Self-check at homeBy parent
In clinicBy our staff
Child’s details
Maklumat kanak-kanak
Name / Nama
Filled in by
— Select —
Hazwan Amirul Syikin
Miza Nurul
Parent (self-check)
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What have you noticed?
Tap any that apply. Tekan yang berkaitan. Signs listed by the American Optometric Association.
✓
Sits too close Duduk terlalu dekat
✓
Tilts head or covers one eye Memiringkan kepala / tutup mata
✓
Rubs eyes often Kerap menggosok mata
✓
Headaches or tired eyes Sakit kepala / mata penat
✓
An eye turns in or out Mata terpesong
✓
Sensitive to light Sensitif cahaya
✓
Poor focus at school Kurang fokus di sekolah
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Does your child already wear glasses for short-sightedness?
Adakah anak sudah memakai cermin mata untuk rabun jauh?
NoTidak
YesYa
This decides which questions come next.
Please answer Yes or No before you continue.
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Risk questions
Tick only what you are sure about.
A
Risk of developing myopia
Child not yet myopic · Kanak-kanak belum myopia
✓
1. Age 9 or younger Umur 9 tahun atau kurang Proxy for low hyperopic reserve
✓
2. Less plus than expected for age Kurang plus dari jangkaan umur Zadnik 2015 · strongest predictor
✓
3. At least one parent myopic Sekurang-kurangnya seorang ibu/bapa rabun jauh IMI Risk Factors
✓
4. East Asian ethnicity Etnik Asia Timur IMI Risk Factors
✓
5. Outdoor time under 2 hours a day Masa di luar kurang 2 jam sehari IMI · 2 h/day protective
✓
6. High near-work load Beban kerja dekat yang tinggi Association, soft flag
0 / 6 Low risk
B
Risk of fast progression
Child already myopic · Kanak-kanak sudah myopia
✓
1. Age 9 or younger Umur 9 tahun atau kurang IMI 2019 · dominant factor
✓
2. Progression over 0.50 D a year Progres melebihi 0.50 D setahun ≈ 0.25 D per 6-month visit
✓
3. At least one parent myopic Sekurang-kurangnya seorang ibu/bapa rabun jauh Contributory
✓
4. East Asian ethnicity Etnik Asia Timur Contributory
0 / 4 Low risk
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See the result
Low risk
Risk of developing myopia
You ticked 0 of 6.
Myopia self-check result
Menara Optometry Speciality Centre TTDI
Child —
Age —
Date —
Filled in by —
Signs None ticked
Assessment —
Score —
Result —
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Disclaimer / Penafian. This screening does not provide a medical diagnosis
or advice; the result is a guide only. Scores are an internal clinical aid to guide follow-up,
not a validated risk score. Criteria adapted from IMI and Zadnik et al. 2015. Always confirm
your child’s eye health with a registered optometrist.