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Children’s Eye Care: What You Need to Know

by on 07/12/2020 4152

Paediatric ophthalmologists at Ara Damansara Medical Centre (ADMC) and International Specialist Eye Centre (ISEC), Dr. Norazah Binti Abdul Rahman, Dr. Choong Yee Fong and Dr. Tsiang Ung shares the importance of caring for eyes at an early age.

80% of learning in children happens visually. More often than not, a vision-related problem is the culprit to children falling behind in school. And at such young ages, they lack the ability to tell parents what they are experiencing. Furthermore, they may not realize what they are seeing (or not seeing) raises a red flag or two. This is why eye exams are so critical for young children.

First Eye Exam: When?

Paediatric ophthalmologists, Dr. Norazah, Dr. Choong and Dr. Tsiang, unanimously stress the importance of early eye exams to rule out any undiagnosed conditions that could potentially lead to irreversible blindness, as well as impact children socially, emotionally and academically. “Even if there are no obvious symptoms, children should have their first comprehensive eye exam between 3-4 years of age,” recommends all. Most parents wait until their children start primary school before bringing them for a vision test, and while most schools do have routine eye screenings in place, the problem is that this can be quite late to reverse certain eye conditions, such as lazy eye (amblyopia). Also, once children reach 7-8 years of age, their brains become less malleable to adapt and reverse vision-related problems. It is even more important for early screening if there is a family history of vision problems. “Despite what many people think, children do not need to be able to talk or know the alphabet in order to have an eye exam,” Dr. Choong dispels a common misconception.

Did You Know?

The ideal time for your child to have a comprehensive eye exam from an eye care professional is between the ages of 3 and 4 years. Remember, the earlier we catch a disease, the easier it is to beat it!

When a child gets the first in-depth eye test, parents should expect a visual acuity test with refraction assessment to determine if the child needs glasses, 3D vision screening, squint assessment and an overall examination of the eyes. - Dr. Tsiang Ung, Paediatric Ophthalmologist, ISEC Penang

What to Expect at Your Child’s Eye Exam?

Eye care professionals check for many different things during a child’s eye exam. Dr. Tsiang points out that it can include several eye tests, such as a vision (visual acuity) test that looks at how well a child sees at different distances; a pupil test that checks how a child’s eyes respond to light; an eye movement test that checks a child’s side (peripheral) vision. A comprehensive eye exam can detect many refractive and non-refractive errors. Some of the common eye problems in children are nearsightedness (myopia), astigmatism, squint (strabismus), lazy eye (amblyopia) and chalazion. A full eye test can even save lives by revealing underlying life-threatening diseases.

What’s more concerning is that eye problems can be warning signs and symptoms of an underlying life-threatening disease, such as brain tumour and cancer. Therefore, a comprehensive eye exam is probably one of the most important things you can do for your child’s overall health. If it’s early enough to initiate treatment, it can save vision and occasionally even save lives! - Dr. Choong Yee Fong, Paediatric Ophthalmologist, ISEC Mid Valley City

Protecting Children’s Eyesight

Though a childhood cancer diagnosis is scary and rather rare, with approximately 100 cases a year in Malaysia, most can live long lives if it is diagnosed and treated early. What about other more “common” eye conditions? You must be wondering if there is a cure or at least something that can be done to slow its progression. Good news is yes there are numerous ways to prevent eye problems by changing lifestyle habits, genetics aside. “Decreasing time on technology is always a good place to start,” suggests Dr. Norazah. To reduce the strain, try using the 20-20-20 rule. For every 20 minutes spent on a near vision activity, take a break and look at something 20 feet away for 20 seconds. What else it to blame for the current “epidemic” of myopia, more commonly known as short-sightedness, affecting children in Malaysia? Spending too much time cooped up indoors. This condition now affects approximately 50-60% of the East Asian population, and the numbers are expected to rise to an alarming 90%, meaning 9 out of 10 children will become short-sighted. This is twice as prevalent as the global obesity crisis. “It is important to balance activities that involve prolonged near concentration to those that take place outside. Participating in more outdoor activities reduces the risk of myopia in children,” agrees all three paediatric ophthalmologists.

New Treatment for Progressive Myopia

In recent years, there are newer advancements in treatment for progressive myopia – short-sightedness that continues to worsen year after year and usually occurs during childhood. The types of treatment include orthokeratology (“ortho-k”), MiSight multifocal contact lenses, and the most promising therapy – low-dose atropine (0.01%) eye drops. Atropine eye drops are shown to be effective in slowing down the progression of short-sightedness in children by as much as 70%. The trials were conducted at the Singapore Eye Research Institute. ISEC, ADMC, Subang Jaya Medical Centre, ParkCity Medical Centre are a handful of places where parents with children who are suffering from rapidly deteriorating short-sightedness can turn to for atropine eye drops therapy. “It's amazing if a child whose myopia could have reached -8.00 dioptres (800 degrees) is kept at -3.00 dioptres (300 degrees) with atropine eye drops therapy. This not only reduces the child's final degree of myopia but also significantly reduces the risks of blinding eye conditions associated with high myopia such as retinal detachment, myopic macular degeneration and glaucoma,” added Dr. Choong.

Offer More Insurance Coverage for Eye Patients

There may be some important advancements in eye treatments but Dr. Norazah hopes that the government can make changes to Bank Negara Malaysia’s provisions on medical insurance coverage for eye patients.

If a child has a squint and needs surgery to correct it, it is not for cosmetic purposes, but it is for the child to see properly again and to prevent further permanent problems from occurring. We really hope the government will look into these insurance guidelines and make the needed changes. - Dr. Norazah Binti Abdul Rahman, Paediatric Ophthalmologist, Ara Damansara Medical Centre

Don’t Wait for School Eye Checks

While there are common telltale signs of eye problems, many parents might still miss the mark on eye conditions and diseases. Moreover, the national vision screening programme is only conducted on children aged 7, 12 and 15 years in government schools, and there is currently no formal national eye assessment programme for preschool children. For these reasons, it is important for parents to schedule the first full eye test for their children at approximately 3-4 years of age. If there are other risk factors, such as premature birth, family history, developmental delays or previous injuries, earlier and more frequent tests are recommended. Bear in mind that most eye problems are treatable but early detection is key!

Acknowledgement: We would like to express our heartfelt appreciation to Dr. Norazah Binti Abdul Rahman, Dr. Choong Yee Fong and Dr. Tsiang Ung for the informative contributions to this article.