YOUR CHILD’S VISION: YOUR CHILD’S VISUAL MILESTONES

YOUR CHILD’S VISION: YOUR CHILD’S VISUAL MILESTONES

At birth, the infant’s visual function is not fully developed but continues to develop in the first few years of life.  It is therefore important to monitor your child’s vision as he/she grows so that any abnormalities can be detected and treated early.

The visual milestones (see Table below) are a useful guide to monitor your child’s visual development. If the child does not appear to follow the milestones or if you have any concern, do consult an eye doctor, optometrist or orthoptist for a more thorough eye examination.

Children’s Visual Milestones

Age Visual ability
0-3 months At birth, the vision is poor (only in the range of hand movements or count fingers).  The newborn infant will initially choose to look at light sources such as a torch and only begin to develop eye contact with adults from around the age of 6-8 weeks.  The infant will soon be able to follow large objects which move slowly within his/her environment.
3-6 months The child will now begin to reach objects with his/her hands especially brightly coloured and larger objects.  The eyes will begin to move more widely and with less head movement.  The child will also be learning to grasp with his/her hands and also watch the parent’s face when being talked to.
6-12 months The child is now able to see smaller objects such as ‘100s and 1000s’, bread crumbs or sweets.  The child will try to pick them up and place them in his/her mouth!  The child can also interact with the parents as he/she will be interested in simple pictures in books or drawn for him/her.  He/she will be able to fixate and follow objects of interest such as his/her favourite toy.
12-18 months The child is able to recognize people’s faces and pictures. As the child begins to crawl, he/she is able to know the way around the house.  At this age, the child’s vision can be estimated by putting ‘100s and 1000s’ in your palm and watching the child reach for them.
18-24 months The child now becomes interested in picture or cartoon books, and may even recognize them as representations of real objects.  The child’s vision can be estimated by rolling STYCAR balls of decreasing sizes at around 3 m in front of the child and the child should be able to follow the balls movements.  The vision corresponds to the smallest ball that the child is able to see moving.  The child’s vision can also be assessed using Forced Preferential Teller Acuity Cards or Cardiff picture cards if the child is cooperative.
2 years onwards The child’s vision is almost at its peak development but continues to improve until the age of 7-9 years old. The vision can now be tested accurately using picture recognition and matching technique with Kay or Cardiff picture cards.  All children should be screened by the age of 3 years because squints and amblyopia (lazy eye) usually manifest by this age group.

Children at risk

In most cases, the child’s vision develops without any problems. However, in some children, there may be problems during the early development of their vision and this may affect the development of the child’s other milestones such as speech (as the child cannot see words to learn) or motor development (as the child does not have the confidence to see where he/she is crawling or walking).  The child may also have difficulty bonding with the mother as he/she may not be able to see the mother’s facial expressions.

Image Source: Freepik.com

Children at risk include those:

  • Who have someone in the family with eye diseases such as congenital cataract, squints or high refractive errors which may be hereditary in nature
  • Born to mothers who were ill during pregnancy (especially during the 1st trimester) with infections such as rubella, cytomegalovirus or herpes virus
  • Born prematurely (especially less than 32 weeks gestation)
  • With low birth weight (especially less than 1.5kgs)
  • Who have Down’s syndrome or are educationally subnormal

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THINGS YOU SHOULD KNOW ABOUT DIABETIC RETINOPATHY

THINGS YOU SHOULD KNOW ABOUT DIABETIC RETINOPATHY

Click below to watch about diabetic retinopathy

What is Diabetic Retinopathy?

Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM) and is an important cause of avoidable blindness worldwide. Over time, diabetes causes damage to many organs in your body, including the retina. Your retina helps you see by acting as the film projector in the back of your eye, projecting the image to your brain.

Diabetes damages the tiny blood vessels that nourish the retina. In the early stages, known as non-proliferative or background retinopathy, the vessels in the retina weaken and begin to leak, forming small, dots of bleeding. When retinopathy advances, the decreased blood circulation deprives areas of the retina of oxygen.

Diabetic retinopathy can lead to severe visual loss or blindness in 2 ways. The first is when it affects your macula, the central part of your retina that provides you with sharp, central vision. When this part becomes swollen, it is called diabetic maculopathy.

At the same time, blood vessels can also become blocked or closed, and parts of the retina die. New, abnormal, blood vessels may then start to grow along the retina and surface of the vitreous (the transparent gel that fills the inner part of the eye).

Unfortunately, these delicate vessels can bleed easily. Blood may leak into the retina and vitreous, causing “floaters” (spots that appear to drift in front of the eyes), along with decreased vision. This is called proliferative diabetic retinopathy, and it can even cause scar tissue which can pull off the retina, causing what’s called a tractional retinal detachment (TRD).

In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause a total retinal detachment and glaucoma. The result of either problem, if left untreated, is loss of sight and potentially blindness.

Signs of leakage and bleeding in DR
Figure 1: Signs of leakage and bleeding in DR

Symptoms of Diabetic Retinopathy

You may not be aware the symptoms of DR in the initial stages of the condition, unless it progresses quickly to the more severe stages. The symptoms of DR include:

• Blurred vision
• Sudden loss of vision in one eye
• Seeing rings around lights
• Dark spots or flashing lights

The symptoms described above may not necessarily mean that you have diabetic retinopathy. However, if you experience one or more of these symptoms, contact your ophthalmologist for a comprehensive eye examination.

The following are the risk factors for accelerating DR:

• Poorly-controlled diabetes
• A long duration of diabetes
• High blood pressure
• Elevated blood cholesterol levels
• Sleep apnea
• Gestational diabetes (diabetes during pregnancy)

Tests for Diabetic Retinopathy

A dilated retinal examination will be recommended by your ophthalmologist to examine the retina and detect the presence of any diabetic changes in the eye.

In addition to this, your ophthalmologist may also recommend certain diagnostic procedures such as a fundus fluorescein angiogram (FFA) or optical coherence tomography (OCT) to assess the severity of DR and to determine the best mode of treatment.

The angiogram test involves the injection of fluorescein (a yellow dye) into your arm. The dye can then be seen coursing through the blood vessels in your retina and photos are taken.

Normal, healthy blood vessels do no leak, however, damaged blood vessels like in DR do, thus helping to target treatment. An OCT scan uses reflected light to build a cross sectional image of the retina. Maculaedema is noted when areas of your retina are shown to contain spaces filled with fluid.

Treatment of Diabetic Retinopathy

In mild cases, treatment is not necessary. Regular eye exams are critical for monitoring progression of the disease. Strict control of blood sugar and blood pressure levels can greatly reduce or prevent DR. In more advanced cases, treatment is recommended to stop the damage of DR, prevent vision loss, and potentially restore vision.

Treatment options include:

1. Intravitreal Anti-VEGF injections
Anti-VEGF therapy involves the injection of the medication into the back (vitreous cavity) of your eye. The medication is an antibody designed to bind to and remove the excess VEGF (vascular endothelial growth factor) present in the eye that is causing the disease.

2. Laser Therapy

Laser retinal treatment is often helpful in treat- ing DR. To reduce macularedema, a laser is focused on the damaged retina to seal leak- ing retinal vessels. For abnormal blood vessel growth (neovascularization), the laser treatment is targeted over the peripheral retina (Panretinal Photocoagulation). The small laser scars that result will reduce abnormal blood vessel growth. Laser retinal therapy may be performed in outpatient clinic and greatly reduces the chance of severe visual impairment.

3. Vitrectomy

A vitrectomy may be recommended in advanced proliferative diabetic retinopathy. During this microsurgical procedure that is performed in the operating room, the vitreous is removed and replaced with a clear solution. Your ophthalmologist may wait several weeks to see if the blood will clear on its own before going ahead with surgery. In addition to a vitrectomy, retinal repair may be necessary if scar tissue has detached the retina from the back of your eye. Severe loss of vision or even blind- ness can result if surgery is not performed to reattach the retina.

Proliferation of new blood vessels with scar tissue forming on the retina and in the vitreous

Figure 2. Proliferation of new blood vessels with scar tis- sue forming on the retina and in the vitreous

How to Prevent Diabetic Retinopathy

• Visit your ophthalmologist or optometrist at least once a year. You may be recommended to visit more or less frequently depending on your situation.
Maintain optimal blood glucose levels, blood pressure and blood cholesterol.
• Know your HbA1c (a test of your average blood glucose level over three months). Most people with diabetes should aim for a target of lower than 7%. Talk to your healthcare team about what your target should be.

Who should be screened

All individuals with either Type I or Type II diabetes should be screened annually.
• The interval for follow-up assessments should be tailored according to the severity of the retinopathy. In those with no or minimal retinopathy, the recommended interval is one to two years.
Women with type I or type II diabetes or women who plan to become pregnant should be screened before conception, during the first trimester, as needed during pregnancy and within the first year postpartum

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MODERN LIFESTYLE BEHAVIOUR WHICH CAN CAUSE EYE PROBLEM

MODERN LIFESTYLE BEHAVIOUR WHICH CAN CAUSE EYE PROBLEM

image credit: home.bt

Watching TV or computer for too long causes eye strain and dry eyes. The symptoms are called Computer Vision Syndrome (CVS). This happens because the eye focusing ciliary muscle works hard (contracts) when looking for near. After looking near for too long, you get ciliary spasm (like muscle cramp) causing eye discomfort or even headache. In addition, weblink 30% less when reading or concentrating too hard at something. Blinking less results in less tears being produced by the eyes causing dry eye symptoms such as sandy or gritty feeling. Young children who play games on their mobile devices or read a lot tend to start wearing glasses at a younger age for myopia (short-sightedness).

To avoid this, remember the 20-20-20 rule. Namely, take a 20 second break after 20 minutes concentration to look at 20 feet away (considered infinity distance) whereby the eye focusing muscle is most relaxed.

 

 

Do not look at your phone in the dark for long periods because the our pupils (like a camera aperture) dilate in the dark. This means a lot of light get into the eyes and brain. The blue light emitted by the phone reduces the amount of melatonin and affected our sleep pattern. If you really need to look at your phone at night, either reduce the brightness of the phone or turn on some background light.

 

 

Do protect your eyes from harmful UV light. Excessive sunlight can cause corneal dryness and an eye growth called pterygium which is very common in fisherman, sailors and mountaineers. At the sea or snow covered areas, there is double the amount of UV light coming into our eyes because of the reflection of sunlight from the water and snow. Protect your eyes by wearing UV blocking sunglasses when outdoors for long period of time like playing golf or fishing.

 

 

Exercise more because blood flow is good for the eye and brain. The eye is like a camera which sends the images to the brain which is like a computer that analyses the images. A stroke in the brain can also make a person blind even though the eye is functioning normally. Walking 3-4 times a week reduces the pressure in the eye and helps patients with glaucoma (eye condition caused by high eye pressure) improve their eye pressure control.

As we age, there is always wear & tear in our body including the eyes. The retina and macula is a layer of cells in our eye which convert the images we see into electrical signals to be transmitted to our brain. These cells gradually degenerate (die naturally) as we grow older. We can help protect against age-related macular generation by eating more food containing vitamins A, C and E, as well as antioxidants like lutein and zeaxanthin.

Written by,
Dr. Hoh Hon Bing

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I underwent Lasik surgery in Malaysia and I was able to attend follow-up consultations because I currently live in New Zealand. However, upon returning to New Zealand, I managed to consult my doctor through TeleMe’s online video consultation platform and it went smoothly. I highly recommend TeleMe’s service to everyone !

Jenny Cheng

Patient, From New Zealand

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Dr. Hoh Hon Bing

 

Dr. Hoh is an Ophthalmologist (LASIK & refractive) with over 15 years of experience who focuses on LASIK Laser Eye Surgery, Cataract Surgery and Lens Implant. 

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