Common Childhood Eye Conditions - Doctor Q&A

Posted by wenghim

My son is 9 years old this year. Start a couple of years ago, we noticed that he watches the TV with the corner of his eyes.. and from then on, we found that he does this most of the time. As a result, he does not really look straight at the thing that he is looking at, but rather, with a "cool", side ways look..

I know this is not right and should be bad for his eyesight. We took him to a specialist and we were given some prescription glasses and some medication to drop on his eyes. He is also short sighted now.

I just wonder if this is something that a pair of glasses can solve or there are other things that we can do to help my son. Thanks !!!

Answered by Dr. Audrey Senior Consultant Ophthalmologist Paediatric Ophthalmology and Strabismus Service Singapore National Eye Centre & KK Women's and Children's Hospital

There are a few reasons why children look at distance objects using the corner of their eyes. The most common is because they have spectacle power (eg. astigmatism or myopia) and by turning their head, or squeezing their eyes, they can see better.

You will know that this is the case when your child stops adopting a side-way look the moment they put on their glasses.

Other less common reasons a child may turn their head is if they have abnormal shaky eyes (nystagmus), limited eye movement (squint), itchy irritated eyes, loss of visual field, or a neck or hearing problem. The specialist will check for these when he/she sees your child in clinic.

Posted by kwhou

Hi, My son is 3.5yo. May I know what's the age to start him on regular eye check up?

He has done a simple test when he was 1.5yo. But I think the test was limited because he couldnt speak well yet.

Where can we go for regular affordable eye check up?

Answered by Dr Audrey Chia Senior Consultant Ophthalmologist Paediatric Ophthalmology and Strabismus Service Singapore National Eye Centre & KK Women's and Children's Hospital

Children’s vision can be checked at any age with non-verbal visual test. These can be done at eye clinic in government hospitals offering paediatric eye services (like Singapore National Eye Center or KK Women’s and Children’s Hospital). Rates at these hospitals are relatively reasonable, and you can ring to check if you feel they are sufficiently affordable.

The School Health Service also do annual visual screening from K1, so check if the kindergarten you intend to send your child is involved in the program. If so, you could wait till then. But if you suspect a problem with your child’s vision, then you should have your child checked sooner.

Posted by janey

My child is in P4 and starting to have to do much more homework and studying. Can you please advise: what is the optimum reading /studying time for her to spend each day, without overstraining her eyes and thus being at risk of getting myopia?

Also, when reading, etc; what kind of lighting is best?

Should there be a special table lamp? What kind of bulb/power?

Should the study desk be beside the window, facing the window or away from the window with direct daylight/sunlight?

I heard carrots are good for eyesight? Anything else in terms of diet and lifestyle advice is welcome please. thanks

Answered by Dr Audrey Chia Senior Consultant Ophthalmologist Paediatric Ophthalmology and Strabismus Service Singapore National Eye Centre & KK Women's and Children's Hospital

Our recommendations mirror the ‘Good eye habits’ proposed by the Health Promotion Board. Important points include:

- Maintain about a 30cm distance between your child and their near work, and at least 2-3m from television.

- Take regular eye breaks after 30 minutes of intensive near work

- Limit un-necessary in-door activity (eg. computer games, tv, and particularly hand-held games) and encourage more outdoor activity

There is no scientific evidence that any special lighting helps although there are some (as yet unproven) theories.

Our advice is that there should be sufficient lighting for comfortable reading. You can use yourself as a guide by sitting where your child sits and assessing whether it is comfortable.

Bright glare for the window and reflected surfaces may be quite uncomfortable, so use your own judgment how the room should be arranged. Carrots contain carotene which is required for eye function. However, everything should be taken in moderation; excessive carotene can cause yellow skin hue. Otherwise, we recommend a healthy balanced diet with adequate carbohydrate (rice/noodles), protein (lean meat and fish) and fibre (both green and other coloured vegetables, and fruit).

Posted by sm

My 4-year-old daughter watches TV with her head tilted to one side and from the corner of one of her eyes. She has been doing this for 1-2 years now. Every time we adults corrected her, she will eventually revert to the same old position after a few minutes. Is there something wrong with her eyesight? oe is it just a habit.. Should I bring her for an eye checkup?

Answered by Dr Audrey Chia Senior Consultant Ophthalmologist Paediatric Ophthalmology and Strabismus Service Singapore National Eye Centre & KK Women's and Children's Hospital

Answer is similar to question no. 1. There are a few reasons why children look at distance objects using the corner of their eyes. The most common is because they have spectacle power (eg. astigmatism or myopia) and by turning their head, or squeezing their eyes, they can see better. You will know that this is the case when your child stops adopting a side-way look the moment they put on their glasses. Other less common reasons a child may turn their head is if they have abnormal shaky eyes (nystagmus), limited eye movement (squint), itchy irritated eyes, loss of visual field, or a neck or hearing problem. The specialist will check for these when he/she sees your child in clinic.

Posted by shah28

Dear Doc

I have a 35 year old family member who has Lazy Eye (Amblyopia) which has been left untreated since childhood. Is there anything that can be done now. Thanks.

Answered by Dr Audrey Chia Senior Consultant Ophthalmologist Paediatric Ophthalmology and Strabismus Service Singapore National Eye Centre & KK Women's and Children's Hospital

Amblyopia is best treated before the age of 8. There is usually no good treatment option for treatment of amblyopia after the age of 10. However, it is important to rule out other causes of poor vision (eg. glasses power) which when treated can make poor vision better.

Posted by grandmafull

Hi Dr Chia

I am very happy to find this forum! Please advise!

My grand-daughter, 8, started wearing glasses wearing glasses last year when she was in P1 as she said she cannot see the white board which reflects. She had her eyes checked at the School Health Services in

June 2008 with logMAR right +0.32 left +0.14
COMPUTED SNELLEN Right 6/12p LEFT 6/7.5P

Feb 2009 with SNELLEN RIGHT 6/24 LEFT 6/12p

Jan 2010
WITHOUT GLASSES SNELLEN Right 6/60 Left 6/36
WITH GLASSES SNELLEN Right 6/09 Left 6/09

The doc told me that she has astigmatism.

Before putting her on glasses, I have limited her TV n Computer n Reading times, not wanting to make her eyesight go bad. She loves to read. Her father,(my son) and mother and my daughter all wear glasses. So do I, since I was 10.

Now her brother, aged 6, and in K1 has to wear glasses too.

His readings are

LogMAR right +0.56 Left +0.46
Computed Snellen Right 6/19p Left 6/15p

They both sometimes watch TV through the corners of their eyes and I need to remind them to look straight.

Do I need special lights when they do their homework? Please advise how I can prevent their eye-sight from getting worse. Their glasses on on all their waking hours.

Thank you and with warmest regards Margaret (grandmother)

Answered by Dr Audrey Chia Senior Consultant Ophthalmologist Paediatric Ophthalmology and Strabismus Service Singapore National Eye Centre & KK Women's and Children's Hospital

Children often look at things through the corner of the eyes when they need glasses. So, the first thing I would do is to see if glasses helped. Sometimes, it does so for a while and then child starts turning their head again which may indicate that the glasses power has increased, and need to be changed.

Astigmatism is a condition that your granddaughter probably has had (undetected) since early childhood. It occurs when the surface of the eye is not spherical like a ping-pong ball, but flatten like a rugby ball. Occasionally, it is also associated with amblyopia (lazy eye) and we often recommend that the child wear glasses all the time as it can affect both distance and near work. The more common condition in Singapore, however, is myopia, and this can occur together with astigmatism. This usually starts in the school years, and increases every year till the child is 13-14. To slow this down, your grandchildren should practice ‘Good eye habits’ (see question 2). No special lights are needed.

Posted by lisa 2223

Can you share any good tips on how we can spot vision problem on our children? I am quite worried as there number of kids in Singapore suffering from lazy eye and myopia is very common. What is the best preventive measure? Thanks

Answered by - Dr Audrey Chia Senior Consultant Ophthalmologist Paediatric Ophthalmology and Strabismus Service Singapore National Eye Centre & KK Women's and Children's Hospital

We are fortunate that School Health Services provides annual eye checks for children in government schools from kindergarten. If they find a problem (eg. poor vision), they will often advise you to take your child to see an eye doctor or optometrist for a more detailed eye check or to change glasses.

Other signs that your child may have a problem include squeezing eyes or turning his/her head to see, frequent rubbing or blinking, complaining that they cannot see the tv or board at school, or being unable to read letters or words (eg. bus numbers or road signs) which you can see quite clearly.

You should also take your child in to see your doctor if you think that their eyes look odd (eg. misaligned with one eye deviating in, out or up) as strabismus (squint) is a cause and sign of a lazy eye.

Prevention for lazy eye is early detection and treatment (glasses if necessary and occlusion of the good eye to strengthen the lazy eye).

Prevention for myopia is having ‘Good Eye Habits’ (see HPB recommendations). In particular, we are now encouraging children to have more outdoor activity.

Other than this, there are few proven treatments that slow myopia and many which people claim will help. Not all are supported by good scientific studies, so you will need to discuss the pros and cons of all these treatments with vendors. Your eye doctor can also provide you with information and advice regarding the most current developments.