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Lazy eye, squints, glasses etc.....

(906 Posts)
cheekyginger Thu 01-Sep-11 22:38:05

Im an orthoptist (binocular vision specialist) and a mummy.

I thought i would start this thread in case anyone was wanting any advice, re-assurance, opinions about any eye problems that you wee ones are having.

rrbrigi Mon 25-Feb-13 18:26:23

Hi cheekyginger,

Thanks for offering your service. My son is 4.5. He wears glasses and we patch his right eye since May 2012. He has a squint in his left eye, he has a lazy eye and he long-sided. Since May his vision improved thanks for patching, however it is still very far from good vision, but his squint is the some if not worse. He has squint even when he wears his glasses. We spoke to the doctor about the surgery, but it seems it would not help hi squint. So they told me they could not help any more. It means he won't be able to use his two eyes together to get a binocular vision. I cannot believe it. So I asked the doctor about vision therapy, she told me she does not know what it is. Pease could you tell me if vision therapy can help to improve his squint and his lazy eye?

Thanks.

rrbrigi Wed 27-Feb-13 10:23:53

Hi, one more question. My son has a glasses (+2), because he is long sided. When he read the letters for the eye doctor he could not read the last 2-3 lines with his left eye and he could not read the last 2 lined with his right eye with the glasses on. Should not they be able to read all the line with the glasses? I thought if he wears the glasses he should have good vision and it means for me he can read all the line (like me without glasses). Also we can see his squint even if his glasses are on although the squint is reduced when he wears the glasses. It means for me the glasses he wears is not the best for him, probably the strengths of the glasses not enough? Thanks for your answer.

dumbalina Wed 27-Feb-13 22:29:15

What a helpful thread, thank you cheeky ginger smile

gaschick we are also in the relatively early stages of diagnosis of superior oblique palsy, in my 3 year old DS left eye. He has been seeing the consultant since last August following a fast-track referral due to the 'squint' and head tilt (and an incredibly fraught and worrying weekend sitting on hands so as to not scare ourselves silly with googling). Thankfully there was nothing sinister, 'just' the superior oblique palsy.

Our consultant said there shouldn't be any impact on DS sight due to the sup ob palsy on its own, there is a slight risk that it could deteriorate if it becomes too hard work for DS (or he becomes lazy I guess) to correct his vision with the tilt and messages on the pathways from eye-brain become less efficient (reeaally poor description there, sorry!) but glasses wouldn't have any positive impact for the sup ob palsy in its own right. That seems at odds at what you have been told about binocular vision gaschick, so would be interested to hear cheekyginger's take on that.

DS had another eye test and consultant appt on Monday, and he now has to go back for the drops again in April as he has developed a slight (I think consultant said 0.5, but not certain now, need a dictaphone!) astigmatism since August and will likely need a prescription for that, but that's in his right eye and as far as is possible to say, is completely separate issue to the sup ob palsy. Would be interested in your thoughts on the likelihood of a prescription for that cheekyginger, whether that is likely to be long term and if so whether he will need to wear glasses full time - I have an astigmatism (no idea what my numbers are though) and only wear mine for driving/reading/working.

Consultant was also sounding more operation focused this time to correct the sup ob palsy, whereas last time he was very hands off, would only really for cosmetic reasons so long as DS is correcting by tilting, again now I'm not so sure.

Have also done some serious mummy-bashing about whether this is something we could have prevented, he had some fairly hurty head bangs last summer, one thing after another and still always that small niggle in the back of my mind that it is something more sinister despite the consultant being unable to find any signs of pressure on the optic nerve. Once the seed has been planted though....sad

LittleMissAnon Mon 04-Mar-13 01:42:30

Great thread cheekyginger! Finding it so helpful!

A question for you....

My 9 year old DD has worn glasses for "lazy eye" since she was 3 1/2. Never noticed a squint, her eyes always looked straight to me, so I assumed she had a mild case that wasn't so noticeable. Optometrist suggested glasses but no patching as it was a mild case. At the time I thought the Optometrist said DD only had to wear glasses until the lazy eye sorted itself out, around 8-ish when the eye stopped developing. Since wearing the glasses DD eyesight has improved however her prescription has never changed (L +3, R +1). The last check-up the Optometrist said DD would have to wear glasses for the rest of her life, for school, homework, reading, but could take them off at other times. Was kind of shocked at this as I always assumed the glasses were a temporary thing and that DD's eyesight wasn't that bad. This particular Optometrist has the worst bedside manner and is not so good at explaining things to me, hence me asking YOU the questions!

DD is now at an age where she's more conscious of her appearance and isn't so keen on wearing her glasses anymore (previously wore them all the time!). She tells me things look the same with or without her glasses and the times she's not wearing them for school (when glasses were in for repair) she never experienced headaches or tired eyes. I guess what I'm asking is does she really need to wear them now? I've also read somewhere that most children are long-sighted and this naturally corrects as the eye matures. If she did stop wearing them now, would her eye-sight get worse? What would you suggest?

Many thanks!!

cheekyginger Mon 04-Mar-13 21:45:59

Hi gaschick,

Glad you feel better after your appointment. I would trust in what your Ophthalmologist is saying with regards to binocular vision. I can't really say yes or no as that really depends on the test results on the day.

cheekyginger Mon 04-Mar-13 21:52:24

Hi rrbrigi,

Sounds like your child has a squint that is partially corrected with his glasses. Patching can help improve the vision but will not change the size of the squint.
The Doctor may be inclined not to operate on this type of squint as there is a risk that it could over correct. If there is no evidence of binocular vision (which the orthoptist will have tested for) then your LO is best left alone.

Vision therapy wouldnt not help improve his binocular vision.

cheekyginger Mon 04-Mar-13 22:00:43

Hi dumbalina,

Think your DS sounds as though he is controlling better then gaschicks wee one.

From what you've written there is nothing to suggest that your DS has a problem with his binocular vision.

Surgery can be very useful in sup oblique palsy if it starts to cause a problem in the straight ahead position. For example an actual squint when looking straight ahead even with his head posture.

The glasses may be purely coincidental....but i cant say if they will be longer term without knowing the prescription. The better is vision is the better his control of his eyes will be....

And stop the doubting!!! There cant have been anything else going on otherwise your Dr would have ordered a MRI scan etc immediately. They dotn hang about with these things! Congenital superior oblique palsies are one of the most common ocular nerve paslies a child can have, and many go undiagnosed as they dont have any problems smile

cheekyginger Mon 04-Mar-13 22:10:34

Hi littlemissanon,

They eye stops developing around age 8-9. So she certainly wouldnt go blind if she stopped wearing her glasses.

She has a difference in prescriptions in her glasses (anisometropia) so when she takes them off she can see fine as her right eye will be doing more of the work.

For my patients in similar situations i recommend glasses full time until the end of primary school (in scotland thats about age 10/11). Once she is in high school let her decide. If she decides not the wear them thats fine....as it wont do any long term damage. However if she complains of headaches/sore eyes etc then the glasses must be worm again for all closework.

Annual glasses checks at your optometrist will keep on top of the prescrpition. And if it was to reduce over time then yes she may be able to stop the glasses altogether. TBH though this level of anisometropia is unlikely to correct itself completely.

LittleMissAnon Tue 05-Mar-13 00:23:16

Thank you so much cheeky ginger! I'll encourage DD to wear them until the end of primary school. I just didn't want her eyesight to worsen because I wasn't strict enough with her wearing her glasses.... mothers guilt rearing its ugly head!!!

mctrouser Fri 08-Mar-13 19:04:37

Hi Cheekyginger, I would love your opinions on my daughter's diagnosis at a vision clinic. She is 7.5 months old and we were referred to the clinic because I was worried about a possible squint. After various tests, I was told that she does not have a squint but is 'very long sighted' :/

We are being referred to a consultant but am told that she will need glasses straight away.

I was so taken aback I didn't think to ask all the questions I now have, so would be so pleased if you can shed any light.

Is there any chance this diagnosis could be wrong? How subjective are these tests on such a young baby?

Wouldn't we have noticed if her vision was so impaired?

Any advice you can give would be much appreciated - thank you so much for starting this thread smile

polilyzoe Mon 11-Mar-13 15:28:58

You have previously given me advice regarding my daughter Lily. I have been trying to learn and understand as much as possible about my daughters treatment. I stumbled across details of some research carried out by Dr Anita Simmers at Glasgow Caledonian University which commenced in 2010 in which an alternative treatment for Amblyopia was researched. I wonder if you would know whether this treatment was now available on the NHS??
http://www.bbc.co.uk/news/uk-scotland-glasgow-west-17616818

TTurnip Wed 13-Mar-13 20:27:12

Hi Cheeky Ginger. Just a quick question please. My daughter was prescribed with a +8.5 just before Xmas and the hospital told me not to patch for the first few months. Her sight became 3 lines better in the first 2 months just wearing the glasses but no change at this appointment. It's now patch time (she's 5) the optometrist said let's try 2 hours and when I ask if we could try more she said optimum is 4 hours per day. Having spoken with my daughters school they are v happy to support the patching but as she's being so good I believe she's keeping it on for up to 5 hours per day. Is there any harm to the other eye if she wears it more than advised? Many thanks for your help.

cheekyginger Thu 14-Mar-13 21:47:40

Hi mctrouser

Was you DD checked with drops in her eyes at the vision clinic? (Was it an orthoptist/optometrist who tested your DD at the vision clinic?) If she had her eyes dilated then the reading for the glasses is pretty accurate.

The ophthalmologist will dilate her eyes and check the prescription again. They might hold off with glasses until she is a bit older...

There is absolutely no way that you would have noticed any problems! Let me know how it goes with the ophthalmologist....

cheekyginger Thu 14-Mar-13 22:03:04

Hi Polilyzoe,

I've met Anita a few times at various meetings. Her research is still in its early stages. As far as I'm aware it is only being used on children that the traditional patching treatment has been tried and completed. It's not available on the NHS. The equipment that is required its really expensive and therefore it will be a long long long time b4 it ever available on the NHS.
Can you find her contact details online? If you live in Scotland it might be worth contacting her as your DD may be suitable to be included in one of her trials??

Bonsoir Thu 14-Mar-13 22:08:52

My DD is 8.4 and has worn glasses to correct her long sight since she was very young. Her current prescription is +4.5 in both eyes; her left eye used to be +5.

Extreme short sight runs in my family - I used to be -8 in both eyes and was considered to have good sight by our standards. Is there any chance my DD's long sight be shortened when she hits puberty?

cheekyginger Thu 14-Mar-13 22:14:59

Hi TTurnip,

Was it an optometrist or an orthoptist that prescribed the patching?

All the recent research says that 6 hours per day is the maximum amount of patching you should be doing. But even if you go over 6 hours occasionally this will NOT do any long term harm to the good eye. Way back in the "old days" kids used to be patched full time.....up to 12 hours per day!! Now a days with all the evidence based practice the research has shown that 6 hours is just as effective as 12 hours and also no risk of damage to the good eye. smile

Sounds like she is being a wee star grin

TTurnip Fri 15-Mar-13 06:49:58

Hi Cheeky Ginger. Thankd for the reply - put my mind at ease. It was the the orthoptic clinic so a orthoptist - ( I get easily confusedsmile) I am VERY lucky with my daughters school they are being fab and have a reward chart up - although I wish I had picked it up earlier I thinks she's at a good age to understands the patching and it's importance! ( it's either patching or a dark room with lots of kittens [only joking (:] - thanks again

TTurnip Mon 18-Mar-13 18:52:10

Hi seaside72! How are those eyes getting on? My daughter is now on her second week of patching and doing really well. Her eyesight got 3 lines better with glasses then stopped so were giving it a blast with patches. Hope all is well with you and yours (:

seaside72 Mon 18-Mar-13 21:47:12

Hi there TTurninp - I had lost track of the thread!
We seemed to have calmed down since the shock of finding out and my DS has adapted really well to the glasses. He is also patching but again we were told 2 hours a day was sufficient.

At the beginning the tests showed he was +7.5 in the left eye (right eye is fine and 20/20) after 2 months of glasses and 6 weeks of patching they have lessened his prescription to 6.75 in the left eye. But I am not sure if this is improvement or just adaptation. He still cannot see the 3D images even with the glasses.

Apparently he will always have this prescription (even though it has lessened in the 3 months hmm) but I have been told that what we are working towards is improving the acuity of the eye and then hopefully he will also gain binocularity.

Like your DD he is a real star with the patching and we do it after school everyday (4-6pm).

It is still a bit of a roller coaster, and I am still getting used to him with glasses but I guess that is just who is is now!

seaside72 Mon 18-Mar-13 21:54:36

Hi Polilyzoe
My DH got in touch with Anita and she was really lovely and helpful. Unfortunately her funding has been cut for that project but I think she is still researching. She said my DS would prob not benefit as his eyes are so different (left very far sighted but right is normal) but I would definitely drop her an email and ask her about your DD.

TTurnip Tue 19-Mar-13 20:21:50

Hi Seaside72 - great news about you sons prescription - the hospital t

TTurnip Tue 19-Mar-13 20:30:47

Hi Seaside72 - great news about you sons prescription - the hospital told me that instead of a +7.5 she actually had an +8.5 but they reduced her prescription to make her eye work better... All very confusing... I've paid for the thinner lense for her glasses, and we almost think she looks strange without her princess glasses (: although the hospital suggested 2 hours, I read that the first 12 week of patching saw the most improvement and as it doesn't seem to bother her I've gone for 4 hours a day during school to get as much 'close work' as possible in. I really think its working as she now is happily reading, writing and colouring (within the lines I'll have you know (: ) with her patch on. She's on line 3 and we want to get down to line 6 - challenge on !! Thanks for posting.

cheekyginger Tue 19-Mar-13 21:25:57

Hi TTurnip, just make sure you tell your orthoptist how much pathcing you are acutally doing so that he/she are getting the whole picture!!! The most recent research has shown that it is the first 200 hours of patching that is the most effective so that can be achieved in a variety of ways. But the patch should not be worn more than 6 hours per day unless in very specific cases.

Happy patching! grin

cheekyginger Tue 19-Mar-13 21:27:33

For all parents out there.

WOuld you find it useful if your local eye clinic/orthoptic department had a facebook page?

Would you feel you could ask the questions you've been asking me????

Any feed back would be great....

TTurnip Wed 20-Mar-13 05:59:26

Thanks Cheeky - will do!! Is it a bad thing doing more hours? I've been keeping the log filled out with times etc. My daughter has another appointment mid may so am hoping a short sharp blast of patches might do the trick. The NHS leaflet said patching aims to improve one line every 120 hours worn up to 400 hours. Then it slows. It also said the biggest change in the first 12 weeks - is this right?
100% do I think a Facebook page would be great. I take my hat off to you answering all our questions so swiftly and descriptively - thank you !!

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