Child squint treatment

[Caramelsalt]

My DS who is 4 has been having patching therapy via the hospital since he was 2 years old. He also wears glasses and is currently wearing +5.0 in his 'good' eye and +5.25 in his 'lazy' eye. I'm just getting a bid fed up/losing confidence in the hospital... He goes every 6 weeks and always sees someone different who contradicts the last person he saw. Eg for the last 6 months they have been saying they will stop the patch at next appointment and then when he goes back they say it has to continue. We keep asking about surgery but feel like we are being fobbedoff. Just wondering if anyone has any experiences they can share? We are also considering asking for a private opinion so if anyone can recommend a specialist that would be great too. Thanks.

[dementedpixie]

Surgery won't help the sight in the eye that patching is trying to help. My dd only got surgery once patching had stopped and the squint was still noticeable while wearing glasses.

[Emochild]

Has his prescription changed over the 6 month period?

Dd's prescription changed from +8.75 and +5.5 to +5.25 and +5.00

When her prescription stabilised is when the patching stopped and she was put forward for surgery -that was age 5

I was told a difference of 0.25 was pretty normal even for people without a squint and not something they were concerned about

[Caramelsalt]

His prescriptions have been pretty stable throughout although they only test his prescription once a year. He started around +4.5 I think so has slightly worsened. I know the surgery won't help his sight (alythough have read online it may help the eyes work together) but DH and I both grew up with squints and are worried about purely the cosmetic sides as we don't want DS to be self conscious like we were.

Although the difference in between prescriptions on both eyes is small he really can't see much out of his lazy eye at all even with glasses on. The turn is still there with his glasses but much more noticeable without however we've been told he's not a candidate for surgery as the squint is nearly solved by glasses? Was this not the same for you then pixie?

[dementedpixie]

No, my dd had a noticeable squint while wearing her glasses so had an op around age 4 which improved it a lot. She still squints without them but is not as bad while wearing them.

The patching will continue while he has poorer sight in his bad eye. Dds sight was pretty much the same in both eyes when patching stopped (her left eye had the poorer sight and was the squinting eye)

[bostonkremekrazy]

caramalsalt
my dc is seen at GOSH for eye problems - if a squint is almost gone with glasses on then surgery is not offered on the NHS because glasses have corrected the problem.
patching can work up to age 8, so do persevere with it.
we we told for dc age 2 or 3 yep surgery will be needed - patched until age 7.5, and now age 9 surgery is now longer needed as with glasses the squint is barely noticeable - without glasses it is very noticeable!

hth, its a worry isnt it...

[TondelayaDellaVentamiglia]

what can happen is that with his specs on, both eyes see well and the squint is controlled.

However if they are recommending patching it is probably because without any specs the squint kicks in because the eyes are trying really hard to focus, the brain imagines that effort means the thing is really close and the eyes converge as a consequence of the effort of focusing

Or the brain is ignoring one of the images as it is poor quality, and the patching is designed to make that weaker eye work much harder for that the acuity and definition develops correctly

weaker (in this context) may not necessarily be the eye with the worst prescription , and that is where lots of confusion comes in as you have the prescription to consider AND the quality of vision

[Swatsup]

I understand how you feel! Sometimes it feels like they don't know what they are talking about! I lost trust in my kids old consultant, went for one private appointment at a bigger hospital and he then transferred us to his nhs list.
My ds had eye surgery at 2years old, now wears glasses and only squints when tired :-) also apparently has binocular vision, they can do a test a bit like the magic 3 d pictures you can get. They are happy to do another opp to improve it but it would be just cosmetic so leaving my son to decide for himself when older.
I recommend Southampton eye hospital and they have a option to go private. Think it was £500 for the first appointment.
Best advice is to learns as much as you can and make it clear at appointments that you want them to explain exactly what they are doing and that you are not going to be ignored (Private helps here)

Oh and tomato glasses are the best glasses ever!

[Caramelsalt]

Thank you everyone for all your input. We're just so conscious of time and knowing that we really only have until he's 8 to get the best out of this. Getting fed up of seeing a different person each time who has a different opinion to the last, it's hard to know what to believe. How often did you dcs have their eyes tested with the drops?

We are Midlands based and am considering going to see a consultant privately at the spires who also works at Birmingham childrens on NHS so hoping the consultant could transfer us there if she feels she can help.

[chopchopchop]

Argh, I wrote a really long reply and then it got lost. So here goes again.

DD had a really severe squint and had two operations to sort it before she started school. She still has a slight squint, but before her eye was entirely turned in.

I do understand how you feel about the consultants: we had much the same experience when her squint started to return again after the second operation and they said there was nothing else that could be done. So we ended up looking at alternatives as well.

But I wouldn't pin all your hopes on surgery. After DD's two ops, we are at about the same place you are, which is that she has a slight squint which is corrected by her glasses prescription. The hospital thought that this was a very good result, so it's not that accurate. They also refused to do the operation until patching had ensured that she was using both eyes equally. If he can't see out of his lazy eye that much, it sounds as though you are not there yet.

We have ended up doing eye exercises with her - she wears red/cyan glasses and plays 3d games on screen to encourage the eyes to work together. This has definitely helped, although progress is painfully slow, and she does now have some 3D vision, which is a great improvement.

We use a site called Engaging Eyes, which is mostly geared towards dyslexia, but DD just uses a bit of it. But it might be worth going to see a vision therapist to see what they suggest and whether exercises will help.

I have read that exercises actually work better if you haven't had the surgery. DD's squint was so extreme that there was no way she could not have had it, and I only came across the exercises a long time after that. But I would definitely look at this first.

Oh and another cheering thing, people have developed 3D vision even as an adult. So as long as he is seeing with both eyes, then they can learn to work together. DD is now 9 and her vision is still getting better.

[Caramelsalt]

Thanks chop. How do they test for 3D vision in a 4 year old?

I will look into the vision therapy and red glasses. Never heard of those!

[Caramelsalt]

Also wondering what methods were used to test your dcs vision. When DS sees the orthoptist they patch one eye and get him to look at pictures that gradually get smaller until he can't see them, then they repeat with the other eye patched. Depending on who he sees this has varying results as some of the orthoptists are not child friendly at all and have no patience. As its so important to know how/if the eyes are improving I'm worried about how accurate the assessments are. Is there another way of doing it?

[chopchopchop]

The tests that the NHS optometrists used for 3-d vision are kind of like magic eye pictures, and she was asked to look at them and can she see something in them. They only started to use those on her when her eyes were fully aligned.

But these are very binary yes/no, and we knew she had some level of 3-D vision because she'd been able to get something out of some 3D film with the glasses on, so we persevered regardless of what that said. So I'd see if you can find somewhere which does that (the Dr Who experience did, but I don't think your DS is really old enough for that!) and ask if he can see anything.

Vision therapist will, I imagine, have some tests. This is the find-an-accredited-therapist page.

DD had those tests, and then also various other ones where they would patch one eye and get her to look at a small toy or light that they moved nearer and further, or side to side, and then as well ones where they looked through a prism at her eyes, which was I think to do with the squint.

She also only had the eye drop eye tests once a year (thank God, because she loathed the drops with a passion). But I don't think it's the vision that they mind about so much at this stage as getting the eyes to work equally.

Whereabouts are you? DD was seen at Salisbury, and I have to say, all the consultants there were lovely, and very geared up for children with boxes of toys to look at and stickers and plenty of time.

[bostonkremekrazy]

caramelsalt - both of my dc were seen 8 weekly at GOSH - usually with eye drops to dilate for accuracy, now they are older and not patching we are seen 6 monthly. (we started at GOSH aged 1 & 3)
neither of them has any 3d vision even now - they test with the pictures popping out, and age 9 and 11 they cannot see them at all.

its normal to just test with the pictures getting smaller - age 4 is actually fairly old for the tests. they test from age 1.

we used to practice at home, i'd hold up a flashcard and dc would say what it was.....i'd say remember the pictures are clock, apple, boot, duck, lorry etc.

when they put drop in and look into the eyes with a lens in front that is more accurate than looking at the pictues, but of course the child has to comply with the drops...

hth.

[Caramelsalt]

Haha Boston, sounds like we have the same flashcards! Thank you everyone.

[Karoleann]

There's no point having surgery if the squint is corrected wearing glasses as then wearing the glasses afterwards to see may put undue pressure on the visual system and cause a squint the other way.

Its very strange that the patching is not having much effect on the vision of the poor eye. Are you adhering to the patching schedule? Is the patch over the eye rather than the glasses? Is the patch properly fixed on? Are the glasses fitting well?
If all of the above is as prescribed, I'd be slightly worried that something else is going on with the eye with poor vision. The orthoptics department at the portland is very good, I've referred people there before.