little four eyes

I loved the Mr. Men and Little Miss books as a kid, so I was excited when Dr. Holser at Advanced Eye Care in Grand Rapids posted a video of the three characters from that series that wear glasses (Little Miss Whoops, Mr. Persnickety, and Mr. Nervous) doing a glasses are cool rap.

But after watching it, I was a bit less excited.  It’s pretty catchy and funny, and I’m all for songs and characters that portray glasses positively.  But with the refrain of “four eyes are better than one”, and a scene of one of the glasses guys (Mr. Persnickety) fighting a pirate with an eye patch, and winning, I think this is not a good video for encouraging patching, which is really too bad.  At first, I thought perhaps the characters were targeted at an older group, that is less likely to be patching, but according to the Mr Men Show website, the show is targeted at kids age 4-7, which is when a lot of patching for amblyopia happens.  And the more I think about it, the less I like that the personalities of the characters that wear glasses feel a bit stereotypical, but I could very well be overly sensitive.

Thursday is Thanksgiving in the US, the day that we pause for a moment to give thanks for all that we have.  But I feel like starting a bit early.  So in the spirit of giving thanks, here are a few things that I have to be thankful for:

• That Zoe’s vision problems were caught early, are treatable, and are being treated.
• That we can afford to pay for her glasses (two pair, even), for prescription changes, new frames, and for her regular exams.
• That I have had the chance to meet (even if mostly only through the computer) so many wonderful people through this blog, and I have learned so much.
• That Zoe is not particularly hard on her glasses, and has not attempted to bend either of her current frames into an unrecognizable shape.
• That somehow, against all odds, we have not lost any of her glasses, not even her sunglasses.
• That Zoe now puts her glasses on herself, and reminds me to put my glasses on.
• That there is a good children’s eyeglasses shop only a mile away, staffed with people who are kind, and willing to do many, many, many glasses adjustments for us.
• That at Disney World, when we went to our second 3-d show, Zoe reached for the image once.  She completely failed the 3-d vision test at our last appointment in May, but I have hope that it’s beginning to develop.
• That glasses today are so dang cute!

I’m sure more will come to me in the next few days.  What are you thankful for?

I recently got a question about when a doctor might not prescribe glasses for a child, even if the child was nearsighted or farsighted.  I did some research and found consensus guidelines for prescribing glasses published by the American Academy of Ophthalmology (Pediatric Eye Evaluations: Screening and Comprehensive Ophthalmic Evaluation, 2007, link to full text).

Before jumping to the guidelines, it’s worth emphasizing that these are general guidelines only, based on professional experience and not scientifically researched data.  Let me repeat that: there are no good studies showing when a child should be prescribed glasses – this is in part due to the fact that prescribing glasses is complicated.  Each doctor needs to take into account everything about the individual patient and there are many things that would lead a doctor to prescribe glasses at much lower refractive errors.  These include strabismus or history of strabismus, developmental delays, other medical issues, visual acuity, acceptance of glasses, among other factors.

Prescribing Glasses to Children with Anisometropia

Children who have a significant difference in refractive error between their eyes (called “anisometropia”) are more likely to be prescribed glasses.  This is because anisometropia is a significant factor is causing amblyopia.  If one eye sees much better than the other, the brain is more likely to favor the vision from the “good” eye, leading to amblyopia.

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Prescribing Glasses to Children with Isometropia

For children whose eyes have similar refractive errors (so both eyes are seeing similarly), also called “isometropia”, doctors are less likely to prescribe glasses at lower refractive errors.  In this case, there is a difference in prescribing guidelines for farsighted children depending on whether or not the child has strabismus or misaligned eyes.  Again, this is due to the increased risk of developing amblyopia if strabismus is present.

It is again worth noting that these are only guidelines, and in fact, other studies have shown that many doctors prefer to prescribe glasses at lower refractive errors (Spectacle prescribing recommendations of AAPOS members).

The guidelines do fit closely with our own experience.  When we first took Zoe in to the ophthalmologist, she was not crossing her eyes often, or severely.  In fact, in some of the pictures we took with us, while it looked like her eyes were crossed, when you looked at the reflection of the flash in her pupils, they were actually aligned.  Her refractive error at that time was probably around +4.5 or +5, high enough that the ophthalmologist told us to keep a close eye out for her eyes crossing and told us to come back in 6 months for a follow-up.  Four months later, her eyes started crossing significantly, and her ophthalmologist had us back in and got her into glasses.

If you ever have a question as to why your doctor is or is not prescribing glasses for your child, please ask your doctor for an explanation.  If you still are unsure, or if that explanation does not make sense, a second opinion may well be in order.

I’m very happy to announce that Amomofelly gave birth to a little boy on Nov. 7. They’re hoping to head home from the hospital today.

She writes, “Elly is in LOVE with him and tries to give him tons of kisses and hugs. We are already running into a glasses issue as his skin is so sensitive and she wants to get cheek to cheek with him. When I told her she has to be really careful that her glasses don’t scratch him, those glasses flew off quicker than you could imagine and she was rubbing her cheek to his. (very sweet, but will need close monitoring!)”

Melissa from Children’s Hospital Boston’s pediatric blog, Thrive, wrote about a baby undergoing a new surgical procedure, called keratoprosthesis to replace her damaged cornea with an artificial one.  It’s an interesting story with a hopeful ending.  I have to say, writing this blog has given me a new appreciation for vision, and how fragile it can be, and some of the amazing advances in medicine.  I feel like I’m forever learning more and more (that’s a good thing).

I just got this question from Jenny.  Her daughter is almost 4 and has just (this weekend) gotten glasses for strabismus, amblyopia, and farsightedness.  She’s wondering whether her daughter should wear her glasses in her gymnastics and skating classes.  She was also thinking of signing her up for skiing class this winter, but is hesitant now with her daughter in glasses.  What, if any, physical activities has your child done with glasses?  Any constraints or tips?

• Humor and patching – at Insights, a sweet post about her daughter’s sense of humor around patching.
• Interview about Corneal Reshaping – Dr. Bonilla-Warford (Bright Eyes News) has an interview with Dr. Despotitis, an author and Doctor of Optometry who specializes in Orthokeratology (corneal reshaping – I wrote about it here).  He has written a book, My Children Are Nearsighted Too, about children with myopia.  From the interview, “even though I prescribe eyeglasses daily, when my young children needed eyeglasses, I was upset, even distraught.”