Healthy eyes are critical to a child’s growth and development. However, even young children can suffer from eye conditions such as myopia, amblyopia or lazy eyes, and astigmatism, which is blurred vision caused by imperfect curvature of the cornea. Early detection and treatment are key to healthy eyes in children.

Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC), a member of the SingHealth group, gives detailed answers to your questions.

Question by s277400

Hi Dr Chia,

My son is 5 this year. on the 4/9/2012, he went for an eyecheck with polyclinic to show 6/6p perfect eyesight. One month later, 4/10/2010, his school conducted a mobile eyecheck by School Health Service, showing the result as LogMAR, Right 0.08, Left 0.12 and Computed Snellen, Right 6/6P, Left 6/7.5P. Kindly explain these readings. As a worried mother, we went back to polyclinic on the 30/11/2010. The result came back to be perfect eyesight. Why is that so and what method of testing is most accurate? Please enlighten. Thanks

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

Vision is checked in children by getting them to read letters at a distance. The normal vision in older children and adults is 6/6. However, in young children, we accept that they are within normal limits if they could manage 6/7.5 or 6/9, as young children can be inconsistent with testing depending on attention span and mood etc. Accuracy improves with age and literacy, so that our ‘normal’ criteria become more stringent as child gets older.

The logMAR is just another way to describe vision with 0.00 being equivalent to 6/6, 0.10 being equivalent to 6/7.5; with 0.02 decimal points added for each letter missed.

Question by rsim

Hi Dr Chia, My nephew was diagnosed lazy eyes and we were told there is no correction available, what exactly is lazy eyes and what causes it?

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

The term ‘lazy eye’ is bandied around quite freely, and can be used to describe many conditions eg. a misaligned eye, an eye with greater spectacle power, an eye with poor vision etc. So it is important to know what condition you are referring to. In some of these conditions, vision is good when corrected or tested, and the child does not really have a ‘lazy eye’.

In medical terms, ‘lazy eye’ or amblyopia is an eye with poorer vision despite best correction with spectacles and when there is no visible abnormalities noted with eye. It is due to a child not having developed vision in that eye from a very young age, and it needs to be treated before the age of 8 years. It can be caused by high spectacle power in one or both eyes, an eye misalignment or an obstruction to vision (eg. a droopy lid). Treatment involves providing spectacles (if needed) and covering the better eye to force the child to use the ‘lazy eye’. However, if treatment is delayed (ie. after 8 years), then the child may not respond to treatment and vision in that eye will remain poor.

Question by pocoyosky

Hello Doc, What are the treatments available as my child has myopia, and how can we prevent myopia? Now I limit my second child on her gadget screen; PC watching hours, as I worry this will strain her eyes. Am I overly concerned?

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

Myopia is caused by genetic and environmental factors. If you yourself are myopic, then the risk in your child is increased. Environmentally, it is due to our urban living with too much near/indoor work. To help limit this, the Health Promotion Board has a program, which we support, where we encourage children to spend more time outdoors, and less time indoors on computer games or watching tv. So, I think it is wise for you to limit your child’s PC hours BUT do not forget to allow him/her to Keep Myopia at Bay, Go Out and Play.

If, however, your child’s myopia is still progressing, then several other agents have been proposed for myopia control (eg. specially designed glasses or contact lenses and atropine eye drops). The effectiveness of glasses and contact lenses are variable, ranging from 0-30%. Care needs to be taken with contact lens use in children to ensure that your child does not develop any sight threatening eye infections. As a myopia retarding agent, atropine eye drops are also quite effective with control ranging from 50-80%.

Question by esim

Hi Dr Chia,

What are the causes of lazy eyes and astigmatism?

I always restrict reading while lying down, watching telly too near and my child was told of having mild lazy eye and astigmatism when doing an eye check.

Are there any natural remedies available without the need for surgery or sort? Does eating wolf berries helps?

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

We have already discussed lazy eyes earlier. Astigmatism is a common cause of lazy eyes in Singaporean children. Normally, it is condition which children are born with or occurs early in life, and is due to shape of the front surface (cornea) of the eye. If the cornea surface is perfectly spherical like a foot-ball, then there is no astigmatism. However, if is oval like a rugby-ball, then astigmatism may be quite high. Some actions (eg. frequent rubbing of the eyes) may increase astigmatism. However, in many cases, it is simply how your child’s eye is shaped, and there is not much you can do to alter it. Astigmatism usually does not change much although some slow fluctuation (increase and decrease) can occur over years. It is treated by providing the child with spectacles.

No surgery is required. There is no evidence that wolf-berries will help.

Question by c_s_soh

Dear Dr. Chia, My son is on Atropine (once a day 0.1%). Does he really need bifocal lens or will the normal lens do? Thanks for your time.

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

Much depends on how much near blur your child experiences. In a recent study, we found that 60-70% of children on the 0.1% dose felt they required bifocal lens.

Question by make8work

Hi Dr Audrey

Are those off the shelf eye drops safe/suitable for kids? There is no indication of age limit in most of the 'Patient Information Leaflet' found inside the box. What to do when my kid feel eye irritation?

Thanks
Regards JC

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

It depends on what the drops are and on the age of your child. In children, particular those younger than 6 years, you should consult your pharmacist or doctor if you are uncertain.

There are many causes why children may have irritated eyes (eg. tired, if they had dry or oily eyes, an allergic condition, or if the air is dusty etc.) Some simple measures are to get your child to wash his/her hands and face, and wipe the outside of your child’s eyes with a wet cloth. If your child’s eyes is ‘itchy’ then a cool towel applied to the eyes may help. You should, however, consult your doctor if symptoms persist as there are different treatments for different conditions.

Question by lydia_nsy

I would like to get rid of my glasses and my boy's glasses. I have shortsightedness and astigmatisma and my boy has astigmatism. Would you recommend Lasik? Is 6 year old able to do Lasik? Any other recommendations?

Specially for my boy, I hope his condition (2.5 on the right eye) could improve and does not get worse. Thanks.

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

In adult with shortsightedness and astigmatism, like yourself, LASIK surgery is an option. You will need to consult a LASIK surgeon for advice whether your eye is suited for LASIK.

We have discussed astigmatism previously, and the treatment in children in glasses. LASIK surgery is not indicated for children as their eye will continue growing till his/her late teens. LASIK is only indicated once eye growth is stable, usually after the age of 21 years.

Question by mosmos

Hi Dr Audrey Chia, Are there any food or supplement for the child that can prevent or reduce myopia and astigmatism in the future when they grow up?

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

There is no evidence that any food or supplement will prevent or reduce myopia or astigmatism.

Question by octane

Dear Dr Chia, If a child has lazy eye and is seeing double what can be done? Thanks.

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

There are several reasons why a child may be seeing double. It could be that he/she has uncorrected spectacle power. If your child has a lazy eye, it could also be due to having a blurred image (from the lazy eye) being superimposed on a clear image (from the normal eye). However, double-vision could also be due to more sinister reasons such as a sudden misalignment of the eye (due to an eye, eye socket or brain problem) or problems with the eye itself. You should bring your child to your ophthalmologist for assessment.

Question by​ jennychanon

I have an intellectually disabled son. He doesn't have eye contact with anyone whenever anyone speaks to him.

He will look on the floor whenever anyone speaks to him and when we stressed to him to look at the other person's eye he will try to look up but there is no direct eye contact.

Even when he eats his food he doesn't look at it. Is there something wrong with his eyes or his focusing. He is not like that when he is a child. Now he is 31 years old.

I don't know if he needs an eye checkup.

Please advise.

Thank you.

Regards,
Jenny Chan Ong Neo (Mrs Yeo)

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

If your child has had a change in visual behaviour, then it may be wise to bring him for an eye check. In some conditions and syndromes, individuals may be prone to cataract or retinal detachments, and your local ophthalmologist could assess him to ensure that there are no eye conditions that require treatment.

Question by ivonne

I'm so glad that Health Xchange having this forum. I'm from Indonesia, and I'm planning to checking my son vision at SNEC. But me and my husband both working and hard for us to plan a visit there in addition to weekend. Actually, what will the paediatric ophthalmologists do when a 3 years child has cylinder 3.00? is there any cure? is there any treatment for cylinder eyes? what caused the cylinder in childhood? my son got cylinder 3.00 from school eyes check up. Initially we were sceptical of the results. Then we take it to a local ophthalmologist. results remain the same. so far there are no signs that his vision disturbed. so we want to ensure the best treatment for him. thank you for your kind reply. warm regards, Ivonne

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

Cylinder is measure of astigmatism (see discussion above). Astigmatism is a condition which is present from early in life, and is determined by the shape of surface of the eye. A cylinder of 3.00D is relatively high, and the risk here is that your child may develop amblyopia. Regular eye check will determine whether your child’s vision is normal in both eyes; and as amblyopia can develop at any time between the age of 0-8 years, these eye-checks should continue (eg, at least annually) till your child is >8 years old. There is no cure for astigmatism in childhood. The treatment is correction with glasses, and treatment for amblyopia (if necessary).

Question by kimkong

My grandson is 18 months old and he loves watching videos on the iPad. He averages about 3 hours a day watching. I'm concern that his eyesight will suffer....... is my concern unfounded?

Thanks,
Mdm Lim

Answered by Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

We do know that child who spends long hours at near tasks are more likely to develop myopia. As such, your concerns are not unfounded. It may be wise not to encourage your grandson to be overly attached to ipad videos and games, and instead encourage social interactions with family and friends (eg. with other more old-fashion games) and also to take him out to enjoy himself outdoors.

Question by dianaong

Dear Dr Chia

Is it possible for babies to be born with high shortsightedness due to family history or parents with high power shortsightedness? How to tell if the baby can see clearly or not from birth?

Answered by​ Dr Saadia Farooqui, Consultant, Paediatric Ophthalmology & Adult Strabismus Department, Singapore National Eye Centre (SNEC)

Yes. It is possible. It can be sometimes difficult to know if a child < 1 year can or cannot see well unless the vision is very poor. This is because a child who cannot see so well from a young age simply accepts what they ‘see’ as normal, and may not behave differently.

Ref: L20