Keep your child's eyes healthy

A child learns about the world from what he sees and observes daily. With his eyes, he would be able to recognise his parents' faces and things around him.

A child's vision goes through tremendous change and growth, a critical part of healthy development.

When a child has vision problems, he might face learning and developmental issues and difficulty in performing everyday tasks.

Specialist consultant opthalmologist, cornea,cataract and refractive surgeon Dr Ainur Rahman Anuar Masduki of Vista Eye says common eye problems relating to vision usually manifest when the child is between 18 months and 4 years old.

To ensure good vision, parents must be aware of the normal visual milestones, such as having a child undergo formal eye assessments by an optometrist or ophthalmologist as early as 3. Two of the most common but important issues include squinting (strabismus or crossed eye) and uneven focus leading to lazy eye (amblyopia).

"Refractive errors including short and long-sightedness and astigmatism are common among older children, affecting 30 per cent of them, depending on populations studied," says Dr Ainur.

THE IMPORTANCE OF EYE EXAMS

According to Dr Ainur, the visual centre of the brain is fully developed by 6. He says it is important to keep a mindful eye on the child's normal visual milestones during this time.

"If you notice anything unusual about your child's eyes, or feel that the visual milestones are delayed or are not met for his age, prompt consultation with an optometrist or ophthalmologist is prudent. In general, a child should have his eyes assessed as early as 3, and certainly not later than 7.

"When you are in doubt, even if your baby is only a few days old, prompt consultation with an eye care professional is strongly advised."

He says children should get their eyes checked by an optometrist or an ophthalmologist at least once a year, especially if they have significant refractive error or other eye-related issues.

Dr Ainur adds that a child might have to wear glasses following a detection of significant refractive error such as short-sightedness, long-sightedness, astigmatism, amblyopia, or strabismus.

"Unequal or uneven focus happens when there is a significant difference in power between eyes, and there is a risk that the child will eventually choose to use one eye preferentially and neglect the poorer seeing eye. As a result, the visual centre in the brain on the side of the poorer seeing eye will be under-developed. If timely intervention is not instituted, this will lead to irreversible poor vision.

"Squints, which is in the form of crossed (esotropia) or wandering eyes (exotropia) may respond to the correction of refractive errors and treatment of amblyopia, if present. Special glasses or lenses may help alleviate squints, but some children may still require surgery to correct significant eye deviations."

Dr Ainur says while minimal refractive are acceptable, higher degrees of refractive errors can have effects on the development of good vision in a child.

VISUAL ASSESSMENT

If left untreated, he says a child with vision conditions will face a number of issues.

"Teachers often highlight to parents children's constant mistakes in their writing or homework. Unfortunately, these children are sometimes wrongly described as slow learners, have poor attention, are lazy, dyslexic or even learning-disabled when they may just be suffering from poor vision or its related issues."

Parents should monitor their children's progress and refer to a professional for visual assessment to get a correct diagnosis.

"Contrary to popular belief, using glasses early in life, or using high powered glasses will not worsen a child's eye and cause dependence on glasses. Nothing could be further from the truth and such anecdoctal views are not supported by scientific evidence.

"If a child needs glasses, ensure compliance to glasses during waking hours. Ensure that the child is examined at least annually as glasses' power will change as he grows."

Dr Ainur says most children will willingly use their new glasses as they can see more clearly with them.

"Parents should select eyewear based on fit and functionality. The frame should be comfortable and the eye must be in the centre of the lens. Lenses made of polycarbonate are safest for young children as it is shatter-proof.

"Once your child starts wearing glasses, he will go through a transition phase where he may not be comfortable with his eyewear. Parents must explain to their children why they need to wear glasses and be sensitive to their feelings," he says, adding that it is advisable to keep a spare pair for emergencies.

Dr Ainur says although there is no strong scientific evidence to support the link between any particular diet and eye development and health in children, maintaining a healthy and balanced diet is vital.

"Time spent indoors should be balanced with time spent outdoors to reduce the risk of myopia progressing," he adds.

VISUAL MILESTONES IN CHILDREN

• Birth: peripheral (side vision).

• 1 month: Fixate on objects (bright lights, faces) up to 3 feet (91cm).

• 2 months: Follow moving objects.

• 3 months: Look towards new sounds and parents' faces (when spoken to), reach for nearby moving objects.

• 3 to 5 months: Development of visual skills (focusing, convergence, binocular vision, colour discrimination), smile at parents and look at objects across the room.

• 5 to 7 months: Further development of eye-hand coordination. Eyes should appear straight. If not, this should be assessed by optometrists or ophthalmologist.

• 7 to 12 months: Crawl or move towards objects, longer interest in books or TV.

• 12 to 18 months: Improved eye-hand coordination, draw with circles with crayon, stack up blocks.

• 18 months to 2 years: Draw vertical and horizontal strokes, able to walk across different surfaces.

• 2 to 3 years: Hop, run, skip, jump with fewer falls, build tower of blocks, and imitate drawing.

• 4 to 5 years: Draw simple objects, colour colouring book, write letters, tell others about things seen.

Any obvious delay warrants an assessment by an eye care professional.