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| Get your child's eyes checked for problems by an opthalmologist. |
By BRIGITTE ROZARIO
More children today suffer from myopia compared to 20-30 years ago. It's not because they don't eat enough carrots. A lifestyle that includes extra classes, tuition, more homework, more TV, computer games, handheld gaming devices and tablet PCs is what really affects the children's eyes and is detrimental to their vision.
According to consultant opthalmologist Dr Khaw Hoon Hoon, the most common eye problem in Malaysian children is short-sightedness or myopia.
Myopia
“It is more common today because children are now starting kindergarten from a younger age. From the time they are small, parents put them in front of the TV; it's the easiest way to manage children. They are starting to look at the TV screen from a younger age and they spend long hours just staring at the TV, thereby increasing eye strain.
“These days, children start going to daycare from the age of three or four. And, when they are home, they play a lot of videogames. Those are actually not good for the child. A child should be out playing in the field, which is what we used to do when we were small.
“If you compare the population in rural areas with the one in urban areas, the rate of myopia is lower in the rural areas than in the cities,” explains Dr Khaw.
She says children normally start wearing spectacles from the time a vision problem is detected, some as young as three years old. She explains that those cases are usually the ones with congenital problems - pre-existing problems in the eye.
However, for those whose eyesight deteriorates due to lifestyle and environmental factors, normally the earliest they would start wearing spectacles is age five or six.
Amblyopia
Another eye problem in children is lazy eye, or amblyopia. This is when the child has less fibres in the optic nerve or the optic nerve is narrower than normal. That means whatever corrections (lenses) you put in front of the cornea, even if the light is well focused in the retina, the information doesn't cross over and go to the brain. So, that means this eye will have reduced visual acuity.
According to Dr Khaw, before a child is diagnosed with amblyopia, everything else must be tested and corrected first. This is one eye condition that is diagnosed by a process of elimination.
“We must actually correct everything else first. That means, first of all we must bring the light to focus on the retina, check the eye and make sure there is no disease in the cornea, lens or retina, and check the brain scan to make sure they are well. If all of these come out negative, the only thing left is the amblyopia which is due to the nerve fibres itself.
“It is a process of elimination.
“So, once we have diagnosed that the patient has no other pathological problem in the eye, then we say that the child is having amblyopia or lazy eye.”
She says that the treatment for this is visual therapy. The younger the child is, the better it is and the easier therapy will be.
“We might patch the good eye and train the lazy eye to see. Nowadays, there are also computer programs that help with visual stimulation. These are graded to help the patient know which level they are at in the process of healing. It's like physio therapy but for the eye.
“The younger the child is, the better the chance of success,” she explains.
Dr Khaw clarifies that diagnosing lazy eye is not as simple as just looking at the eye or the child's power and saying that he has lazy eye. There is a complex and comprehensive list of tests and scans that need to be done first before a child can be diagnosed as having lazy eye.
She explains that in the past, children have been misdiagnosed as having amblyopia just because they might have a power of 500 on one side and a power of 200 on the other side. A sizeable disparity in power in both eyes does not mean a child has amblyopia.
Nystagmus
The third, but less common problem, is wandering eye or nystagmus, which is very much a medical problem.
A child with good eyesight will have a good alignment of the eyes so that the image that each eye sees is slightly different and these images overlap and the brain picks up this image.
A child with nystagmus will have a jerking movement of the eye and poor vision as a result of a cataract problem, nerve problem, congenital or even malformation of the nerve. It typically develops before the child is even three months old.
“If you can correct anything before three months old, then it will be fully corrected and the eye will start focusing again. But, how often do we know and how can we detect it in a child before the age of three months old?
“Nystagmus is always diagnosed very late. By the time we detect it, most of them don't see well.
“Depending on the cause, that's how we treat it. If it's cataract, we remove the cataract. But, if it's a congenital problem like malformation of the nerve, there's nothing much we can do.
“We will do whatever we can and hopefully the child will develop some useful vision.
“You will notice the eye jerking, but usually detection is late.
“Usually, if your child is three months old, you would notice if the child does not see you. If you call the child and he is not looking at you, and he's not interested in anything else, you have to start suspecting something is wrong,” she adds.
Strabismus
The last problem that Dr Khaw sees in children is strabismus or cross-eyed. This is when the eyes are out of alignment. One eye may be looking at you and the other eye is looking somewhere else. There are many causes of strabismus. It could be congenital (the child could be born cross-eyed), it could be developmental or the child could be having refractive error. Most of them are hyperopic – the opposite of myopia. They have a very short eyeball so the light focuses behind the retina.
In such a case, the child would need to wear very convex lenses.
“If you correct that, you find that the eye pops straight to the centre,” says Dr Khaw.
She explains that in the worse case scenario for strabismus, if the eye cannot be corrected by spectacles or any medical therapy, then the child might have to go for surgery. This would be followed up with therapy to keep the eyes aligned.
Whatever the problem is, Dr Khaw urges parents to bring their children in for an eye checkup with an opthalmologist.
General symptoms
What should parents be looking out for when it comes to vision problems?
“First of all you have to notice your child – is your child sitting very close to the TV? And, if you put the child farther, are they no longer interested in the TV? Is your child squinting to see? If your child is squinting it could be astigmatism. Or, is your child tilting her head back to see?
“Parents should notice all these things.
“Some parents, after noticing, still wait six months or a year. In that time, the child's eyesight will become worse because he is straining to see.
“Another thing a lot of people miss out on is checking one eye at a time. A child will never tell you that they can't see in one eye because both their eyes are always open. They never read with only one eye open.
“A child's eyes should be well aligned and he should have equal vision in both eyes,” she explains.
Dr Khaw advises parents to get their child's eyes checked at an opthalmologist, if they can. This is to avoid problems in getting wrongly prescribed lenses. For unco-operative children, the opthalmologist would be the best bet, rather than an optician in a shop.
If the prescription is under-corrected, the child's vision will still be blur. If it is over-corrected, the child will be dizzy all the time and they would be straining their eyes to see things.
Going to an opthalmologist will ensure that the child's eyes are checked properly for other possible problems and the child will be given a followup date for the next checkup.
“One pair of spectacles is not for life. You would need to come back in to check your power in three months to a year's time, depending on the power and the age of the child. The child will never tell you that they can't see because their power has gone up. If you don't get their eyes checked, they will just wear the same spectacles for the next 10 years!” warns Dr Khaw.
The onus is on the parents to bring the child in to an opthalmologist for an eye checkup.
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| Dr Khaw: 'The more you strain, the higher your power will be.' |
Dr Khaw warns parents against undercorrecting their child's vision.
“Always give them the full correction so that they see clear and sharp images. Encourage them to wear their spectacles all the time. What happens when you remove your spectacles? Your vision is blurred, and then you will just strain your eyes to see.
“The more you strain, the higher your power will be.
“So, always wear your spectacles except when you're bathing and sleeping.
“Do not listen to the older generation who say that the more you wear your spectacles, the thicker the spectacles will be. It's not true.
“For astigmatism, I do encourage them to wear their spectacles all the time if their power is very high (more than 300). If it's less than 100, I don't prescribe spectacles as I think they can just squint,” she says.
She warns that there are also malingering children who pretend to not be able to see the blackboard to get out of doing school work.
If they can't see from far, and when they go to the front, they still can't see, then you know they are malingering.
Some of them want to wear spectacles because all their friends wear spectacles.
Slow down the rate of increase
Is there relief from a child's power increasing?
According to Dr Khaw, a child's power will eventually stop increasing, usually at the age of 14 or 15.
“We cannot stop the progression but we can reduce the increment. There are many ways to do this,” she says.
Here's how a child's power increment can be slowed down:
- Take your child for regular eye checkups as scheduled by the opthalmologist. If you don't, the child's power might have gone up and the child might still be wearing the same spectacles with the wrong power. This will cause the child to strain just to see. Always give them the full correction so that they won't have to strain much.
- Using rigid gas permeable contact lenses gives the child sharper clearer vision so that the child does not strain the eyes so much. It's a semi-hard lens.
- Ortho-K, or Orthokeratology, is a lens which is larger than the size of the cornea. The child would wear it at night to sleep so that it presses the cornea down. In the day time, when the Ortho-K contact lenses are removed, the child will be able to see well. However, this is expensive and takes a period of time to get to the desired reduced power. The results so far have been very good. However, Dr Khaw says that once the lenses are no longer used, the power returns to what it was.
- Minimise time watching TV and playing videogames, cut down on tuition and extra lessons. Get better lighting, practise better posturing, and when it comes to the computer, don't strain the eyes so much.
“The computer rays itself don't harm the eyes, but it's the prolonged usage that will be bad. It's the same with the TV; even if it's so far away, you are still staring at the screen.
“You can't stop the child from watching the TV or playing videogames, but try to minimise usage and straining.”
Contact lenses
While Dr Khaw says there is no minimum age for wearing contact lenses, she warns parents that their child should be of a responsible age to ensure they clean their lenses properly and don't fall asleep with them on. If the child is too young and still insists on wearing contact lenses, then the onus is on the parents to make sure good hygiene is practised and that the child remembers to remove them.
If the contact lenses are not cleaned or if the kids share contact lenses (something not unheard of), or if they are worn to sleep, there is a risk of infection.
“Don't leave them on overnight, clean your hands before handling contact lenses, don't swap lenses with friends, don't buy cheap lenses …. These are all the frequent practices among teenagers,” warns Dr Khaw.
Lasik
Can Lasik (laser-assisted in situ keratomileusis) be done on children? (Lasik is a type of refractive surgery to correct myopia, hyperopia and other such conditions.)
Dr Khaw explains that Lasik cannot be done on children as their power is still increasing.
In addition, the patient will need to be alert and they will have to follow instructions like looking at a certain direction during the operation; it's harder to get children to do this.
In the womb
While Dr Khaw says there is nothing much a pregnant mother can do to improve her unborn child's eyesight, she does ask mothers to be wary of getting infections like rubella and herpes while pregnant. These can result in congenital problems in the eye.
Apart from that, after delivery is the best time to take care of the child's eyesight.
“Spend more time with the child and play with the child instead of putting him in front of the TV,” she says.
Nutrition
Dr Khaw explains that your diet cannot improve your vision.
While she says eating carrots to improve vision is not a myth, she explains that vegetables contain vitamins A and C which are good for the eye for the lubricants and the cornea surface. Vegetables also contain lutein which is good for the photoreceptors.
“Lutein and vitamins A and C are all found in our normal diet. We have more than enough food in Malaysia to give us all the vitamins that we need. We do not need additional supplements for our eyes, provided that we do not go and strain them.
“Our eyes are healthy but due to our environment and lifestyle, we strain our eyes.
“It is not necessary at all for a child to have any additional nutritional products for the eyes.
“If you notice any problems, bring them in to see an eye doctor. If not, then when they start going to school, at four or five, would be a good time to get their eyes checked for the first time,” says Dr Khaw.
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