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.

Hi cartblanche,

I'm actually really enjoying being back at work! My DS has settled into nursery really well so that has helped.

As for your DD. Sounds like they have decided the glasses were not making much of a difference to the angle of the squint so surgery is the next step.
"Potential for abnormal binocular single vision (BSV)", suggests that your DD might actually end up with some 3D vision (depth perception/BSV). This is a good thing as it means the squint should remain at a stable smaller angle after the operation. Without BSV the eyes can drift again over time either back inwards or outwards.

Good luck at your next appointment

Thanks cheekyginger - glad it's all working out on the work front. Really interesting to read your interpretation of "POTENTIAL for abnormal binocular singular vision" as meaning there is actually a potential for SOME 3D vision/depth etc AFTER an operation. The word "potential" is obviously quite loaded!

I know the whole purpose of catching squints early is to make sure the brain doesn't switch the eye off and the goal is to try and obtain binocular vision.

The phrase "intermittent squint" in all her previous appointments seemed to rule out any patching or operative solution. I was told before just to accept a slight squint and that perhaps she would never be able to be a pilot! Obviously that's changed and my DD HAS a constant squint (although she looks perfectly "normal" to us most of the time) that is no longer just a cosmetic issue.

My next question is, are there any alternatives to the operation? Exercises? Patching? What's the likelihood of her having to have more than one operation? Who are the best surgeons in the UK etc. etc.

And can I thank you once more for being such a fabulous resource on this here Mumsnet?!

Hi Cartblanche,

Thanks for the lovely thanks!!

If the glasses didnt straighten it then no there is no alternative im afraid. Exercises only work when there is already good binocular vision to work with. Patching purely treats the vision. We often say patching helps the lazy eye but when we say "lazy eye" we mean reduced vision a.k.a ambylopia. As far as I'm aware there is no stand out paediatric surgeon they are all really good. Certainly haven't heard any negative things about any Dr's on the grapevine.

I dont even know the name of the surgeon that carried out dd's squint operation! She had the op at age 4 and it greatly improved the look of her eyes. Like your dd, she still had a visible squint even with her glasses on. She isnt likely to need any further operations but sadly does not have binocular vision (she is nearly 9 now)

hi, just wondering if anyone can help me as I'm at my witts end with my 3yr old dd. Since my last post regarding the patching my daughter has refused to wear the glasses. She hides, covers her face, tries to break the glasses, and for the last few weeks we have been unable to get them anywhere near her. She has started nursery last week and I think every member of staff including the head teacher has tried to persuade her to no avail. We've have tried coaxing, bribery, punishment, taking toys away and I'm just lost to where we go from here.

Been to the hospital today and they had to call extra people in to hold her down while they pulled her eyes open to check them, with her hysterical. They have now decided an operation isn't the best way forward but to continue with the glasses. They have given me drops to stop her been able to see without the glasses, in hope that she will then wear them, giving her no option as she will basically be blind. The trouble is, they have also increased her prescription, meaning we have to go and get her more glasses. They have told me not to use the drops until she gets the stronger glasses. Trouble is, I just don't know how we are going to get the glasses anywhere near her. I have asked my friend who works at specsavers and they won't issue her glasses based on her last measurements even though they were only a month ago. I just don't know what to do for the best. Put her drops in with her old glasses and hope she can see till we have her use to the glasses enough to get new ones. Her new prescription is +3.00 in both eyes. Her last one was +2.25 and +1.50 I think x

Hi Cheekyginger,

Just hoping for some advice? My baby is 12 weeks old and I have been noticing that his left eye sometimes strays inwards. I have read that until 3 months babies can appear a little cross eyed so have tried not to worry but it is getting more noticeable to me.

He can focus on objects and both eyes will follow objects too, it is just occasionally the right eye will drift abit inwards.

Would you advise a trip to the GP?

Hi,
Would just like a bit of reassurance and advice!!
My daughter age 5 (we live in Scotland) has just got glasses.
They picked up at her pre school eye test at nursery that there could have been a problem, she got the drops in her eyes a few weeks ago and the results were + 4.75 in one eye +5.75 in other, so I ordered glasses from my local opticians which I paid for, I got lenses free but then paid to get them reduced.
The thing is she has never had a squint,she started school last month and has been managing fine, I have never noticed a thing and feel completely awful!! I can tell by the glasses they are strong they magnify her eyes a little, I realise it's a strong prescription, but is it terrible? She has to ware glasses all the time, is it likely she will need forever?
She is happy to ware them and keeps saying how everything looks different and how everything looks bigger? Is this normal, I'm now panicking that they have made a mistake and her eye's are not that bad!! (which is prob wishful thinking on my part)

Hello, not cheekyginger, but optom with hospital experience

sarahken - they should have issued you with a new NHS voucher so you can get new glasses. If not you just need to get one from the hospital she was tested at.
Have you tried the chocolate button method. (it often works combined with dora/barbie glasses). If you put your glasses on you get a button.
Yum....if you keep them on for 10 minutes you get another button...etc
As 3 year olds have no concept of time 10 minutes can last a while and keep buttoning.
The other one that seems to work is you can only watch your TV programme if you keep your glasses on.

flossy101 - turning in eye at 3 months is normal (turning out isnt!), no need for gp referral if still doing at 6 months then ask for referral then.

rapunzel - it is a moderate prescription, they will magnify her eyes, just as prescription for short-sightendness make eyes look smaller. Its great she's happy with her new vision. I'm assuming they've asked to see her in a couple of months to check how things are.
Her prescription will probably get a little bit better when she's a teenager and she can wear contacts in a few years too. You've been a lovely mum by getting them thinned - they look so much better.

Sorry for delay in replying! But Karoleann has helped me out :-)))

Hi Sarahken: Im not sure if Karoleann's solutions worked, however I would recommend the no TV or no toy route. I try and avoid sweetie bribery but thats just IMO. From what you describe though it seems a bit more than just not wanting to wear her gls. If the eye clinic are suggesting using drops to help relax her eyes into the glasses.....then i would tend to suggest getting her into the weaker prescription first, and only once she is tolerating these then progress to the stronger lenses.
When the drops are in they will stop her being able to focus at near but she will not "be blind". The drops will mostly affect her near vision so doing lots of looking at books and colouring pictures will encourage her to see the benefit of the glasses. Hope this helps

Hi Flossy101
I would recommend you talk to your HV. The eyes can be a bit "all over the place" for the first 6 months of life (in OR out), but if you are seeing a persistant squint that you feel is getting more noticeable, then there is no harm in mentioning this to your HV. If there is a family history of squints lazy eyes etc it's best to be on the safe side and ask your HV or GP.

Hi reapunzel123
That is why the screening is so important . Us parents dont always see these things. Children are so adaptable so her vision would have been fine for the things she was doing in nursery and early P1. Eye tests with the eye drops in are extremely accurate in 5 years olds so i wouldnt doubt her prescription.
Just be glad she loves her glasses and as Kann said she can get contact lenses when she is older.

....Thought i would have a moan....

Why oh why oh why would you not bother to take your child for their FREE pre-school eye test???

There are no eye tests in primary school.

Yet in most of Scotland a lot of departments have a 40% fail to attend rate at our screening clinics. Which are designed to catch the children that haven't been tested at nursery.

We screen children because THEY cant tell you they have a problem, thats all they've ever known!!!!

Dont waste our time or tax payers money!!!!

......good to have a moan.....

Hi Cheekyginger

I have been reading through some of your posts and have learned so much from your answers...thanks!
From about the age of 4 months we noticed that my daughter's left eye would turn in at times - often when she was tired. It also seemed to be more noticeable in photos and this is still the case. It seems to have improved over time and she is now 16 months and I don't really notice it at all any more. Except the other day I took a close-up photo of her face peeping over our coffee table and when I look at the pic the left eye is noticeably turning in. Should I be asking for a referral and if so, where to? I feel a bit clueless as it doesn't seem too bad but I would hate to be not acting on something especially if it is a problem and can be corrected early.

Thanks again.

I have a lazy left eye and was patched as a child, absolutely unsuccessfully. I still stuggle to read the top line of the chart with my "bad" eye. My chief memories of the period are the absolute impossibility of seeing well enough to do my schoolwork, making me endlessly frustrated. Then there were the endless trips by bus to our local city to be examined.

My mother (rest her soul) was endlessly patient with me, but in retrospect the whole thing was, IMO, cruel and pointless. It also cost my parents a lot of money they simply didn't have.

Just realised that there was a glut of "endlessly" in my last message. My bitterness clearly overcame my erudition.

Hi CTgirl,
It would be worth getting her referred. Your HV or your GP can refer you to the nearest Orthoptic department, just get an appointment with whoever is easiest.
If you can, take the picture with you to the HV apt and any future hospital apts

Hi Oldandcobwebby,
Sorry to hear you have some crappy memories of your treatment. But if you remember the "absolute impossibility of seeing well enough to do my schoolwork, making me endlessly frustrated." then that would suggest you were actually quite old for the treatment to actually work . Patching is most effective prior to the age of 7/8.
Most cases of amblyopia can be treated quickly and effectively if they are picked up early. That is why pre-school screening is so important so that the treatment can be done early and in a lot of cases can be completed prior to starting school.

My ds has lazy eyes one tend to goes outwards and the other looks straight and the alternate between both eyes. He is 3.7 yr old and we have been going to the hospital for over a year and half. We have an appointment with the consultant in nov I would just like some advice on what to ask as have no idea where we are going. Apparently he can't have the patch because his eyesight is good. Before it wasn't as noticeable but I can see it nearly all the time now. I'm sorry that I have rambled on. Thank you

Hi Afsana1,

Intermittent (not there all the time) divergent (outwards) squints can be difficult to "cure".

The Dr may be going along the "wait and see" approach. If you think that it is getting worse then make this clear at the appointment. They may still continue to observe and not do any active treatment at this stage.

One of the main things that we look at when dealing with divergent squint is their control at near. If you feel you are seeing it when he is looking at thing up close then let them know that too.

There is no easy cure. Surgery for this type of squint is most effective when left till the child is about 6-8 years old. Reason being the orthoptist can get more accurate measurements and the childs eyes are more fully grown. Early surgery is only really indicated when there is a risk that the squint is going to break down completely to a constant squint.

Hope this helps.

Thank you cheeky ginger it's just heartbreaking when you can see it most of the time. I'm just worried about when he starts school because children can be so cruel. Thank you once again xxx

IMO honesty is the best policy! Let him see his squint in the mirror or in photos. Let him know that his eyes are different so that it doesnt come as a surprise. Often kids can make these things into a "party trick", and it can be something to be proud of and not embarrassed by.

Surgery may be an option in the future so dont be too disheartened.

Hi Cheekyginger. Our story: DS was diagnosed with a squint and very poor eyesight in one eye at the age of 3. From age of 3.5 he started patching with a very minimal improvement first of all. We increased to 3 hours a day from about 4 years old. For the past 6 months he has been patching for 6 hours a day. He is now 6. The orthoptist has reported no improvement in his eyesight and has advised that he is one of the few children for whom patching doesn't work.
A few weeks ago we saw the eye specialist and for the next three weeks we are putting a drop of atropine into his good eye on a Saturday and a Sunday only. We have stopped patching. We have been advised that if there is no response to this the next step will be to use drops every day for a short period of time.
What do you professionally think about this case?
Thankyou!

Bump. Cheekyginger are you there?

Hi Helgicita,

I would agree with their treatment.

We tend to start with least amount of patching poss (approx 2 hours) and increase this in "2 hourly" steps to a max of 6hrs if no improvement.

By the sounds of it they are trying atropine as a last resort. If the daily atropine doesnt improve the vision in his amblyopic (lazy) eye then im afraid the orthoptist will have to accept that your sons eye is saying "this is the best im going to get" and stop the treatment.

But you sound like you've tried your best.

Hi Cheeky,

My 6 yr old son has just been diagnosed with a lazy eye. We are waiting for his glasses and have a referral to hospital. I have been doing some research and have come upon visual therapy which can be used as well as patch wearing which has been having great results. What is your experience of this therapy and is it used in the UK?
Thank you

Thankyou cheekyginger
I'm kind of glad that this is probably the end of the road for us. It's been frustrating and upsetting and heartbreaking at times and this is with a compliant child!
Thankyou for your service here!
x

Hi minimoose,

Can you give me a description of the "visual therapy" and who carries it out?

Hi Cheekyginger,

I believe the term is more used in the USA. Bascially it is a set of eye exercises performed by a specialist eye dr, sometimes described as physio therapy for the eyes. Basically my son will attend regular appointments whereby he will be conduct different visual exercises whilst his good eye is covered. Research appears to suggest that this method is having long lasting results unlike just using patching alone.

Leyland Opticians in Lanchashire are the only opticians that have a specialist in my area who may be able to perform visual therapy with my son.