Focusing on eye health

Jordan Wong was just 10 when her vision started to blur. Her mother dismissed her complaints, assuming that her daughter just wanted attention.

However, Wong’s uncle realised her plight and brought her to the optician’s, where she was prescribed reading spectacles for myopia (short-sightedness).

However, the refractive error squint of her eyes increased over the years.

Now, age 30, she wears contact lenses for an optical power of minus 700 diopters. If you were to hold an apple 10cm from her face, all she will see without wearing glasses is a fist-sized mass of red.

Many parents have expressed their concern about their children’s progressive myopia, where, like Wong, their vision deteriorates to the point that they are totally dependent on visual aids.

“Start with taking note of tell-tale signs in children such as their going very close to the TV or tipping their head and squinting very hard and long, ” Dr Yen Siew Siang, a consultant ophthalmologist who runs a private practice in Kuala Lumpur, urges parents.

Reading while lying down, under poor lighting, or holding the book too close to the face – we know to avoid these habits; yet they don’t account for concrete proof as cause of progressive short-sightedness. Nor will curbing these habits promise to limit myopia.

Dr Yen says according to a local study, myopia increases consistently with age; approximately 10% in seven-year-olds and 34% in mid-teenagers.

“Children who lean in very closely to their work, books or computers tend to be associated with myopia more than others,” explains Dr Yen. “But apart from that, there is no conclusive link between genetics and environmental factors with deteriorating eyesight.

“Furthermore, young children are often unlikely to express their needs. Thus, it’s important for parents to be sensitive to what their children are saying,” she adds.

Severe squint

Refractive error squint (esotropia) is a relatively common problem. It is essentially a condition caused by a misalignment of both eyes, making the person unable to look in the same direction. The misalignment may present itself sporadically or throughout the day.

Susan Lee, of Kuala Lumpur, was perplexed when she found her two-year-old daughter Faye struggling with the condition.

Her eyes would roll apart and appear unfocused most of the time.

“We consulted an ophthalmologist, who confirmed that Faye had congenital squint, and prescribed her corrective prism lenses,” Lee, in her 40s, says. “We were informed that surgery would be necessary if the glasses didn’t ‘fix’ her problem.”

Keeping glasses on a reluctant toddler was a big challenge for both working parents, but the family worked together to help the child. By age six, Faye’s vision hadn’t improved to a satisfactory level. She needed surgery, followed by intensive therapy.

“She was seven by then and we spent the year shuttling between home and eye therapy in the heart of Kuala Lumpur. It was stressful for us but we were able to stop after a year,” Lee recalls. (The sessions comprised eye exercises to help recuperating squint sufferers use their eyes better.)

Today, nine-year-old Faye wears ordinary myopia spectacles to school (for reading, mostly) and corrective prism lenses at home. If you were to look at her directly, you’d hardly be able to tell that she’d once had severe squint.

“She’s cheerful and confident. Nothing in the past with her visual problems has fazed her. We’ve taught her what to say to strangers and friends who express their curiosity over her prism glasses,” Lee says. “So when people ask, she simply replies that she sees better with them.”

Dr Yen emphasises the need for early detection. “If the problem goes untreated, the disorder digresses into amblyopia, otherwise known as the lazy eye syndrome.” (Lazy eye is a visual disorder in which the brain partially or wholly ignores input from one eye; it can be a congenital condition.) Since the disorder is caused by overstretched muscles in the sockets, the patient’s eyes would have adapted to the inborn flaw.

“Untreated, it becomes permanent. It’s difficult to treat once the child reaches seven years of age,” Dr Yen warns.

Lazy eye syndrome or amblyopia is harder to treat once the child is seven years of age. Ewe Shing Yen, who has amblyopia, is seen here during orientation at Tunku Abdul Rahman College, Penang, in 2010.

Lazy eye

Fortunately for Selangor local James Qin Chitty, his congenital “lazy eye” condition was detected early.

The four-year-old (then) was at the clinic with his mother when the paediatrician noticed an oddity in the child’s visual response to his environment. Instead of looking directly at the object, the young boy would tilt his head slightly to one side and peer through the corner of his eye.

“Have you considered bringing him to an eye specialist?” the paediatrician enquired.

It hadn’t occurred to 44-year-old Jacky Ong, owner of a consulting firm, that her son might have a problem with his eyes. After all, he was healthy and the newfound “problem” was barely noticeable.

A trip to the ophthalmologist’s confirmed James’ problem - long-sightedness and amblyopia.

“It was only after James was diagnosed that we realised that amblyopia runs in our family. My sister-in-law and nieces have it too,” Ong says.

James' lazy eye problem was discovered and treated when he was just four years old. Now, 10, he continues to wear his reading glasses to keep his vision focused.

The boy was prescribed corrective spectacles (to force both eyes to focus correctly) and half-yearly visits to the ophthalmologist for monitoring. The sprightly kid is now 10 and his eyesight has improved.

“Thank God for medical advancement today. In our time, most of these eye conditions went undetected and those children are now adults with severe lazy eye problem. We’re fortunate that James’ condition was found early,” Ong says gratefully. “We monitor his activities, he’s doing well and the doctor has noted an improvement.”

Serious conditions

Compared to myopia, lazy eye has a lower occurrence rate of 2% of children’s eye problems. Even less common but more severe eye problems that affect young children are congenital cataract (opacification of the lens that’s usually diagnosed at birth) and glaucoma, an eye disease that can damage the optic nerve.

With congenital glaucoma, the child experiences great discomfort from excessive tearing, sensitivity to light, spasms, cornea haze or abnormally enlarged eyes (nystagmus). If the doctor determines the cataract to be vision-threatening, lens implant is prescribed. Early-detected glaucoma patients usually start with eye-drop treatment, but if that does not work, corrective surgery will be necessary.

“Although occurrence is low, both congenital conditions are almost totally unpreventable,” says Dr Yen. “The only measure a mother can take is to receive complete vaccination – especially against Rubella – prior to pregnancy.”

Unfortunately, there is a lethal condition that even vaccination cannot prevent: Retinoblastoma (abbreviated as RB), a savage and aggressive cancerous tumour that grows in the retina cells. It also accounts for 3% of cancers in children, with leukaemia being the most common.

RB affec ts one in 14,000 to 20,000 live births, depending on the country.

“It is caused by genetic mutation. We don’t know the cause for mutating genes in the body, not even if malnutrition plays a part. Parents whose child is suffering from this cancer must undergo genetic counselling, where child planning is discussed,” Dr Yen explains.

“If the first child is born with the disease, there’s a good chance that subsequent births will be affected, too. It’s called hereditary occurrence, although most times, we see this mutation develop in a child whose family has never had eye cancer. Through the counselling, some couples eventually decide not to conceive again.”

Displaying images of young victims of the life-threatening condition, Dr Yen points out that their retinas appear cloudy and spotted, and in the more severe cases, the eyeball is completely consumed by the tumour that presses heavily on the child’s face.

“The tumour grows behind the eye. If it reaches the brain, it can kill the child,” the ophthalmologist adds.

Depending on severity, treatment ranges from chemotherapy reduction and radiation to complete removal of the affected eye.

“Some parents aren’t able to stomach such news and choose to seek other channels of help, such as the 'bomoh' (shaman),” Dr Yen reveals. “By the time they get back to us, the cancer would have advanced. We know that it’s a difficult decision to make but this is a choice between losing an organ and life.”

The good news is that early detection would give infants and young children a higher chance of survival.

“In any case, early detection is key. Bring your babies and young children in at least once a year,” Dr Yen advises.


Potential eye health problems for children can be detected through a quick visit to the optometrist before primary school and subsequent annual check-ups at the ophthalmologist, until they reach 12 years of age. 

Dr Yen ... watch out for signs that indicate weakened eyesight in children.

“Essentially, children can’t express their needs clearly enough, so if they mention that they can’t see, don’t ignore them even if they seem fine. Your investment in their eye health will go a long way,” Dr Yen says.

As for the diet aspect of things, researchers have yet to find a direct link between specific nutrients and good eyesight and eye health.

“Plant pigments lutein and zeaxanthin, however, have been associated with eye care although, again, evidence is inconclusive. It’s also been suggested that lutein is found in breast milk,” says consultant dietitian and International Medical University adjunct senior lecturer Goo Chui Hoong, who co-writes the column You & Eye in The Star’s Fit4Life pullout with eye specialist Dr Fong Choong Sian.

“Having said that, another study was done to ascertain that breastfed children were less prone to myopia as compared to children who weren’t. The results were negative,” says Goo.

As for eye cancers, she points out that genetics and environmental factors, rather than diet, are key here.

“Eye cancers – and other cancers, for that matter – are the result of prolonged exposure to free radicals,” she says. “You can help your children by incorporating antioxidant-rich foods such as fresh vegetables, especially deep-coloured, yellow and orange ones.”

Better safe than sorry

Children’s eye injury might seem unlikely, especially if your family lives in a safe environment, but preventive measures will go a long way.

Recently, I visited my friend Tina at her house. They were packing for a short trip and Tina’s attention was focused on her eldest child Michelle as she helped the girl sort out her clothes. Her two younger sons, Roy, three, and John, one, were left to entertain themselves in the same room.

As Roy pranced about, I caught sight of a mechanical pencil that he’d been holding on to. He leapt onto his sister’s bed and began jumping, hollering at the top of his lungs, his hand with the sharp object flailing. As he made his final leap, he landed heavily on his front (on the cushion), the pointy tip of

the pencil missing his eye by several inches.

“That’s exactly the sort of thing that happens very often. Just last month, I operated on a boy in a similar situation. A piece of pencil lead had gotten lodged in his eye while he was playing in school and no one knew until his parents picked him up in the afternoon,” relates eye specialist and Universiti Malaya Medical Centre associate professor Dr Fong Choong Sian. “I found the nib in the centre of the boy’s eye where there is no blood flow, hence he didn’t feel the discomfort enough to alert his teachers

about it.”

The poor boy lost complete sight in that eye.

Parents and guardians always want the best for their children, however, injuries still occur.

“There is just a lack of awareness on the adults’ part when it comes to potential dangers that prevail even in a seemingly ‘safe’ environment.

“Sharp edges such as dining tables can be hazardous to young children, who sometimes walk straight into them (at eye level),” Dr Fong warns. “Use protection devices for furniture corners and never leave sharp objects lying around.”

Additionally, there are other precautionary measures to take, as done in developed nations like Britain, where Dr Fong was formerly based.

“In Australia, children are strongly encouraged to wear proper sunglasses with UV protection when they go out to play. We ought to do the same here.

“You don’t need to spend too much on them; fairly good quality with UV protection will do. Just keep away from the cheap 'pasar malam'-type (night market-type) , as those don’t offer any protection from the sun,” advises Dr Fong.

“Parents should also be aware of the cosmetic contact lenses that are being sold to children. These lenses are usually coloured, or come with the claim to make the eyes appear larger,” he continues.

“We have had so many teenagers come to us with eye infection from using those products, which are sold openly for about RM20 a pair. Kids are even exchanging their lenses with friends at school.”

He stresses that a child who wishes to wear contact lenses should only do so under adult supervision.

“We don’t recommend it, except in special cases where myopia is very high. However, we have applied them onto babies who are born with congenital refractive error and would not be able to see properly otherwise.

“Potential severe eye health problems for children can be detected early through regular trips to the optometrist and ophthalmologist. Many people tend to have the misconception that their young children will be made to read the alphabet charts. We actually just want to ensure that they have good three-dimensional vision, and we have methods for that.”

Finally, Dr Fong reminds parents of the need to beware of eye trauma.

“Baby-proof sharp corners and stow away objects that can potentially hurt your children. Don’t expect them to know any better because they won’t.”

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