Recently, Zoe had an eye appointment and we heard something we’d never heard before: “come back in a year.” A year?!? Zoe has never in her life gone a full year without an eye appointment (her first was at 9 months old). It’s thrilling and a bit scary all at the same time. Her eye doctor explained that now that she was nearly 8, many of her visual pathways had matured, so the chances of developing amblyopia again are very, very small. Certainly we will bring her in if she’s having trouble seeing, but otherwise, we’ve graduated to yearly eye exams!
It got me thinking of other milestones that you might get to celebrate if you have a young child in glasses, patches, or contacts (not all kids will have all the same milestones, and they won’t all happen in the same order).
- The first day she goes the whole day without taking her glasses off
- The first day he asks for his glasses without prompting
- The first year a pair of frames make it without being broken
- The first year you go without a change in prescription
- That appointment when the doctor says you don’t have to come back for 6 months
- That appointment when the doctor says you don’t have to come back for a year
There’s patching ones, too:
- First day she goes patches for the whole time without complaining
- First week of patching (you all survived!)
- That appointment when the doctor says you can start weaning off the patching
- That appointment when the doctor says you can stop patching
There’s some eye test ones
- First appointment when she was able to use an acuity chart (even if it was with symbols)
- First appointment when he was able to read the chart with letters
- First appointment when she got to do the “which is better, 1 or 2?”
- First appointment when she could get her eye pressure read without doing an EUA
And some for contacts
- First day you got the contacts in without tears
- First day you got the contacts out without tears
- First day she put her contacts in by herself
What other milestones have you hit with your child? And what milestones are you looking forward to?
There’s a cliche of “looking through your eyes” as a way of trying to see the world as someone else might. It’s usually not meant literally, of course, but it reflects our desire to understand how others see things. That’s certainly true when you learn that your child has a vision problem. It’s very common to wonder how your child had been seeing.
Very young children don’t have the words to tell us what they want for dinner, let alone how they see. Even older, more verbal kids have difficulty explaining how things look. It wasn’t until Zoe was 4 that she started telling me that things were fuzzy without her glasses. But the first time I really understood how she saw was after a trip to the science museum where she visited a human development exhibit. They had glasses you could put on that approximated how babies’ vision develops in their first few months. “Mom, babies see really blurry they’re first month. Then at 2 months, they see the way I see without my glasses. By a year, they see how I see with glasses.” Finally, I could put on glasses and see the world the way Zoe does with glasses.
If you can’t make it to a human development exhibit, there are quite a few online vision simulators that claim to let you see how another person sees, most are based on a person’s glasses prescription. Of course, there are a lot of problems with even the best of these. In fact:
A glasses prescription will not tell you exactly how a person sees
A glasses prescription will only tell you what shape the lenses on a pair of glasses or contacts should be in order to have the best possible corrected vision. This is based on how much the shape of the eye differs from what it should be to see clearly (something called the refractive error). Some (not all) of the reasons why someone may see differently than their glasses prescription implies include:
- Hyperopic children can often compensate for much of their hyperopia, allowing them to see relatively clearly. This does cause eye strain and can pull the eyes out of alignment, which is why glasses are still important.
- Amblyopia is when a person does not see clearly even when glasses or contacts are correcting for the full refractive error. Generally this is due to the brain suppressing the vision from one or both eyes. It can be caused by the eyes not lining up, an eye having an injury, or one eye having a much stronger refractive error than the other.
- There may be other problems in the visual system (either in the eye structures, the optic nerve, or the brain) that is causing vision problems.
One very simplified way of looking at it is imagining the visual system as a camera. The lens of the camera may not be in focus, that’s the part that glasses can fix that. But there are a lot of other components of the camera that may not be functioning correctly, and any one of them can lead to unclear vision.
The measurement that best describes how clearly a person sees is their visual acuity. It is usually expressed as two numbers, like 20/20 or 6/6. The first number tells you the distance at which the measurement was taken (20 or 10 is in feet, 6 or 3 is in meters). The second number tells you how far away a person with good vision could be to see what you see clearly.
For example, the visual acuity of my left eye without glasses is around 20/200. That means that what I see clearly at 20 feet away, a person with good vision would see clearly at 200 feet away. (I do not see terribly well in that eye). There’s a conversion chart here that converts between metric and US measurements as well as giving reading performance for those acuities.
If you’d like to see what a specific visual acuity looks like, there are a couple of options:
Wolfram Alpha will show you a simulation of any acuity you type in. Simply type in the visual acuity with the word “vision”: in this case “20/200 vision” (if you don’t include the word “vision” it’ll just calculate the fraction for you).
Fork in the Road Low Vision Simulators are vision simulators that you can purchase and wear to see the effects of different eye diseases. Their cataract simulators demonstrate reduced visual acuity. On their website, you can see examples of the blur simulation for 20/80 (6/24), 20/200 (6/60), 20/400 (6/120), and 20/800 (6/240). Scroll through the page to see the different acuities.
Vision Simulators based on Prescription
As I mentioned, vision simulators based on a glasses prescription are flawed at best. Even the very good ones will only show you an approximation of how someone with no other vision issues would see with that prescription. That said, the simulators can give you a feel for how strong a prescription is and how your child might be seeing without glasses.
- Eyeland Web Tools – there are different simulators for different refractive errors. Many children have a spherical (hyperopia or myopia) component as well as an astigmatism component. I like that these allow you to see how those different components affect vision.
- Sehschärfen Simulator – this site is in German, but is still pretty straight forward to use. One of the features is that it changes the simulation based on a person’s age, so that the effects of hyperopia (farsightedness / longsightedness) are reduced for young children. This means if your child has a + prescription, you may think from this simulator that your child shouldn’t need glasses. This simulator will not show you how much eye strain a child will have due to hyperopia.
- Enter your child’s age in the “Alter” box
- Enter the spherical and cylinder amounts
- Click “Berechnen”
- The top image is the simulated vision, the bottom image is what would be considered “normal” vision.
Other visual simulations of eye diseases
- Fork in the Road sells vision simulators for many eye diseases resulting in low vision. This includes cataracts (linked above), glaucoma, and more.
- Inclusive Design Kit from the University of Cambridge also has a simulator for many vision problems.
- Causes of Color includes a vision simulator for various types of color blindness and cataracts.
Sometimes you see a photo, and read the explanation and your heart just sinks:
“Totally heartbroken – my one-year-old dropped his glasses down the sink and they went through the garbage disposal.”
Posted to the Little Four Eyes facebook group, shared here with permission.
I’ve posted a bit about the children’s book about glasses that I’ve been working on – it’s one that I held a Kickstarter project to raise the funding for. Well I’m thrilled to say that the book has been published and is now available for purchase. The whole experience has been fascinating, eye opening, way outside my comfort zone, but in the end, a really good experience. The project was largely inspired by the comments I’d gotten on the photo gallery page. I had figured the photo gallery would be great for parents to see the range of glasses available for kids, but I hadn’t expected that parents would show their kids the gallery, and that kids would feel better about their glasses after seeing other kids like them in glasses. I also remember how much Zoe loved looking at books with pictures of kids, and I wanted her to see kids who wore glasses just like she did. And I was also a bit sick of books that talked about kids who hated glasses or who were teased about their glasses. Those are definitely good stories to have, but they didn’t reflect Zoe’s experiences at all.
After waiting for 5 years for someone else to write a book that featured photos of kids in glasses, I finally decided that I was going to have to do it. And luckily, I knew that my friend Kristin from Peeps Eyewear was just as interested as I was in helping kids in glasses, and since she had published a children’s book, she knew a lot more about the process and had the contacts to actually make it work. She agreed to be my publisher, for which I am so very thankful. I’m thankful, too, for so many of you who backed the Kickstarter or shared the project or gave me support (I wrote a bit about Kickstarter here and here). I was able to get funding to cover most of the up front costs (photo shoot, graphic design, printing, etc). We held the photo shoot for the book in January. The daycare center that my children attend was gracious enough to let us use their classroom (with fun colorful toys, and huge windows to let in the sunshine) for the photo shoot.
Our photographer, Heide, was simply amazing. She worked hard and had a fantastic rapport with the kids. And the kids were all amazing, too! It was honestly a lot of fun – just watching these kids play and have fun, and watching Heide work her magic to get some amazing shots, and meeting the parents and hearing all about their stories. Then came more work – choosing photos, working with the graphic designer, trying to get the print run to be true to color, getting an ISBN for the book… all sorts of things that I had never, ever dealt with before, so again, I’m thankful for Kristin’s help.
It took longer than anyone of us had expected, especially since we had to not only produce the book, but also the other rewards for the Kickstarter backers. But now I can hold all that hard work in my hands!
I have to say one more huge thank you to all of you out there for your support and inspiration for this book. I don’t know how I can thank you all enough.
Is there anyone out there with a child diagnosed with CHED (Congenital hereditary endothelial dystrophy), either recessive or dominant? Another parent is really hoping to connect others facing the same thing, as it’s a rare disorder, their having trouble finding others out there.
Leave a comment, or drop me an email (email@example.com) if you would like to connect.
It’s again time for the annual Children’s Eye Foundation photo contest for their calendar. The Children’s Eye Foundation is the foundation of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS).
The theme for this year’s photo contest is “Best Buddies to See You Through“. Once you submit a photo, people can vote on their favorites. The top 10 vote-getters will win a camera, and a panel of judges will choose from all submissions the photos that are featured in the calendar. Voting is open until August 31, 2014.
A number of kids from our community are featured in the calendar each year (of course they are – our kids are super cute!).
You can also vote for your favorite photo! You can vote for one photo once each day.
The third annual Great Glasses Play Day is just around the corner! I’ll be celebrating in Minneapolis, but there’s a whole lot of events this year and even if there are none near you, we have many ways for you to join the celebrations!
Many thanks to Jessica Butler of Eye Power Kid’s Wear for the graphic!