Eye tests

[2bayumimum]

Hi there,

I had my DS's eyes tested a couple of weeks ago, because he occassionally complared that print was too small for him to read. He is 5 in April and I was keen to ensure he wasnt just making an excuse to not read, or to try new words...The Optician I took him too, said he needed a mild prescription for glasses, for when he was reading or doing close up work, I wasn't fully convinced ( although he did make a couple of mistakes on the eye test, but he has only been reading since September, and does something get certain letters muddled, B becomes D etc ). He now has the glasses, doesnt really seem to be using them ( they were a novelty to begin with ) and today had a "New Entrant Health Review " and his eye sight has come out as within normal range, with right eye being -0.050 and left eye 0.000 on the Logmar screening, so wondering now if the Optician was simply trying to get a sale out of us and he doesnt really need them ? If he needs glasses then off course I want him to wear them when he needs too, but equally if he doesn't, I dont want to potentially aggravate his eyesight. Any Opticians out there, knowledgeable on those LOGMAR ratings ?

Many thanks

The optician shouldn't have got a sale out of you because there is a wide choice of free children's glasses. Plus children's eye tests are free.

Sorry I probably didnt word that well, he didnt make any money out of me personally, as yes the test and glasses were "free", but of course he had the cost ( £100 odd quid ) covered by the NHS...to me the issue here is does my ds actually need to wear glasses...

Were his eyes tested at a regular high street optician. Some of them aren't great at assessing kids. If you are concerned either go to an independent optician who specialises in children or ask your GP to refer him to the eye clinic at your local hospital.

The logmar screening would refer to visual acuity at distance. Where as your son is having problems with near vision, so the two don't really apply to each other.
Mild prescriptions for reading glasses can often make a big difference.
Personally if you're not happy I'd go for a second opinion with another Optician - unfortunately you're generally not entitled to have more than one every 6-12 months on the NHS, but if you tell the practice that he's still having problems with his eyes they can put it down as a special case.
At 4/5 99% of Optometrists can examine well, you really don't need to go down the hospital route at that age.

I am very skeptical of part time glasses for young children.

If there is a reason to prescribe glasses then, in the vast majority of cases, for the sake of visual development they should be worn all the time.

Your son appears to have performed very well on the vision test.
This does not rule out needing glasses but it does narrow down the reason why one might be required.

Do you know the glasses prescription?
Were eye drops used at the opticians?
Or if they found any trouble with eye muscles?

Thanks very much for all your replies.

I have his prescription in front of me now, which says

Right Sph + 1.00 Cyl -0.50 Axis 90

Left Sph +1.00 Cyl -0.50 Axis 90

No drops were used and they didnt find any trouble with eye muscles and interestingly he has not asked to use his glasses once for the last few days...all though could be out of sight out of mind.

Good point regarding the LOGMAR and being a distance test, it was this method used at the Optician, plus some lenses over his eyes...

All the guidance I am aware of would advocate the use of drops in a child of that age.
Without them there is likely a considerable error margin on the glasses prescription.

The same guidance lays out the amount of prescription likely to cause trouble with visual development.
Your sons prescription is not one of these.

There are other reasons why glasses might be required.

But you have ruled out eye muscle problems.
And the vision is well within the normal range for his age.

At this point I'd like to think it has been only bad communication, that there is an appropriate reason for your son to have been prescribed glasses but it has not been explained well enough.

But I'm beginning to think that it is more than that.

I wouldn't neccessarily use drops at that age, dynamic ret is usually sufficient, especially if there aren't any signs that their accom isn't relaxing enough to allow for accurate results.

I probably wouldn't prescribe that prescription though - but it really depends on the patient. You really need to get a second opinion from someone. I do sometimes prescribe part time prescriptions.

Incidentally its very normal for children of that age to get b and d mixed up, their visual systems haven't yet developed enough experience for them to fix the direction of an object.

Apologies for topic diversion into the land of the technocrat but I having trouble using PM at the moment.

@Karoleann

On what basis do you think that information about accommodative lag bridges the gap between cycloplegic and non-cycloplegic refraction?

Or are you implying that this specific prescription has been dispensed due to a diagnosis of accommodative insufficiency and, if so, how did you come to that conclusion?
And, if that is the case, why do you feel that a +0.75 S.E. prescription could be appropriate?

Im going to make an appointment with the school nurse today, who was there ( or indeed may have carried out ) the New Entrant Health Check last week, which produced a "normal " reading and ask her to recommend someone I should see for a second opinion. No problem was mentioned with DS's muscles and I have no reason to suspect there is, but want the second opinion, from someone impartial as it were, to see if he does need glasses....thanks for all your advise, as usual MN been very useful x