September 2021
HSon (M/5) came for eye examination, father complains that he always blinks his eyes and he also tends to rub his eyes. He has never worn any glasses before. He has sinus.
Vision without glasses
R: 6/9-
L: 6/12
Examination shows:
R: +0.25/-1.50×180 (6/6-) N5@33cm
L: +0.25/-2.00×170 (6/6-) N5@33cm
Other assessments show:
3D Vision (Random Dot 3S)
50″
(normal value: 12.5″)
Examination of Eye Alignment (Hirschberg)
centre, symmetry
(normal value: centre, symmetry or slightly nasal)
HSon has longsighted power/hyperopia of +0.25, indicated with “+” sign with significant astigmatism. Children who have sinus tend to rub their eyes. When they rub their eyes, they may have high astigmatism/”san guang” or they may take after the shape of parents’ eyes that have astigmatism. Hyperopic power can also mask astigmatism along with it, so when your eyes autocorrect hyperopic power, it will also autocover some of the astigmatism power.
Children having such power, they are fine when their eyes are fresh.. especially after long hours on near work do they find that their vision get blurry hence eye rubbing/blinking their eyes.. same goes to adult.
These days, we have many patients (non spectacles wearers & vision is fine at seeing far) who come in with complaint of tired eyes or sometimes blurry vision at near especially after long hours of computer/hp.. most of them in fact have longsighted power/hyperopia at far. When our eyes are relaxed, they have no problem helping to autocorrect a little hyperopic power and also do some autofocusing at near when we look at hp/computer. Vision only becomes symptomatic (sometimes blurry near vision or even sometimes blurry far vision too/headache) when you keep working in front of computer/hp on prolonged period of time and our eyes cannot cope with it.
Not only do they need to auto correct your hyperopia at far vision, they also need to auto focus when you look at hp/computer. Double the work demanded on them easily exhausts our eyes’ system, hence vision becomes blurry and you feel tired eyes to burning/dry eyes. Give our eyes the power that they need, give them the little support will mostly resolve this vision complaint. Normally, for this kind of condition relating to Computer Vision Syndrome, for children or young adult before the age of 40, your vision will become better back again after taking a break from near work or a nap/sleep. Should your vision remain symptomatic even after rest, a visit to your nearby optometrist is needed for further examination on your eyes system. Whereas for adult above the age of 40, we need a pair of reading glasses to help support seeing near.. and this is normal and no problem at all by then.
HSon’s 3D vision is slightly reduced and he has never worn any glasses before, so we have referred for cycloplegic refraction – put eye drop at eye specialist clinic to temporarily paralyse eye muscle in order to get true eye power. On the other hand, if your child has not worn any glasses before and he/she sees good 6/6 vision with optimum 3D vision without any complaint, we may not require you to go for cycloplegic refraction if all are fine.
*Updated
Cycloplegic Refraction
R: +0.25/-1.25×180 (6/6-)
L: +0.25/-1.75×170 (6/6-)
We prescribe Cycloplegic Refraction and HSon will wear his glasses full time. We will see him in 3months.
……………………………..
Generally, children the age of 5 should have about +0.75 hyperopic power as their eyes are still growing before their eyes settle at Plano or PL or no power. Nowadays, our lifestyle has changed tremendously over the years with the era of digitalisation. Excessive near work sends signal to our eyes that prompts further elongation of our eyeball.. so from no power, children slowly become myopic/short sighted as they grow.. and is further accelerated by this pandemic. So, not only we want to correct their vision, we can do much more to slow their power progression, especially in children with high risk factor of myopia such as having strong family history of high myopia and showing aggressive pattern of yearly myopia progression. The gold, window period of intervention is during primary school when their eyes grow rapidly. The younger the child starts intervention, the more time we have to do something to control the progression.
High power means thicker & heavier eyeglasses.. but it is no longer just about that.
Looking at the prediction by researches.. it is estimated that almost half of the world’s population will be myopic in 2050. And we know that myopia is packaged with various sight-threatening complications – the invisible deterioration that we are battling with in the long run. Children with low myopia, will slowly become highly myopic when they become adult, if record were to show that they progress rapidly. With myopia management intervention, we cannot say that we can halt progression completely.. but we can definitely do something to slow the progression in order to optimise good health of our eyes. All the main myopia management strategies hail to slightly more than 50% efficacy as published.
*Updated (December 2021)
3months Follow Up
HSon came for follow up.
Vision with spectacles
R: +0.25/-1.25×180 (6/6-) N5@35cm
L: +0.25/-1.75×170 (6/6-) N5@35cm
Other assessments show:
3D Vision (Random Dot 3S)
12.5″
(normal value: 12.5″)
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
NMD @Near
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0-2 XP (blue part)
Near: 0-2 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NRA (Accommodation analysis – ability to relax accommodation) by plus lenses
+2.00
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lenses
-2.00
(normal value: -1.37 to -3.37)
MEM (to measure accommodation response seeing near target)
R: +0.75
L: +0.75
(normal value: +0.25 to +0.75)
HSon’s 3D vision is optimum now. His eye posture is fine & accommodation/focusing are good. That’s great!
When we talked about proceeding to eye check and he told us where he needs to sit already? He is very attached to his aunt, PSan.. so heartwarming!❤️
Glad to see children coming in so bubbly & cheerful. They are happy & having good vision & we are happy too!
We will see him in 6 months.
Thank you to father & aunt for remembering to bring HSon in for follow up. Sometimes, we may miss out follow-up appointment, let us all work together – remind each other so that vision of all children will be taken care of. WA us to schedule your child’s follow-up appointment today!