little four eyes

This question came in from Jacqui, who is hoping someone else may have experience with this.  -Ann Z

Our daughter Coco is longsighted with  both eyes +4.  Six months ago our specialist advised us that she did not require glasses because she was coping well and would probably require them later in life for reading and studying. We returned to him after a few months however as we noticed that one eye occasionaly turns out slightly when she is tired or focusing on us when we are close to her.

Anyway the woman who did some testing before we saw the specialist himself implied to us that putting her in glasses may cause the eye to turn in and she was concerned about this.

We went to see the specialist straight after and he made the recommendation that she does wear glasses in an attempt to straighten the eyes. He did say it was unsual that her eye turns out given that she is long sighted.

But now we wonder if the occasional eye turning out is even related to the long sightedness as our older daughter with normal vision had a similar eye that has strengthened as she has got older. I guess we are worried that we have put her into glasses unnecessarily and will that be causing worse problems for her now. i.e an eye turning inwards that can’t be straightened. She copes so well without glasses, staff at her preschool are not at all concerned and we see no evidence of difficulty.   She finds Wally quickly!

This story came in from Jennifer. -Ann Z

When I found out Bo has Accommodative Esotropia and would have to wear glasses, I was not concerned about how he would handle it.  I was concerned about how his brother and sister would handle it.  I have Triplets.  When Bo got glasses they were a little over 1.5 years old (they are currently 2.5 years old).  In August Bo will be wearing glasses for a year.  I can not even begin to count the number of frames he has had.  Just this week two pairs have been broken.  JUST THIS WEEK!  His glasses were broke over the weekend and he had an eye dr appointment on Wed.  So, I dropped his VERY broken glasses off. Since they were unfixable they had to order new frames.  Then, this morning I had to drive the hour back to the eye glass place to drop off his other pair and of course they are beyond fixable and another set of frames is being ordered.  He now wears a pair that the eye glass manager was nice enough to make us for free, but since those too are broke, they are ducktaped, holding the arm in place.  We live in a very small town and have to travel an hour one way to the eye dr and eyeglass place.

Bo, Anna, and Alex. Bo wears glasses for accommodative esotropia.

Having 3 toddlers the same age with one having something that the other 2 do not, is a major adjustment and hassle.  They have always had the same things and gotten the same things.  If one gets something, the other 2 get the same thing.  They always go everywhere together (I am a SAHM with no help and my husband does not get home until 6pm).  So, when Bo got glasses he did not want them and Anna and Alex did.  It is a constant battle.  I must ask a million times a day “where are you glasses?” and “where are Bo’s glasses?”  I will found them in a bed tangled up with sheets, or at the bottom of the basement stairs or stuffed somewhere.  MOST of the time whichever one hid or threw them will find them and bring them back to me.  BUT, times like this week I leave the room for less then 5 minutes (or even just turn my back) and I find them in pieces, looking like they have been run over by a truck.  Two pairs have ended up like that just this week.  Bo is great about putting them on and taking them off and handing them to me.  They all know his glasses is my button to push to get me upset.  If Anna or Alex get mad and Bo is anywhere near them, they sling his glasses off his face.  Anna and Alex also know this is the way to pick on Bo.  He has always been the quite one and the one to be picked on.  And taking his glasses is how they pick on him.

And then when I am told Bo will have to wear a patch an hour day my first thought was “great, stick a big sticker on his face.  Something else for the other 2 to be jealous over”.  We have tried everything from giving Anna and Alex play glasses and stickers, but nothing works.  I can’t turn my back or leave the room for a minute without worrying about his glasses.  I don’t want to have to take his glasses off everytime I leave the room.  Nor do I want to have to drag him with me.

We have been luckly enough to have found a wonderful group of people working at VisionWorks.   We had no vision insurance when Bo first got glasses.  The glasses at the eye dr were going to run about $300.  When all was said and done (taxes, warranty, special lenses, scratch resistant–yeah right!) I got 2 pairs of glasses at VisionWorks for $180.  They have been great, not making us pay for replacement frames and even ordering him an extra pair for free.  Like I said before, I can not even begin to count the number of frames we have been through.  His prescription is due to change in August and I am looking for sturdier glasses.  The ones at the eye dr can be twisted and rolled up into a ball and they bounce back in place.  My thought is to get those on the insurance and then get a replacement pair (or two) at VisionWorks.  I am very open to thoughts and suggestions on sturdier glasses!

It is an ongoing battle and I can only hope that it gets better as they get older. That one day (sooner than later) Anna and Alex will learn to leave Bo’s glasses alone and that Bo will learn not to let them take them off.  I know I have probably made my children sound like horrible monsters, but I promise they are not (only when it comes to the glasses)!

So here she is with her new glasses.. We are totally loving her cute new look, and it’s been fun to show her off to friends and family. At the office when she put them on the Optometrist said “Look outside Birdi..” and she did. I choked up a bit. She just took it in. Then we tried some other frames on (discounted frames to have a backup pair made) and she eagerly looked around and was disappointed to see (or not see) that everything looked the same. She wasn’t able to wear them for an hour while the ear loops dried, so I put them on her as she climbed out of the car. She looked around the garage and said “It’s SO CLEAN!!” I couldn’t help but laugh. She ran around touching things saying “This is CLEAN! That is CLEAN!” and then she trotted over to the garage door which was covered in smudges and said “Whoah… that door is NOT clean!”

As the day wore on, she did want them off as they did start to bother her eyes. I gave her some tylenol and she seemed to relax after that. As of this morning she is happy as a clam. A few things I do have concerns about now that she has her sassy new specs. First of all, her pupils really seem to dialate when she is  wearing them. Why is that? Also, she has mentioned seeing a rainbow as they come off. I assume she is seeing some prisms. They go away, but is this something to be concerned about? Ah, and as I post this she has approached me with a bare face. Thus begins the phrase that will be heard a plenty in this abode….

Birdi! Where are your glasses?!

Well if I’m going to be completely honest, I’m Diane, Amy, Birdi and Frank’s mom. They are each a bit more than two years apart, and I may be one of the older 30-year-olds that I know. Birdi is not my first child to need glasses, but she’s the youngest of the crew so far, and has a very strong prescription. So here’s how our story begins.

Spring is upon us, and Birdi is enrolling in her second year of preschool. As we ready our paperwork, we realize that she is a bit overdue for her four year checkup. I make an appointment, and wrestle my 20 month old son under one arm, while holding Birdi’s little hand with my own. At the doctor’s office, she obediently and cheerfully hops on the scale, a perfect 30 pounds. Then it’s over to the wall to be measured. She’s a peanut just a hair over three feet. The nurse asks if I think she could handle the vision test, which is merely a poster with simple black and white pictures. The nurse positions Birdi and I at a predetermined distance from the wall.

“Okay Birdi, what’s this a picture of?”

Birdi fidgets, rubs her eyes and looks shyly to me.

“I don’t know.”

I press her a little…

“Birdi, you know what that is! You just had one of your own at your party not long ago.”

She continues to fidget and won’t look up. The nurse walks up to us and takes Birdi’s hand, then steps Birdi forward about 5 feet.

“A birthday cake!” yelps Birdi as the nurse points at the top picture.

Oh dear.

In the exam room, the doctor suggests we follow up at the eye care place of our choice. There is a chain place that I go to and figure that will be enough to see if she really has a need for correction, or just has a short attention span. We are actually able to get her in that same afternoon.

Now, I walked into that office with a resolve to not be “sold” glasses. I have come to question the integrity of some chains, and figured that if she only needed minor correction, we might do some homework before buying a pair of glasses that will be ready in an hour. So we step into the dim room, Birdi starts her exam. About 15-20 minutes later, the optometrists takes off his own glasses to rub his eyes and say

“I would like to send Birdi to a pediatric specialist.”

It turns out, that by his best measurements, Birdi has a prescription of  +7.5 in one eye and+7.0 in the other.  He explains that this is a very strong Rx for a kidlet, and wants someone who works very closely with children to take a better measurement. He gives me a phone number and sends us on our way.

Oh, and of course he reminds me that I am welcome to bring the Rx back and they can fill it for us. I snickered. I couldn’t help it.

So I go home a bit shell shocked. I mean, she can see right? She does sit directly in front of the TV, but what kid doesn’t? I find myself quizzing her with a black and white picture of her and Chuck E. Cheese from her birthday. I turn it sideways so that instead of side by side, she and the resin figure are alternately on the top or bottom of the picture. She’s excited about the game until she can’t see it anymore, and it should be clear as day. Suddenly things are making sense.

Birdi is pushy to be in front, and she has a short attention span. She loves to hear a bedtime story, but will fidget as soon as the book is out of her hands. What I think was happening, is that she loses interest the minute the object she is to be focusing on grows blurry.

So our next stop was the specialist. We made an appointment with the only pediatric ophthalmology office in our area. The drive is just shy of an hour, but the office was great. We were seen in a timely manner. The verdict: both eyes are around +5.5.  He informed me that though this was a pretty big prescription, it was not horrible. My biggest question of course is how she sees now. He explained it this way..

Small children have a remarkable ability to accommodate for vision shortcomings. Birdi is able to see things, but it takes a lot of work. Basically she focuses on something (say a flower) and takes in the information about it (it’s yellow with petals) and then her eyes relax again. Her brain has all the info it needs and moves on. Once she gets her glasses, though she will recognize things the way they always were, I might notice her staring, because now there is no stress when trying to take in more details. It made sense to me, and I am very eager for her to get her new specs.

The doctor decided that we would start with a Rx of +4.5 in both eyes, and see how that affected her sight over the next few months. He handed me our prescription and suggested we just use the optometry shop right there. We ordered her new glasses to the tune of over $300, and still do not have them. I called after 10 days had passed, and it turns out that her glasses had come in, but were unreasonably thick and heavy, so he sent them back to have them remade. It has now been 15 days, and I left a message today. I am frustrated and impatient, and have decided to order a backup pair from Zenioptical so that if something should happen to her “good” glasses, she won’t be without for terribly long.

There’s our story thus far. My questions are still many: How will she look? Will she really see things differently? Will she keep them on? Will her eyes look funny? Will her vision seem worse when she takes them off? Will this get better?

I look forward to sharing some pictures of her in her new specs, and I’m thankful for the opportunity to share our story.

Kim

Melissa who blogs at Ask Miss Mommy, sent in this story of her daughter, Grace.  The story was also published on her blog. – Ann Z

Grace at 6 months

This is the story of Pumpkin (aka Grace). My second born, my baby. Kind, calm, happy baby with a fiery will that explodes with force. Grace came into the world fast, in the middle of the night, giving me only 2 hours to get to the hospital. She was immediately absorbed in nursing with a passion that has yet to diminish.

The focus of my little story, though won’t be on her birth but yet her darling eyes. Back in April 2009 (wow a year ago) I posted about Pseudostrabismus. We continue to monitor her eyes after that just to see what would happen. Would the periodic “real” crossing go away or increase? It increased and in January my baby got glasses.

My wish was granted and we headed back the next week for visit with Dr. M. This time I felt respected, as part of Grace’s team and not just an uninformed bystander. But I was still frustrated. Dr. M couldn’t elicit the crossing either. Finally at the end of the appointment, Grace was sitting on my lap looking at my necklace and she crossed. Never have I been so excited about a somewhat negative thing ever. Dr. M was able to see it in action and validate my concern that, yes it was an issue and true esotropia.

The thing about Grace’s vision is in order to see any crossing she has to be super focused (literally and figuratively) on something close up. Which she frequently is but it’s not the standard way they test vision. The “tests” are done too far away. Grace is also quite young to be given an Accomodative Esotropia diagnosis. It usually appears around 2 years old and she was around 14 months. So I was relieved to have a professional see what I was talking about and note how to test Grace’s vision for the future.

Grace got glasses in January with +200 prescription* (meaning she is farsighted within the mild category). Today we went back for a recheck. Her prescription has increased to +450 (which is now in the high hyperopia range). I’m still a bit confused about the long term outcome for Grace. As far as I know, the best case scenario is to lessen the strain on her eyes (the increase in prescription means her eyes are relaxing so that’s good) and to wean her from glasses as her eyes get stronger and she gets older. I’m trying to stay neutral and just take it one day at a time. We are also patching using a partial occulsion patch for 30 minutes a day.

*Many people post about prescription written as a “+4.5D” number. I was only told a +200 or +450 so that’s what I know. Anyone have words of wisdom on that??

upset Dagny

When my daughter Dagny was five months old she would cross her eyes when she was upset about something. It was a phase that only lasted a few weeks and I was relieved when it stopped. At her one year well-baby checkup her pediatrician asked me if I noticed her right eye turning in. It was so slight that I often thought I might be imagining it but it worsened rapidly over the next few months while I waited for her optical appointment. Her eye crossing became a source of stress for me. Somehow I connected it to my failure as a mother. I know this is completely unrealistic but I knew it must be my fault. I felt as if people were judging her, and me, for it.

On the day of the appointment we sat in the waiting room for hours waiting to be seen. I was nervous the entire time and Dagny was beginning to get antsy. I was relieved when we finally met the staff. They were warm and welcoming. I found out that my daughter is farsighted and she was given a prescription for glasses.  We made progress and I was anxious to get the glasses. I rushed home and began calling optical stores in my area. There are many within walking distance so I knew we would be just fine but one after another the stores told me that they could not help me with a child of 15 months.

“We don’t have glasses that small.”

“I have never worked with a baby before.”

“Maybe you can call another branch. I am not really…uh…can you hold please?”

After making over a dozen phone calls I broke down and cried. I felt defeated. All of the emotions came out at once. I did not want my baby to face this obstacle so early in life. I never had glasses soI could not relate to her vision problems and I know that this will be something she will always have to deal with.

We finally found eyeglasses nearly an hour away. She has had them for a few days now. She wore them all day at first but she is already struggling with them. She bent them on day two and today scratched a lens. I am just going to keep smiling and putting them back on her face. We go back in a couple months to see if her vision has changed any. She still crosses her eyes. I was told that the glasses would correct this but I was not told if it would be instantaneous or gradually.

Dagny's new glasses

I will learn to accept this over time as I learn more about her condition and what I can do to help her. It’s not the worst thing ever and I am so glad that we caught it early. Besides it is the cutest thing ever when a 15 month old says “gyasses.”

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).

I recently got a question about when a doctor might not prescribe glasses for a child, even if the child was nearsighted or farsighted.  I did some research and found consensus guidelines for prescribing glasses published by the American Academy of Ophthalmology (Pediatric Eye Evaluations: Screening and Comprehensive Ophthalmic Evaluation, 2007, link to full text).

Before jumping to the guidelines, it’s worth emphasizing that these are general guidelines only, based on professional experience and not scientifically researched data.  Let me repeat that: there are no good studies showing when a child should be prescribed glasses – this is in part due to the fact that prescribing glasses is complicated.  Each doctor needs to take into account everything about the individual patient and there are many things that would lead a doctor to prescribe glasses at much lower refractive errors.  These include strabismus or history of strabismus, developmental delays, other medical issues, visual acuity, acceptance of glasses, among other factors.

Prescribing Glasses to Children with Anisometropia

Children who have a significant difference in refractive error between their eyes (called “anisometropia”) are more likely to be prescribed glasses.  This is because anisometropia is a significant factor is causing amblyopia.  If one eye sees much better than the other, the brain is more likely to favor the vision from the “good” eye, leading to amblyopia.

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Prescribing Glasses to Children with Isometropia

For children whose eyes have similar refractive errors (so both eyes are seeing similarly), also called “isometropia”, doctors are less likely to prescribe glasses at lower refractive errors.  In this case, there is a difference in prescribing guidelines for farsighted children depending on whether or not the child has strabismus or misaligned eyes.  Again, this is due to the increased risk of developing amblyopia if strabismus is present.

It is again worth noting that these are only guidelines, and in fact, other studies have shown that many doctors prefer to prescribe glasses at lower refractive errors (Spectacle prescribing recommendations of AAPOS members).

The guidelines do fit closely with our own experience.  When we first took Zoe in to the ophthalmologist, she was not crossing her eyes often, or severely.  In fact, in some of the pictures we took with us, while it looked like her eyes were crossed, when you looked at the reflection of the flash in her pupils, they were actually aligned.  Her refractive error at that time was probably around +4.5 or +5, high enough that the ophthalmologist told us to keep a close eye out for her eyes crossing and told us to come back in 6 months for a follow-up.  Four months later, her eyes started crossing significantly, and her ophthalmologist had us back in and got her into glasses.

If you ever have a question as to why your doctor is or is not prescribing glasses for your child, please ask your doctor for an explanation.  If you still are unsure, or if that explanation does not make sense, a second opinion may well be in order.

I just got this question from Jenny.  Her daughter is almost 4 and has just (this weekend) gotten glasses for strabismus, amblyopia, and farsightedness.  She’s wondering whether her daughter should wear her glasses in her gymnastics and skating classes.  She was also thinking of signing her up for skiing class this winter, but is hesitant now with her daughter in glasses.  What, if any, physical activities has your child done with glasses?  Any constraints or tips?

This second question came from Barb K in a comment.  -Ann Z

We have a lovely 4 years old daughter  who – unfortunately like her parents –  is extremely farsighted. Her eyeglasses are +20.00 and even when she wears them she has very poor vision. I s there a chance, however, that she can  grow out of her farsightedness, or must we prepare for her to be visionally impaired for the rest of her life?  What experiences do you people here have with contact lenses/implants?