little four eyes

To Our Patching Families,

Sometimes it is hard to remember why we are patching.  After placing the patch over our child’s stronger eye vision or pealing a sticky patch away from their reddend skin, it is easy to say, “We’ll skip patching today.” The most important thing to remember though, is that if your child’s Opthamologist asks for 4 hours every day, we as parents, MUST make 4 hours every day happen.  

I am reading the book “Children with Visual Imparents, a Parents’ Guide,” and came across some words that must be shared.  This book is a fabulous resource and I am hoping to write a book review when I am finished.  The chapter I just read was on medical issues, treatment, and professionals written by Steven Stiles, O.D. and Robert Knox, M.D.   There is a section on Amblyopia and they write, “It is very important that you realize the number one factor in the success of eye patching is to keep the patch on the eye as prescribed by the doctor (p.29).”  Our chidren’s doctors may tell us what we need to do to give our kids a chance at improving their vision, but it is our responsibility to make sure that we follow through with this task, no matter how difficult.  The best time to treat it is NOW, when our kids are young.  Just think of this,

“Damage to the eye caused by failure to wear the patch will likely be permanent.”

Amomofelly

Have you ever heard of Ficklets? Not me. At least not until a few weeks ago when someone online introduced me to them. But they are cute and apparently make all the difference for some children who would rather not wear glasses at all.

We were thrown into the world of children’s glasses back around December when we found out our oldest (5yrs old) has Amblyopia. He has between now and when he turns 10 for his brain and eyes to work together to strengthen the focus in his left eye. If glasses don’t work, there is the patching technique. ( I did get ahead of myself by establishing another contact online who actually makes attractive patches for kids. She made one for Brendan which we are not using yet, but may start soon. I plan to introduce this product to the Opthamologists at Brendan’s next appointment this month). Watch for my review on this patch in the near future.

Back to the Ficklets. These are eyeglass charms in their own way and they aren’t expensive. Brendan picked out the pair of blue dogs but Ros at Ficklets sent him a set of soccer balls too, and he chooses to wear one of each. I will add, he’s been wearing these for weeks and they stay on great! In the short time he’s had his glasses (and he wears them almost 24/7) the frame is already bent and I found a small crack in one lens ( ughhh)- he’s a boy, what can I say?

All that to say, the Ficklets have hung on VERY well. They are attached by a small rubber band you twist around the eyeglass frame and wrap onto the ficklet. Only recently did one pop off and we just used our “backup” rubber band that came with the pack to replace the missing band. I’ve never worn braces myself but know others who have and these bands remind me of tiny brace bands.

If you have a child who must wear glasses and just WILL not do it, you should consider looking into Ficklets. Ficklets might just give them the boost they need to overcome their self-consciousness about wearing glasses. Click here to read what others are saying about the difference Ficklets made in their childrens’ lives. I especially like the flower-ficklets for little girls, but I don’t have one of those

We did receive our Ficklets free in exchange for providing a review of them on my blog. Ficklets has a variety of charms available so be sure to check them out! The Ficklet motto is…”Give four-eyes a fresh perspective.”

This review was done by me and previously posted at my blog HallofFameMoms.com.

I’m reposting this comment from Stacy in hopes that others will have information for her. -Ann Z

I have a 15 month old son, Ethan, and we just had our first visit with a pediatric ophthalmologist. I feel very disappointed, frustrated and scared after this appointment. We took our son to the ophthalmologist because his left eye turns in. I was not terribly worried because I had amblyopia as a child and anticipated that at the most we would be patching our son’s eye. The eye doctor told us that Ethan’s right eye has 20/20 vision, but his left eye is extremely nearsighted and that he had something called “myelinated retinal nerve fibers.” The eye doctor told us we would need to patch his right eye and that he would need to wear glasses with a Rx of -8.5 in the left lens. He told us we could “read up” on these myelinated retinal nerve fibers as it is a rare condition. He also said that with patching and glasses (6-8 hours a day) that a reasonable vision expectation for Ethan would possibly be 20/50. I feel lost. All I can find on “myelinated retinal nerve fibers” are medical journals full of jargon that I do not understand!!! I’m still unclear as to what Ethan’s actual diagnosis is or how long we will need to patch and wear glasses. All I know is that I am to return in 2 months to check his vision again. We are seeking a second opinion. But has anyone been told their child has “myelinated retinal nerve fibers?” Any help would be soo appreciated! I feel defeated.

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.”

It is always fun to get mail, a new patch in the mail is like icing on the cake =)  WHOOOO HOOOO!  Oh, can you tell patching for umpteen million hours a day for the last thousands, no wait, gazillion days gets boring….

A new patch is always exciting in our house.  Sometimes our sweet neighbor girls make my daughter one and leave it on our doorstep so they can be patching twins (she patches too) other times Camille at frame huggers sends us a new product she is trying out for our input.  I guess it is one benefit to being a long time patcher. 

Her latest trial is a sticker slicker… which is a soft patch with an extra vinyl piece to put a sticker on.  Elly was extremely excited about putting stickers on it, although I can see a little goo build up as we are a little sticker happy at this household.  All in all, we gave it a seal of approval.  Besides, who can resist an adorable little girl with a hot pink patch!!!!

To see all of her products, visit https://www.framehuggers.com/index.htm  and if you need something for your glasses or have a specific patching request, she is very talented, creative, and dedicated to helping our little ones, so just send her an e-mail.

This update comes from Danielle, whose daughter Mia had cataract surgery as an infant, and continues to deal with glaucoma, patching, and contacts.  You can read more of Danielle’s posts about Mia here (introducing Mia, after her second glaucoma surgery, occluding lens for patching, glaucoma valve shifting and corneal scarring, Mia’s contact lens).  -Ann Z

Mia at 20 months

I have been avoiding little four eyes because we have been having a tough time with contacts and patching.  As Mia gets older, the stronger she gets, not only with physical strength, but with mental strength and stubbornness. She is my little firecracker and she does not like having her vision taken away. She has become crafty with her contact lenses and has learned how to remove them, or a new trick where she puts her finger on her occlusion lens and slides it to the corner of her eye. It must be very uncomfortable, however she chooses to be uncomfortable in order to see.  Mia’s vision without correction is 20/1300 so she is legally blind in her right eye; and with correction she is 20/360. I compare her vision with someone that is blind, so when she is patched I am literally stealing her vision and expecting her to function and move around like she can see; which she can’t. I understand that patching will increase her vision, however the time it will take to regain vision in her right eye is torture to her.

Mia after her glaucoma surgery

During an exam under anesthesia 2 months ago, we found out that Mia’s glaucoma returned. She had valve surgery 3 weeks ago and everything went really well.  As usual she was starved when she woke up and wanted her juice and crackers, and to get the hell out of the hospital; saying “bye bye” every few seconds. Since Mia is so strong willed about having anything on her face, we purchased soft splints for her arms to prevent her from removing her eye shield and bandages. She hates the splints and learned very quickly to keep her hands away from her eye or they will go back on.  It broke my heart that she does not even realize that her right eye is covered; which means she is pretty much blind in this eye. She is walking around like normal, not even skipping a beat. It kills me, it makes me feel like I have not done everything in my power to prevent her right eye from going blind. I am sitting here crying as I type thinking, how and why. This has been such a hard and devastating road that we have traveled. But I hope and pray that it is not to late to save her vision. Sometimes I think about the choices we have made; what if we decided to do nothing when we were informed about her cataract when she was 12 days old. Yes, she would have gone blind in her eye, however she would not have to endure surgery after surgery, or nystagmus, amblyopia, exotropia, glaucoma, patching, glasses, contact lenses, eyes drops, ointments. My father always says “you make the best decision based on the information you are provided with, that is all you can do”. But this does not make me feel like the decisions we have made were the right decisions, or even the best decisions. Mia is only 20 months old and she has had to endure more than most people during her short 20 months of life. I just wish I could take it all away, that I could be the one going through all of this rather than her. I am sorry that this post is so pessimistic, I am just having a difficult time and I need to get this off my chest and this is the best place for me to vent, you all know the pain I am feeling.

We are planning to use her arm splints to help with patch time. I just hope that we have not lost all that we have worked so hard to save.

To all the parents that are faced with surgery, it is hard, the hardest situation you will ever be placed in, and going in the operating room to assist with putting your child under is the hardest part. I have done this 4 times and it does not get any easier.

I have attached a few pictures of Mia. I hope everyone is doing great, and you all had a wonderful Christmas and/or holiday season.

There’s been a few questions posted at the Little Four Eyes facebook group about where to go to get glasses, especially when local stores don’t have a good (or any) selection of very small frames.  So where did everyone get their child’s glasses?  Independent optical shop?  Chain optical shop?  A big retailer like Wal-Mart or Target?  Did anyone have a shop order frames special for their child?  Anyone order frames online and bring them to a shop?

I was just sent this question, and have no experience with this, so I thought I’d see if anyone else had dealt with this:

My daughter has been crossing her right eye for about six months and it is getting progressively worse. We finally got in to the children’s hospital and the doctor was shocked to find that the eye she is crossing is her stronger eye. Essentially she is favoring her weaker eye. Do you know of any other parents whose children did this? The doctor said it made no sense.

Her prescription is

Left eye
SPH: +3 CYL: +.5 Axis 90

Right eye
SPH +3.5 CYL +1 Axis 90

Edited on 26-Jan-10 to correct the errors that Dr. Bonilla-Warford pointed out (thanks Nate!) – Ann Z

Glasses prescriptions can be confusing – lots of numbers and abbreviations that aren’t necessarily easy to figure out, or at least, they weren’t when I first tried to understand Zoe’s prescription.  And in fact, I thought I understood what all the numbers meant, but after doing more research for this post, I found it to be far more complex than I’d originally thought. (On that note, if any eye doctor types read this and catch any mistakes, please, please let me know and I’ll correct them – thanks Nate!).

Before we get too far into what a prescription is, I thought it might be worthwhile to mention what a prescription isn’t.   It will not tell you:

• what your child’s diagnosis is.  You can tell whether glasses will correct for nearsightedness or farsightedness, but that doesn’t tell you what the cause of the vision problem is.
• if your child has amblyopia, it will not tell you what his or her actual visual acuity is.
• if your child has strabismus, it will not tell you how much his or her eyes are turning in or out.
• how well your child’s eyes work together, and whether or not he or she has stereoscopic vision.
• how advanced your child’s cataracts or glaucoma is, and how that affects their vision.
• anything that is not related to how glasses or contacts should be made in order to correct your child’s refractive errors (that is, due to the shape of the eye not being able to focus light correctly).

Okay, so back to the eyeglasses prescription then, and what it can tell you.  Prescriptions have a lot of different components, and I’ve seen them written a number of different ways, but they do have common elements at the core.  I’ll go into more detail on each piece, but I tried to put together something of a “cheat sheet” here:

Which eye are we talking about?

Since we’re nearly always looking at prescriptions for two eyes, you’ll nearly always see two sets of numbers, one for the left eye, and one for the right.  I’ve seen some prescriptions that label them “left” and “right” or “l” and “r”, which even I can figure out on my own.  But more often, I’ve seen “O.D.” and “O.S.”.  These are abbreviations for the Latin words for left eye and right eye.  For the record:

• O.D. : right eye
• O.S. : left eye
• O.U. (which I’ve never seen before, but found this information so figured I’d include it) : both eyes

Sphere

Sphere, often abbreviated as “sph” is the spherical refractive error, or nearsightedness or farsightedness.  It’s pretty much what I think of when I think of an eye glasses prescription.  Then again, I’ve never really had to deal with astigmatism (for me or Zoe).  The first part of this number will be a plus or minus sign:

• + : farsighted, or longsighted prescription: hyperopia.
• - : nearsighted, or shortsighted prescription: myopia.
• 0, Pl, or Plano : no error

How bad is the spherical prescription?

The number is in “diopters” but we don’t need to know too much about that (read about it on Wikipedia here), it’s a measure of how much the curvature of the eye  is off from normal.  Basically, the higher the number (ignoring the plus or minus), the worse the prescription.

Myopia (-)

• 0.00 to -3.00 : mild myopia
• -3.00 to -6.00 : moderate myopia
• -6.00 and higher : high myopia

Hyperopia (+)

• 0.00 to +2.25 : mild hyperopia
• +2.25 to +5.00 : moderate hyperopia
• +5.00 and higher : high hyperopia

Cylinder

Cylinder is the measure of astigmatism.  Astigmatism is when there’s an irregular shape to the cornea, often described as a football shape.  It causes blurriness at any distance.  There are two measurements that go along with astigmatism, the first, cylinder, is a measure of how severe the astigmatism is.

How bad is the cylinder prescription?

Like the spherical error, the cylinder number is measured in diopters.  The thing you want to pay attention to is the number.  It may be written as a plus or a minus, but that doesn’t actually make any difference in how bad the prescription is, ophthalmologists use a “+”, optometrists use a “-” (see Dr. Bonilla-Warford’s comment for more explanation of that).   The higher the number after the plus or minus, the more severe the astigmatism.

• 0.00 to 1.00 : mild astigmatism
• 1.00 to 2.00 : moderate astigmatism
• 2.00 to 3.00 : severe astigmatism
• 3.00 and higher : extreme astigmatism

Axis

The axis tells you whish way the astigmatism is oriented on your child's eye

If you think of astigmatism as a football shape, it makes sense that the football might be turned any direction.  The axis number then, tells you the orientation of the astigmatism.  The number is in degrees, it doesn’t have anything to do with how severe the astigmatism is, just how it is situated on your child’s eye.

Add

If your child needs bifocals, you will likely see a number here.  This tells you how the prescription should be changed for close up.  Let’s say your child has a regular glasses prescription of +3.00, if the add number is +1.00, then the near distance prescription will be +3.00 + 1.00, which equals +4.00 (3+1=4).  In the same vein, if your child is nearsighted, say -4.00, but has an add of +2.00, then the  near distance part of the bifocals will have a prescription of -4.00 + 2.00, which equals -2.00.

Sometimes, you don’t have an “Add” part of the prescription, and instead you’ll just see a prescriptions for distance vision and a separate prescription for near vision.

But what does that mean for how my child sees?

If you’re wondering what your child’s prescription means in terms of how they can see, there are a couple of places online where you can plug them in to see how blurry things appear.  Keep in mind that an eyeglasses prescription is not the final word in how well a child sees.  For instance, it will not tell you how your child’s weak eye is seeing if your child has amblyopia, or how your child might be seeing if he or she has cataracts or glaucoma.

Online vision simulators:

• Eyeland Web Tools – this site has one tool for myopia, and a different one for hyperopia, and one for astigmatism.  All three show you a scene that you might see while driving a car.  So hopefully not a scene that your child would necessarily see, but it still helped me visualize how the world might look with Zoe’s prescription.  Simulates prescriptions from +9 to -9 for the spherical error, and up to -8 for the astigmatism.
• Eli Billauer’s blur simulator – I’ve mentioned this site before on Little Four Eyes.  Enter your child’s prescription (sphere, cylinder and axis) for each eye, and it will show you two Snellen charts (the one’s with the big E at the top), one for each eye, that simulates how your child might see it.  Simulates prescriptions from +5 to -5 for the spherical error and +5 to -5 for astigmatism.
• Wolfram Alpha – this is a weird search engine that tries to answer your questions, and calculate equations that you enter.  You can enter your child’s eyeglasses prescription, and it will give you information about it, including a simulation of looking at the Snellen chart, and the far or near point for clear vision.  You will only see the Snellen chart if the simulator thinks one of the lines would be visible, which is +2.5 to -2.5.   You need to enter the prescription this way:

  OD +4.25 cyl 0.5 x 90

  (the number after the “x” is the axis for astigmatism, you can leave off the astigmatism numbers if they don’t apply).

There’s been a lot of news about myopia (nearsightedness) recently, much of which I thought might be of interest to some of you.

In December, the results of a large survey were released in the Archives of Ophthalmology.  The findings were that the number of nearsighted people in the United States (age 12 – 52) has risen by 66% in the last 30 years (abstract here).

The reason for this increase is the subject of quite a lot of discussion and debate.  Just last week, NPR (National Public Radio) ran a story on one of the investigations into the cause.  While genetics certainly play a role, it appears that time spent outside is another big factor.  One study found that children who spend 14 hours per week outside see a dramatic reduction in the risk of becoming nearsighted.  And the outdoors part seems to be the key – children who get plenty of exercise indoors don’t see the same benefit.  And perhaps even more surprising, the amount of time reading or doing other close-up activities doesn’t seem to make a difference in how likely a child is to develop myopia.  You can read or listen to the full NPR story here.

One final recent report, this one on the topic of the progression of nearsightedness in children – the tendency for some children’s nearsightedness to get worse over time:  Archives of Ophthalmology just published the results of a 2 year study of nearsighted children age 8-13 years old who had seen significant worsening of their myopia in the previous year – their prescription changed by at least 0.5.  The study looked at whether prescribing bifocals instead of single focus glasses made any difference in how much their prescription changed over 2 years.  In all of the cases, the prescriptions worsened over the 2 years, but for children who wore bifocals or prismatic bifocals, their nearsightedness increased less (the progression was reduced).  The children with prismatic bifocals saw the least amount of worsening.  The authors of the study caution that prismatic bifocals should not be prescribed to all nearsighted children, and it remains to be seen if the bifocals continue to control the progression of nearsightedness past the 2 year window.  Nonetheless, the research is promising.   You can read the full study here.

Many thanks to Dr. Bonilla-Warford at Bright Eye News and Dr. Maino at Mainos Memos, their blogs first pointed me to these reports.