Bright Future, Bright Eyes

Insights from an ophthalmologist on safeguarding your child's vision

Peering into the world through a child’s eyes is a captivating experience, but ensuring their visual well-being is a responsibility that cannot be overlooked. In this illuminating article, we have the privilege of sitting down with Dr. Azura Ramlee, Consultant Ophthalmologist (Adult and Paediatrics) from Prince Court Medical Centre to further uncover this topic.

With a keen focus on uncovering the secrets to optimal eye health in children, we delve into a thought-provoking discussion that unveils the importance of early detection, dispels common misconceptions, and reveals invaluable strategies for preserving and nurturing your child’s precious vision.

Dr. Azura Ramlee, Consultant Ophthalmologist (Adult and Paediatrics) from Prince Court Medical Centre

Get ready to delve into a captivating conversation that will open your eyes to a world of possibilities when it comes to safeguarding your child’s ocular future.

At what age should parents or guardians bring their children for their first eye exam?

Dr. Azura Ramlee: Parents or guardians can bring their children for their first eye exam as soon as they observe any eye symptoms. A child may complain or voluntarily tell their parents that they’re having vision problems, or when parents or observe any eye condition. At this moment, an assessment should be done as early as possible regardless of age.

In fact, when a child is born, the pediatrician in charge would have done a quick screening of the child’s eyes to exclude any congenital eye deformities or provide due referrals at that point if needed.

In a child whose vision is normal, ideally, the first eye check would be before they go to kindergarten. In some countries, the child would go for their first eye exam at an even earlier age. Currently, in Malaysia, kids get eye screening when they are in Standard 1. Now, as we progress, facilities are made more available and this has enabled the child to be screened at an even earlier age. Ideally, getting an eye screen at the age of 4 to 5 before they enter kindergarten is good. This can be done with an ophthalmologist or optometrist at private centres.

It’s also important to highlight that every child gets their rightful screening at the age of 7 years old (or Standard 1) in schools. This programme is already in place with the school team consisting of teachers who are trained to screen and detect their students who have a suboptimal vision.

We are working towards implementing eye screening in children at kindergartens to detect who might be having suboptimal vision so that these students can be referred earlier if necessary.

Are there any signs or symptoms that parents or guardians should be looking out for to indicate that their child may be experiencing vision problems?

Dr. Azura Ramlee: Children these days are very smart and sometimes they voluntarily tell their parents if they’re experiencing blurred vision. As for kids who may not be aware that they’re experiencing blurred vision in one or both eyes, this can be detected when they go for screening.

Parents and guardians should also be on the lookout for obvious eye findings such as eye swelling, eye redness, or anything abnormal that is visible. Other than obvious findings, subtle eye findings are also important to take note of. These subtle findings can be:

  • Abnormal head posture

This abnormal head posture will be consistently observed when the child is attempting to focus. This may indicate either the child has a refractive error or any ocular misalignment.

  • Intermittent eye rubbing

The eye rubbing may be subtle at times, however, it’s important to observe whether it’s done repeatedly or the eye rubbing happens during a specific time of the day. In this case, the child may be dealing with allergic eye problems and should see an eye doctor for treatment.

  • Ocular misalignment

Normally, our eyes should be aligned in all directions of gaze. If you notice your child’s eyes deviating, seeing an eye doctor is advisable as early treatment may prevent amblyopia (lazy eyes).

  • Frequent eye blinking

Frequent eye blinking in children is common nowadays due to digital eye strain. This is something many parents are observing in their kids. While artificial tears may help to relieve the symptoms, the root cause has to be addressed. Managing screen time well will be the definitive treatment.

There are less common but more visually threatening conditions that should also be taken note of by parents, such as

  • White pupil reflex

Usually, during feeding time, parents would engage in eye contact with their children. White pupil reflex is a condition where the pupil of the eye appears white instead of the usual dark colour. If white pupil reflex is present, parents should urgently bring in their child to meet an eye doctor to seek further treatment. It could be a cataract or a more serious condition involving the retina. Retinoblastoma is an eye cancer in children which can be life-threatening.

How often should parents or guardians bring their children in for eye exams as they grow and develop?

Dr. Azura Ramlee: If the child is symptomatic, parents should bring the child to see an eye doctor immediately. The subsequent follow-ups and management depend on the child’s eye condition.

On the other hand, if a child has gotten an eye assessment when they are four or five years old and the outcome is normal, the next eye screening will be done in primary school.

An older child will be able to inform if they’re experiencing blurred vision. However, parents still play an important role in monitoring any abnormalities in their children’s vision and bring their children to an eye doctor to have it checked.

If the child is symptomatic, parents should bring the child to see an eye doctor immediately. The subsequent follow-ups and management depend on the child’s eye condition.

Are there any steps parents or guardians can take to help prevent their child from developing vision problems?

Dr. Azura Ramlee: I love this question! It gives me an opportunity to emphasize to parents that they should try and avoid the early introduction of gadgets among kids.

If parents were to search online for the recommended screen time for kids, guidelines may slightly differ. However, generally, most guidelines agree that there should not be screen time for kids before the age of 2 to 3 years old. Something glaring these days is a lot of young kids are holding gadgets such as tablets or handphones in their hands. If we can change that, there would be a lot of things we can prevent.

As a rough guide, I would say if the child is around 5 to 7 years old, parents can consider allowing the child one to two hours of total screen time, per day. This screen time can gradually increase as the kids age but please don’t go beyond 4 hours of total screen time per day, at least until the kids are around 12 years old. This is one practical way parents can prevent their children from developing vision problems. Another approach parents can consider is to implement minimal gadgets usage during school days and allow play time with gadgets for two hours per day during the weekends.

Another aspect to take note of is also the social development of the kids. When the child is so engrossed in using gadgets, this may impact their communication abilities and their emotional development.

There is strong evidence to suggest spending time in outdoor activities for two to three hours per-day is beneficial to prevent the progression of myopia in children. Evidence shows that when children are using gadgets, most of the time they are indoors.

This limits them from carrying out outdoor activities. Many studies have shown, kids spending two to three hours per day outdoors are able to buffer the progression of short- sightedness.

We live in Malaysia with an abundance of sun! However, please be mindful of the current heat wave situation as well.

Parents can also consider using the ‘mirroring’ feature on their devices to project to a bigger screen such as a smart television. By doing this, the child is not so engrossed to the small screen and indirectly, the ‘20 20 20’ rule is being implemented as they can be easily distracted by surrounding movements.

On a separate note, potential trauma to the eyes is another aspect parents should be aware of. If the child is participating in a sport or activity that can expose them to blunt injuries such as badminton or cycling, parents are recommended to equip their children with protective eye gear.

A balanced and healthy diet is key. Parents are recommended to provide their kids with healthy diets throughout their childhood years, without giving up.

What are some common vision problems that children experience, and what are the symptoms and treatment options for each?

Dr. Azura Ramlee: Some of the most common ocular conditions among kids include:

  • Refractive error and astigmatism

The most common refractive error we’re observing right now would be myopia (short-sightedness) followed by astigmatism. Here’s where early screening when the child enters kindergarten helps.

Some may perceive refractive errors as trivial, however, if the child’s eye power is high and it goes undetected, this is a potent cause of amblyopia (also known as lazy eyes). With the right prescription of glasses, these children can see better. The eye doctor may decide to add a specific eye drop to minimize the progress of short- sightedness if indicated.

  • Digital eye strain among kids

The best treatment for this would be to abstain from devices. The practice of using blue filter lenses for comfort viewing may contribute to longer screen time. Blue light filter lenses have not been proven to be helpful to children’s eyes.

  • Allergy eye conditions

Children usually develop allergic eye conditions around the age of 5 years old. They are often with symptoms like intermittent eye rubbing due to itchiness, teary eyes, and eye discharge. Please bring your child to see an eye doctor as eye drops may alleviate the symptoms effectively.

What role do diet and nutrition play in maintaining healthy eyesight in children?

Dr. Azura Ramlee: A balanced and healthy diet is key. Parents are recommended to provide their kids with healthy diets throughout their childhood years, without giving up. There are certain properties that are beneficial in promoting eye health such as:

  • Vitamin A
  • Vitamin C
  • Vitamin E
  • Omega 3 fatty acids
  • Zinc
  • Lutein and zeaxanthin

These properties can be found in:

  • Vegetables such as Sawi, Kangkung, Kailan, and Spinach
  • Beans and peas
  • Nuts
  • Fishes, lean meats, eggs and milk
  • Oranges, guava, pineapple, and mangos