little four eyes

It has been a while since we have had to atropine drop.  Last week, the ophthalmologist had us use the drops in both eyes for 3 days to get the most accurate measurement that they could.  These days were a reminder of why we ended up switching back to patching.

So, you may ask, how in the world do you get the eye drops in.  Well, we line up all the babies who are also getting their eyes dropped (for pretend)  Then we practice on them, telling them it will hurt a little and praising them for holding still.  When I get to the end of the line (Elly)  I hop on, hold her arms down with my knees, pry her eyes open with my left hand and drop with my right.  This is all done swiftly and in less than a second all the screaming, huffing, puffing, kicking, thrashing, you name it, is over.  I then tell her how brave she was and life moves on.

She really hated her glasses for about a week and a half until the atropine wore off, was a bearcat in her disposition, and expressed her distaste in the drops.  The good news is that the reading was the most accurate so far and resulted in a prescription changed.

Yeah eye drops and yeah no more eye drops.

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.

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.

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.

Welcome to 2010!!!  In honor of the new decade, I’ve decided to give the blog a makeover.  The content is all still here.

I had my regular eye exam a couple of days ago.  It had been 2 years since my previous one, which was a week or so after we learned Zoe needed glasses.  Since then, I’ve been to so many pediatric eye exams with Zoe, that I’d forgotten what an adult one was like.  So many machines for mapping your eyes and visions.  And far fewer toys.  They have Zoe follow a toy tiger with her eyes to measure her range of eye motion, I got to follow a pen tip.  Zoe gets to look at a cute card of a house with a path leading to it with lots of shapes, I got to read letters.

It reminded me of a survey I’d recently read about, the 2009 American Optometric Association’s Eye-Q survey.  It surveyed 1000 American adults about their knowledge of eye and vision health. Towards the end of the survey – starting on page 5 in the link above – are questions about infant’s and children’s vision.  This one in particular jumped out at me:

60. What concerns would you have about taking your infant to see an eye doctor before age one?
Please select all that apply. (multiple answers permitted)

• Infant can’t communicate — 37%
• Infant can’t sit still — 25%
• Too early to detect problems — 19%
• Expensive–  15%
• It will hurt the infant — 8%
• Inconvenience — 5%
• No eye doctor nearby — 4%
• None of the above — 41%
• Other — 2%

When I first read the results, it surprised me that so many people would think that their infant not communicating would be a reason for not doing an eye exam.  After getting my own exam though, I was reminded of how different the exams are, and if you are only used to the adult exams – reading letters, choosing between 1 and 2, and 1 and 2 again, and again – of course you might think that it’s crazy to expect a young child, and a pre-verbal one at that, to do that exam.

If you’re interested in reading more about infant eye exams, I think Dr. Bonilla-Warford’s post about the exam that he did on his own 7 month old (at the time) daughter, Nora, has a nice explanation about the process, from a parent and eye doctor’s perspective.

My eyes are healthy, by the way.  My prescription got slightly stronger (I’m nearsighted).  And I picked out a beautiful pair of Lafont glasses, so now Zoe and I will have the same brand frames.

Wishing everyone a wonderful 2010!   May your child’s vision grow stronger, may their glasses stay up on their little noses, and may their lenses remain unscratched!  I’ll be playing around with a new look for Little Four Eyes for the new year, so don’t be alarmed if things look a little different in 2010.

Dear Doctor of My Child’s Eyes,

Thank you for being so positive about my child’s vision and taking the time each visit to answer all of my questions.  I am very nervous about Elliana’s muscle surgery tomorrow, so much that it is hard to sleep and I have often found my eyes welling up with tears thinking about it.  I know that you have done this surgery many times and are experienced, but this is my first time and it is my only daughter who will be put to sleep and operated on.

It meant a lot to me yesterday when you walked me through step by step how the procedure would be done.  Explaining that as she fell asleep with the anesthesia that you would take her to see the fish in the fish tank and play little games with her so that she would be relaxed and with someone she knows and trusts. Letting us know that she will not come out with bandages or an IV, but that she will be pretty angry for the first 20 minutes.

I also appreciate how calmly you explained how the procedure would work to my 3 year old.  It demonstrated that you not only know about eyes, but also about children.  I could not have done a better job myself.  I like how you told her that the office visits help make her eyes stronger, the patches help make her eyes stronger, the glasses help make her eyes stronger and now you are going help make her eyes stronger.  That she would see you for an appointment at a different place and that you would be wearing green pants and a green shirt.  We would meet a whole bunch of new people and then your would go back into a different room so that you could help make her eyes stronger.  I also appreciate how you told her that when she woke up she would be angry and that her eyes may be sore.

We, as parents, trust that you will make the best decisions about the new placement of her eye muscles based on your many measurements over the last year and a half.  Her eyes will be in good hands.  Please take good care of her.

Amanda

Left eye turns out and Right eye turns out

Zoe had her regular eye appointment this morning.  I had been looking forward to it for a while because I was anxious to know whether she has developed any binocular vision.  Zoe was looking forward to it because she knows the eye doctor doesn’t give shots.  She had been asking about the shots in particular for a couple of months now, especially since her last visit to the pediatrician did involve shots.  The no shots is a big selling point for the eye doctor.

Lea chart shapes. Today was not a good day for the house shape.

Her visual acuity measured at 20/25 and 20/30, which was good to hear.  Last appointment, she hated the square shape and refused to say square or point to the square, even though she’d get every other shape right.  This time, it was the house shape that annoyed her.  Gotta love 3 year olds and their moods.

We got to give her ophthalmologist the Children’s Eye Foundation calendar that has Zoe on the page for December.  We hadn’t told the doctor about it at our last visit (I think we didn’t know which pictures had been chosen yet), so that was a fun surprise.  And I was happy to learn that Zoe’s prescription hasn’t changed.  I had already decided we’d keep Zoe’s frames for another year (as long as they don’t get irreparably damaged), but it’s nice to get to keep the lenses, too.  Though now they’re out of warranty, so we’ll have to pay to replace them if they get horribly scratched.

But the big news is that she did pass a couple of the stereoscopic vision tests.  She reached out and tried to touch the square that she saw in 3-d!  I am simply thrilled.

(Shortly thereafter, we got into a huge fight over whether or not I should have drank any of her apple juice – answer: no – but I’m going to focus on the good news of the day).

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.

Eye Exam Video.  This is an oldie, but a goodie from the Sesame Street website.  If you ignore the very outdated clothing and equipment, the exam featured in the video is very similar to what our experience have been.  We have been going about once a month for the last year and a half.  All visits include having Elliana “read” the letters or shapes, have  her track, or follow an object and often have a light shown in her eyes.  Only every once in a while do we have to have her look through the “machine.”  We watched this video after our last visit and talked about how our visit was similar and how it was different, but you could also show your child before you go, so that they have some ideas about the activities that the PO may do.  I also made sure to point out to Elly how calm and patient the little girl was and how important it is to be on your best behavior for the doctor.   (our wait is often 1-2 hours and Elly is SO ready to go home by the time we see the PO)

Teller Acuity Cards, picture from www.stereooptical.com

Zoe is young enough that most of her eye exams didn’t use any of the eye charts that we normally think of to determine her prescription.  They used Teller Acuity Cards – where they showed Zoe a grey card with a box of black and white stripes, if she looks at the box, then she can see the stripes.  They show cards with progressively thinner stripes until she no longer noticed them (they get thin enough that I could hardly perceive the box of stripes).  You can read more about the test in this information sheet from Seattle Children’s Hospital (pdf).  They also dilate her eyes and then the ophthalmologist use a retinoscope to measure the refractive error of her eyes.

At her last appointment in December, she’d just turned 2, they tried having her use an eye chart.  Zoe was given a card with the 4 different shapes, and then the optician would point to a shape and ask Zoe to point to the matching shape on her card.  Zoe didn’t get it.  She was deep in the mimicry stage and did a very good impression of the optician, holding her card out for her to see and pointing at each shape one by one.  Cute, but ultimately unhelpful.

Lea chart. From the Visionary Eyecare Blog

We tried again at her appointment on Friday and she did awesome – both in terms of understanding what we were asking her to do, and in that she’s seeing well and equally well out of both eyes.  About a month ago, her daycare had focused on shapes, and just recently, we’d started playing matching games with her.  Though we weren’t intentionally trying to prepare her for the eye exam, I think those activities helped a lot in getting her to understand the task.

If you have a young toddler going in for their first eye exam, or if your child is getting old enough to start using eye charts, I’d recommend practicing ahead of time, especially with matching games.  We played a memory game – where you have cards with pictures on them laid out and you turn them over and try to find a match – but we had all the cards face up.  I’d pick up a card and ask Zoe to find a match.  You could draw a bunch of different shapes on paper and again ask your child to find matches.  Shape-sorters would probably also work as well.  At home, you can explain that these are matching games, and then at the eye exam, again explain that you’re going to play another matching game.  Zoe seemed to find the exam pretty fun.

The Visionary Eyecare’s Blog has a great post with pictures of some of the more common eye charts for children, if you want to look at some examples.  At Zoe’s appointment, they used the Lea chart.

To cover Zoe’s eyes, the optician hung a patch over her glasses on one eye, and then the other.  She told Zoe that Zoe would be a little pirate for a bit.  I don’t know if it’s related or not – but I can’t come up with another explanation – that evening, Zoe kept singing to herself, “hi-yo, hi-yo, I’m a pirate.  Pirate, pirate, I’m a pirate.”