Lazy Eye, Astigmatism and the Dangers of Delaying Spectacles when Needed

I did not know Health Promotion Board goes around pre-schools islandwide to conduct free eye checks until we received a letter to inform us of it. Ewan and his schoolmates had their eyes tested in school and I cannot stress enough about the privileges Singaporeans automatically inherit with our citizenship. 

"How was your eye check today son?" I casually asked over dinner. 

"Oh it was good! I can read everything!" Ewan replied without hesitation. 

Daddy was checking through the children's school bags and pulled out Ewan's results from the communication book, "Huh Ewan? You need to go for a reassessment for your eyes?"

The results came back with a 6/9.5 and 6/12 reading. 

I know 6/6 meant perfect eyesight and anything that isn't, just isn't. But what exactly is it? After becoming a mother, I realised I choose to understand a lot more beyond the superficial. By the time I'm done with motherhood, I would have earned myself a Medical Degree with first-hand experience of febrile seizure, croup, MRIs, broken bones and more! And now, medical knowledge on the Anatomy of the Eye.

Oh don't fret. I won't be going into too much technical details but definitely touching on the importance of correcting Lazy Eyes and the Truth behind Astigmatism. 

The test used in school is known as the Visual Acuity Test. What do these fractions [6/6, 6/9, 6/12] mean? 6 meters is the distance taken for the visual acuity test and this numerator is a constant. The larger the denominator number, the poorer is the vision.

Ewan getting a 6/12 on one eye would mean the last line of letters he could see clearly [from six meters away] is U, Z, D, T, F at 6/12.

Ahhh! All these fractions are making good sense now!

In all honesty, I was disappointed. We spend 90% of our time outdoors and the only time the children get iphone/ipad time are when they are at their grandparents' which makes up to 60 minutes a week. I ensure screen time be played on the television with a two meter distance when possible. Digging further into my memory bank, I questioned if it was that time when they watched cartoons in the car or if we didn't have enough light in the bedroom for our nightly reads. Or hey, could it be genetic?

All I knew was, I do not want my son to be bespectacled at age five. That's too young! That is too unfortunate.

I have to admit, I judge other parents when I see their children wearing glasses at a very young age. I would tell my kids, "See? Watch too much iPad right? This is what happens; your eyes spoil." Under my breath, I whisper to my husband, "These parents ah?" I am ashamed for thinking bad of them. I was ignorant. I didn't know anything about astigmatism nor myopia. The little knowledge I had about being bespectacled was very shallow. Depthless almost. The reason why I am writing this.

From the day we knew of his visual screening results to the day of reassessment, we kept reminding him about reading in good light and the deadliness of reading in a moving car. We talked to a few parents and understood vaguely that "if your child has astigmatism, confirm stamp chope must wear specs one". I didn't know what astigmatism was and didn't probe further since we haven't gone for the [free] reassessment. Trying hard not to jump the gun.

I shared all that I heard with my husband and he retorted, "Ah huh. So now all you parents are Eye Doctors ay?"

15th of August 2017. I brought Ewan and Faye to Health Promotion Board at the stipulated appointment time: 1.45pm. I was probably more nervous than he and got him to promise he will do his best because I really didn't want him to wear spectacles.

That ten minute wait seemed like a lifetime to me. Ewan was escorted into the refraction room and although I requested to sit in with him, I was rejected and told to Wait Outside Please.

"Yang Ewan's Mom. Please Come In." announced the lady who saw to him.

I held onto little Faye's hand and walked gingerly into the room. I skimmed the results slip and heard her say, "Ewan has astig."

"Aiya. So need to wear glasses huh?" I asked. All the mommies I spoke to say astig kids cannot run away from it [跑不掉的]. It's a must.

She said yes and quickly explained to me a few important facts:

1. Astigmatism is not a vision problem but a structural problem with the eye. The human eye is usually shaped in a sphere like a basketball but with astigmatism, the cornea of the eye is an oval shape, more like a rugby ball.

2. It is not caused by watching one too many videos or reading in bad light. 

3. It can be hereditary and is usually present from birth so basically, there's nothing you can do about it. [daddy has it]

The good news from this reassessment is, Ewan is not short-sighted all all! It is just the astigmatism issue that is causing his blurred vision. Yay! At least I know that I've been doing everything else right to keep him a 6/6 in terms of shortsightedness.

Ewan's Diagnosis: To use spectacles during visual work and it won't be required when playing outdoors.

That said, I was still hoping to delay the need to have a bespectacled boy at home. I decided to seek the opinion of Doctor Joy Chan, Medical Director and Senior Consultant in Singapore International Eye Cataract Retina Centre.

My Question

Hi Joy, would like to seek your opinion. Ewan went for a second review at HPB and they say he has no shortsightedness but astigmatism; 125 and 225. I couldn't stay to ask more questions because the kids were bugging me to go. He is recommended to use glasses during visual work and can do without during normal play. What's your opinion about it? Would glasses make things better through the years or worse if I decide not to let him use one for the time-being?

Her Answer

Depends on what his vision is without glasses. If his vision is poor, he can develop lazy eye. 

 Basically if vision is poor in childhood, the connections between eye and brain don't develop properly. If the connections don't develop in childhood, it cannot be corrected in adulthood. 

The time frame is age 7. 

Before 7, vision must be good in both eyes for the connections to develop. Otherwise, it cannot be treated anymore because the brain has matured. So good vision in early childhood is important. 

 That is the basis for the eye screening in kindergarten. It picks up poor vision in kids and corrects before it's too late. K1 was the chosen age because before that not all kids can read eye charts accurately. This kind of screening on a mass scale is expensive. However, the intervention, picking up and treating kids at age 5, yields results. That is why our government is doing this.
[It's no wonder our Myopia rate here is stable amid rising levels worldwide]

I treat a lot of kids from the region where screening is not done - Indonesian, Malaysian and Vietnamese. Usually they come to me too late and lazy eye has already set in and it's not treatable anymore. 

Good news is, Ewan could potentially outgrow astigmatism. The eyeballs are still growing so the shape can still alter with time. 

My advice is to wear glasses and watch Ewan, make sure he achieves and maintains 6/6 vision.

Contact Doctor Joy Chan at +65 6887 2020. 

She practices at Mount Elizabeth Medical Centre and Farrer Park Medical Centre

With that said, I knew immediately that a delay in spectacles-wearing just for vanity and convenience is shallow as compared to developing a lazy eye that can cause irreversible damage in the long run. I told my husband that I will have him paired a new pair of glasses the very next day. No delays!

I thought about heading into Owndays for affordable [and fashionable] frames. I just wasn't sure if they do kids. Well, Vivo City has a lot of optical shops. If one doesn't work, I'll just hop in into the next shop to check out their glasses.

Little did I know, it is important to have a child seen by a professional optometrist. When Dr Joy told me about how the sales people in Optical shops differ in qualifications, it suddenly dawned on me about these two shops I walked in at Bugis Junction recently.

Meyer wanted me to help him buy a few boxes of contact lenses and I was shocked to be rejected from the first shop I went. She said it is important they examined the eyes of the wearer and sell it to him in person. It is against their policy to sell it off the shelf and suggested quietly that I could try the optical shop downstairs because they may just sell it to me; and they did.

When Dr Joy suggested a few optometrist whom she trusted, I zeroed in to the one nearest one to my home which happens to be a shop in an old HDB estate. I grew up in that area and felt the urge to support someone in the old neighbourhood I once spent my childhood at.

Mr Benny Chang. An optometrist and owner of Your Eye Guardian, runs his optical shop himself. You can call him your friendly neighbourhood optometrist who aims to build lasting friendship. At least that is the impression he gave me.

My children were all over his humble shop, touching everything they could possibly reach out to. They were curious about the machines and computers, rows of glasses but especially that big jar of sweets! Any adult would have sent me an angry glare, "Mind your kids will you?" and to be honest, I was trying to. But Benny seemed to handle the kids well enough for me to take a step back.

When Ewan played with the automated chair going up and down like a horse of a carousel, Benny did not get agitated nor stop him from doing it but told him, "Be careful ah! Don't giap yourself. Do you know what is giap?" *hahah* Yes Ewan knows. I use the word giap a lot too i.e. get your fingers pinched or stuck between gaps.

He patiently checked Ewan's eyes again with the machine and my boy couldn't sit still for a moment. He kept putting his face in and out of the machine, sharing stories with Benny as if they were best of friends. My son is a very sociable little fella and I was surprised to see our new-found optometrist taking interest in everything Ewan had to say.

While the kids were tottering around his shop and the adults discussing about best options for our little astig patient, Ewan suddenly jumped off a chair towards Benny! As if on cue, Benny caught him in his arms and my son laid his head on his shoulder.

I had my jaws dropped to the ground.

They say kids cannot be wrong when it comes to sizing people up because they can differentiate the good-hearteds from the bads.

Judging a book by its cover is superficial. Your Eye Guardian is not a fancy shop like the big names in shopping malls. It shares half a shop space with a hairdresser next door and has an adorable photo of a baby donning a pair of black glasses. I say he had successfully attracted a certain right crowd aka my daughter who saw it from afar, "Mommy! Mommy! Look at that baby! So cute right? Wearing glasses?"

The man behind the signage is who that matters. Benny Chang graduated as Optometrist 1997 and assisted in research work and public talks with the late Assoc Professor Chew Sek Jin, renowned as a pioneer in myopia research and was president of the Myopia International Research Foundation. He is a proud father himself [you will see photographs of his son in the shop] and has spoken on topics related to effective eye care at the Prime Minister’s Office and Ministry of Home Affairs.

He is knowledgeable and knows how to make a child comfortable.

I think we have found a friend in him. Ewan walked out of Your Eye Guardian saying, "I like this guy."

YOUR EYE GUARDIAN 
Address: 18, Jalan Membina, #02-10, Singapore 164018 [Directly opposite Tiong Bahru Plaza]
Opening Hours: Mon to Sat 1100 to 2000 hours | Sun and PH 1100 to 1500 hours | Closed on Tuesdays

SMS "LIANG MAY" to 9126 2829 when making appointment with Your Eye Guardian to claim your free paediatric eye check worth S$88 and receive a S$80 optical e-voucher!

Footnote: The Difference between an Ophthalmologist and Optometrist 
An ophthalmologist [Dr Joy Chan] is a medical or osteopathic doctor who specializes in eye and vision care. They diagnose and treat all eye diseases, performs eye surgery and prescribes and fits eyeglasses and contact lenses to correct vision problems. Many ophthalmologists are also involved in scientific research on the causes and cures for eye diseases and vision disorders.

An Optometrist [Mr Benny Chang] are healthcare professionals who provide primary vision care ranging from sight testing and correction to the diagnosis, treatment, and management of vision changes. An optometrist is not a medical doctor.

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