Vision is a dominant function in the growth, development and performance of children. 80% of what children learn is acquired through visual processing. This leads to a lot of parents, especially those who have small babies, asking: does my child have good vision? As a paediatric ophthalmologist, this is one of the most common questions I hear.

While there is no single, standard answer, it helps to understand a little bit about common eye related issues, especially amongst kids. The more we know, the easier we are to decide when is the right time to visit a doctor.

Eye related issues amongst children can strike across various age groups. Younger children are especially at risk, since they are usually at a pre-verbal stage making it very difficult for them to communicate, thus unable to complain if they are suffering abnormal vision. What is equally concerning is that kids in this age group typically never complain as they think what they see is completely normal.

A lot of parents mistakenly think that there is no way to figure out if their child, be it an infant or toddler, has vision problems. In fact, there are a couple of signs and symptoms you can look out for which may indicate that your child is having difficulty seeing. Note that this might not always mean that your child needs glasses.

To be assured of your child’s vision, he or she would need a comprehensive, painless eye examination which includes visual acuity testing, cycloplegic refraction, eye motility test and complete eye examination by a licensed medical professional.

‘Can my kids see normally?
When should I bring them for an eye check-up?’

Abnormal eye appearance

Please bring them to see a medical professional urgently if your child’s eyes start to show these abnormalities:

  • Abnormal eye reflex. When an apparel light is shined into the pupil, the normal reflex expected is the red eye. When a white reflex, or Leucokoria is seen, this may indicate eye diseases that include cataracts, Retinoblastoma or several other causes. A cataract is a medical condition in which the lens of the eyes becomes progressively opaque, which could block your child’s vision. Retinoblastoma is a form of cancer that arises from still-developing retinas.
  • Droopy eyelid covering pupil. Unchecked, this can lead to a condition called Amblyopia. Commonly referred to as Lazy Eye, this condition decreases vision since the underlying causes could stem from eye misalignment, irregularity of the eye shape or power difference between near and far sighted. Please seek urgent treatment as this condition can have long term effects.
Photo from Orbis Cybersight at https://cybersight.org/portfolio/quiz-white-pupil/

Significant congenital ptosis of the right upper lid encroaching into the visual axis. Such significant ptosis can lead to amblyopia, and should be repaired.

Photo from https://flylib.com/books/en/3.283.1.16/1/

Abnormal visual behaviours

There are some situations where there seems to be nothing out of the ordinary in the physical appearance of your child’s eyes. However, your child might display some peculiar behaviour in their daily activities, while reading, watching TV or just playing. They are trying to compensate for their difficulties in focusing on an image they are seeing. If the list of behaviours below seems to be a normal occurrence in your child, it is advisable to bring your child to an ophthalmologist for further check-up.

  • Frequently looking at an object with the chin raised, head tilted to one side or turning head sideways. Abnormal head posture might indicate that your child is using one eye to see or is suffering an alignment problem. Children with this condition are adapting to see and are attempting to capture a better image with their eyes.
  • Squinted eyes, also called strabismus, is where the eyes point in different directions, or appear to be drifting apart. This condition can either be indefinite or can only happen at certain time during the day.
  • If your child looks at something with partially closed eyes, or shutting one eye to see better, he/she might be having a case of myopia. This is evident when they are watching TV or looking at an object closely. At times, they can experience headache or double vision resulting from looking at an object for a long time.
  • If you child demonstrates behaviours related to chronic eye irritation such as frequently rubbing the eyes, having watery or teary eyes, excessive sensitivity to light and also having frequent eye redness, these are signs that their eyes need medical attention.
  • The child’s eyes may also appear to be shaky, a condition known as Nystagmus. This voluntary or involuntary eye movement, acquired in infancy or later in life, may results in limited or reduced vision.
  • Having difficulty in completing puzzle, playing with building blocks or arranging toys among toddler before the reading age. For older children, apparent difficulties in recognizing letters or numbers.
  • Facing difficulty or delayed in normal physical development such as walking, unable to pick up dropped objects, or for babies, lack of response to parent’s facial expressions.
  • Abnormal appearing eye movement which wonder and does not seem to fixate to any object. Or the eye appears shaky (nystagmus) or roving.
  • Having problem or difficulty playing with puzzle, building blocks or toys among toddlers. Difficulties recognizing numbers or letters for older children.
  • Having developmental delay resulting from in-born conditions such as Down’s Syndrome or Cerebral Palsy. Another risk group might come from children born prematurely, or through delivery with complications such as long labour and other problems which require prolong oxygenation.
  • Children with hearing impairment or those who have a family history of high refractive errors, squint or lazy eyes.

Eye myth:

“My child will tell me if he can’t see well.”

If your child did not exhibit any of the symptoms above, it is encouraged to send them for a visual screening after they turn 4. The Malaysian Ministry of Health (MMH) also has a standardized eye screening program for children available in your local hospital.

Eye fact

“Most young children don’t always know they see differently than other children. They have nothing to compare with. Some even adapt abnormal posture for them to see the image clearly.”

What to expect when you get your kids eye checked? Wait for my next article to find out.

Dr Norazah Abdul Rahman is Consultant Ophthalmologist with over 17 years’ experience in public and private care, specialising in Paediatric Ophthalmology and Strabismus. She is currently practicing in Ara Damansara Medical Centre.