photographs
• An eye that consistently turns in or out after about four months
• No following of faces or objects by three months
• Constant tearing, crusting, redness or strong light sensitivity
• A droopy eyelid that covers part of the pupil
• Shaking or jerking eye movements
• A family history of childhood strabismus, amblyopia, cataract or retinoblastoma

The AOA lists several of these as signs of possible eye and vision problems in infants: excessive tearing, red or encrusted eyelids, constant eye turning, extreme sensitivity to light, and the appearance of a white pupil (AOA, Infant Vision).

None of these means something is wrong; each means we would rather look. For context, in a Los Angeles population study of African American and Hispanic/Latino children aged 6 to 72 months, strabismus was found in 2.4 to 2.5% and amblyopia in 1.5 to 2.6%. Most of the amblyopia — 78% of it — was traced to refractive error (MEPEDS, 2008). Those two conditions, an eye that turns and an eye that does not develop clear sight, are what our amblyopia and strabismus care is built around. Age does matter for amblyopia treatment, though not as a cliff. Pooling four randomized trials, children aged 7 to under 13 were significantly less responsive than younger children, and yet “some children show a marked response to treatment” at that age (Holmes et al., 2011). In a trial of 507 children aged 7 to 17, 53% of the 7- to 12-year-olds responded to patching plus near activities, versus 25% given glasses alone (PEDIG, 2005). Earlier is easier; later is not hopeless. Our parent’s guide to common eye problems in babies 0-18 months covers each in more detail, and milestones for visual-spatial development covers what comes next.

If your baby is between 6 and 12 months, or if anything on the list above sounds familiar at any age, we would be glad to take a look. Learn what happens at a comprehensive eye examination, or Schedule an evaluation at our Boynton Beach or Boca Raton office.