Eye checks for the whole family: what to watch for at every age

Eye questions rarely belong to just one person in a household: a child's squint, a parent's changing reading vision, a grandparent's cataract. I see children, parents and grandparents, for squint, cataract and general eye care, and I operate on both squint and cataract. Most families first come to me because of a child, and this page is for everyone else in the picture: what to watch for at each age, and when it cannot wait.

What should I be watching for in my child?

The short answer is a turn that persists, a squint that comes and goes, and a white glow instead of the ordinary red one in a flash photograph. If your child's eye seems to drift in or out, especially past three or four months of age, it is worth learning what a true drift looks like against a false one before you decide whether to worry. A pale or white reflection where the pupil should look red or golden in a photo is a different kind of warning, and deserves an eye examination this week rather than a wait-and-see. And if screens, homework and squinting at the whiteboard have become a daily argument, short-sightedness is worth understanding on its own terms, because it is now the commonest reason a child needs glasses at all. None of these need you to diagnose anything yourself. They need you to notice, and to book the appointment.

A family history matters here too, in both directions. If a parent, a grandparent or a sibling had a squint, a lazy eye or needed strong glasses young, that raises the chance for your own child, and is worth mentioning at the first visit rather than waiting for a school screening to catch it. Malaysian school vision checks generally begin in primary school, which leaves the earlier, most treatable years sitting in a parent's hands rather than a system's.

What should I be watching for in myself, as a parent?

Two things are worth checking in yourself: an old squint, and reading vision that is quietly changing. A squint carried since childhood, or one that has come back after earlier surgery, does not have to be lived with. The Cambridge University Hospitals NHS Trust's own patient information on adult squint surgery is direct about this: poor control of the eyes can persist, or return, in adults who had a squint as a child, and it continues to be assessed and treated at that stage of life, not only in childhood. A review of the evidence on adult strabismus surgery, published in the British and Irish Orthoptic Journal in 2024, found that adults living with a visible squint often carry a real social cost, feeling judged as less capable or less confident, and that correcting the alignment helped how people felt about themselves and about being around others, not only how the eyes looked in photographs.

The other common change is smaller and easier to dismiss: the moment a menu, a medicine label or a phone screen needs to be held further away to read clearly. That is usually presbyopia, the ordinary stiffening of the lens inside the eye that tends to begin around the age of 40. It is not a disease and it is not a sign of anything going wrong elsewhere. It is also worth knowing that a family history of glaucoma, a parent or a sibling who has had it, is on its own a reason to have your eyes checked, because glaucoma raises pressure inside the eye quietly and usually causes no symptoms at all until real damage has already occurred. Feeling fine is not evidence that everything is fine, which is exactly why this one is worth checking rather than waiting to notice a change.

What should I be watching for in a grandparent?

Cataract, most often, and it rarely announces itself all at once. The lens inside the eye gradually clouds over, and the pattern to watch for is blur that new spectacles do not fully clear, glare or haloes around headlights and lamps at night, colours that look duller than they used to, and difficulty with night driving in particular. Cataract is not only something that happens to grandparents, it can occur in babies too, but in later life it is by far the more familiar version, and the treatment is the same idea at any age: surgery replaces the clouded lens.

What has changed is the thinking about timing. There is no need to wait for a cataract to become "ripe" before anything is done, an idea that used to be common and is now out of date. The decision to operate is based on how much the cataract is affecting daily life, reading, cooking, recognising faces, walking safely, driving at night, not on how advanced or discoloured the lens has become. If a grandparent in your family has quietly stopped driving after dark, or has started relying on the television subtitles, that pattern is worth an eye examination on its own.

When does an adult's eye problem need to be seen straight away, not at the next routine slot?

A small number of situations move an eye problem from "book when convenient" to "be seen this week or today". A squint or double vision that appears suddenly in an adult who never had one before is one of them, and it is not always a squint in the sense children have: my colleague Dr Catherine Chow, a consultant oculoplastic surgeon, sets out when double vision in an adult is caused by thyroid eye disease or an orbital problem rather than a straightforward squint, and that distinction changes what happens next. Sudden loss or blurring of vision in one or both eyes is the most urgent of all: that means being seen the same day. A painful red eye, particularly with light sensitivity or any change in vision, also needs prompt attention. Most of these turn out to have a manageable explanation, but they are precisely the situations where waiting is the wrong instinct.

Can one eye doctor really see all of us?

Yes. I see children, parents and grandparents, for squint, cataract and general eye care, and I operate on both squint and cataract. Most families meet me through a child, and the adults who bring that child are welcome to raise their own eyes too. A family history of squint, lazy eye or glasses works the other way as well: it is a good reason to have the children checked.

None of this needs to happen in a single dramatic visit. It is enough to notice: a squint that never really left, a menu held further from the face than it used to be, a grandparent who has gone quiet about driving at night. Say it out loud at the next appointment, whoever it was booked for, and let the examination take it from there.

Common questions

References

1. American Academy of Ophthalmology · Considerations in Surgical Correction of Adult Strabismus · www.aao.org
2. Cambridge University Hospitals NHS Foundation Trust · Adult squint surgery · www.cuh.nhs.uk
3. Arblaster, Buckley, Barnes & Davis (2024) · Strabismus Surgery for Psychosocial Reasons: A Literature Review, British and Irish Orthoptic Journal 20(1) · www.bioj-online.com
4. AAPOS · Strabismus surgery · aapos.org
5. NHS · Long-sightedness · www.nhs.uk
6. NHS · Glaucoma, causes · www.nhs.uk
7. National Eye Institute · Cataracts · www.nei.nih.gov
8. NHS · Cataract surgery · www.nhs.uk

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.