Addressing Myopia and Astigmatism in Children: A Guide for Parents

Myopia in children

Hello Doctor: When my child was 5 years old, it was discovered that both eyes had approximately 200 degrees of astigmatism.
The doctor diagnosed amblyopia, and after corrective lenses were prescribed, the vision improved to 1.0 (though numbers that are too close remain unclear).
As my child started school and began reading, my child also developed myopia.
I would like to ask the doctor: 1.
The previous doctor prescribed long-acting atropine, but my child experienced light sensitivity and blurred vision, and sometimes had headaches in bright sunlight, so we stopped using the drops.
Now my child is in the fourth grade and has developed -3.50 diopters of myopia.
Should I consider trying the drops again? 2.
Currently, my child can only see around 0.5 to 0.6 on the visual acuity test with glasses, and about 0.8 when looking at gaps.
My child sits very close to the front in class and says they can see black letters clearly.
Should we consider changing the glasses? Thank you for your help!

kathy, 40~49 year old female. Ask Date: 2013/05/26

Dr. Zhuang Yamin reply Ophthalmology

Dear Kathy,
1.
There are various concentrations of long-acting mydriatics; lower concentrations may be ineffective, while higher concentrations can be inconvenient for daily life.
In fact, the eye drops mainly play a supportive role, and it is essential to focus on improving the child's eye habits for a long-term solution.
2.
Please pay attention to whether your child squints while watching television or looking at distant objects at home.
Additionally, I kindly ask the school teachers to observe if this phenomenon occurs during class.
If it does, it would be advisable to have the glasses re-fitted.
Wishing you good health,
Changhua Hospital, Department of Health

Reply Date: 2013/05/26

More Info

Dear Parent,
Thank you for reaching out with your concerns regarding your child's vision issues, specifically myopia (nearsightedness) and astigmatism. It’s understandable to feel anxious about your child’s eye health, especially given the complexities of visual impairments in children. Let’s address your questions and provide some guidance on managing these conditions.

Understanding Myopia and Astigmatism
Myopia and astigmatism are common refractive errors in children. Myopia occurs when the eye is longer than normal or has a cornea that is too steep, causing distant objects to appear blurry. Astigmatism, on the other hand, is caused by an irregular shape of the cornea or lens, leading to distorted or blurred vision at all distances. Weak vision, or amblyopia, can develop if these conditions are not corrected early, as the brain may start to favor one eye over the other.

Current Situation
You mentioned that your child was diagnosed with approximately 200 degrees of astigmatism at age five, and after corrective lenses, their vision improved to 1.0. However, with the onset of myopia, their current prescription has increased to -3.50 diopters. It’s also concerning that your child experiences discomfort with light sensitivity and headaches when using long-acting atropine drops, which are sometimes prescribed to help manage myopia progression.

Recommendations
1. Consultation with an Eye Specialist: It is crucial to have regular follow-ups with an ophthalmologist or optometrist who specializes in pediatric eye care. They can monitor your child’s vision changes and adjust prescriptions as needed. Given the increase in myopia, a comprehensive eye exam is warranted to determine the best course of action.

2. Consideration of Atropine Drops: Atropine drops can be effective in slowing the progression of myopia in children, but side effects like light sensitivity and blurred vision can be problematic. If your child is experiencing significant discomfort, discuss alternative treatments with your eye care provider. There are other options, such as orthokeratology (special contact lenses worn overnight) or multifocal glasses, which may help manage myopia without the side effects of atropine.

3. Eyeglasses Prescription: Since your child’s vision is currently measured at 0.5 to 0.6 with glasses, it may be time to reassess their prescription. If they are struggling to see clearly, especially at school, a new pair of glasses with an updated prescription could significantly improve their visual comfort and performance. It’s essential that they can see clearly, especially as they engage in reading and other school activities.

4. Visual Hygiene: Encourage good visual habits at home and school. Ensure that your child takes regular breaks during reading or screen time (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds). Proper lighting when reading and maintaining a comfortable distance from screens can also help reduce eye strain.

5. Monitoring and Support: Keep a close eye on any changes in your child’s vision or complaints of discomfort. Support from teachers and caregivers is essential, especially if your child needs to sit closer to the board or requires additional time for reading tasks.

Conclusion
Managing myopia and astigmatism in children requires a proactive approach and regular communication with eye care professionals. By staying informed and involved in your child’s eye health, you can help ensure they receive the best possible care and support for their visual needs. If you have further questions or concerns, don’t hesitate to reach out to your eye care provider for personalized advice.

Best wishes for your child's eye health and overall well-being!

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