How to improve your child's eyesight

Get your child's eyes checked for problems by an opthalmologist. - Photo © iStockphoto.com / dblight

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.