little four eyes

Alex, age 9

Anne from Is this a boardinghouse or something? just sent me a note with some great news.  Her son, Alex – now 9 years old, has worn glasses since he was 3 1/2, and has struggled with amblyopia for years.  From her post:

Over the years, we patched, dropped, argued, bribed & begged. We had sticker charts, bought webkinz and occasionally sat on him to get him to wear the patch. …. The Atropine changed Alex’s personality and sometimes gave him nightmares. When he started school, his vision was so bad he qualified for special education funding; he had special paper with black lines…

On Tuesday, they learned that all of their hard work with patching, dropping, begging and bribing paid off.  Alex has gone from being legally blind in his right eye, to having 20/40 vision, and has  been released from monthly visits to the eye care clinic.

I encourage everyone to read the full post, it’s a great story of why patching is worth the effort and the tears.

I was just sent this question, and have no experience with this, so I thought I’d see if anyone else had dealt with this:

My daughter has been crossing her right eye for about six months and it is getting progressively worse. We finally got in to the children’s hospital and the doctor was shocked to find that the eye she is crossing is her stronger eye. Essentially she is favoring her weaker eye. Do you know of any other parents whose children did this? The doctor said it made no sense.

Her prescription is

Left eye
SPH: +3 CYL: +.5 Axis 90

Right eye
SPH +3.5 CYL +1 Axis 90

Just today I ran across a couple of different cases of Nickelodeon characters wearing glasses or going to the eye doctor.  Maybe Nickoledeon is a big

First, Ann W sent me a link to the book  The Eye of the Fry Cook: A Story About Getting Glasses (Spongebob Squarepants).  It’s a Spongebob Squarepants story about needing and getting glasses.  Apparently, the reading level is for 9-12 year olds, but I know we’ve got some smart kids, and if your child loves Spongebob, it may be worth checking out.

I also happened to stumble across Nick Jr’s page on visiting the Eye Doctor.  It has:

Put the glasses on Uniqua from Nick Jr

• the Backyardigans stickers about glasses.
• printable put the glasses on the character game – like pin the tail on the donkey, but with less pinning, thankfully, who wants their child to think you have to pin their glasses on? (featuring Pablo, YeYe, Walden, and Uniqua – I have to admit, I don’t know who any of these characters are, Zoe could probably tell me, though).
• a set of printable pretend eye charts (with Dora, Yo Gabba Gabba, and Ni Hao, Kai-lan characters).
• a set of Blues Clues eye exam flash cards.

I love the stickers, and the put the glasses on game could be fun, especially if you threw a party to celebrate your child getting glasses.  The printable eye charts kind of bother me, because they really aren’t any kind of real eye chart (and they don’t claim to be), but it could be a nice way to introduce the concept of eye charts to your child if they’ve never done that before.  The eye exam flash cards go over some of the different things that happen at an eye exam.  I’m not sure how much Zoe would enjoy something like that, but again, it may be a nice way to explain what will happen to a child facing their first eye exam.

In any case, it’s nice to see Nickelodeon creating fun games and activities around glasses and eye exams.  I wish that some of the characters stayed in glasses, though.  As far as I can tell, the characters that are wearing glasses in these print outs don’t wear them on a regular basis.  Ah well.  I’ll take what I can get.

Edited on 26-Jan-10 to correct the errors that Dr. Bonilla-Warford pointed out (thanks Nate!) – Ann Z

Glasses prescriptions can be confusing – lots of numbers and abbreviations that aren’t necessarily easy to figure out, or at least, they weren’t when I first tried to understand Zoe’s prescription.  And in fact, I thought I understood what all the numbers meant, but after doing more research for this post, I found it to be far more complex than I’d originally thought. (On that note, if any eye doctor types read this and catch any mistakes, please, please let me know and I’ll correct them – thanks Nate!).

Before we get too far into what a prescription is, I thought it might be worthwhile to mention what a prescription isn’t.   It will not tell you:

• what your child’s diagnosis is.  You can tell whether glasses will correct for nearsightedness or farsightedness, but that doesn’t tell you what the cause of the vision problem is.
• if your child has amblyopia, it will not tell you what his or her actual visual acuity is.
• if your child has strabismus, it will not tell you how much his or her eyes are turning in or out.
• how well your child’s eyes work together, and whether or not he or she has stereoscopic vision.
• how advanced your child’s cataracts or glaucoma is, and how that affects their vision.
• anything that is not related to how glasses or contacts should be made in order to correct your child’s refractive errors (that is, due to the shape of the eye not being able to focus light correctly).

Okay, so back to the eyeglasses prescription then, and what it can tell you.  Prescriptions have a lot of different components, and I’ve seen them written a number of different ways, but they do have common elements at the core.  I’ll go into more detail on each piece, but I tried to put together something of a “cheat sheet” here:

Which eye are we talking about?

Since we’re nearly always looking at prescriptions for two eyes, you’ll nearly always see two sets of numbers, one for the left eye, and one for the right.  I’ve seen some prescriptions that label them “left” and “right” or “l” and “r”, which even I can figure out on my own.  But more often, I’ve seen “O.D.” and “O.S.”.  These are abbreviations for the Latin words for left eye and right eye.  For the record:

• O.D. : right eye
• O.S. : left eye
• O.U. (which I’ve never seen before, but found this information so figured I’d include it) : both eyes

Sphere

Sphere, often abbreviated as “sph” is the spherical refractive error, or nearsightedness or farsightedness.  It’s pretty much what I think of when I think of an eye glasses prescription.  Then again, I’ve never really had to deal with astigmatism (for me or Zoe).  The first part of this number will be a plus or minus sign:

• + : farsighted, or longsighted prescription: hyperopia.
• - : nearsighted, or shortsighted prescription: myopia.
• 0, Pl, or Plano : no error

How bad is the spherical prescription?

The number is in “diopters” but we don’t need to know too much about that (read about it on Wikipedia here), it’s a measure of how much the curvature of the eye  is off from normal.  Basically, the higher the number (ignoring the plus or minus), the worse the prescription.

Myopia (-)

• 0.00 to -3.00 : mild myopia
• -3.00 to -6.00 : moderate myopia
• -6.00 and higher : high myopia

Hyperopia (+)

• 0.00 to +2.25 : mild hyperopia
• +2.25 to +5.00 : moderate hyperopia
• +5.00 and higher : high hyperopia

Cylinder

Cylinder is the measure of astigmatism.  Astigmatism is when there’s an irregular shape to the cornea, often described as a football shape.  It causes blurriness at any distance.  There are two measurements that go along with astigmatism, the first, cylinder, is a measure of how severe the astigmatism is.

How bad is the cylinder prescription?

Like the spherical error, the cylinder number is measured in diopters.  The thing you want to pay attention to is the number.  It may be written as a plus or a minus, but that doesn’t actually make any difference in how bad the prescription is, ophthalmologists use a “+”, optometrists use a “-” (see Dr. Bonilla-Warford’s comment for more explanation of that).   The higher the number after the plus or minus, the more severe the astigmatism.

• 0.00 to 1.00 : mild astigmatism
• 1.00 to 2.00 : moderate astigmatism
• 2.00 to 3.00 : severe astigmatism
• 3.00 and higher : extreme astigmatism

Axis

The axis tells you whish way the astigmatism is oriented on your child's eye

If you think of astigmatism as a football shape, it makes sense that the football might be turned any direction.  The axis number then, tells you the orientation of the astigmatism.  The number is in degrees, it doesn’t have anything to do with how severe the astigmatism is, just how it is situated on your child’s eye.

Add

If your child needs bifocals, you will likely see a number here.  This tells you how the prescription should be changed for close up.  Let’s say your child has a regular glasses prescription of +3.00, if the add number is +1.00, then the near distance prescription will be +3.00 + 1.00, which equals +4.00 (3+1=4).  In the same vein, if your child is nearsighted, say -4.00, but has an add of +2.00, then the  near distance part of the bifocals will have a prescription of -4.00 + 2.00, which equals -2.00.

Sometimes, you don’t have an “Add” part of the prescription, and instead you’ll just see a prescriptions for distance vision and a separate prescription for near vision.

But what does that mean for how my child sees?

If you’re wondering what your child’s prescription means in terms of how they can see, there are a couple of places online where you can plug them in to see how blurry things appear.  Keep in mind that an eyeglasses prescription is not the final word in how well a child sees.  For instance, it will not tell you how your child’s weak eye is seeing if your child has amblyopia, or how your child might be seeing if he or she has cataracts or glaucoma.

Online vision simulators:

• Eyeland Web Tools – this site has one tool for myopia, and a different one for hyperopia, and one for astigmatism.  All three show you a scene that you might see while driving a car.  So hopefully not a scene that your child would necessarily see, but it still helped me visualize how the world might look with Zoe’s prescription.  Simulates prescriptions from +9 to -9 for the spherical error, and up to -8 for the astigmatism.
• Eli Billauer’s blur simulator – I’ve mentioned this site before on Little Four Eyes.  Enter your child’s prescription (sphere, cylinder and axis) for each eye, and it will show you two Snellen charts (the one’s with the big E at the top), one for each eye, that simulates how your child might see it.  Simulates prescriptions from +5 to -5 for the spherical error and +5 to -5 for astigmatism.
• Wolfram Alpha – this is a weird search engine that tries to answer your questions, and calculate equations that you enter.  You can enter your child’s eyeglasses prescription, and it will give you information about it, including a simulation of looking at the Snellen chart, and the far or near point for clear vision.  You will only see the Snellen chart if the simulator thinks one of the lines would be visible, which is +2.5 to -2.5.   You need to enter the prescription this way:

  OD +4.25 cyl 0.5 x 90

  (the number after the “x” is the axis for astigmatism, you can leave off the astigmatism numbers if they don’t apply).

When we took Zoe in for her first eye exam, I was still a bit in denial that there was any problem at all.  Add to that Zoe’s meltdown by the end of the exam, and I really wasn’t prepared to ask any questions of the doctor.  At her second appointment, the one in which she was prescribed glasses, I shouldn’t have been surprised by the outcome, but I was.  And again, I was completely unprepared to ask any questions, except for “where on earth will we find glasses for her?”  Luckily, Chris was with us at both appointments, and was able to ask some good questions, and more importantly, pay attention to the answers.

So here, are some questions I can think of, that I wish I’d asked.  For those of you that are experienced at this sort of thing, what other questions do wish you had remembered to ask, or which questions you’re really glad you asked?

• What is the name of the diagnosis for my child’s vision problem?  Can you spell it for me?  Or can you write it down for me? (suggested by Jodi)
• Do you have any recommendations for placed to go for more information on this?
• If I have more questions at a later time, can I get a hold of you to ask them?  What’s the best way / time to do so?
• When should we make another appointment for my child?
• Are there things I should watch out for between appointments?  Should I bring my child in if I see those, or just call?
• If my child requires equipment (glasses, patches, etc), do you have any recommendations for where I could go to get these?
• Do any of my child’s relatives need evaluation?  (Many conditions run in families and it can be beneficial to evaluate siblings and parents in some cases).  Suggested by Dr. Bonilla-Warford.

There’s been a lot of news about myopia (nearsightedness) recently, much of which I thought might be of interest to some of you.

In December, the results of a large survey were released in the Archives of Ophthalmology.  The findings were that the number of nearsighted people in the United States (age 12 – 52) has risen by 66% in the last 30 years (abstract here).

The reason for this increase is the subject of quite a lot of discussion and debate.  Just last week, NPR (National Public Radio) ran a story on one of the investigations into the cause.  While genetics certainly play a role, it appears that time spent outside is another big factor.  One study found that children who spend 14 hours per week outside see a dramatic reduction in the risk of becoming nearsighted.  And the outdoors part seems to be the key – children who get plenty of exercise indoors don’t see the same benefit.  And perhaps even more surprising, the amount of time reading or doing other close-up activities doesn’t seem to make a difference in how likely a child is to develop myopia.  You can read or listen to the full NPR story here.

One final recent report, this one on the topic of the progression of nearsightedness in children – the tendency for some children’s nearsightedness to get worse over time:  Archives of Ophthalmology just published the results of a 2 year study of nearsighted children age 8-13 years old who had seen significant worsening of their myopia in the previous year – their prescription changed by at least 0.5.  The study looked at whether prescribing bifocals instead of single focus glasses made any difference in how much their prescription changed over 2 years.  In all of the cases, the prescriptions worsened over the 2 years, but for children who wore bifocals or prismatic bifocals, their nearsightedness increased less (the progression was reduced).  The children with prismatic bifocals saw the least amount of worsening.  The authors of the study caution that prismatic bifocals should not be prescribed to all nearsighted children, and it remains to be seen if the bifocals continue to control the progression of nearsightedness past the 2 year window.  Nonetheless, the research is promising.   You can read the full study here.

Many thanks to Dr. Bonilla-Warford at Bright Eye News and Dr. Maino at Mainos Memos, their blogs first pointed me to these reports.

In a funny coincidence, my dad happens to have a model of one of the ORBIS International Flying Eye Hospitals sitting on his desk.

Wanted to post quickly a big thank you to everyone who participated in the Delurk for Sight week.  I hope you’ll all continue to post comments, and submit your stories and pictures of your children.

The final tally was 57 comments and 5 photos, which brings us to $67 donated to ORBIS International.

Thank you!

This question came in from Annie:

Is there any way to find out if your child is color blind? Everett is now 2. He can count to 10 in Spanish, he knows his shapes, all kinds of things…but he doesn’t know his colors. It’s really bad – he doesn’t know hardly any of them and it seems like that is one of the first things they learn. I don’t know if there is a test for kids his age so we stop pestering him all the time, or if we just have to wait and see.

From what I could find online, most children are tested at 4 years old.  Has anyone had their child tested earlier?

Updated to add: From the comments, Daniel left a link to a very good article he wrote about young children and colorblindness, including when and how to test.  In fact, his whole site is full of useful information on colorblindness.  In particular, he also has a great article on how to talk to your young child about being colorblind.

“I am a princess.

Princesses do not wear glasses.

Cinderella doesn’t have glasses.

Belle doesn’t have glasses.

Arielle doesn’t have glasses.

Tinkerbell doesn’t have glasses.

Nemo doesn’t wear glasses.”  says Elliana on this cold Sunday morning.  She has refused to put her glasses on for over an hour.

Please DISNEY, hear my plea… will you please create a character that wears glasses.  PLEASE PLEASE PLEASE

Zoe’s 3 and well into the “why” stage of life.  “Why it’s called ‘breakfast’?”  “Why it is snowing?”  “Why I can’t wear a dress and a skirt at the same time?” And recently, “why he (or she) doesn’t wear glasses?” (Her word order for asking questions isn’t quite right, but I find it kind of charming.)

"why?"

Sometimes it seems like the only question she hasn’t asked yet is “why do I wear glasses?”  I think that starting glasses at 14 months, plus having family who wear glasses, it just hasn’t ever occurred to her that there was even a possibility that she wouldn’t wear glasses.  And I’ll be the first to say that we’re very lucky in this regard, and I am not complaining about that.

But I’m still struggling with answering why someone else doesn’t wear glasses.  I often find myself using analogies when I try to explain things to her, but I haven’t found a good one to explain glasses.  I don’t like telling her that other people have “better” eyes, even if that is essentially what’s going on, because she has the most beautiful grey-green-blue eyes I’ve ever seen.  I can’t think of any eyes that are better.

I end up trying to explain that other people don’t need glasses to help them see, but that never seems to quite satisfy her.  Then again, she’s 3, and none of my answers to her “why” questions seem quite good enough.  Have you explained glasses to your child?  Any explanations that seemed to work especially well?