MANY KIDS HAVE VI­SION PROB­LEMS

A study has re­vealed that one in 10 chil­dren in Malaysia has an un­di­ag­nosed vi­sion prob­lem that can af­fect their learn­ing abil­i­ties and later lead to other health is­sues. Med­i­cal ex­perts are calling for a na­tional pol­icy to be in place, where com­pre­hen­siv

New Straits Times - - Front Page - THARANYA ARUMUGAM writes

ONE in 10 chil­dren in Malaysia has an un­di­ag­nosed vi­sion prob­lem that can lead to chronic headaches and learn­ing dif­fi­cul­ties. If left un­treated, it could lead to per­ma­nent visual im­pair­ment and even blind­ness.

Ac­cord­ing to a study which in­volved 1,287 chil­dren, 12.5 per cent (161 chil­dren) of them suf­fer from visual im­pair­ment, and 61 per cent of the 161 chil­dren have bi­lat­eral visual im­pair­ment.

Oph­thal­mol­o­gist Dr Sun­der Ra­masamy, who was in­volved with the study, said it showed a rel­a­tively higher im­pair­ment rate among Malaysian chil­dren com­pared with those of other coun­tries.

“Vi­sion prob­lems among preschool­ers may be more com­mon than pre­vi­ously thought. The study opened our eyes to the fact that we have a sig­nif­i­cant num­ber of chil­dren be­tween the ages of 4 and 6 with eye prob­lems,” he told the New Sun­day Times.

The Sega­mat Pae­di­atric Eye Dis­ease Study led by the late Dr Joseph Ala­garat­nam from the Health Min­istry and South­east Asia Com­mu­nity Ob­ser­va­tory un­der Monash Uni­ver­sity Malaysia in Sega­mat, Jo­hor, was done last year.

Re­searchers dis­cov­ered se­ri­ous vi­sion prob­lems among preschool­ers, with 7.5 per cent (12 out of 161 chil­dren with visual im­pair­ment) were de­tected with am­bly­opia (lazy eye).

Seven of the am­bly- opic chil­dren have bi- lat­eral am­bly­opia, which can lead to per­ma­nent vi­sion loss if not treated dur­ing early child­hood.

Lazy eye is an early child­hood con­di­tion where vi­sion in one eye does not de­velop prop­erly.

The prob­lem is usu­ally in one eye, but can some­times af­fect both eyes. When a pa­tient has am­bly­opia, the brain fo­cuses on one eye more than the other, ig­nor­ing the lazy eye.

The study in­volved chil­dren from 51 kinder­gartens, aged 4 to 6, who went through an eye screen­ing test con­sist­ing of Log MAR (chart with rows of let­ters used to es­ti­mate visual acu­ity), ocu­lar motil­ity ex­am­i­na­tion and spot vi­sion screener as­sess­ment.

The chil­dren com­prised 54.8 per cent Malays, 27.7 per cent Chi­nese, 15.6 per cent In­di­ans and 1.9 per cent Orang Asli.

Dr Sun­der, who is also a pae­di­atric oph­thal­mol­o­gist at Kuala Lumpur Hospi­tal, said the study found sig­nif­i­cant and po­ten­tially treat­able visual im­pair­ment and am­bly­opia, which re­quired early de­tec­tion and treat­ment be­fore a

child turns 7 years old.

“Our study high­lighted an ur­gent need for preschool vi­sion screen­ing in Malaysia,” Dr Sun­der said.

“Prior to be­ing checked, the screened chil­dren did not wear glasses, their eye­sight had not been cor­rected and they had blurred or dis­torted vi­sion.”

He said the data from the study would be pre­sented to the Na­tional In­sti­tutes of Health Malaysia with the aim to con­duct a na­tion­wide eye study among preschool­ers.

“The find­ings can then be used by the Health Min­istry to en­act a na­tional pol­icy to make pae­di­atric eye screen­ing com­pul­sory for all preschool­ers,” he said.

“I be­lieve we are mov­ing in the right di­rec­tion. We may not have the pol­icy this year, but hope­fully, it will ma­te­ri­alise in the next few years.”

Cur­rently, eye screen­ing is only con­ducted on an ad hoc ba­sis for Pri­mary One stu­dents upon in­vi­ta­tion by schools or the Par­ent­Teacher As­so­ci­a­tion to de­tect re­frac­tive er­rors and lazy eye that can in­ter­fere with aca­demic achieve­ment.

“With early de­tec­tion and cor­rec­tion (of vi­sion prob­lems), the gen­eral health of the pop­u­la­tion will im­prove and good vi­sion leads to a more pro­duc­tive pop­u­la­tion.”

The most com­mon vi­sion prob­lems among chil­dren, he said, were re­frac­tive er­rors, such as near­sight­ed­ness (my­opia), far­sight­ed­ness (hy­per­opia) and astig­ma­tism (flaw in the cur­va­ture of the eye’s cornea) — all of which could be eas­ily cor­rected with eye­glasses.

These re­frac­tive er­rors, he added, could de­velop shortly af­ter birth or as the in­fant or child was grow­ing.

“Par­ents can­not rely on chil­dren to in­form them about their visual prob­lems, es­pe­cially if only one eye is af­fected.

“In ad­di­tion, poor vi­sion may just be some­thing nat­u­ral for chil­dren since they have no prior ex­pe­ri­ence or ref­er­ence point to tell that there is some­thing wrong with their sight,” he said.

Chil­dren who had to as­sume ab­nor­mal head pos­tures to see prop­erly, and fre­quently com­plain of headaches and pain in their eyes were some of the early signs of visual im­pair­ment.

Dr Sun­der said if chil­dren suf­fered from poor vi­sion, their learn­ing process could be af­fected, and their in­volve­ment in sports and ex­tracur­ric­u­lar ac­tiv­i­ties would suf­fer when they found the tasks dif­fi­cult.

“Par­ents who want to see their kids suc­ceed in school strive to pro­vide the best for their chil­dren by send­ing them to tu­ition classes, get­ting all the learn­ing ma­te­ri­als and pro­vid­ing them with healthy and nu­tri­tious food and sup­ple­ments.

“But of­ten­times, they over­look one cru­cial as­pect of learn­ing, which is the child’s vi­sion. Good vi­sion is key to chil­dren’s suc­cess in school.”

Dr Sun­der said good vi­sion was para­mount to chil­dren’s ed­u­ca­tional de­vel­op­ment as im­paired vi­sion could se­ri­ously af­fect learn­ing and cause ed­u­ca­tional, emo­tional and be­havioural prob­lems.

Con­sul­tant oph­thal­mol­o­gist Dr Manoha­ran Shun­mugam said early vi­sion screen­ing in chil­dren was cru­cial to en­sure that they en­joy qual­ity lives as adults.

“If they are not pro­vided with good, clear vi­sion at child­hood, then the eyes will never learn to ‘see’ clearly and the vi­sion in one or both eyes will never be per­fect,” he said.

He said some chil­dren with un­treated vi­sion prob­lems were of­ten misun­der­stood.

“Some chil­dren are un­able to keep up in class as they can’t see well enough to read books or the black­board. This makes them crave stim­u­la­tion from other senses and so they be­come fid­gety and phys­i­cally ac­tive.

“If they’ve al­ways had dif­fi­culty see­ing colours, like in some reti­nal con­di­tions, they will have never seen the full spec­trum of colours and will some­times mix up colours when paint­ing, for ex­am­ple.

“Check­ing their vi­sion is a mat­ter of global im­por­tance as blind­ness or se­vere visual im­pair­ment has a sig­nif­i­cant so­cio-eco­nomic im­pact,” said the vit­re­o­reti­nal sur­geon.

With early de­tec­tion and cor­rec­tion (of vi­sion prob­lems), the gen­eral health of the pop­u­la­tion will im­prove and good vi­sion leads to a more pro­duc­tive pop­u­la­tion.

DR SUN­DER RA­MASAMY

Oph­thal­mol­o­gist

Dr Sun­der Ra­masamy

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