One in 10 children in Malaysia has an undiagnosed vision problem: Study

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 amblyopic children have bilateral 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 LogMAR (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 Parent-Teacher 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.