October 2017


WHEN SHOULD CHILDREN GET GLASSES?

Babies are not born with perfect vision. It is normal for them to be farsighted with some astigmatism until they are able to see well at about one year old as the brain and visual system mature. In children whose vision does not correct itself spontaneously with growth and maturation, the most common errors are refractive errors. These are caused when the shape of the eye does not correctly focus the light rays entering the eye. They include shortsightedness (myopia), farsightedness (hyperopia) and astigmatism. With myopia, a child can see objects clearly close up, but has trouble seeing further away (like the classroom blackboard). Myopia is most commonly diagnosed in children between the ages of 8 and 12, usually gets worse during the teenage years, but stabilises in early adulthood. If the child is farsighted, words on a page will seem blurry, but distance vision is not as much of a problem. Hyperopia is particularly common in young children, but they may not notice any blurriness because their eyes can compensate by focusing. Astigmatism distorts or blurs vision for both near and far objects. It happens when the cornea is irregularly shaped, and is more like a rugby ball than like a soccer ball. Myopia and hyperopia can be combined with astigmatism, or astigmatism can occur on its own.

Warning signs

Most children should have their first vision assessment at 3 to 4 years of age, but a visit to the optometrist may be advisable earlier if there is a family history of eye problems or if the parents notice certain visual behaviours that seem different from those of other children. If your baby seems to be visually inattentive, is not tracking and following objects by 4 months of age, or recognising you from across the room between 6 and 9 months, there may be cause for concern. Warning signs in older children may include covering one eye, tilting the head, or squinting to see objects more clearly, sitting too close to the TV or holding a book too close while reading, or difficulty concentrating on an activity for long periods of time. Excessive eye rubbing, redness or watering of the eyes after reading or engaging in activities close up, headaches or eye pain may indicate that your child is experiencing eye fatigue or strain.

Comprehensive eye examination

A comprehensive eye examination usually includes an assessment of the clarity and sharpness of vision, the alignment of the eyes and how they function together, depth perception, and the overall health of the inside and outside of the eyes. The optometrist may dilate the pupils with eye drops in order to examine the retina and optic nerve at the back of the eye more effectively.

Correcting vision in children

Optimal learning, either informally through play or in the formal setting of a classroom, is dependent on optimal vision. The most common reasons to prescribe glasses for children are to facilitate normal vision development, to improve vision and help the child to function better in his environment, to help straighten eyes that are crossed or misaligned, to help strengthen a weak or "lazy" eye, and to protect one eye if the child has poor vision in the other. Not all refractive errors need to be corrected, and sometimes the optometrist may decide not to prescribe glasses, to allow the child's natural focusing mechanism to correct the error.

Getting the child to wear glasses

Parents may be overwhelmed when they find out that their child needs glasses, and they may wonder how they will accomplish the seemingly daunting task of getting their child to comply. One expert commented that "generally if a child needs glasses she will wear them because kids like to see their world clearly". While it may be as simple as that for some children, it may be more difficult with others. Another expert says: "It is non-negotiable, like holding an adult's hand to cross the road!"

Children do not have the maturity to understand the possible long-term consequences of not wearing their glasses, and parents need to understand their concerns while still ensuring that they wear their glasses.

Whether or not to wear glasses is not up to the child, but he may accept them more readily if he is included in the process. Discuss with your optometrist the important criteria that need to be taken into account, and allow your child to choose his own frame within these guidelines.

To keep pace with the active lifestyle of children, the frames need to be durable. Plastic frames are less easily bent out of shape and damaged than metal frames. For eye protection, the lenses should be made of a material which will resist impact, so that they are not prone to scratch or shatter. They should offer protection from the damaging UV rays of the sun, and filter out harmful blue light from digital screens. Your optometrist will ensure that the glasses fit correctly and feel comfortable to the child. If possible, an extra pair of glasses may be useful for times when the child forgets to wear them to school. If the child is wearing contact lenses, a pair of glasses is essential to prevent eye strain from over-wear of the lenses.

Common concerns of parents

If my child uses her glasses all the time, she becomes dependent on them. While she may be able to cope without her glasses, your child will appreciate how much better her vision is with her glasses. It is to her benefit to encourage her to depend on her glasses to see clearly without strain.

If my child needs glasses, does this mean that he has "weak eyes?" If the structures of the eyes are healthy, and glasses help him to focus better, your child's eyes are not considered weak.

The glasses should be worn only to see the board at school. The glasses should be worn whenever the child feels she needs them in order to see clearly and function optimally at what she is doing. Talk to your optometrist for guidance.

I passed my astigmatism on to my child. There is a tendency for astigmatism to run in families, but the genetics are not very clear, and sometimes it just happens for no apparent reason.

My child will need to have her eyes examined more often now. People with refractive errors should have a thorough eye examination once a year in order to make any adjustments to their prescriptions and assess their eye health. Unless your child reports problems with her vision before one year or your optometrist recommends an examination sooner, an annual check-up is probably all that is necessary.


THE STORY OF THEMBI AND THE SINGING TREE

October 12th is WORLD SIGHT DAY, a day on which eye care awareness and universal eye health are emphasised. In South Africa, the theme of this year's World Sight Day is "Make Vision Count", and a number of community projects and awareness programmes are carried out. The story of "Thembi and the Singing Tree" is a moving account of the importance of drawing attention to the need for eye care awareness in children.

Ken Youngstein is an American psychologist who spent many years in several countries in Africa working in the healthcare sector. In 1978 he set up a company with the aim of developing medical educational programmes for both professionals and patients. Based first in New York City and later in Zurich, he spent time each year providing these services to charities and government organisations throughout Asia and Africa. According to him, his greatest challenge was finding the right message and the right medium to reach each target audience, and to deliver information that was relevant and culturally appropriate for each group.

In 2016, Youngstein met a man who worked for Orbis, an organisation which works with local partners to develop their capacity for accessible, high quality, sustainable eye-health services for all. By training doctors, nurses and community members, and conducting outreach services to communities, they act on their belief in "a world where no one is needlessly blind or visually impaired". Together they aimed to develop an educational toolkit that Orbis and their partner clinics could use to educate local health professionals, patients and the general public about eye care.

Around the same time Youngstein and his wife became involved with Room to Read, an organisation which works throughout the developing world to promote education through the building of libraries, training of teachers, and publishing children's books in local languages. Youngstein pointed out that countless children throughout the world are missing out on the magical world of books due to avoidable blindness or visual impairment that could be dealt with relatively easily if the children's vision was tested early enough.

Here was a perfect opportunity to merge the work of Orbis and Room to Read by creating a children's book on eye care in local languages. It was decided that they would write about refractive errors, namely shortsightedness, farsightedness and astigmatism. These are common conditions, easy to diagnose, easy to correct, and, once they are corrected, people's lives are dramatically changed, allowing them to read, learn, work, play and interact with others effectively.

Inspiration for the story of Thembi came from Younstein's personal experience as a little boy who, when he received his first pair of glasses at the age of 5, saw birds flying high above for the first time. Thembi, unable to see the birds, believes the beautiful songs she hears come from the tree under which she often sits. The story includes the difficulties of children with visual impairment, their limited ability to learn and interact with others, and their feelings of isolation.

The first edition of "Thembi and the Singing Tree" was published in four South African languages. It has since travelled as far as Asia, and been adapted in India to reach 4.5 million school children.

"Our hope is that The Singing Tree will help children, their parents, and their teachers to better understand the need for testing children for eye problems and for providing appropriate care to allow all children to reach their full potential," comments Ken Youngstein.

Download your free copy of "Thembi and the Singing Tree", and share the joy of sight.


CURVES IN THE WRONG PLACES!

What Is Astigmatism?

Astigmatism is the most common vision problem. It is caused by an error in the shape of the cornea or lens of the eye. Normally, the cornea and lens are smooth and curved equally in all directions, helping to focus light rays sharply onto the retina at the back of the eye. However, if the cornea or lens isn't smooth and evenly curved, it can change the way light passes or is refracted onto the retina, resulting in a so-called refractive error

Corneal Astigmatism

The cornea is a transparent layer of tissue that covers the front of the eye. A perfectly curved cornea bends, or refracts, light as it enters the eye so that the retina receives a perfect image. In a person with corneal astigmatism, the cornea is oval-shaped rather than perfectly round, with the result that the light rays will focus on two points on the retina instead of one.

Lenticular Astigmatism

Lenticular astigmatism, which is less common than corneal astigmatism, occurs when the lens has variations that cause images to reach the retina imperfectly. They may focus either in front of or beyond the retina, causing blurred vision of both far and near objects. Most people with lenticular astigmatism have a normal-shaped cornea. What Causes Astigmatism?

It is not known what causes astigmatism, but it is thought to be an inherited condition. It is often present at birth, but may develop later in life, sometimes after eye disease, injury or surgery.

Who is at Risk for Astigmatism?

The risk of developing astigmatism may be higher if there is a family history of astigmatism, scarring of the cornea, excessive shortsightedness or farsightedness, or certain types of eye surgery.

What are the Symptoms of Astigmatism?

The symptoms of astigmatism may differ from person to person, and some people have no symptoms at all. Generally, the symptoms include blurry or distorted vision for both close and far distances, difficulty with night vision, eyestrain or discomfort, headaches, and squinting to try to see clearly. Having any of these symptoms may not necessarily mean that you have astigmatism, but they do indicate the need for a visit to your optometrist.

While adults with a higher degree of astigmatism may realise that their vision isn't as good as it should be, children who have astigmatism may not be aware of it, and are unlikely to complain about blurred or distorted vision. Uncorrected astigmatism can impact a child's ability to achieve in school and sports, so regular eye examinations are advisable.

How is Astigmatism Diagnosed?

Various tests and instruments are used by the optometrist to conduct a comprehensive eye examination. During a visual acuity assessment, you will be asked to read letters from a chart to determine the clarity of your vision at certain distances.

The curvature of the cornea is measured with a keratometer, and corneal topography may be done to provide additional information about the shape of the cornea. Using a phoropter, which has corrective lenses of different strengths, the lens that is appropriate for the correction of your vision is found.

What Do the Measurements Mean?

Astigmatism is measured in diopters. A perfect eye with no astigmatism has 0 diopters. Most people have between 0.5 to 0.75 diopters of astigmatism, but this does not usually affect their vision. People with a measurement over 0.75 dioptres typically need to have their astigmatism corrected in order to maintain clear vision. Of the three numbers on the prescription for glasses or contact lenses, the last two refer to astigmatism.

"Spherical" indicates whether you are shortsighted or farsighted. A plus sign indicates that you are farsighted, a minus sign that you are shortsighted. The higher the number, the higher the refractive error, and the stronger your prescription.

"Cylinder" measures what degree of astigmatism you have.

"Axis" is measured in degrees, and refers to where on the cornea the astigmatism is located. Axis numbers go from 0 to 180.

How is Astigmatism Treated?

Mild cases of astigmatism without shortsightedness or farsightedness may not need to be treated at all. Almost all other cases can usually be corrected with glasses or contact lenses, which counteract the uneven curvature of the cornea or lens by bending the light rays in a way that compensates for the error caused by faulty refraction.

Orthokeratology (Ortho-K) is a treatment that uses rigid contact lenses to temporarily correct the irregular curvature of the cornea. These lenses are worn for limited periods of time, usually during sleep, and removed during the day. While the improved vision is only temporary and the cornea will return to its irregular shape when the lenses are not being used, many people appreciate having clear vision without glasses or contact lenses during the day.

Refractive surgery to reshape the cornea may be recommended for some cases of astigmatism. Your optometrist will refer you to an ophthalmic surgeon who will explain the various procedures, as well as their benefits and risks.

A discussion with your optometrist will help you to choose the best option for your vision and lifestyle needs.


Achtober

So close but so far. Whoever invented that expression must have been talking about October. Or - as my friends and I like to call it - Achtober. Because ach, who's got the energy to pull through two more months until the end of the year?

Now my friends and I are just a bunch of glasses (with a few sunglasses among the group). But we figure we understand how you feel. And so...

If you're feeling bleary and grimy like a dirty lens, take some time out for yourself. You know, some Me Time (or in your case You Time... you know what I mean.) If you can't take a weekend away, go out for a night or spend an hour at the spa. My friend Sandra is a pair of old cats-eye glasses whose lenses hadn't been wiped in months. Just one rejuvenating treatment with a soft cloth and she felt brand new.

If you feel like your arms and legs are falling off, take some time for exercise in between all the typing, driving and other draining activities. My friend Doug is a pair of wayfarers whose hinges almost came apart. He couldn't even fit properly onto his owner's face. Rest that weary body of yours. And - like Doug did - get your hinges adjusted as and when necessary. Maybe a yoga session is all you need.

If you're generally feeling bent out of shape, you might require the likes of physio or even acupuncture (if that's your kind of thing). My friend Sharon needed a full body realignment because her frame didn't even look like a frame anymore. Okay, that was because someone sat on her. But you'll understand the feeling if your boss (or anyone else) has ever sat on you.

Her cousin Max went through the same thing from being pulled in a thousand different directions. He needed a good session with an optometrist in order to squeeze his frame back into shape. If that's ever happened to you, you'll be able to relate. Achtober has a way of straining us in all directions. People have had the whole year to ask you for things... but suddenly they want it, and they all want it now.

So there you have it. We know how you feel. When you feel like you don't have a moment to catch your breath, that's when you actually need it the most. Give yourself a wipe, take care of those hinges, and get that body back into shape.

Oh by the way, if your actual glasses are scratched and bleary with their hinges falling apart, do yourself a favour and go buy a new pair. There's nothing like a new pair of glasses to give you a boost towards the finish line.