Squint

The one that trips me up the most is the word “squint.”  Until we started our journey with Zoe’s strabismus, I always thought squint meant having your eyes mostly closed, like you do when you’re in bright sunlight.  Turns out that squint is also a synonym for strabismus and having your eyes not in alignment.  This can lead to all sorts of misunderstandings when people talk about their child having a squint, or squinting to see something.  For instance, before realizing there were two definitions, at one of Zoe’s eye appointments, I tried bringing up the fact that Zoe squints one eye in the sun, that is, she closes one eye most of the way, leaving the other open.  Zoe’s ophthalomologist thought I meant that Zoe was crossing an eye whenever she was outside.  I now try to avoid this word altogether.

Zoe exhibiting two different "squints": eyes not aligned (left), and looking through eyes mostly closed (right)

Lazy Eye

The phrase “lazy eye” is similar in that it can mean different things to different people.  I think most people in the eye care industry consider lazy eye to be a common phrase for amblyopia – when one or both eyes doesn’t see clearly even if it has no defects, or even if any refractive error is corrected with glasses or lenses.  Never mind that “lazy eye” doesn’t really accurately reflect what’s happening with amblyopia, since it has nothing to do with an eye being “lazy” and everything to do with the brain not paying attention to the visual input of the eye.  But beyond that complaint, a lot of people hear “lazy eye” and equate it with strabismus, since you see one eye focusing on an object and the other eye looking elsewhere (being lazy?).  And I’ve heard other people refer to ptosis (drooping of the upper eyelid) as a lazy eye, again, presumably because the droopy eye looks “lazier”.   Further confusing things is the fact that both of those conditions can lead to lazy eye or amblyopia, but they’re not the same thing, and the treatments can be very different.

patching for amblyopia

Strengthening the weak eye

Related to treating lazy eye is the phrase that I find myself using a lot: “strengthening the weak eye”.  When a child patches the amblyopic eye, we often explain that they’re doing it to strengthen that eye.   In reality, though, we’re trying to get the brain to recognize the visual input from that eye, the eye itself isn’t being strengthened.  It’s misleading in a couple of ways.  First, when people hear “strengthen” they often think muscles, and I wonder if that adds to the confusion of thinking that lazy eye has to do with eye muscles and strabismus.  It can also lead to the misunderstanding that patching might make it so that the eye won’t need any correction any more if the patching is successful.  While patching can improve the visual acuity, if that eye needs glasses to see clearly, patching won’t fix that.

and on a much lighter note

Finally, on a lighter note, a reason to know the correct terminology for parts of glasses was posted over at Not Always Right (a blog about working with customers who aren’t always right).  I’d recommend using the term “temples” or “ear pieces” when talking about that part of glasses, not “legs”.

• Make a glasses case: Amomofelly pinned this link to instructions for making a simple glasses case that can be decorated however you or your child chooses.
• Turn old glasses frames into picture frames: I found these instructions a long time ago. I think it’s an interesting I idea, though with kids’ glasses, the pictures would be so small.
• Patches: There’s a ton of instructions for making your own patches to go over your child’s glasses, and the great thing is that they can be decorated to fit your child’s personality and likes. The big thing to be sure of is that the patch provides complete occlusion, and your child can’t peek. Here’s a couple tutorials, you can also google for eye patch tutorials or eye patch patterns:
• Using craft foam – pattern developed by Amomofelly and posted here a year ago.
• Using felt – from Lucykate Crafts

Anyone made any of these and want to share a picture?  Or have any other glasses-related crafts to share?

• A pediatrician who took seriously our concerns about Zoe’s eyes crossing.
• A pediatric ophthalmologist who we trust, and who really spends time with Zoe and knows her and her eyes.
• Patient opticians who have adjusted Zoe’s glasses countless times, and who have provided so much wonderful advice on the selection and care of glasses.
• Microfiber cloths, that are scattered throughout our house, so they’re always on hand to clean the always dirty lenses.
• Glasses that help Zoe see (and that are darn cute to boot)

Happy Thanksgiving everyone!  What are you thankful for?

I am a mummy of two great children one of whom needed glasses just before her 3rd birthday I was disappointed to discover the lack of choice and availability in Scotland and the UK. Every high street and local opticians have a small selection of children’s frames which are usually less than exciting. Detailed research has uncovered a huge choice of children’s frames spread all over the world, I would like to bring these together in an online shop featuring fun and funky eye wear to make wearing glasses exciting.  My dream is to one day have a high street opticians dedicated to the junior eyewear market. I am currently running a survey to test the market in the UK, I would be very grateful if would take the time to complete this short survey.  Many thanks Arlene Wilson (Rhys and Zoe’s Mummy)

a very special new accessory for Bitty Baby.

Phew! My two tiniest girls are twins, again.

(Full disclosure, when I bought these Bitty Baby glasses, I got choked up. I wasn’t sad. I wasn’t happy. I was just choked up. Just because it is a thing.  Hey, what can I say? It has certainly gotten easier, but it’s not always easy. I guess motherhood never is.)

Ok, Bitty Baby…time to Bespectacular.

Originally published on Mommy, Ever After

In my career as a mommy, there have been moments that I am not proud of.

Like this weekend, when I told my husband that he just had to watch the baby for a few minutes. I had something important to do.

(Really, I just had to go down to the kitchen and eat cookie dough straight from the refrigerator).

Maybe not my finest moment.

Or later that evening, when we took my daughter out to dinner.

As walked up and down the sidewalk, waiting for our food to be ready, we were stopped by a couple and their young son.

“I have to ask, how do you get her to keep her glasses on?” Asked the woman, lounging in her chair.

And in the same breath, she choked, “But she’s still sooo cute.”

And, in that moment, I loathed her. Loath is too kind a word. I hated her. I didn’t hate her for the question. The question is fair enough. In fact, it is the second most popular question we get.

I hated her for the implication. For the tone.

Why shouldn’t my daughter still be cute? She is beautiful. She is perfect. The glasses are irrelevant. Are you saying they’re not?

My words were acrid in my mouth as I responded to the woman.

“She keeps them on because she can’t see very well without them.”

And then I walked away.

My blood felt hot and my stomach felt heavy.

I did not feel particularly proud of that.

***

But, if I’m being honest, there was another moment.

A moment that I am nearly too afraid to describe.

A moment that was so painful and confusing and embarrassing that it still makes my heart hurt.

I was taking my daughter for a walk. We strolled around a beautiful, outdoor shopping complex, and as I pushed my precious girl in her stroller, we chatted and she laughed with me. I felt so happy. I felt love.

And as we walked, I saw a pregnant woman sitting on a bench. She looked up, studied my daughter and smiled. But, for an instant, I thought I caught a glimpse of her face contorting…I thought I saw another emotion begin to creep across her features…

And that’s when it happened;

My least proud moment:

I worried that this woman, this pregnant vessel to a new life soon to be born, was looking at my daughter and hoping that her baby wouldn’t have to have glasses like mine. I thought I saw pity in her eyes.

And then, I died inside.

Not because I cared what the woman thought–

not at all–

but because I hated myself for letting my mind go to that horrible, terrible, scary place.

I felt ashamed.

I did not feel proud on that day.

So, I gave myself a time out.

I asked myself why I read sadness or fear in the mist that had gathered in the pregnant woman’s eyes.

And in my time out, I recognized that while I have totally grown to love and accept my daughters eyes,

all four of them,

it still hurts sometimes.

It hurt when the woman in the restaurant this weekend asked me how my daughter kept her glasses on.

And it didn’t hurt because of what she was saying and how she said it,

even though it felt that way at the time;

it hurt because of how I had to answer:

“She keeps them on because she can’t see very well without them.”

It hurts. It hurts that my daughter has eyes that don’t work perfectly. It hurts that at night, when I tuck her into bed, kiss her, and tell her how much I love her, that I have to remove her glasses from her face, stealing her sight from her as she drifts towards slumber.

It breaks my heart.

But in my time out, I realized something else; I am allowed to feel crummy. I am allowed to look into the scariest depths of my anxieties, as long as I can shake them off and go on living. Because the truth is, my daughter can see.

The truth is, she looks adorable in her little pink frames with her magnified eyes.

The truth is, the pregnant woman was probably looking at my daughter with misty eyes because she was thinking,

I can’t believe I will soon have one of those. A child with whom I can walk around and talk and laugh with on a beautiful day. How lucky I am. How lucky they are.

***

And so, this weekend, as we strolled up and down the sidewalk waiting for our food to arrive, I shot a smile down to the woman who had asked about my daughter’s glasses. She didn’t mean any harm, after all. And when Another young couple with a little girl stopped us to say how cute my daughter was, I felt wonderful, and the smile that spread across my face was genuine and bright. And when they complimented her on her adorable glasses and fabulous shoes, I felt happy, as I told them, “Yes, my little girl sure does know how to accessorize an outfit.”

And once again, I felt proud.

Yes, we buy every cute glasses-themed T-shirt we see. Busted farmer's hat? Not a typical accessory.

Last night, my daughter experienced double vision. But panic soon gave way to reassurance. It was not a bad thing. Surprisingly, I haven’t lost my mind. (Though if I did, would I know it? Anywho.) Please allow me to explain.

Stella, whose vision I’ve covered here at Little Four Eyes before, just turned three. When she was 18 months old, her accommodative esotropia and anisometropia were discovered and addressed with glasses. Her stylish specs keep her eyes straight–HOORAY! We still patch a little bit, because her left eye is more farsighted than the right and so has slightly lower acuity (really, less than one line difference at last check). We’re finishing up vision therapy. Stella can catch a ball, now without using her chest to corral it. She can snag falling feathers with the grace of a major league outfielder, and hit a birdie with a racket, not so much with grace (yet) but with real and consistent contact. Her peripheral vision was opened up by the vision therapy, and her toe-walking reduced. She’s doing very well, and even asks to do our daily at-home vision therapy activities. Amazing progress all around.

Last night, when I heard her crying out from bed, I blamed the cold she’s been battling. I went in to comfort her and help blow her nose. As I leaned over her, I saw a dazed smile on her face. That’s when she said, “I see two mommies.” I looked more closely, and sure enough, her left eye was turned in. I so rarely see her eyes cross–because she almost always wears her glasses. The sight is still a punch in the gut, but I quickly put the pieces together and saw a big positive.

First off, she has a cold–the stress of illness is what brought out her strabismus out in the first place.

Secondly, she wasn’t wearing her glasses. Spec-free, all bets are off, particularly when she’s studying something up close. At least until age 11 to 13 or so, she’ll need glasses to keep her eyes aligned. The vision therapy helped re-wire her brain to always use her eyes, aligned by glasses, together. If her glasses were on and I saw crossing, only then would I have real reason for concern.

Lastly, and this felt like a big and helpful realization to me: She wasn’t suppressing the weaker eye. She saw double because she was trying to use both eyes as usual. If her weaker eye was being tuned out, she wouldn’t experience double vision. Typically, again thanks to her glasses, her eyes are aligned and work together, enabling great stereoscopy as recently measured by both her new ophthalmologist (who is wonderful) and her developmental optometrist (also super fantastic). It’s no wonder Stella found the double vision amusing and unusual. She’s used to two eyes in concert, not in conflict.

Upon further obsession (err, reflection), I was pleased with how she quickly articulated what was going on. Back when she got her glasses, half a lifetime ago for this three-year-old, she had a relatively good vocab for her age but obviously couldn’t describe her vision to me. She also refused to even look at the feather I held in my hand above her head, nevermind catch one. She’s come a long way!

All that said, last night was a good reminder about how crucial it is for Stella to wear her glasses at all times (sleep, bath, and swimming excluded). I’ll confess that sometimes, upon waking, she comes to our still-darkened room and hangs out in our bed for a bit, usually without her glasses. About time we made “glasses on!” the very first step in our day.

Now, if only she could effectively clean her glasses on her own. This cold is resulting in permanently smeared lenses! (Ew.)

The whole article is really quite interesting.  For one, it’s clear that for children with poor vision, having that vision corrected is extremely important for learning.  (Encourage your friends to have their children’s vision examined if they haven’t done so already, especially if their kids are starting school).  And I’d love to know more about why some families refused the glasses.

The biggest surprise to me was that the radio program then brought in an optometrist who claims that “eyeglasses are the coolest thing you can put on your face right now.”  He sells around 300 pairs of glasses with clear, non-prescription lenses.  I don’t know if that coolness translates to how kids feel about glasses, but I’m certain it doesn’t hurt.  The final thought, from the optometrist was that “any hip-hop star to any idol of a sports star that wears them [glasses] influences children’s perception of eyeglasses.”

What do you think?  Are glasses the coolest thing for your face these days?  Is that coolness factor only for adults, or does it also hold true for kids?  I expect that it is true that seeing sports icons and other celebrities in glasses makes them more attractive for older kids, but what about for our younger kids?  Does your child in glasses notice or point out when they see a character in glasses?  Does it seem to make a difference in whether they wear their glasses?

We started swimming this summer and have been having a blast. Elliana made the decision to wear her glasses in the water and she is a fish! A couple of people have commented and asked why she is wearing glasses in the water and not goggles. Here is my current answer.
1. This is working for her. She is comfortable and having fun. She can see above and below water.
2. These Disney 187cc cable temple frames are taking a beating and still ticking – so I;m not going to mess with it
3. At this time, there are no goggles for the high rx, so we would have to get the maximum available. With her being so young, I am not sure how well the goggles would work, how soon she would outgrow them, and if she would actually wear them.

SO, fo the time being, she swims with glasses!

Also, my #2 LOVES glasses. We bought him a Build A Bear set of glasses to wear around the house. HE is a hoot and hard on the real and pretend pairs! Elly tells him that when he gets to be a big kid like her, hey may be able to get “real glasses” like her!

“Spectacle wear in children reduces parental health-related quality of life,” published in the Journal of the AAPOS, Feb., 2011 (read the abstract here).  I’ll jump straight to the conclusion before getting in to the details: when it comes to questions about vision and their eyes, parents of kids in glasses worry more than than parents of kids who don’t wear glasses.  Our kids with glasses do not worry any more about their vision than their peers who don’t wear glasses.

So the details…

This was a small study, only 49 children between the ages of were 5 and 13 were recruited.  The children all either had normal vision with no glasses (29 of the children) or refractive error that was corrected with glasses (20 of the children).  None of the children had strabismus or other vision issues – the researchers just wanted to look at the impact of glasses on a child’s quality of life.

Each child and their parents completed two questionnaires, the Intermittent Exotropia Questionnaire, a questionnaire that asks specifically about how vision impacts their quality of life – though there are no questions about wearing glasses; and the Pediatric Quality of Life Questionnaire, which is a more general questionnaire about how kids are functioning physically, emotionally, socially, and in school.  For the Intermittent Exotropia questionnaire, the child answered  a set of questions, the parents answered a set of questions for the child (proxy), and then the parents answered questions about themselves.  For the Pediatric Quality of Life Questionnaire, there was no questionnaire for the parents to answer for themselves.

The Intermittent Exotropia Questionnaire  included things like (you can see the full questionnaire here – scroll down to the bottom of the page.) …

For kids:

• Do kids tease you because of your eyes?

For parents to answer for their child (proxy):

• My child feels different from other kids because of his/her eyes.

For parents, about themselves regarding their child’s vision:

• I worry that my child will be less independent because of his/her eyes.

(There were no significant differences in answers between the two groups of children or their parents in the Pediatric Quality of life Questionnaire, so we’re not going to worry about that one.)

Findings

As I mentioned at the beginning, there was no difference in scores between kids with glasses and those without when it came to their quality of life.  Basically, the kids with glasses were no more worried about their eyes or vision than those without glasses.

But when you looked at the responses by the parents, that’s where the differences stood out.  First, if you looked at the proxy questions – where the parents answered for their child, four of the questions showed lower scores (lower quality of life) for kids with glasses:

• Q2. My child is bothered by people wondering what is wrong with his/her eyes;
• Q4. Kids tease my child because of his/her eyes;
• Q8. My child feels different from other kids because of his/her eyes; and
• Q9. My child worries about what other people think of him/her because of his/her eyes.

The really interesting thing here, is that the kids did not report feeling different or teased or worried about what others think of them because of their eyes.  The parents were the ones who felt that their kids were encountering those things.  It’s an interesting (and unanswered) question as to who is right in this case, though I’m inclined to guess that parents are projecting their own fears into their answers.

When answering for themselves about their concerns for their children, parents of kids in glasses had lower scores (p <= 0.03 for the stats people)  – meaning they were more concerned – for the following statements:

• Q3. I worry the my child will have permanent damage to his/her eyes;
• Q6. I worry that my child will get hurt physically because of his/her eyes;
• Q7. I worry about the possibility of surgery;
• Q8. I worry about my child becoming self-conscious because of his/her eyes;
• Q14. I worry about my child’s eyesight longterm;
• Q16. I worry about whether or not my child should have surgery.

(Let me tell you, I can totally relate to every one of those statements there.  If someone asked me to list my biggest fears when it comes to Zoe and her eyesight, it would sound really similar).

So, when you hear someone tell you that this is harder on you than it is on your child, there’s probably more than a bit of truth there.  Our kids are tough, and they know that their glasses help them see, and they don’t worry about their eyesight the way we do.  Which I guess is as it should be, since that worrying is our job as parents.