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Mumsnetters aren't necessarily qualified to help if your child is unwell. If you have any serious medical concerns, we would urge you to consult your GP.

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

(936 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.

cheekyginger Fri 19-Apr-13 21:12:35

Hi nia01,

Speak to your HV to find out where your nearest Orthoptic department is. Most Orthoptists work withing the NHS, very few work completely in private practice. grin

But someone else may be give you some more local info smile

Sooty1467 Wed 24-Apr-13 08:19:41

Hi Cheekyginger
Thanks for your reply. I spoke to an orthopitist at our clinic last week. She explained that they don't do alternate eye patching very often, but use it when children have 2 weak eyes. She said its more common for children to have 1 weak eye. She said that there is some evidence that patching in this way improves vision in both eyes.
She said that 6 hours was great for number of hours to patch each day, and that there was no evidence to say that more than this was detrimental or that longer was actually beneficial.

I feel much better about it all now, so thanks for your input. Just have to wait till June now to see whether it has made any difference.

Orange32 Thu 25-Apr-13 17:27:45

hi Cheekyginger

DS, 8 years, has extreme short sight of -18 in both eyes with lazy right eye, extreme astigmastim in both. He is also very senstive to light. Is there any chance that vision would stablize with such a strong prescription or just continue to get worse. It usually decreased by abut 3 - 4 diopters each time he gets a new prescription


Sparrow8 Fri 26-Apr-13 02:23:55

Hi cheekyginger,

I have previously posted a thread about my dd 10 years old having headaches and double vision.

We have been told she is slightly long sighted, +1 in both eyes and that her right eye moves out slightly, a hidden squint, which is giving her diplopia.

We have been told that this is very unusual to just happen in a 10 year old. Usually the squint is there from birth and unless she has had a head injury or stroke 😳it would not normally manifest at 10. This is making us panic and question whether we need to get a second MRI scan done!

In your experience, have you seen this before? Thanks

activebaby Fri 26-Apr-13 17:53:01

Hi Cheeky ginger I need your help! My daughter is 22 months old. Around Christmas time I started noticing her left eye turning inwards. I pretty much took her to the GP straight away who referred us to hospital We've just returned from there today. The doctor did various things (looking at images/light in eyes etc) and said she did notice a slight squint. She tried covering her right eye but my daughter just got stressed. She is going to make an appointment for us to return in 6/8 weeks to test for glasses/examine back of eye)
I'm getting a bit stressed because I'm now blaming myself thinking should I have noticed this sooner! Is the only reason a child's eye turns inwards is because they are long sighted? What other reason could there be? If there is no other reason then I assume my daughter will have to wear glasses forever?
Thanks x

Sparrow8 Fri 26-Apr-13 17:56:10

Just to add that her distance vision is perfect, she can read the bottom line they show her. The double vision is near vision, from about 1 foot away.

We have been given eye exercises, glasses which we are still waiting for and tgey are talking about putting prism stickers on her glasss so that she can cope at school.

Just wondered if you have seen this before in a child of her age? She has been having the double vision for 6 weeks now. Thank you

cheekyginger Thu 02-May-13 22:08:16

Hi sooty1467,

Glad you spoke to someone and feel more confident about what you are doing. Wonder where they found there evidence for that confused ???

Hi Orange32,
I cant really predict how his prescription will change as he grows im afraid sad However if his prescription is reducing each time he get its checked then thats a good thing smile

Hi Sparrow8
Try not to panic. If your DD has already had an MRI then i would be quite re-assured! Sounds like she has reduced convergence which can result in double vision at near. This tends to show up when kids are in there teens when they are doing a lot of closework at school. However have seen it in younger kids too.
Were you been seen by an orthoptist or an ophthalmologist???? Prism are generally avoided in children or should be used as a temporary option while she does her exercises.

Hi activebaby,
Try not to panic too much, and definitely dont be hard on yourself. These things happen spontaneously and some squint dont show up till kids are around 1.5 - 2 ish, when they start using their eyes more.
They will be able to tell more at your next appointment when they do the glasses check to see if she is longsighted. Being longsighted is one of the most common causes of a convergent (turning in) squint. As for the glasses being long term i cant tell without knowing her prescription and what effect the glasses have on her squint. Post again once you've been to your next appointment and i'll try and answer you better then smile

oscarwilde Fri 03-May-13 11:37:53

Hi Gingerbaby. Have just discovered this thread, at work so apologies but have not had time to read the whole thread.
I have a lazy eye, had glasses for "close work" from about 4, patches when I started school and the eye corrected at around 12. I'm also quite longsighted. Enough about me. DH has a "slight turn" when he is tired but has never had to wear glasses. His flakey eye is the opposite one to me.

I have two DD's. The eldest is almost three and the youngest is 6 months. To date I have not noticed any issues with DD1, but I think I am seeing a squint with DD2 when she is tired. DD1 will start nursery in September. What would you recommend in terms of best time to have their eyes tested, and how often I should repeat it given family history.

Finally, if you don't mind. I was told years ago that laser surgery could not be done for longsighted people. I understand that this is now not the case for some people. What is the best healthcare professional to consult and objectively advise me? Optician, opthamologist, eye surgeon? I know that my eyesight is deteriorating and I would consider surgery now that it is a more established procedure.

Orange32 Fri 03-May-13 13:24:30

hi Cheekyginger, i meant to say his prescription is getting stronger each time by about 3 or 4 diopters, which would be about every 14 months. he started as a -6 just before 1 year old and it is getting worse each time. Is it common for young children to have some a high degree of shortsight? just reading over some of the other posts and a good amount of them seem to relate to longsight

JilbyK Fri 03-May-13 21:26:29

Hi Cheeky Ginger. I posted on this forum approx 6 months ago about my DS's (3) eye problems (lazy eye and long sighted (+4 and +5), squint) and you gave me some very helpful advice. Just wondering if I could pick your brains again?

He's been patching 4 hours a day for the last 5ish months and at today's appointment the orthoptist said although he's making progress it's quite slow and there's been no initial surge of improvement followed by plateau - just continued slow progress. She's talking about increasing the patching time to potentially all day although not just yet. Is this something that is still regularly done?

He currently has no binocular vision (not sure if this is always the case with lazy eye's/squints?) - does this mean he never will have? I know this impacts depth perception etc but does it impact anything else educationally (reading/writing etc)? Are there any other things we could look at - behavioural optometrists/vision therapists? Think I know your views on this already!

Sorry for the long list of questions! Although the orthoptist we're seeing is perfectly professional she's not very forthcoming/chatty. Hence coming on here.

Thanks again.

cheekyginger Fri 03-May-13 21:45:56

Hi oscarwilde, Ooooo i like the name ginger baby!!

Bit of a postcode lottery im afraid when it comes to vision screening. In Scotland all children are either screened by an Orthoptist in their pre-school year at nursery or they are offered an eye test at their nearest eye clinic. At the mo all children with a date of birth between 01/03/2008 - 28/02/2009 are being screened.
However, in england the screening is a bit of a mix at the mo, so it depends on where you live.
Most high street optometrists will be able to carry out an eye test on a 3 year old, and if they find anything they will refer you on to your nearest eye clinic. In general i would recommend that all children have their eyes checked by orthtoptist/optometrist anytime between 3-5. If all ok then they dont need to be checked again until the are 10-11ish to pick up any short sightedness.
Your 6 month old would be worth speaking to your HV about and being referred to your nearest eye clinic. When there is family history and you feel you are noticing something always worth getting it checked sooner rather that later.

As for you and laser surgery. Depends on your prescription. Yes they can do longsightedness but it depends how much. Laser can not be carried out on the NHS. However many ophthalmologists work for companies like optical express and such like. Google would be you best bet to get more info. Laser isnt my area im afraid...

cheekyginger Fri 03-May-13 21:59:12

Hi Orange32,

It is more common for kids to be longsighted. However there are a fair number of kids that are shortsighted too. Is there anyone in the family that is short sighted?

Your DS does have a high prescription. But it sounds like you are in good hands with regular checks. It should start to stabilize at some point but impossible to predict when this will happen.

cheekyginger Fri 03-May-13 22:16:28

Hi JilbyK,

The maximum amount of conventional patching we give is 6 hours per day. There is literature that states that 6 hours was just as effective as 12, and there was more recent literature that suggests that more than 6 hours per day can cause damage to the "good" eye. This is minimal but enough that no departments in Scotland (that im aware of) patch more than 6 hours per day. When did your LO last have the drops in his eyes? We tend to only do the glasses check once a year, however if a childs vision is slow to respond to patching then sometimes it is worth double checking the prescription.

If children develop a squint at a young age then they lose the cells in the brain that are "binocular". Therefore no vision therapy can get that back again. Behavioural optometrists are a waste of money have no evidence that supports their treatments wink
There is no reason that this will impact on his school work etc grin Might not be able to be a neurosurgeon, an RAF pilot, or in the marines but apart from that he can do what he wants!

Sparrow8 Sat 04-May-13 17:01:29

Hi cheekyginger, thanks for the reply. We are seeing an ophthalmologist who is working in conjunction with our optometrist. The ophthalmologist prescribed the +1 glasses. It was our optometrist who ordered the fresnel prism sticker to go onto dds glasses as she just can't cope at school with the double vision. It was getting her very down as she loves reading and school in general and basically she couldn't do anything! the optomotrist thought the fresnel was the best solution. Do you not agree? The sticker is on one lens and she wears the glasses at school only when doing close up work.

Our next appt with the ophthalmologist isn't for another few weeks, but we are still doing the exercises. So far the exercises haven't made any difference. How long should it take to see an improvement? Apparently the vision in both eyes, separately, is great. It's that the muscles can't seem to work together anymore up close! Why does this happen? Her muscle movement in each eye is fine.

cheekyginger Sat 04-May-13 21:43:55

Hi sparrow8,

It sounds like primary convergence insufficiency and also an accommodative insufficiency if she has been given +1 yet her vision is "great".

10 is on the younger side but not unheard of. Is she definitely doing the exercises correctly? Have a look at this website for some advice regarding exercises. In our department we call it pen convergence rather than "pencil push ups". But you get the idea from this website.

Prisms are fine but ideally only a temporary measure as they don't exercise anything. Same with the +1 glasses. However they can help in the early stages of treatment.

Are you in the UK? Have you ever been seen by an Orthoptist? The only reason i ask is that Orthoptists are specially trained in this area.

When we prescribe pen convergence ex we dont mess about. They need to be done about 8 times per day for a couple of minutes at a time. We always warn patients that the symptoms will initially worsen (especially if the ex are done correctly), this should ease off after the first week. We generally review people after 6-8 weeks. Is that along the lines of what you have been doing?

cheekyginger Sat 04-May-13 22:02:30

Im away on my happy holidays as of tomorrow, so there might be a bit of a delay in replying smile

Rebeccas7023 Thu 09-May-13 21:42:27

Hi cheekyginger,

I came across this thread after Internet searching and hoping you or anybody else can help me out. My dd1 is 4.9 and we have received a letter from her eye screening in school saying that one eye is rather weaker than another. The results were right eye : logMAR 0.1 (6/7.6) and left eye 0.45 (6/16-9) and the blur test was 0.2 .

I am waiting for appointment from hospital but I don't know whether to take her to an opticians in the meantime? Does this mean her eyesight is reallly bad? Will she need glasses and if so would this be forever or could she be treated using patching?

Sorry for all the questions it's hard to understand and I feel awful for not having noticed anything!

Nicknamefail Thu 09-May-13 23:03:48

Hi cheekyginger, thanks for the generous thread and hope your holiday was good.
I wanted to ask you about dd aged 6 months. Had nystagmus from birth initially near constantly but at 7mo I have not seen it for about 6 weeks. The ophthalmologist wasn't worried but refered us to an orthoptist. She said dd's vision wasn't as good as it should be but could be do to her being bored with the test. She will be seen again in 6 months. I was just wondering what your experience of this was, and if you might ever retest a child and they be normal. I suppose I am not expecting it to be normal given her nystagmus at birth. (Traumatic birth with resuscitation needed btw and late to meeting her milestones. )

VickyTee Fri 10-May-13 12:04:58

Looking for some additional advice as we are still puzzled by it all! DS was referred to eye hospital in Glasgow by GP when he was two as our GP noticed some convergence. Tested by both Orthoptist and Optometrist and given the all clear.
Just had test at nursery for 4 years olds and was referred back to eye hospital. Tested by orthoptist who advised that the test scores were nearly normal and that she did not think glasses would help as the convergence was minimal and identical for both eyes but she would see what optometrist thought.
The optometrist did the tests ( sph +0.5 & cyl +0.75) in both eyes and didn't think prescription would be required but would speak to Orthoptist. Didn't mange to speak to orhoptist but then recommended prescription to be on the safe side!.
I've now spoken to my own optician and shown him the prescription and he was sceptical that this prescription would add any value to DS sight and if it were his kid he wouldn't bother with the glasses at this stage and continue to monitor eyes at 6 month intervals as DS develops as he is very small for his age at this time, however he will examine him in two weeks time. Can I ask your thoughts on this???. (PS my DS is wearing the glasses at the moment and cunningly stating that he sees better without!! I wonder why!

VickyTee Sat 11-May-13 19:08:19

Sorry, the readings I gave you should be +0.75 sph and +0.5 cyl!!!

Karoleann Sat 11-May-13 22:45:17

Hi again not cheeky, but optometrist (20 year qualified as a friend reminded me yesterday!)

Rebecca - its not too bad at all - if the vision was measured on a computerised system it's not always very accurate. Her vision with both eyes together is likely to be better than each eye individually anyway. With those individual visual acuities she's likely to see almost 6/6 (20/20) with both eyes together so you wouldn't have noticed anything untoward.

It may just be that she is slightly shortsighted in each eye and that glasses can fully correct your dd's vision. It may be the test was inaccurate. It may be that she does need patching. I would just get an eye exam done at your local opticians (it's free).

Nickname fail - I'm sorry I know very little about congenital nystagmus.

Vickytee - it is a very borderline prescription. Was your ds diagnosed with a convergent squint or a convergence latent squint (also called a phoria).
Some convergent squints are completely better when glasses are worn (fully accommodative squints), some only partially and with some glasses make no difference. So it depends which type your child has as to whether glasses are beneficial. Some children only have squints at distance or near and that can make a difference to when I prescribe as well.

Have you ever noticed one eye turning in? If you have then I would suggest he wears them.
It's probably one of those occasions when it's difficult to tell without seeing the child.

VickyTee Sun 12-May-13 09:58:46

Karoleann- thanks for taking the time to advise. I think the convergence has not been diagnosed as either of above as its so minor. The hospital have not been to clear on what they are actually treating with the glasses i.e. convergence astigmatism etc. which is why we are not sure on what the long term goal actually is?

Rebeccas7023 Sun 12-May-13 10:16:42

Hi karoleann

Thank you for your help I will make an appointment today!

Dadwheresmum Sun 12-May-13 19:42:34

Hi, this is my first post on mum's net ( so please, be kind xx )
Our little foster child is now 3.4. He has a right convergent squint. He has worn glasses since he was 12 months old, and patched daily until a few months ago but there was no significant change.
His script at the moment is +10.25 in left eye and +11 in left eye. We saw one opthomologist in january 2013 who said he was ready for an op or two to straighten his eye, and his script couldn't be increased without it having an adverse effect on his long sighted vision?.. but the next one we saw in march 2013 increased script to current strength, and has postponed op ( or op's as the squint is so severe) but they tell me his eye sight has not got worse. Why increase script if eyes have not got worse? Could the longer they put off op, damage his eye sight anymore.

Karoleann Sun 12-May-13 21:03:03

Vicky if I found that prescription in a 4 year old I would think:

1. Is the visual acuity (which is the line they can read down to on the chart) the same in both eyes. If not, I would give the prescription, and see them in 6 weeks.

2. Can I see a squint in either eye or has the parent reported a squint in either eye. If yes, I would give the prescription and refer to the hospital eye service.

3. Is there a decompensated esophoria (this is a latent squint that is only seen covering one eye, BUT can still cause double vision or reading problems with intensive reading. If yes - I would prescribe.

If there is none of these, I may still prescribe if the child is experiencing reading difficulties. But to put it into context, my prescription is +1.50DS in both eyes and I still don't wear glasses very often. It is also possible that your son has problem with accomodation, which is the ability to change focus from distance to near and that would be made easier by wearing his glasses.

Anyway, when you are seen again you need to get a definative diagnosis and get it written down and then make the decision with the eye care professional.

dads - lots of ophthalmologists contridict each other (so do optometrists and orthoptists).
It may be that your childs squint is fully straightened with his glasses on (which is a fully accomodative esotropia) _ googling may help. In which case an operation would have little or no effect.

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