little four eyes

This came up in a comment from Erin, “I would love to hear what people say about the younger siblings is the glasses.  My son is ALWAYS grabbing at mine and my husbands and we’re not as close to the ground as my daughter is.”

Zoe is an only child, so we don’t have any experience with this, but I’ve always wondered about this particular question.  So those of you with more than one kid, have you run into problems with grabbing of glasses or jealousy or teasing by the child without glasses?  Any advice?

Wow, it’s been a long time since I’ve done one of these…

• Pictures – Amblyopia Kids has a post about her daughter’s preschool pictures.  When her daughter got out of school that day, she said that the photographer took her glasses off for the picture.  Do you have pictures taken of your child with or without your glasses?  Would you want a photographer to take their glasses off?  Stop by and leave your thoughts.
• Strabismus Surgery – Motherhood and Potatoes has a wonderful and thorough post about their experience with her daughter C’s strabismus surgery (everything went fine and she’s recovering well).
• Eye of the Tigger event in Toronto – parents of children with strabismus are invited to an event in Toronto, Canada to learn more about treatment options from professions.  November 14, starting at 10:00 am.  Check out the website or the facebook group for more details.
• Call for blogs – I’ve organized the list of blogs on the resources for parents page and added a few more.  Who am I missing?

Since GeorgeB asked…  How often have you had to replace your child’s frames or lenses in the past year for non-prescription related reasons (that would be broken or scratched lenses, or outgrown, broken, bent, twisted, or otherwise destroyed frames).  I did two polls, one for lenses and one for frames.  You can vote more than once if you have more than one child in glasses.

A friend asked me this morning how often you could expect a child’s glasses prescription to change, and I don’t have a good answer (though I’ll try to do some research when I get a chance).  The answer will no doubt depend on your child’s age, and their vision, but I wanted to get a sense of how often children need their glasses prescriptions updated.   Zoe’s prescription changed 3 times her first year, and hasn’t changed yet this second year.

In Tami’s story, her daughter Lilly passed the vision screening that their school system required for kindergarten, but was found to have amblyopia at an eye exam at an ophthalmologists   (read the whole story) .  As I was looking in to this, I was surprised to learn that this isn’t all that uncommon.  Children can and do pass the quick vision screenings at their doctors or at school, when in fact, they do have vision problems that need to be treated.  In the United States, most states require some vision screening before a child starts school (though 16 states have no requirement at all), only 3 states require a comprehensive eye exam.  I’d love to hear from readers in other countries about whether they have any vision screenings or exams that are required of children before they start school.

What’s the difference between a vision screening and a comprehensive eye exam?  A comprehensive eye exam is performed by an opthalmologist or optometrist and includes a visual acuity test using one eye, and then the other, cover testing, and then dilating drops and retinoscopy (if you’re reading this because your child wears glasses, this would be the very familiar eye exam).  The screenings, on the other hand, vary from place to place, but most typically involve reading an eye chart or vision acuity cards, though some use refractors that measure the refractive error of the eye without dilating the eye first.  Screenings may be done by pediatricians, school nurses, technicians or trained lay persons.  There is no question that the full comprehensive eye exam is necessary to get the complete picture of a someone’s vision needs.  The question is whether a screening can identify kids with vision issues and get them to an eye exam to figure out exactly what treatment is needed.

The Report of the National Commission of Vision and Health on Children’s Vision that was released this summer does a nice job of compiling and explaining studies that have been done to compare vision screenings to vision exams (the report is here, start on page 9 for the section on screenings and exams).  Vision in Preschoolers, or VIP, is one such study, conducted in 2001-2004, by the National Eye Institute, which compared 11 vision screening tests to see which were the most accurate.  The three best tests still missed more than 30% of kids with vision problems (though they did identify 90% of children with the most severe vision problems).

At least one study cited in the report found that the additional cost of having all children go through a comprehensive eye exam is easily offset by the increase in the number of children whose amblyopia could be detected earlier and treated successfully, compared with the numbers detected and treated with a vision screening program (full text of that study is here).

I know that I’m preaching to the choir here at Little Four Eyes, but please encourage friends and family to have their children’s vision checked out at a full eye exam, rather than relying on vision screenings.  Programs such as InfantSEE (at infantSEE.org) provide exams at no cost for infants, and many insurance programs cover comprehensive eye exams once a year or once every two years.

Tami sent me this story about her experiences in getting her daughter diagnosed.  I have more to write about the importance of vision exams over vision screenings, but there is so much good advice in this story, that I wanted to publish it on its own.  -Ann Z

My daughter, Lilly, turned 5 in June. During her annual check up we were sent to the optometrist’s office to read the eye chart. That is the only thing that is required by our school system for kindergarten entrance. There was no specific line for her to stand on, the lady just told us to stand in an approximate spot about 4 feet from the chart and read as many lines as possible with both eyes. Next she was told to cover her left eye with her hand and read as many lines as possible. Then the same with the right eye covered. We were handed a slip of paper saying she had 20/20 vision.

I knew our health insurance covered one eye exam a year as long as we saw an ophthalmologist. We don’t have vision insurance and I have been wearing corrective lenses since I was 10 so I always take advantage of that. I had also taken Lilly in before she started preschool when she was 3. He didn’t find any problems at that time. Her preschool also had the Lion’s club in doing eye checks and there were not problems found.

I had an exam already scheduled for her the next week after her annual pediatrician’s exam (June 30th). I figured it was a good idea to get her in before she started kindergarten, just to be sure there were no problems.

After going back to the office she sat in the exam chair and was told by the nurse to read the chart with both eyes, no problem. Then the dr came in. He had her read the chart with both eyes, no problem at all. Then asked her to cover her left eye with the plastic thing, no problem. Next he told her to cover her right eye, she sat there for a moment, then started moving the plastic thing and cheating. I could tell the dr was getting annoyed by it so I went over and covered her eye. To my complete shock, she could not read it! Not even the top line. My heart sank. How could I not know that my baby couldn’t see out of one eye?

Next the dr put dilating drops in and asked us to wait in the hall for a few minutes. When we went back in he did all the usual things optometrists and ophthalmologists do with adults. Looking into her eyes, changing lenses to find the right prescription the reading the charts again.

Sadly this dr was not very good about explaining her situation. He told me she had good vision in the right and bad vision in the left along with an astigmatism. She would need glasses and I would need to put atropine drops in the good eye every day. That was about it. As soon as I left the office I was on the phone leaving a message with a friend who’s daughter also wears glasses, just to get  some general information from her such as a good place to buy glasses.

After a night of stewing, not sleeping and worrying about how we were going to pay for all of this with no vision insurance I talked to the nurse and she informed me that it was called Amblyopia and that our health insurance would probably pay for it. So, I called the insurance company, they told me that yes it was a medical diagnosis so insurance would pay for exams, but not glasses. I find that crazy. If you break a bone your insurance pays for getting a cast put on!

I was talking to the mother of one of Lilly’s t-ball teammates. Her daughter had amblyopia also and they had a wonderful pediatric specialist that they really liked in another city about 45 minutes away. I decided we’d go back for her re-check the next month and see what the dr said.

A month later (August 6) we had to go back for a re-check. After reading the eye chart and looking at her eyes he tells us that she’s had tremendous improvement and we could stop the drops, continue wearing the glasses and come back in a year.

After all that I had read on the internet, I didn’t like what I heard. So I called the specialist I had been told about, and actually had heard his name from a few other people too. It was hard to get an appointment (September 6) and I had to take Lilly out of school for half the day, but I had no choice unless I wanted to wait until January.

I am totally sold on the pediatric ophthalmologist! When we were called back into the exam room the assistant asked us what brought us there and I explained everything up until that point. That place is fantastic. What a difference going to a place that is geared toward children! The staff is so much more patient and they have so many tricks to making the kids cooperate. In the first room Lilly read the eye chart with her glasses on and the lady took her glasses for a bit to check them. Then she dilated both her eyes and sent her into the waiting room filled with toys and a Disney movie playing.

After a few minutes we were sent into a different room to wait for the dr. When he came in he asked us to again tell him the story of what brought us to his office. He seemed very irritated by us being told that everything was fine after a month. He told us that treating amblyopia can take many months and even years to treat. He did all the same things as the other dr, but he was much more patient with her and had the tools to get her to cooperate for him, such as animals and movies to draw her attention.

At the end of the exam he told us that she definitely needed to return to treatment and gave us the option of doing the drops again or try patching. She also needed new lenses in her glasses, a stronger prescription for the bad eye. He told us that if the drops didn’t make enough improvement we would have to start patching and also warned us that it was possible that she would need surgery if the the patching didn’t work. He asked if we had ever noticed the lazy eye , which we hadn’t, so he made her eye drift off so we could see what was going on. He was also very thorough about telling us all about the condition, such as most of the time children have it from birth and how often it goes undiagnosed. He waited to see if we had any more questions for him before he left too. Nothing is worse than a dr that darts out of the room before you have a moment to think about things.

I walked out of that office feeling much better about the situation than I ever had. I will NEVER deal with someone who is not a pediatric specialist for anything again. The original dr is a good dr for me, but not for her!

We go back next month (November 5th) to see if she’s improving with the drops.

Elly was super excited about patching at the pumpkin patch today!   Using  a stack of foam from the dollar store, a black permanent marker, packing tape, scissors and an exacto knife… we came up with this patch.  I would say it is only sturdy enough for a one or two time use, but we had a ton of fun making and wearing it! 

This question was posted by a reader on the Little Four Eyes facebook group.  -Ann Z

We found out a few weeks ago our child is near-sighted. Can anyone speak to whether doctors usually write notes to inform schools that a child needs to wear glasses? We have written two notes so far this first month of school and the teacher has reminded my daughter once and the rest of the time her glasses are stowed away in her desk. My child is 6. The past couple of days her eyes looked strained, puffy, tired and bloodshot. At what point should I involve the principal or should I try popping in unexpectedly and interrupting the class in order to remind her myself? Thanks in advance.

I’m almost out of time, but I wanted to post something in recognition of World Sight Day, 2009 – an international day of awareness, held annually on the second Thursday of October to focus attention on the global issue of avoidable blindness and visual impairment.  World Sight Day is part of the VISION 2020 Global Initiative for the elimination of avoidable blindness, launched in 1999, jointly by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB).

The VISION 2020 site provides information about the prevalence, causes, and means of preventing vision loss and blindness.  Some of the facts (which come from the World Health Organization) were astonishing to me, even though I consider myself pretty well-read on the topic of vision issues:

• 80% of blindness is avoidable – either treatable, curable or preventable
• 90% of blind people live in low-income countries
• Nearly two-thirds of blind people worldwide are women & girls
• Cataract is the leading cause of blindness – yet it is curable by a simple, cost-effective operation
• 145 million people’s low vision is due to uncorrected refractive errors (near-sightedness, far-sightedness or astigmatism). In most cases, normal vision could be restored with eyeglasses.
• 8 million people worldwide are blind due to uncorrected refractive errors. A simple sight test and glasses could restore sight to most of these people
• Restorations of sight, and blindness prevention strategies are among the most cost-effective interventions in health care

I think that having a baby (then toddler, now almost 3 year old – gah!) in glasses has really sensitived me to global vision and blindness issues.  I knew that blindness was often preventable or treatable, but I had no that the number of avoidable cases was 80%.  It’s gotten me wondering about ways support initiatives such as VISION 2020 to help prevent vision loss.

Julia Kelly at BlogCatalog wrote a very nice spotlight on Little Four Eyes, which includes an interview with me.   I’ve enjoyed interviewing other people for this blog, so it was fun to be on the other side and get a chance to talk about Little Four Eyes, and especially how much you all mean to the blog.