Understanding Vision

If your child has blurred vision, it could be a warning sign of myopia (short-sightedness).

Myopia is one of the more serious child eye disorders that can affect your kid’s ability to learn and develop.

10. December 2020

Myopia can have a serious effect on a child’s quality of life and learning, and it’s estimated that by 2050, 50% of the world’s population may be myopic.1 If your child complains of blurry vision, you should know how you can test for, prevent and manage myopia.

  • If your child has blurred vision, it could be a warning sign of myopia (short-sightedness).

Important visual skills for children

Sight is a crucial part of a child’s development, and child vision problems can influence their development and learning abilities. According to the American Optometric Association (AOA), children should possess the following visual skills to perform developmental activities such as reading, studying, and participating in sports and physical education:

  • Your child should be able to see clearly at close, intermediate and far distances. Think of the activities this enables them to perform, such as looking at a projector or black board (far), working at a computer (intermediate), and reading a book (close).

  • Maintaining clarity when the distance to objects change. For example, copying lines written on a board into a book on the child’s desk.

  • Following something that’s moving, such as a ball, and being able to keep the eyes “on track” when moving from one object to another. This is also an essential skill needed for moving the eyes between lines when reading.

  • Any child should be able to use both eyes together, coordinating them when reading. This skill is also necessary for judging depth and distance on the playground or when the child participates in sports. Later in life, this is an essential visual skill needed for driving.

  • When drawing or writing, or catching and throwing a ball, children must be able to perceive visual information and use this to direct their hands.

  • Children learn through sight, and child eye problems will influence their development.

    Children learn through sight, and child eye problems will influence their development.

    This is the brain’s ability to make sense of what is seen. It’s an essential skill needed for building puzzles, drawing, cutting, reading and writing, as well as everyday tasks such as getting dressed or finding missing clothes or toys.

Signs of learning-related visual problems

If your child is complaining of blurred vision or struggles with any of the above visual skills, it may be a sign of a vision problem. Research shows that there’s a link between learning problems and certain visual factors, and this is described as learning-related visual problems,2 the symptoms of eye problems in children include:

  • Eye strain
  • Blurred vision
  • Headaches
  • Nausea
  • Dizziness
  • Excessive blinking and eye rubbing
  • Squinting
  • Covering one eye to see better
  • A change in school performance
  • Tiring easily when doing homework or reading
  • Using a finger to track words when reading
  • Tilting the head to see better at a distance or up close

To pick up on these symptoms as well as the possible causes of a learning disability in time, it’s important to keep a close watch on your child when they read, do homework or play sports. Communicate with their school teachers on a regular basis, and ask them about your child’s developmental progress – they may be able to identify signs of a visual problem that you won’t notice at home.

Can visual problems cause learning disabilities?

Keep in mind that learning problems are complex, and vision may not be the only factor influencing your child’s educational progress. For example, learning disabilities, dyslexia and vision were previously believed to be linked, and many theories suggested that visual dysfunctions were to blame for dyslexia. However, the American Academy of Paediatrics explains that vision is a secondary form of reading difficulty, and that it should be separated from learning disabilities such as dyslexia. If your eye health professional doesn’t diagnose myopia or any other visual impairment, your child may have a learning disability and you should consult a specialist in childhood development such as an educational psychologist, an occupational therapist, or a paediatrician.

Is it possible that my child has myopia?

Although there are several learning-related visual problems that may cause the symptoms mentioned above, myopia (short-sightedness) is one of the more prevalent visual problems in children. Studies have shown an increase in the global occurrence of myopia. Currently around 30% of the global population is myopic, and projections indicate that by 2015, 50% of people will be myopic.1 In urban areas in Asia, 90% of young people develop myopia before the age of 20.2
A recent and well-known study called the Sydney Myopia study conducted on Australian school children also suggests that myopia is becoming more prevalent among children and teenagers,3 and according to the My Kids Vision organisation, Myopia among Australian 12 year olds has doubled in 6 years. To summarize, various sources suggest that overall, myopia has reached epidemic proportions,4 and every parent should be concerned and aware of this.

Furthermore, Myopia can progress to high-level myopia, which leads to a higher risk of eye problems such as retinal damage that may even result in blindness.5 If your child shows any of these symptoms, or you suspect that he or she may be myopic, it’s important to consult your eye health professional for a proper evaluation and possible diagnosis.

If the eyeball is elongated, light entering the eye reaches its point of focus in front of the retina.

If the eyeball is elongated, light entering the eye reaches its point of focus in front of the retina.

What exactly is myopia?

Myopia is short-sightedness or nearsightedness, meaning that a person with this condition can see nearby objects clearly and in focus, but faraway objects appear blurry and out of focus.

Let’s take a step back and consider how the eye works in simplified terms. Light enters through the pupil, and in order to see clearly, these light rays must be bent into a precise point of focus by the lens to reach the retina at the inner back surface of the eye. This is called refraction. Myopia is described as a refractive error, meaning that light entering the eye doesn’t bend properly. So, when the eyeball grows too quickly, or starts growing again in adulthood, it becomes elongated. Light entering the eye reaches its point of focus in front of the retina, making objects at a distance appear blurry. Refractive errors can also occur when the cornea and lens are too curved relative to the eyeball.

Natural light is crucial for healthy eye development, so make sure your child spends enough time outdoors. Remember to protect the skin and eyes against harmful UV rays!

Natural light is crucial for healthy eye development, so make sure your child spends enough time outdoors. Remember to protect the skin and eyes against harmful UV rays!

What causes myopia?

Various lifestyle, environmental and genetic factors are associated with myopia, including:

  • Visually demanding tasks such as reading and writing, and the time spent by children doing these activities have long been considered a potential cause of the development of myopia.

  • Watching TV, playing or working at a computer, on a smartphone or tablet is also considered near work. Children today are digital natives, and they spend a large amount of time operating digital devices.

  • Research has shown that myopia is more common among children living in inner city-urban areas compared with outer suburban areas because of more indoor activities and consequently the lack of natural light.6

  • Natural light is essential for healthy eye development, and due to urbanisation and the high demands of schoolwork, children tend to spend less time outdoors. Research suggests that children who spend more time outdoors have a lower chance of developing short-sightedness.7

  • Studies suggest a link between an increase in the occurrence of myopia and educational pressure, linked to longer times spent indoors, completing work at near distances.8

  • If one or both parents are myopic, there’s a bigger probability of the child being myopic. Studies have also shown that 90% Asian people living in urban areas develop myopia before the age of 20.9

Regular eye tests are a preventative measure.

Regular eye tests are a preventative measure.

How often should I have my child’s eyes tested?

If your child shows any of the abovementioned symptoms, or you suspect that he or she may be myopic, it’s important to take them for an eye test as soon as possible. This is a preventative measure, and if potential eye problems are detected early on, the prognosis may be more positive.

Have your child’s eyes tested on a regular basis, even if they have no obvious visual problems. The first eye examination should be between the ages of 2 and 3, and this must be followed with another one before they start school. Following that, make a point of taking them for an eye test every 2 years.

If there’s a family history of myopia (parents or siblings have been diagnosed) or any form of defective vision, the child must be examined as soon as possible between the ages of 6 months and 1 year, and then regularly afterwards. Your eye health professional will be able to advise you on the frequency of eye tests needed.

If your child has been diagnosed with progressive myopia, they should visit an eye health professional once every 6 months.

My child has been diagnosed with myopia, what now?

Although progressive myopia can’t be stopped, the condition can be managed and treated. There are various treatments available, and the rate of success will depend on the individual. Nearsightedness is frequently corrected with surgery in adults, and you may have heard of popular and effective laser refractive surgeries such as LASIK surgery. However, children’s eyes are still developing and the myopia can continue to progress, so this type of treatment is not a suitable option for them.10

Myopia treatment options for children include:

  • Multi-focal, soft contact lenses are commonly prescribed to treat myopia progression. Such lenses have different optical zones, each dedicated to providing myopia correction and control. This treatment has the same side effects associated with wearing contact lenses, including lower eye oxygenation, infections and irritation.

  • As explained above, myopia is a refractive error, and to compensate for the eye’s refractive error, an eye doctor may prescribe specially designed contact lenses that will alter the shape of the cornea.11 This is called Orthokeratology (OK) or Corneal Reshaping Therapy (CRT), and the aim is to correct or manage the progression of myopia with rigid contact lenses worn at night. Research into the success of this treatment is ongoing, and there are some serious side effects associated with it, including eye irritation and infections.

  • Pharmaceutical treatments doesn’t restore vision, but rather assists in the management of myopia progression. It’s effective only for the duration of use, and research into the long-term side effects and permanent efficacy of such treatments is ongoing.

  • Standard glasses for children are often prescribed, and it may correct your child’s vision for as long as they wear it. Although this treatment doesn’t have any serious side-effects, it doesn’t slow the progression of myopia.

    Probably one of the more comfortable management tactics, specific myopia management lenses simultaneously correct and manage the progression of myopia without any side-effects. Lenses such as ZEISS MyoVision Pro are specially developed for children’s growing eyes, and are ideal for kids between the ages of 6-12.

How can I protect my child’s eyes?

As explained above, environmental and lifestyle influencers are linked to the development of short-sightedness in children. If not treated and managed properly, myopia can progress to high-level myopia, and healthy vision can deteriorate due to a number of influencing factors. It’s therefore essential to protect your child’s eyes – whether they’ve been diagnosed with myopia or they have completely healthy vision. In addition to consulting your eye health professional on the most suitable myopia treatment for your child, here’s what you can do:

  • Let your child play outdoors for at least one hour per day. Research shows that outdoor activity reduces the progression of myopia in children. Your child doesn’t necessarily even have to do sports or physical outdoor activities – it simply seems that more time spent outdoors decreases the risk of myopia developing or progressing.7

  • We tend to focus on protecting the skin from harmful UV rays, but did you know that UV also poses a threat to eye health? When your child spends time outdoors, make sure they wear sunglasses or clear lenses that offer the highest possible UV protection.

  • When working at a computer, your child should sit upright, and as far away from the screen as possible. Also keep an eye on the amount of time they spend on digital devices – of course it’s important to complete homework and tasks, but intersperse these activities with regular breaks, preferably spent outdoors.

  • To ensure that your child’s eyes get enough rest during near-work activities, the 20/20/20 rule is an easy guideline to follow. Get them in the habit of looking up every 20 minutes and focus on an object about 20 metres away for 20 seconds.

  • A balanced diet with a good combination of vitamins and minerals is essential for healthy development. Your child’s daily diet should include at least 3 portions of fresh fruit and vegetables, and make sure that they drink 6-8 glasses of water per day.

  • Sleep is another essential component of your child’s general development, and enough sleep may be beneficial to their vision. The sleep foundation recommends 9-11 hours of sleep for school aged children (6-13 year olds), and 8-10 hours for teenagers (14-17 year olds).

  • Near work must be done in good light. Make sure the space where your child plays and does homework gets enough natural light during the day, and invest in a good reading lamp for night-time work and activities.

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