putting the library degree to good use

Zoe had her ophthalmologist appointment on Friday. I’d noticed that her eyes were crossing again, even with glasses, so I was expecting her prescription to increase, and indeed, it did. As her ophthalmologist was writing out her new prescription, she warned us that “this is going to look like a big change in her prescription. . . because it is a big change in her prescription.” Um, thanks for that. She went from +4.5 to +5.75 in the left eye, and from +4.75 to +6.00 in the right eye. I think it worried Chris more than it worried me, since I was hoping to hear that her prescription was off, and that’s why she was crossing her eyes again. Her ophthalmologist didn’t seem too concerned that her prescription had gotten worse, and didn’t see any reason why her eyes should keep getting worse, but I don’t think that made Chris feel any better. And once he mentioned to me how he was worried that her eyesight might keep deteriorating, I admit, I got a bit worried.

So I turned to PubMed and did a bunch of searches to try to find a bit of reassurance. The big thing I learned was reassuring – a study of 126 kids with Zoe’s condition found that all of the kids had their eyes get worse (need a stronger prescription) at first, followed by them getting better a few years later. The bad news being that the earlier the condition occurs, the worse their eyes get before getting better, and the younger kids also show less improvement. Link to the abstract for the study – I don’t have access to the full text, though I can easily get that if anyone is interested in it.

Along the way, I learned a lot about searching the opthalmologic and optometric literature – which may well be of interest only to librarians, but here goes:

  • I love searching PubMed (I’m a library geek, ok?). I pretty much just searched on the name of the condition (see below), and got good results. But you can also limit to articles that focus on a specific age group – Click on the Limits tab, then scroll down to age groups and check the ones you’re interested it. So if you’re interested in nearsightedness and glasses in preschool children, you can enter: myopia and glasses in the search box, and then click the box next to “Preschool Child” and you’re on your way. Link to those results.
  • I’ve always heard and referred to Zoe’s condition as “accomodative strabismus”, but at least for the sake of searching, “accomodative esotropia” is the phrase to use. Esotropia is more specific, meaning that they eyes turn in, as opposed to strabismus, which is the eyes not being aligned.
  • Some authors use the term spectacles, not glasses, which isn’t surprising so much as a pain when running your searches. I’m going to update the RSS feed on the side of the blog of articles to look for both terms.
  • Optometrists and Ophthalmologists don’t read (or at least cite) each other’s studies. Link.
  • Also, the PubMed related article links are a great way to find more articles about a similar topic. They’re listed just to the right of the abstract for the articles.
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7 responses to “putting the library degree to good use

  1. You are one awesome library geek. I don’t get to stretch my ref skills that much at my place, so it’s good to be reminded of some of the basics. (ask me about John Stanford’s “Prey Series” and which books come in what order though and I’m ALL OVER IT)

    Try not to worry too much about Zoe’s eyes, go with what the doctor said. If the doc’s not worried, you shouldn’t be. I had to see a cardiologist at the U today because of my carnitine thing and even though my metaboligist told me everything was fine and this was just routine, I was nervous up until the cardiologist told me everything was fine…and then I just felt stupid for freaking out for a week. I wish we didn’t worry so much, especially about the kids, but try and trust the doctor. They know more than we do, even with our super library skills. 🙂

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  2. Heh. Thanks! I’m with you on trusting doctors – or at least, believing that you should have a doctor you trust, and we do trust Zoe’s eye doctor. But it was nice to get independent reassurance, and I need to keep up with medical search strategies anyway, since I seem to get more of those questions recently. It’s funny, even though I didn’t mean to have such a theme, I just posted on the same topic (research vs trusting your doctor) two days ago on my other blog.

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  3. I’m a Professor of Pediatrics/Binocular Vision at the Illinois Eye Insitute/Illinois College of Optometry in Chicago, Il. I’ve worked with many families with children with accommodative esotropia and usually have pretty good success just with glasses. I know you were disturbed that the power of your little one’s glasses went up….but that was actually a good sign. It meant that the focusing system was starting to let up a bit…which is good. I might also suggest that your doctor consider a multifocal design (for those of us who are chronologically enhanced … we call this a bifocal) which would give extra help to the focusing system when your little one is looking at near. I have a blog that concentrates on research associate with children (and disability and a few ohter things) so please stop by … http://www.MainosMemos.blogspot.com. You may also wish to visit http://www.covd.org for additional information on eye problems and children.

    Dominick

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  4. Thank you so much, Dr. Maino! I really appreciate you taking the time to give me some reassurance and all that information. I know Zoe’s doctor did mention bifocals, I’ll ask again on our next visit in a few weeks.

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  5. This is great research and info! I think it is OK for a prescription to change. C’s PO never showed concern of a change in prescription.

    Bifocals mentioned again! Would a toddler know which part of the glasses to look through? We go back to the PO at the end of September so I’ll see if the PO mentions bifocals again.

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  6. My two year old son has bifocals and they definitely took some getting used to. I thought the prescription was wrong when he got them because he started falling more and bumping into things…sicking to see..BUT he did get used to them and figured out how to look through the top (like a little professor) and reads his books while looking through the bottom of them. PS….they are working..We were able to cancel his strabismus surgery in September because of the improvements, still holding on to hope that we can cancel the possibility of surgery in Dec.

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