Aiman (second from left) used to place the book or phone close to his eyes to read, but thankfully, his parents noticed this and took him to the optometrist, who diagnosed him with myopia. — Photos: YAP CHEE HONG/The Star
Myopia, or short-sightedness, is the most common eye condition affecting children.
They can see objects that are near clearly, but have difficulty seeing objects that are farther away.
Myopia occurs when the eyeball grows too long from front to back, or when there are problems with the shape of the cornea or lens.
These problems make light focus in front of the retina instead of on it, and that makes far-away objects look blurry.
No one knows exactly why it happens, but experts believe there is a genetic and environmental link to it, alongside spending more time doing close-up tasks indoors, such as using computers and mobile phones, and playing video games.
The risk of developing myopia increases in children with myopic parents (one parent: two-fold increase, both parents: five-fold increase).
However, children who spend more time outdoors are less likely to be affected.
“We’re seeing more children below the age of nine needing glasses.
“What we worry about is that when the kids with high myopia grow up, they are at an increased risk of getting eye diseases such as cataracts, retinal detachment, glaucoma and macular degeneration.
“We can only control the myopia progression when they are young, but if they already come in with a power of -6.00 dioptres, then it’s a bit late for us to do the controlling, hence we advocate early management,” says optometrist Sim Wei Kiat.
Left undetected in childhood, myopia can also lead to a disorder known as amblyopia or lazy eye.
It is estimated that half of the world’s population will be myopic by 2050, due mainly to lifestyle factors.
According to the International Myopia Institute, the hot spots of myopia are East and South-East Asia where countries such as South Korea, Taiwan, Singapore, China and Japan have an overall myopia prevalence of 80-90%.
Published reports on myopia prevalence in Malaysia show a rate of 9.8% in children aged seven, which increases to 34.4% by the age of 15.
There is also a condition called pre-myopia (a refractive state of an eye between +0.75D and -0.50D) where kids don’t need glasses yet, but need preventive intervention.
Early detection
The current practice for newborn eye examination by an ophthalmologist in Malaysian hospitals is limited to only premature, syndromic or ill infants.
Sim (right) testing Aiman's eyes to see if his myopia has progressed.
Healthy newborns are usually discharged without a thorough eye examination.
“For those below three [years], we use different tools to determine if they are myopic as they cannot read yet.
“For the older ones, there is the visual acuity test [Snellen eye chart] to examine how well they can see details of a letter, picture or symbol from a certain distance,” Sim says.
There is also the random E chart for children, which contains rows of a “tumbling” E facing different directions.
Each row decreases in size, similar to the Snellen chart.
Visual acuity only measures the sharpness or clarity of vision at a distance.
Vision strength also includes eye coordination, depth perception, peripheral awareness, focusing ability and colour vision – all of which Sim checks to ensure the visual pathway is healthy.
“We want children to start wearing glasses as old as possible.
“Normally, kids with myopia will have symptoms, but they don’t think anything is wrong – that’s part of the danger.
“Parents usually tell us the kid can’t see well, is performing poorly in school, or they’re copying their friend’s work in class.
“Some schools have eye-screening tests and affected kids are referred to an optometrist or ophthalmologist,” he says.
Pay attention
So parents, keep a lookout if your child is exhibiting symptoms such as squinting; eye-rubbing; watching television or reading at a close distance; unusual posture, such as turning to one side to read; and getting headaches.
“Don’t assume your child has good eyesight.
“If the myopia is not corrected, they can’t see the finer details, they are slower in many aspects and are usually quieter, but when glasses are prescribed, they behave differently because they can see the world better,” says Sim, who advises parents to bring their child for an eye check – provided the eye is healthy – once at three years old and annually after the age of five.
Aizuddin Mohd and Noor Azlin Lokeman experienced this firsthand.
During the movement control order, the couple were juggling with working remotely and looking after four young kids below the age of 13; at times, the kids were left to their own devices.
“For our older two kids, we didn’t impose a limit on gadget use, so they’d be on it till night, sometimes up to 10 hours!
“They also watched a lot of television because we couldn’t go out during the MCO,” admits Aizuddin.
All that changed when their third child, Aiman Safuan, then eight years old, inched closer to watch television, even though the monitor was fairly large.
Aizuddin says: “I noticed this and asked him to sit on the sofa, but after a while, Aiman would still move closer to the television.
“Then I did a simple test and asked him to read something on the wall, but he would go nearer to read.
“That’s when we realised there was a problem with his vision.”
While Aizuddin is far-sighted now, Noor Azlin has been myopic since she was nine.
She says: “Both my parents and grandparents, as well as my siblings, didn’t wear glasses, but it was more my lifestyle – I liked to read close-up, in the dark, lying down.
“When I was referred to an ophthalmologist, my mother was shocked my power was -2.50D – she didn’t expect it to be so high.”
The duo decided to take all their kids to an optometrist to get their eyes checked.
The diagnosis: eldest child Aleesa Sofia and Aiman were myopic with a power of -1.50D and -2.50D respectively.
Correct and control
Noor Azlin (right), who has been shortsighted since age nine, and Aizuddin (left), who is farsighted, with their four kids, two of whom are shortsighted.
There is a range of treatment available for myopia management, including using glasses, contact lenses and atropine eye drops, which are effective in controlling a child’s myopia from getting worse.
Sim says that they ideally want to keep the myopia below –6.00D in children.
“Now there is the HALT [Highly Aspherical Lenslet Target] lens, a type of spectacle lens designed to control myopia progression.
“It’s just like normal glasses, but when the light hits in front of the eye, it will send a signal to the brain to stop the eyeball from growing too much.
“This lens controls the power and eyeball length,” he says.
The use of contact lenses depends on the purpose, as well as the motivation of the kid and their parents.
“It’s more suited for kids active in sports, especially water sports, so we fit them with corrective contact lenses at night [orthokeratology], which they wear during sleep to reshape the cornea surface.
“These lenses help slow myopia for children and improve vision without the need for additional vision correction during the day.
“The next morning, they take them off and they can see clearly,” explains Sim, adding that kids as young as six can be trained to wear contact lenses.
The treatment involves daily maintenance and consistent use until the optometrist or doctor decides on the right time to stop.
However, the effects could slowly reverse and the child may need to use prescription eyeglasses or contact lenses again later on.
“The latest generation of myopia control lenses are as good as contact lenses,” Sim points out.
Aiman, who also has astigmatism, started off wearing single vision lenses (one optical prescription to correct only one field of vision), but two years later, his power increased to -4.00D, so Sim switched him over to myopia control lenses.
With the new lenses, Aiman’s power increase has been -0.55D in the past two years.
Sim adds: “The acceptable range of increase in a year is less than –0.75D; if it’s more, we look at other risk factors.”
Aizuddin says: “We’ve now limited their gadget use to two hours daily and they must go outdoors to play every evening for two hours.”
Sim’s tips for better eyesight in kids:
- Two hours of daily playtime outdoors at daylight and limited close-up viewing.
- If the child loves to read, limit it to two hours and break up the duration into small sections by placing a bookmark after a few pages as a reminder that they need to stop reading.
- Reading distance should be an elbow’s length away from the eyes – place the knuckles of one hand next to the eye; the book should be as far as where the elbow is.
If the child needs it to be closer to be able to read clearly, then that signals an eye problem.
- Follow the 20-20-20 rule: Look 20 feet (about six metres) away for 20 seconds every 20 minutes.
More frequent breaks are better than one long break.
