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

[cheekyginger]

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 - you've posted some really useful info on this thread - I have a question about my binocular sight but I'm a great big 35 year old, so I didn't think I could crash in - I've started my own thread in general health and if you had a moment to take a look, i'd be very grateful, Thank you so much.

Hi Cheekyginger...wow your advice & knowledge has been invaluable so have a couple of questions please...
My dd 5yrs 10mths has wore glasses since she was 4yrs...her prescription being +2.0 & 0.0 so thus had a lazy eye & mild squint (optho said the squint is at minimum level for surgery so not really been discussed & not a squint that we or any family or friends have ever noticed.)
Initially we did the 8hrs of patching which over time reduced & for the last 2 check ups were told patching was no longer required as the vision is now the same in both her eyes with her glasses on.
Firstly is my dd likely to always need glasses full time as +2.0 is classed as mild or when she is 8years+ will she just need them for reading & close up work?
Also when they test her eyesight 8wkly in clinic they always test her with her glasses on so how will we ever know if her long sightedness has improved?

I feel when I ask questions in clinic the opthos are very non committal & never feel my questions are answered.
Many thanks in advance.

Hi again cheeky

You might remember our story with DD from earlier in the thread (stopped patching after 8 months, still only managing the 4th line on the chart, had approached Glasgow about the vision therapy trial) and I thought you might be interested to know that DH took DD back to Glasgow this morning and she's been accepted for the trial so looks like the last week of the hols is going to consist of lots of train journeys from Ed to Glasgow. BUT they are averaging 2 lines of improvement in a week so I am just trying not to get too excited as if DD makes that then it would mean only 2 lines difference between the 2 eyes which would be fantastic.

Will let you know at the end of the week how it all goes.

DS is now managing much better with his glasses (4th pair) since the optician bent the legs right round his ears. We are back next week with him to check his eyes are still seeing equally.

Hope work is still going well and your DS settled in at nursery. DS starts school nursery next week so we'll have to go through the whole glasses chat again.

Hi Cheeky
It is a while since I've been on this thread.
DD2s (she is 5.5) latest prescription was:
R: SPH +2.5, CYL +0.25, AXIS 90
L: SPH +2.25, CYL +0.50, AXIS 90

She has been under the hospital orthoptist for about 2 years due to long sight plus lazy eye (her left). It turns inward when she looks close up. They tried patching but it had a detrimental affect on her 'good eye'. She has had her latest glasses for about 6 weeks. The orthoptist tested her last week and said her vision is the best it has been in these glasses, the glasses correct the squint, and there is nothing more theu can do, therefore they have discharged her and she will need a check up in 1 year at a normal optician.

My query ref the cosmetic issue of her lazy eye was met with 'it could do more damage and go the other way'.
My query ref did she need closer monitoring till she was 8 or so. 'No, normal optician will be fine'.

So, I saw a high street optician today (other dd had eye test) and asked her advice. She raised her eyebrows at most of above points, was careful not to criticise hospital, and has suggested that we get DD checked with her in 3 months, then every 3 months thereafter. She has said if necessary she can liase with GP to get referral to another hospital, and we shouldnt rule out surgery as it CAN work.

Now I am very confused. It breaks my heart to see DDs eye turn in, and although it isnt a problem now I am sure it may be when she is a teenager.

Any advice.

Well, DD completed the week's visual therapy trial in Glasgow last week and achieved one line further than at the start of the week and one letter on the next line. That's virtually the same improvement she got from 9 months patching! So she went from 20/90 equivalent to 20/60 equivalent which was just brilliant. She also had an improvement in her binocular vision to just one off normal! We are so pleased that the effort paid off.

Anyway, the researchers are planning a much larger trial (currently securing funding) which will be taking place in Glasgow and Bristol (I think) and possibly other sites when up and running and I'd strongly recommend for those with DCs who have finished patching but still have a difference in vision between the 2 eyes think about volunteering for the trial if you are near a site. You have nothing to lose and potentially an important gain in terms of a good spare eye for the future should anything happen to the strong one.

DS's optician's appointment was slightly disappointing as he seemed to have reverted to about the 5th line with the weaker eye so we're back to 'watchful waiting' and some patching and back in December. He did have some binocular vision though so that is good news.

So sorry i havent been on for a while.

Im starting with my last 3 messages so if i miss previous ones im really sorry. Feel free to post again and i will try and answer!!!

Life is a good bit busier now back at work part time and a toddler on the go!!!

flirtythirty76
If you came to my clinic. I would recommend that your DD keeps wearing her glasses full time up until the end of primary school. My reason for this is that she will be well beyond the developmental age by this point. So very unlikely for vision to deteriorate (in her previously lazy eye). Starting secondary school is quite a good cut off date as she might be keen to not be wearing her glasses all the time by this stage, and she will be at an age that she will remember when to use her glasses (all reading/writing). If she does this and she was to start complaining of sore heads sore eyes etc, then the glasses would need to be worn more often. +2.00 is a mild prescription. But its the difference between the 2 eyes that is significant. If she doesn't have her glasses on and she looks at something at a "reading" distance, the poorer eye will be slightly blurred. As for testing children without glasses.....When a child is slightly longsighted they can just focus their eye hard and still see at a normal level....so there is no point testing there vision without glasses. The annual glasses assessment with the drops in their eyes tests for the amount of longsightedness/prescription. Hope that makes some sense

Hi Birdybedtime,

Thanks for the update. I hope the research goes ahead. Its about time there was some money put into it. The theory of patching really hasnt changed over the past 100 years so it would be great if they can come up with newer treatment options!!

Hi EustaciaVye,

Here goes....

The Ophthalmologists can only operate on squints that are over a certain angle. If the squint does not measure very much (some squints look larger than the measure) then there is a risk that surgery would over correct it and the eye would turn the opposite way. If you LO's vision has remained static over the past few visits with the Orthoptists then annual refraction/glasses checks will be fine. Unless you see a sudden change to the squint.

3month review appointments seems a bit excessive TBH.

Squint surgery can be carried out at any age so maybe if she still notices it as a teenager she should be re-referred then??? Or if you feel the squint is cosmetically poor (looks really bad), why dont you get your GP to refer to to someone else for a 2nd opinion....cant hurt.

Hi TroubleIsBrewing,

Your DD has quite a high prescription. She is moderately longsighted. In theory she can see things that are far away but her eyes have to work extra hard to see anything up close.

The ophthalmologists will tend to hold off operating on squints till children are about 4-5. The orthoptists can get much more accurate measurements by this age and generally any patching will be well under way or completed by this age. Squint surgery will not change the vision but if you are really not happy with the appearance of her eyes make this clear to your consultant this may make him/her think about doing it sooner rather than later.

Hi candyflossy,

If your optician is happy then im happy.

It's not worth their job to overlook anything!!!

Sometime the sclera the white part of the eye can have slightly thinner patches and therefore gives it a greyish spot appearance.

Found this following quote in an online eye journal....
Scleral melanocytosis is a congenital melanocytic hyperpigmentation of the sclera that is more commonly seen in the Asian population. Scleral melanocytosis often presents as bilateral spots of black or gray-blue pigmentation in the sclerae

So, in other words dont worry

Thanks, Cheekyginger.

Thanks cheekyginger.
Her sight seems ok with her glasses. My concern is primarily with the cosmetic issue when she is older as she is very sensitive, although I always tell her she is beautiful :) Friends have commented on the turn in her eye as it is quite apparent at times.

Hi, can I join in please? My daughter developed a turn in her left eye suddenly in November last year when she was 2 1/2. After she was given glasses she has had regular check ups at the hospital. She also see's better with her right eye so this Tuesday we began patching the right eye. We patched for 45 minutes on Tuesday and Wednesday, yesterday she was out all day with my parents so she had a day off. This afternoon all of her sudden her right eye (the one without the turn and better vision) turned in and stayed there. She has been covering the right eye all afternoon or has kept it shut. I phoned the eye department who have told me the patching may have been too effective and to stop immediately. I have an appointment for her next week. I'm just wondering has anyone else experienced this, and what is the way forward now if patching won't work :)

hello, I ve noticed taht for the past week or so, my 7 yr old dd has just started to wink in one eye quite often. She says it feels fine and is not even aware that she is doing it. She doesn't wear glasses although was referred to an optician at age 5 when she 'failed' her school eyesight test. She passed the optician's examination, however. An ideas?

Been to the hospital today following what I wrote on my last post. They were atonished as my dd's vsion has been totally corrected in the left eye with just two days of patching. She was meant to be doing it for 4 mths, as they said they difference between the eyes was quite a lot. They ran through the same tests they performed last week and her eyes are now equal. We just have to wait now for the appointment to see the consultant to have the squint fixed :)

Hi sarahken, glad you managed to be seen at the hospital so soon. Thats great news about your daughters vision. When the squint swaps eye like you describes then this generally means that the vision is equal between the eyes.....thats great that it happened so fast! Good luck at your next appointment .

Hi lottie63
Seems more like a habbit than an eye problem. But if in doubt have her checked at the optician again. If they say she's fine, just try not to mention it to her and it will likely pass.

Hello Cheekyginger,
I have a 4.5 year old boy, he has been wearing glasses for the last 3 years because of his squint, during this time he has worn patches on his weak eye, the left one and everytime we have an appointment his vision seems to have improved. Our next appointment is in 2 weeks, however since last week I have noticed that my lo keeps rubbing his left eye and when we were playing a game on the computer, he couldn't find the small picture we were looking for. He has never been too keen on puzzles and I wonder if it is because he can't see image's details properly. His glasses prescription is quite high, +5 and he is longsighted. He is starting school this week and I am worried his learning will be affected by his squint, he wears his glasses all the time and we have check ups every 3 months, is there anything else we can do? Would it be worth it to go to a private doctor? I would really like to hear your opinion, thank you.

Hi Mum73,

His eye rubbing might simply be due to his eyes getting tired.

Are you sure the patch was worn on his weak eye? The patch tends to be worn on the good eye to make the "lazy eye" work harder.

He is moderately long sighted but this shouldnt affect his learning in any way. A spare pair of glasses would be handy so if the get broken/lost he has a spare pair at the ready.

TBH it wouldnt be worth going to a private Dr as the majority of the Dr's that work in private practice also work in the NHS.....so you would just be getting the same service, but spending lots of money to do it. (IMO Private medicine is great for avoiding waiting lists but isnt doesnt in general provide a better service)

The main thing that you can do is make sure you keep your eye appointments and make sure your LO's glasses are kept up to date. And stop worrying !!!! The fact that he has been wearing his glasses from such a young age is brilliant

Thank you Cheekyginger 😉 , and you are right, I meant to say he wore the patch on his good eye! I feel reassured reading your comments, thanks again 😁

Hi Cheekyginger. Wonder if I could ask some advice about my DD who is 8 in a few weeks time. She has worn glasses since she was 5 for long-sightedness and did patching up until end of March this year for a lazy left eye. When we were signed off by the hospital, her lazy eye had improved significantly and she went from only being able to read the top letter on the chart to being able to read the fourth line from the bottom.

At her routine optician appointment a couple of weeks ago, the sight in her lazy eye had deteriorated a bit and she has slipped back a couple of lines. I wonder if this is because, during the school hols, she kept 'forgetting' to wear her glasses and I was forever asking her to put them on?

The optician has given us a new prescription (+6.5 in lazy eye & +4.0 in right eye) which should hopefully help improve the lazy eye again and we are going back in 3 months. If there is no improvement, she says we may need to go back to patching an hour a day.

As she is nearly 8, I am wondering if I should re-start patching now without waiting another 3 months when it might be too late to benefit her? What is your opinion?

Hi Pammym,

If the vision was stable at the hospital, then i would tend to encourage full time wear of the glasses prior to re-starting patching. So dont rush back to patching. Dont worry too much about her age the brain is still fairly flexible right up until age 9-10 so there is a bit of lee-way.

If patching needs to be re-started i would recommend referral back to an Orthoptist, so she can be closely monitored.

IMO Glasses glasses glasses first

What a great thread :) Thanks. My DS 8, has recently had an eye test and been prescribed glasses - short sighted. I took him initially as he had been complaining of seeing double and split second loss of vision. Optician said his eyes look generally healthy but told us to make an appointment with GP as she wanted him to check if blood supply was ok to optic nerves...this could cause loss of vision. Went to GP, explained this..he read opticians letter and just said "oh this is common, glasses will sort it out" !! In your opinion, shouldn't GP have at least looked at his eyes??

Thanks Cheeky. I really appreciate your advice.

Hi cheekyginger - we haven't "spoken" since back in June. Hope you are still enjoying being back at work! My DD (now 5) had been going back and forth to the eye hospital since we detected a squint just before she was 3. She was prescribed glasses with a very weak prescription and then, at her last appointment, after a year of wearing glasses, they said it was such a slight prescription they would see how things would progress NOT wearing glasses.

So 3 months down the line and she had a thorough examination today. The upshot is that her vision in her left eye has actually improved but her squint has worsened. We have an appointment with the consultant in just over a week and I think she was suggesting that the operation might be an option.

This time, I managed to get her to write down my DD's diagnosis, so here goes:

Constant left/alternating esotropia with slight accommodative element - low hypermetropia
Potential for abnormal binocular single vision at reduced deviation

So there you have it. Would love to know your thoughts on the above. The Consultant we will be seeing is based at Yorkhill, Glasgow unfortunately I didn't get their name.

Hi rattlesnake,

TBH the optometrist should be able to check the health of the eye better than the GP! The optometrist trains for 4 years specifically about the eye....whereas GP's spend the equivalent of about 6 months learning about the eyes! (I dont have anything against GP's......i'm just trying to highlight that optoms are highly trained !!!)
Seems a bit odd .....Glasses correct long/short sightedness or astigmatism not "split second loss of vision". Might be worth giving your optometrist a phone and letting her know what the GP said. She may have been expecting your GP to refer you onto an eye Dr (Ophthalmologist).