little four eyes

Many thanks to Sarah who sent in her account of working with a teacher of the visually impaired. – Ann Z

My nearly four-year-old daughter Isabella has multiple ocular diagnoses: severe hyperopia (farsightedness), astigmatism, mild macular hypoplasia (“underdevelopment of the macula, a small area on the retina responsible for seeing in detail” – read more) , latent nystagmus (“involuntary rapid movement of the eyeball, occurring only when one eye is covered” – read more), and intermittent exotropia (“eyes that turn outward” -  read more).  She began seeing an ophthalmologist at six weeks old and received her first pair of glasses at 15 months. Today at nearly age four, her acuity measures about 20/70 with correction. Isabella also has bilateral sensorineural hearing loss, childhood apraxia of speech (a motor speech disorder),  hypotonia (low muscle tone), and fine and gross motor delays.

Isabella

Read more…

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.)

Zoe’s prescription increased pretty dramatically recently (her astigmatism jumped from +0.75 to +1.75).  It really surprised me, since previous big prescription changes were usually preceded by her eyes crossing more, or Zoe not wanting to wear her glasses any more.  This time, she had neither of those symptoms.  But looking back, I guess there were a few clues.  Most notably, she had been looking at things through the outside edge of her glasses rather than straight on.  Turns out, she gets a stronger magnification looking through the edges of the lenses.  I hadn’t noticed so much, but her teacher had noticed it at school.

Since getting her new glasses, she’s been looking at everyone and everything straight on again, and her teacher mentioned that she has just recently (again, since the new prescription) been able to catch a ball that is thrown or bounced to her, and accurately kick a ball about 4 feet towards a person.  We’re thrilled with that!

So for us, signs that we might be looking at a prescription change include:

• eyes crossing
• eyes drifting apart (when she needed her prescription reduced)
• not wanting to wear her glasses
• not looking at things straight on, rather, looking out the side of her lenses

What other clues have you noticed that indicate your child’s prescription has changed?

Cheri wrote this story of her whole family getting involved to help her youngest son, Reid, a young boy with Down syndrome, start wearing glasses last summer. The story was originally published on her blog “Raising Reid” and is reprinted here with her permission.  Thank you for sharing, Cheri! – Ann Z

Well, our newest bump in the road has been that Reid’s eyes have started to drift inward…sometimes more his left and then sometimes more his right, and often both eyes at once. We went to see the eye doctor and we were told he was very farsighted, which is what we were told last time as well…except this time they said now that he is older and his attention is held longer on items and he is focusing more to see things up close his eyes are drifting. To help strengthen those muscles we were told it was time for glasses.

I was not sure how he was going to take to glasses….so we set a plan in motion. While we waited the week for the glasses to come in I sent away for some books on getting glasses. We read and read those books in preparation, we oogled and ogled over anyone and everyone we saw in public or on tv that had glasses, and we bought Luke some frames because Luke is Reid’s hero and if Luke will wear glasses chances are better Reid will follow suit. …actually this was a surprise to Luke, I could tell he secretly wanted glasses so when I went back yesterday to pick up Reid’s glasses I asked if they had any discontinued frames that did not have any prescription in the lenses..and viola they did and now Luke has glasses too.

When I walked out of the office with the glasses I quickly took Reid’s out to see just how strong the prescription was and …honestly my heart suddenly had this very sad feeling. I just sat in my car for a bit with that old familiar feeling of being hit in the gut when you realize your child will have one more struggle. When I looked through those glasses I could barely see anything…geez louise they are strong. The poor thing has been living with incredibly blurred vision all this time and it really made my heart sad.

We decided to “unveil” the glasses as if it was a present. We handed Luke his present first with prior directions to cheer and act excited when he opened his case (which truly he was excited to be getting his own glasses ) and then we handed Reid his….which he opened excitedly with all of us standing near cheering, and then we had Toby put his glasses on that we had to dig out of the archives.

Below are pictures from the big “reveal” of the glasses. Read more…

The Treat Game: Stella's baby helps find matches during vision therapy at home

Stella’s developmental optometrist views patching as a first step in amblyopia treatment. Patching (in our case, Magic tape over the lens of the stronger eye) boosts the acuity of the weaker eye. Stella’s lazy eye is growing stronger, and vision therapy is more and more focused on training her eyes to work together for strong binocular fusion, in an effort to encourage stereoscopy, prevent or minimize regression and provide a lasting fix.

Stella’s daily patching time now feels pretty turn-key, even though (as is my nature) I do it on the fly. She does a solid hour, at least, first thing in the morning, kicked off by some video watching. Sometimes it says on and patching is done by late morning. Sometimes patching is completed in two or three chunks. I seize opportunities strategically. If she’s engrossed with a toy that demands a ton of hand-eye coordination, I’ll throw on her patch to give her amblyopic eye a workout. We’ve got patching down! Vision therapy? Or more accurately, getting 20 to 30 solid minutes of vision therapy done at home? Still a challenge. But as her weaker eye improves, the nature of  her vision therapy is changing. The latest exercises seeming to provide more improvement bang for our frustration buck. So we’re trying harder than ever.

Ever since Stella’s vision therapy progress evaluation which showed great gains, we’ve been doing a bit of what Susan Barry discusses on page 150 of Fixing My Gaze: monocular fixation in a binocular field (MFBF). This means that instead of being completely excluded via the patch, the stronger eye is merely put at a disadvantage. Her dominant eye is still able to receive and contribute visual input, allowing the eyes to work together, but the amblyopic eye is forced to do the heavy lifting. Several doctors/researchers, over several decades, have endorsed the effectiveness of this approach (Brock, Cohen and Hess for starters). Our experience with MFBF is limited but growing.

Almost every day, Stella dons a green-tinted patch over her strong eye and watches a video on our TV, the center of which is covered by a transparent red sheet. Her strong eye can’t see what’s in the red area thanks to the green tint, but it can still see what’s going on the periphery. In order to take in all the action and view the complete picture, her un-patched amblyopic eye has to pick up the slack and garner what is usually the most important part of the scene (whatever is centered, like close-ups of facial expressions, etc.). Her eyes are working together but her weaker eye has to perform at a higher level, setting the stage for binocular fusion. This work counts as patching time, so hooray for that!

Read more…

Isa wrote this great story of her son getting glasses the summer before starting kindergarten.  The story was originally posted on her blog Raising SOS and is reprinted here with her permission. – Ann Z

Guess who?

At back to school night, it was easy to pick out Samuel’s self-portrait.

It wasn’t the blonde bed head that tipped us off. It was the blue, rectangular eyeglasses. The funny thing is that I stopped noticing the glasses shortly after he started wearing them. To me, he just looks like Samuel, but to many parents at our school, Samuel is “the kid with glasses.” I get it. I know the girl with club feet, the boy with an eye patch, and the two lonely black kids. I also understand that I really don’t know them at all.

Other parents often ask me how I found out that Samuel had a vision problem. What they are really wondering is if their children will need glasses too. They wonder if there is a medical explanation for their kids’ wiggling, short attention span, and confusion about the numbers 6 and 9. I hate to report that the glasses didn’t solve any of these problems.

We got the official diagnosis, at his five year-old check-up, but we would have figured it out much sooner if we were paying attention. A referral to the optometrist unearthed the fact that Samuel’s “blinking face” was not an attempt to sabotage our family photos, or the early sign of a social disorder; he probably just had a vision problem. Samuel is nearly blind in one eye when looking at objects up close like letters and numbers—all the rage in kindergarten—and had been compensating with his good eye. We had grown so accustomed to his tilt-blink-and-grimace move that we had almost stopped noticing it.

The optometrist informed us that glasses would allow Samuel’s eye to strengthen over time. If he wore them enough, he would likely grow out of them in a few years. It was good news.

I was devastated.

I didn’t want a foreign object on my son’s face. I didn’t want Samuel to look different from the other kids. I didn’t want to nag him to, “put on his glasses.” I was already on his case enough and wanted to reserve a bit of nagging for say, when he started piano lessons.

I really didn’t want eyeglasses in our family photos.

I realized my hypocrisy. I genuinely thought that other people’s kids with glasses were cute. (I also think that triplets are cute, but I do not want a set of my own.) My darling niece wears glasses. One of my best friends’ daughters wears glasses. I love these girls, glasses and all. The husband wears glasses for Pete’s sake and I fell in love with his sexy, smart looks.

Was I really that (gulp) shallow? How could I be so oddly vain about my child when I care little about my own looks—evidenced by my lack of makeup and daily uniform of ponytail, flip flops and stretched out yoga pants.

With prescription in hand, we visited the eyeglass shop to choose Samuel’s new frame this past June. I adopted a weird, overly enthusiastic tone when pointing out his choices.

“Wow, those are really cool! Look at the boys in the poster (gesticulating madly)! They are wearing their glasses at the skate park! How super awesome!”

I started to hate the sound of my own voice. I knew Samuel could see right through me with his newly attuned, five year-old parental-bullshit-o-meter.

Or maybe not. It turned out that he did want glasses just like the boys at the skate park. These specs also happened to have rectangular frames just like Dad’s. Astonishingly, Samuel happily wore the specs all summer. No need for nagging. He loved wearing his glasses. Still, I steeled myself for public kindergarten.

Look at me

Kindergarten started and none of his classmates commented on his glasses. Three months into school, I see why. First of all, kindergarteners are pretty forgiving. A kid with a peg leg, turrets and a penchant for licking can still be pretty popular. One of Samuel’s new friends has a face covered in tiny clear warts. Another wears athletic socks on his arms for “warmth” and another wears mismatched tye-dye separates that highlight his flaming red hair. There are kids who rely on the free “community snack” at recess and wear the clothing we donate to the free clothing exchange.

I stopped worrying about Samuel and his designer glasses.

A few weeks ago, my cousin, a professional photographer, took family photos for our holiday card. We started the shoot indoors with Samuel wearing his glasses, but quickly realized that the camera flash reflected badly off his lenses. We ditched the glasses for the rest of the session.

The photos came out beautifully—thanks to my cousin’s talent and an arsenal of juice boxes. This year, I managed to mail a bonafide Christmas card as opposed to the procrastinator’s New Year’s Card.

The photos look like us—a much cleaner, more color-coordinated version of us—and capture a moment in our family history. A moment when our three small children could still be easily bribed with a juicebox. I adore the photos and know that someday I’ll look back at them to remember what our little kids looked like.

The only thing that will be missing is Samuel’s glasses.

Photo shoot outtake

Vision therapy: Skills and porcupine quills! Stella's first time wearing therapeutic prism lenses.

Last night and this morning, there was a nerve-wracking build-up to Stella’s check-up, wherein her developmental optometrist would gauge how patching and vision therapy have helped Stella, or not. I’ve worked very hard (okay, harder on some days than others) during Stella’s first three months of vision therapy, sometimes pulling my hair out, often swallowing pesky doubts, and occasionally guzzling wine. She’s 27 months old now, and has been such a trooper through glasses, patching and vision therapy. She asks to do certain “eye games” and requests her patch in the morning so she can watch a video (it’s her routine, plus there’s no TV watching without a patch). But she can also be impossibly resistant in that flippant, in-your-face way common to two-year-olds. And Stella’s not the only one with a short attention span! What was I talking about? Oh yeah–this isn’t easy, folks!

I’m proud of Stella regardless, but has all our effort paid off? As we headed out to the doctor’s office, part of me was absolutely certain that yes, her progress has been hit-you-over-the-head obvious and will be decisive and documented for posterity in the history books (or at least Stella’s patient records). But, I’ll be honest. Another part floundered and secretly wondered if we’d been throwing away hundreds of dollars each month.

The verdict: Stella has made solid improvement! Stella’s amblyopic eye is getting stronger and her eyes are working together more effectively. In August, when Stella was 24 months old and had been patching for maybe three weeks, her left eye was judged to be 20/40 [edit: found out at vision therapy that it was 20/80 before patching began]. Her right, 20/20. Since then, her left eye ramped up to 20/30, and her right is still 20/20. Other positive signs: During the exam, Stella’s eyes didn’t cross like last time. She showed much clearer evidence of 3D vision and binocular vision while wearing red/green glasses. These areas still need a lot of work, but Stella’s doctor and I see her first three months of patching and vision therapy as a success.

Read more…

This question came in from Wendi, who has experience with a toddler in glasses, but is now facing having her 6 month old in glasses, too.  Those of you with babies in glasses, what tips do you have?  – Ann Z

My daughter was iagnosed with strabismus and hyperopia (farsightedness) at the age of 2.  She is now 4 1/2 and we have just started to patch one eye for 4 hours/day.  The diagnosis was a shock to us because neither my husband nor I are farsighted, in fact we are both nearsighted and have low presciptions (plus, no farsightedness on either side of the family).  My daughter was a preemie at 7 weeks early, so I thought that maybe that was the cause.   Anyway, last month we brought our 6 month old son to get his eyes check per the recommendation of the doctor (apparently, it is common practice that if a sibling has eye issues, to have the child checked early).  We were shocked to learn that our son’s eyes are worse that our daughters (my daughter has a prescription of +5.0 on both sides, whereas, my son is +8.0 on both sides).  My first question is for those that had glasses on babies…   do we go with the straps or not ?  We are having a hard time getting glasses that are small enough.  Also, I am inclined to get a second opinion….did you?   I just don’t feel that my doctor was thorough enough…it was more like, “Yup, same as his sister, here’s your prescription.”  Why glasses so early?  Will his eyes improve?  Will they get worse if he doesn’t wear them?  Is eye therapy an option? I would just love to hear your experiences with babies and glasses.

This question just came in from Jen.  Anyone out there in a similar situation?  -Ann Z

My daughter was diagnosed at 20 months old and we have been patching since. She was also prescribed glasses a month ago, her prescription is +1.5 ONLY but our doctor says we should give it a shot to see if that will help straighten her eye. So it turns out that the prescription is so low that it does not help her “see” better at all so it’s been a struggle to get her to wear it. I’m just getting frustrated that nothing is helping her yet. She has been a trooper in patching and we just had another baby so there are so much changes in her world. I want to see if there are anyone here with a child in similar prescription and has seen a difference in straightening out the eyes or successful in keep the glasses on?

Our early days of "tape patching." On vacation, sans napkins, apparently.

They’re not easy to spot, but if you look closely, you’ll find little ovals of Magic Tape jutting out from just about every surface in our home. Like an infestation of ghostly flat beetles, they peek out from door jams, edges of dressers and bookcases, and the side of our bathroom mirror. You’ll even discover them slapped to the dashboard of our car–because we take our occlusion to go!

For three to four hours a day, the right lens of Stella’s glasses is covered in a little patch of tape. I’ve been wondering if anyone else in the Little Four Eyes community is patching this way. I’ve never seen it mentioned, and have read here many times that doctors insist on the importance of full occlusion. At the risk of sounding controversial, I’d like to propose that 100% full occlusion, provided by the standard adhesive patches, is not necessary or “right” for every child with amblyopia. Stella’s story (so far, anyway) and solid research back up this premise.

Quite simply, translucent tape on the glasses lens over her stronger eye works for Stella. Her reaction to the adhesive-on-skin-style patch was so over-the-top. To me, it was heartbreaking and scary. She’d had an NG tube as a baby, a feeding tube that is taped to the face and goes into the stomach through the nose, so maybe old trauma was involved. Regardless, we all know that patching can be very trying for some kids and parents (though for some it seems to go quite smoothly), even without negative past experiences with adhesive! That said, I’m relieved to point out that Stella’s intense resistance is not why we patch with tape.

Read more…