In normal vision, light enters the eye and the image is focused clearly at a single point on the retina (the light-sensitive area similar to the film of a camera) at the back of the eye.  Refractive errors result from an abnormality of either the length of the eyeball or curvature of the front of the eye called the cornea.

When a refractive error exists, the image is not in focus and 3 situations can arise.

1. Myopia (short-sightedness)

The image is focused in front of the retina because either the eyeball is too long or the cornea too curved.  The child can see near objects but distant objects appear blurred. 

This is the commonest refractive error is Asians and usually manifests between the ages of 6 to 16 years of age.  There is a correlation between short-sightedness and high intelligence, excessive reading, excessive playing of computer or handheld games and not spending enough time outdoors to see distant objects.

2. Hyperopia (long-sightedness)

The image is focused behind the retina because the eyeball is too short.  Both far and near objects appear blurred although the distant vision is slightly less blurred.

3. Astigmatism

The image is focused at 2 points on the retina and objects at all distances appear blurred and distorted. Astigmatism is due to unevenness of the cornea.

A child who develops a refractive error will require spectacle correction to be able to see clearly. This is very important for the child visual development (especially if the child is below the age of 9 years) because not wearing spectacles can lead to amblyopia.

When and how often should a child have the eyes checked?

It is recommended that children should have their first eye examination at the age of 3 years and again just before the start of school (around 6-7 years old) by either the eye doctor, orthoptist or optometrist.

The eye test should include:

• Measurement of any refractive errors (shortsighted, longsighted or astigmatism)
• Eye movement assessment and detection of any squint
• 3D vision (depth perception) assessment

Risk-free children can have the eyes checked every 2 years while children who wear spectacles should have their eyes checked every year by the optometrist as the prescription may change within this period.

Age	No Symptoms & risk-free	At risk children
Birth to age 6 years	One check by the age of 6 years. An eye check at age 3 years is optional	One eye check by the age of 1 year & as recommended thereafter
Ages 6 to 18 years	Every 2 years	Every year
Children who wear glasses	Every year	Every year

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