Archive for the ‘strabismus (misaligned eyes)’ Category

Interview with Kristin Ellsworth on giving back

August 1, 2012 2 comments

I’ve been talking a lot about the Great Glasses Play Day that’s happening this Sunday.  And it would not have happened at all without Kristin Ellsworth, the founder of Peeps Eyewear and the author of “Princesses Wear Glasses.”  She is the Program Chair for Prevent Blindness Wisconsin and was recently appointed to its Board.  She and her husband live in Madison, WI and have three daughters, the youngest proudly wears glasses.

I met Kristin about a year ago and was blown away by her energy and her passion for children’s vision and her work to make sure that children who need glasses love their glasses.  I’ve often thought about ways of giving back and helping other families with children who have vision issues, and I’m inspired by how much Kristin does.  I wanted to share an interview I did with her, focusing on her work with Prevent Blindness Wisconsin.  – Ann Z

Tell me a little about your daughter getting glasses.

My daughter was three years old when my sister noticed one of her eyes turned in slightly. I hadn’t noticed it. My husband and I took her to a pediatric ophthalmologist who diagnosed her with Strabismus and Amblyopia. I was shocked, I had no idea she wasn’t seeing clearly. We began patching her strong eye in order to stimulate her weaker one. We also found her a pair of glasses that she seemed fine wearing.

What inspired you to write your book, Princesses Wear Glasses?

One day my daughter was playing dress-up when everything got quiet. I peeked around the corner and saw her staring at her image in the mirror. I asked her what was wrong and she said, “Princesses DON’T wear glasses.” Then she threw her glasses to the floor. I was surprised because she was only three years old and hadn’t been exposed to a lot of princess things. She started hiding her glasses around the house and refused to wear them. It became a problem, so I got out some paper and markers and created a story about an adventurous girl who saves the day wearing her glasses – she just happened to be a princess, too! My daughter loved the story and stopped hiding her glasses. I decided I could do something to help other young children feel good about wearing glasses.

What led you to start volunteering with Prevent Blindness Wisconsin?

I was fortunate my daughter’s vision problem was caught early. What I learned was 1 in 20 preschool children and 1 in 4 school age children have a vision problem. I didn’t know this and most of my friends didn’t either. I also learned that up until the age of eight, the brain is rapidly developing. If vision problems are caught early, vision can often improve.

That is where Prevent Blindness Wisconsin comes in. The organization helps vision screen thousands of children. I volunteer in a number of ways. I present to groups to raise awareness and to recruit vision screeners. I contribute and help raise funds for the organization, and I vision screen.

What have you learned from volunteering?

I’ve learned a lot more work needs to be done to address this issue in our nation. Many parents I talk with are not aware that early childhood vision health should be on their radar. Vision health laws and services for children vary state to state. A number of states, including Wisconsin, do not have uniform vision screening and testing guidelines, so it is very important that parents stay informed.

What do you do at screenings?

It involves two tests, a wall chart test (with shapes instead of letters for kids who cannot read) and a stereopsis test (used to help detect if the two eyes are working together). If a child fails the vision screening, he or she is referred to a doctor. It is important parents know a screening does not replace a comprehensive vision exam by an eye doctor.

Do you think having a daughter who needed glasses early has helped you in doing the volunteering?

Absolutely—I take vision screening very seriously since I saw how vision issues affected my daughter. I want to make sure children are screened properly and get comprehensive vision exams. The earlier a child’s vision issue is caught, the better.

What is your favorite part about volunteering for Prevent Blindness Wisconsin?

My favorite part is vision screening children. It motivates me to keep working on Peeps Eyewear and give back to organizations like Prevent Blindness Wisconsin. There are so many rewards, especially coming back to a preschool and seeing one of the children we screened the year before happily wearing glasses.

Is there anything else you would like to add?

Just that I want to thank Little Four Eyes for supporting families and children with glasses. With Peeps Eyewear, I hope to encourage children who wear glasses to imagine they can be anything they want to be. I hope they will identify with less-commercial characters who wear glasses that spark imaginative play, not define it. Every child is unique. It’s time for young children to celebrate wearing their glasses!

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Reader Request: Poll about accommodative esotropia

March 20, 2012 1 comment

Updated: I’ve added Vision Therapy as a choice, but it’s not showing up yet.  It should show up shortly.  Sorry for that, I knew there was something I was forgetting when I hit publish.

One of our readers, Heather, asked if I’d do a poll about how many children with accommodative esotropia end up patching.  I’m expanding the poll just a bit to include other treatment options.

If your child has accommodative esotropia (partial or full), let us know what treatments you’ve done.

Your stories – Our experiences with a teacher of the visually impaired

January 31, 2012 5 comments

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.

girl wearing glasses


Read more…

reader question – child with strabismus closing one eye in the sunlight

November 15, 2011 7 comments

Ingrid wrote me with the following question:

I’m wondering if any parents of children with intermittent exotropia notice that their child constantly closes one eye in sunlight? Of all that we go though with Paris’s eyes, including patching, this for me is the thing that bugs me and bothers me the most. Especially as we live in Australia and it is always sunny!As soon as we walk outdoors she closes her exotropic eye, so she is closing it a large part of the day. I have tried sun glasses but she really doesn’t want to wear them. I am thinking of getting transition lenses? Has anyone got any advice on what to do? Is this something that can be rectified. It is really distressing to see her with one eye closed a good part of the day!

Here’s the thing, Zoe does the same thing, though she has esotropia, not exotropia.  Has anyone else noticed this with their child?  We’ve both asked our POs and not gotten much of an explanation.

Double vision as a sign of success?

September 6, 2011 9 comments

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.)


Beyond patching: Stella’s vision therapy now includes MFBF

January 30, 2011 4 comments
The Treat Game: Stella's baby helps find matches during vision therapy

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…

Your stories: intermittent exotropia and conflicting treatment options

January 13, 2011 109 comments

This story was sent in by Sheetal.  She’d love to hear from anyone else dealing with intermittent exotropia. – Ann Z

My daughter has intermittent extropia. Her eye drifts outwards intermittently. We discovered it when she was about 7 months, but doctor said not to do anything about it then. We started patching when she was about 1 1\2 years; we patched only one eye (right eye) to make the left eye stronger. We did it for about four months. We went for a follow up in November 2010; she was 2 years by then. Doctor said, he sees the drift and he says he will have to do surgery soon. He also told us that her vision is fine in both the eyes. (20\20)

I really panicked, because though I see the drift in her eyes, I don’t see it all the time and I see it occasionally, maybe 5-10 times a day and it is different on different days. Whenever the drift is there, it stays for few seconds and she corrects it. Drift usually comes when she is looking at certain angle, I don’t see it when she is looking straight at things. So I was completely shaken when doctor said surgery is the only option.

I subsequently took appointment from 2 other doctors.

The second doctor told me that the drift is about 20-25 prism units, but he suggested not to do anything, he is very experienced and he told me to wait, according to him 1\3 of the cases stays the same, 1\3 gets better on their own and 1\3 gets worse. So he told us to keep a watch and I have appointment with him in April. (He also advised is against patching because he of the binocular vision). He also mentioned an interesting fact, that small kids have to look up at everything because their height is small, but as they grow everything is at an eye level and that helps in getting the drift better.


We went to the third doctor and he also mentioned that the drift is about 20 prism units.

He knew my first doctor and he said, he didn’t agree with him as far as the surgery goes, he said surgery is the last option and he recommended to continue patching and suggested pencil pushup exercise.


Now, I am a little relieved that surgery is off for now but am confused that there are different statements from different doctors. Am not sure if whatever I am doing is right, fear of something going wrong is always there.

Now I am patching the right eye for 1 1\2 hours and left eye for 1\2 hour alternate days.

We also try doing the Pencil Pushup exercise with her, we got 100 sticks from dollar store and we stick stickers on the tip and move it from back to front, she does it or few minutes and then looses attention.


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