Our children are at higher risks of being short-sighted than before. Our modern-day lifestyles and living in today’s digital age doesn’t help. When I take a quick glance around the schools of my own children, I see many young ones already wearing glasses. One of mine included!
Myopia, or short-sightedness, is a significant health concern. It can lead to irreversible vision loss if left uncontrolled. Good vision is crucial for normal development of a child, as it aids them in the learning and acquisition of other life skills. As parents, we play a part in ensuring they maintain good eyesight.
Recently, we had an insightful moment with Dr Malisa Ami who shared guidance to care for our children’s eye health. Continuing where we left off, she now shares with us the low-down on eye health.
Dr Malisa is an eye Doctor and Surgeon with special interests in Cataract, Children’s Eye Health and Squint. She’s passionate in increasing awareness on eye health and improving vision for all.
She’s an Ophthalmologist at Sunway Specialist Centre Damansara.
First, Let’s Talk About Eye Tests
Q1: Dr Malisa, how often should one’s eyesight be tested?
To start with, newborns should have eye inspection by experienced health personnel to look for congenital eye problems such as cataracts. Then, at the age of six months to one year, another eye inspection is required to check for squints and steady fixation and following of eyes to a target.
For children aged three to five years old, it is recommended that they get a formal eyesight test by experienced optometrists or ophthalmologists, which should include a check for squints. Another eyesight test should then be performed when the child enters school around seven years old, or whenever there is any concern regarding the child’s vision.
In adults, a formal eyesight test is recommended anytime when there is persistent drop in vision, and once we reach 40 years of age. Subsequently, annual checks are recommended from the age of 50.
For someone who has a family history of glaucoma, they need to get the eye pressures checked once at the age of 35, followed by annual eye pressure checks.
Q2: Many optical shops offer free eyesight tests. Are these tests accurate?
It depends what the tests are for. Visual acuity, or eyesight test, is pretty much standard and accurate. Tests for short-sightedness can be done using machines, called autorefractors, or they can be done manually.
Estimation of spectacle power using an autorefractor can be under or over estimated. Therefore, any need for glasses should be rechecked by a qualified optometrist who will perform a refraction test which is done manually.
Cycloplegic refraction should be performed for children below six years old as they have very strong accommodation, which can under or overestimate the spectacle power. This is usually done at an eye clinic as special eyedrops need to be prescribed. Other tests using machines may be regarded as screening tools and any diagnosis should be confirmed by an ophthalmologist.
Short-sightedness And Treatment Options
Q3: Is short-sightedness reversible?
This depends on whether someone has pseudomyopia or true myopia. Pseudomyopia that occurs due to accommodative spasm can be reversed by cycloplegic eyedrops and minimising prolonged near work. However, true myopia caused by anatomical changes of the eye, such as a long eyeball cannot be reversed.
Having said that, large studies have shown that environmental factors such as reduced outdoor time and high amount of near work cause myopia. Therefore, exposing your child to outdoor time of at least two hours a day and reducing the amount of near work can prevent myopia. Additionally, there are treatments that can slow down the progression of myopia. The most effective treatment is low-dose atropine eyedrops, followed by peripheral myopic defocusing lenses and orthokeratology contact lenses.
Q4: What is orthokeratology contact lens?
Orthokeratology, or simply ortho-K contact lenses, change the shape of the eye surface and are worn overnight and removed the next morning. They are used to treat myopia and has been shown to slow down the progression.
However, there is an increased risk for corneal ulcers which can lead to permanent scarring. Hence, its use has to be closely monitored by a trained optometrist. My first choice for treating myopia progression would still be daily low dose atropine eyedrops as it is found to be the most effective and safest compared to other treatments.
Q5: Is it advisable for children to wear contact lenses instead of glasses?
I generally do not encourage contact lens wear in children to treat simple refractive error, such as myopia, hyperopia and astigmatism.
Wearing contact lens has a higher risk for corneal ulcers which can lead to severe infection of the eye, permanent scarring and visual loss. Rigorous contact lens hygiene and cleaning is required to prevent infections and this is performed less reliably by children.
Children also tend to rub their eyes more, leading to microtrauma to the eye surface and causing corneal ulcers to occur. Long term contact lens wear can also lead to contact lens intolerance and dry eyes earlier in life if they were started at a young age.
Natural Goodness In Eye Care
Q6: What kind of foods or supplements help in maintaining eye health?
High anti-oxidant foods (containing vitamins A, C, D and E) and foods rich in carotenoids (lutein and zeaxanthin) are recommended. It helps to maintain the health of the photoreceptors of the retina. These are the tiny cells that are responsible in converting light stimuli into nerve signals.
Such foods include leafy greens (spinach and kale), coloured vegetables (capsicum and carrots), citrus fruits, berries, eggs, nuts and seeds. Omega-3 rich foods such as salmon, mackerel and sardines are also good in maintaining a healthy tear film. They help to reduce dry eye problems.
A healthy balanced diet incorporating these types of foods should be sufficient.
Q7: Lastly, any advise and words of wisdom to share with us?
I would advice parents to be aware of abnormal visual behaviour in their children. These are behaviours such as squeezing the eyes together to see, coming up close to screens or abnormal head posture. When you see these, get an early eye examination.
Vision screening should also be done according to the recommended schedule or earlier. This is especially so if there’s a family history of poor vision in childhood or squints. Early detection and treatment of eye problems in children lead to better success and preservation of normal vision.
Children are spending lots of time on screen these days. Excessive screen time is not just a problem to the eyes. It can also lead to childhood obesity, poor mental health, language and behavioural problems. Screen time should be regarded as a treat or reward, and not a given thing.
Children do what they see rather than what they are told. Parents should be mindful when using their mobile phones or digital gadgets and allocate gadget-free time with their kids. Limiting screen time and increasing outdoor activities are more achievable when done together as a family.