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.

Im an Orthoptist who is often referred to as a "physiotherapist of the eyes" and i havent heard of this.

There is a current study being carried out in Glasgow by a research orthoptist (Anita Simmers)who is looking at treatment of amblyopia when all other treatment has been tried and failed. Maybe its similar to this. But this is purely at the research stage and any patients are volunteering for this treatment. At present this isnt a recognised form of treatment. (If you google her name you can find out more information)

I hate to ask this....but are you going to be charged for this service????

Patching can be very successful all by itself without having to pay money to people that may not be able to back up this practice with scientific evidence. Patching is generally carried out by an Orthoptist and monitored by an Orthoptist. I would go along with the treatment plane that your sons orthoptist recommends at the hospital eye clinic before forking out any money IMO!

Good luck with your decision.

hi cheekyginger going to try and see the consultant (in Glasgow) this afternoon with my 5yr old DS. Been on the thread before - she got referred because of an intermittent squint, had glasses for a year with a very slight prescription. No lazy eye. The last appt I had said that surgery was an option so that is what I am going to discuss with theconsultant this afternoon. Unfortunately I have been trying to get an appt with a consultant for over a year. This is the third attempt as the previous two attempts he was a no-show!

She is no longer wearing glasses and I can still see the squint at moments during the day. The main reason for posting is to ask how I would go about asking for a second opinion? Is there an etiquette? Is it something I would ask the consultant himself at the end of the appointment or is it better to ask the staff on reception AFTER the appointment? Also, do you know how I could compare consultants track records. ie. how many ops they've done, success rates etc? And finally am I restricted to treatment in Glasgow or could I access treatment elsewhere ie. Edinburgh, Dundee(!)??

Probably won't get an answer from you before the appointment!! However it would be good to know for future reference.

Thank you

Hi cheekyginger. Just found this thread after doing a search for squints. You're incredibly kind to have started this thread and for keeping it going for so long!

We noticed a squint in my Ds' (3) left eye a couple of weeks ago and after an initial eye test we were referred to the hospital for a further examination. At the appointment today we've been told he's got a lazy left eye and is also long sighted in both eyes (+5 and +4).

They queried whether he had any interest in books etc as they thought he would have problems with close work and picking out details. However, he is in fact a complete book worm and can pick out the tiniest details in pictures that neither I nor DH would ever have noticed without him.

I guess my question is whether being long sighted and also able to pick out these tiny details are mutually exclusive or whether the diagnosis makes sense?

Sorry for length of post and also if I'm asking a really stupid question!

Hi cheekyginger... thank you for starting this thread although I see it's become a mammoth job for you! I would love some advice. My baby is 4 months old and i've recently noticed a very slight turn in her eye when she's looking to the side ( eyes appear straight face on) and i've also noticed that on the very odd occasion her eyes havent moved together when shes looked at something (one eye slightly slower to move if that makes sense?) I'm going to go to the GP this week and get her checked although i'm a bit concerned that she mightnt see it (not always apparent). i know shes very young but from what i've read the earlier you catch eye problems the better... is there anything else i should be doing? also is it always a case for glasses? my little one is just at that stage that anything she can grab goes into her mouth esp if its near her face so cant imagine how i'm going to keep glasses on her!!

thanks again for your kind thread!

Hi cartblanche

How did your appointment go?

Did you ask for a 2nd opinion? You can ask your GP to refer you to another consultant if you decided not to ask the consultant!! Professor McEwen, based at ninewells in dundee accepts tertiary referrals from other hospitals. When consultants from elsewhere arent happy to carry out surgery etc.
However, Intermittent squints are sometimes best left alone TBH. Surgery can be carried out at any age and as long as it's not getting worse then the orthoptist can get more accurate measurement which in turn results in more accurate surgery.

Hi JilbyK,

It's been a rather eye opening experience doing this thread!

Longsightedness is a funny thing!!! The little lens in your eye is incredibly flexible especially in young children. This means that they can actually focus really hard and see surprisingly small things. However when kids are doing this for longer periods that's when squints can start to become apparent.
What you describe all sounds fairly typical.
As long as the glasses check was carried out with drops in the eyes then this will an accurate reading of the eyes.The glasses will ge checked once a year unless the orthoptist isn't happy then he/she may arrange a sooner glasses check.

Hi mullingo,

Dont worry too much at this stage. Little ones eyes can be literally all over the place up until about 8 months. If the Gp is happy with everything just wait it out for a little while longer.
Have you managed to get a picture of it? That can sometimes help.

If its a true squint or muscle imbalance then it will not go away.....if it is persisting past 6 months i would go back to my GP or HV and request a referral to your nearest eye clinic.

Thanks cheekyginger. I got to see the Consultant at last! I was pleased with the outcome because he was very reluctant to do the surgery because she was so borderline and he kept stressing the very real risk of overcorrecting (as my DD's squint is very intermittent) citing potential double vision and a more severe squint. Her eyesight is fine. They want to keep monitoring and so we will be back there in 3 months. I think I would have gone for a second opinion if he had been pushing for surgery but as he wasn't, I will hold fire.

Thanks for the info on Ninewells. When you say they take referrals from other hospitals, does that mean I would have to organise that through the hospital I am at, or would I do that through my GP?

Anyway, happy with the outcome so far. He was rather perplexed that the squint became apparent when she was so old (3 years old) WITHOUT there being any major weakness in vision. He thought this unusual but said that each child is "unique" - got me slightly worried though but I guess that's my job as a mother to find something to worry about

Oh another thing. He said that at the next appointment they would be putting stronger drops in her eyes (she HATES the drops!) - I believe they are called atropine. He said that they could knock her vision out slightly for up to 5 days. Could you please explain what these drops are about - are they much nippier than the normal drops?! He also mentioned that because her eyes are dark brown it's harder to examine them

Hi cartblanche,
Glad you were pleased with how it went.
Your GP can refer you to another Dr and they would just make a request for a copy of your DD's hospital notes.
The Atropine drops nip the same amount as the other drops im afraid . Atropine is just a bit stronger than the usual drops, and ensures the pupil is dilated as much as possible. This is occasionally used with children with dark iris's as the darker the iris the quicker it can absorb the usual drop which can results in the pupil still having a bit of flexibility to it. This then can prevent the Dr from finding the maximum prescription.

The pupil may stay dilated for 2-3 days after but the focusing of her eyes will come back after about 12 hours. She might not be too impressed if its a really sunny day as her eyes will be sensitive to the sunlight.

Have you been told her diagnosis? Fully accommodative esotropia or convergence excess??? Any of these sounds familiar?

Thanks AGAIN cheekyginger! The diagnosis last time (3 months ago when they decided she could ditch the glasses) was as follows:

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

When I mentioned that surgery had been suggested to enable my child to have binocular vision, he baulked a little and said it was difficult to explain in "lay" terms and that binocular vision wasn't a black and white thing that could be measured that easily. Felt like I'd been told off for trying to understand the situation and bandying around terms like "binocular vision" like I understood it!! But then maybe that's how all Consultants talk! (and perhaps he has a point!)

It was a funny meeting and he had a student Opthalmologist there so was scanning through my DD's notes and throwing questions at this guy and chatting away like my DD and I weren't there.

I'll make sure I have the shades on standby for my DD after the drops!

Hi cheekyginger, hope you can help, found you when looking for info on lazy eyes and would appreciate any ideas you have. DD is five , had glasses and been patched since three, she has a lazy eye and long sight. We have noticed that as her glasses prescription changes her lazy eye goes downhill. Twice now weve stopped patches and the orthoptist has said she needs a new prescription but it takes so long to get one(left her six months last time and three this). Its disheartening when youre told her patches have to come back because she needs a new prescription but noone seems in any hurry to sort this they just say we will have a look again in three weeks.Took her today and saw the orthoptist who told us she wouldnt get a new prescription today as consultant off sick and to come back in three weeks even though she told us six weeks ago the glasses were no good. She looked at her today and admitted her eyesight with her glasses is the same as without and because of this we need to start patching again.Its all starting to get a bit wearing now,why cant she have a new prescription when she needs it instead of messing up the good work the patching has done and having to start again.(she does see the orthoptist every six weeks)Sorry for epic post, hope youre still having fun at work

Thanks for getting back to me cheekyginger.. Was good to get some reassurance! I took her to the gp and he initially thought they were fine til he used a light and saw she has a slight intermittent squint. So he's going to refer her to an orthopist to see if its bad enough for correction or within a normal range. It'll prob be December before the appointment is through which will also bring her to 6 months so at least we're getting on it in time! In the mean time is there anything I can do to help strengthen her little eye muscles? Or anything I should avoid to stop it getting worse?

Hi cartblanche,

If its "abnormal" BSV then there is a risk that it wouldnt be strong enough to stay at the smaller angle if surgery was carried out. BSV is like an "anchoring mechanism" that keeps the eyes straight Hope that makes sense.

In other words there would be a risk that she could be over corrected and the eye would then diverge (turn outwards).

It's important that junior dr's get experience but NOT at the expense of your time with the Dr .

If your not happy after your next appointment then you are within your rights to ask for a 2nd opinion. However another Dr may tell you the same. Our consultant (who is now a Professor!) would always correct a child's longsightedness first and continue with the glasses as long as possible unless the glasses were actually making the child's vision worse. She tends to leave children in there glasses as long as possible to ensure she can get more accurate measurements when the child is older.

Hi I have set up a group on Facebook for parents of children with lazy eye please feel free to join
The group is called parent's of children with strabismus, amblyopia, lazy eye(uk)
It's to share stories, advice and pictures of our beautiful children with special eyes

Hi cheekyginger. Dd had her appt today. Orthoptist checked her vision and said the weeks patching had gone well and both eyes were exactly even now. She even managed stealth eye drops without dd realising what she was going to do-very impressed ! The consultant checked her eyes, told me her prescription was indeed wrong she in fact needed much weaker lenses. He also told me if it wasn't for the lazy eye they wouldn't have even bothered with glasses as her prescription wasn't worth it. I'm really short sighted, so was nice to see +1.0 in both her eyes.Would I be right in assuming once her lazy eye is corrected the glasses will go ? We have this week to wean off patches then no more till 6 week appt.

Hi Rowgtfc72,

Sounds a bit bizarre! A bit wishy washy IMO!

Our treatment regimes are fairly standard:

Glasses are given if required and are worn full time.
If the vision is not equal (ie the vision is lazy in one eye) then the amblyopia is treated with patching.
The hours of patching will vary depending on age of the child and level of vision.
If the vision is stable for two visits then that would suggest that the amblyopic eye has reached its maximum level. Recent studies show that this is generally up to 600 hours of patching).
Patching is then stopped.
IF vision drops then yes we would restart patching. BUT only once. If the vision then comes back up then some degree of regression has to be accepted. The potential will still be there.
As for the glasses. Childrens glasses generally only need checked once a year. Bit confused as to why you are having to get them checked so often. .
Soonds a bit of a guddle TBH!

Hi Rowgtfc72
Oops my previous post was posted after my computer crashed....so i hadnt seen your next post!!!

Glad you felt you were getting somewhere. +1.00 is really not much at all. If the lazy eye (amblyopia) is caused by a squint then the glasses may be required for longer if they make a difference to the appearance of the squint. If she has straight eyes then the glasses could be discarded once the treatment has been completed.

Hi Stephanie32,

What a great idea!

I'm not going to join as i find it tricky to always keep up to date with this thread never mind anything else, but thanks for passing that on.

Thanks for answering! This is the third time we have started patching. This time however coincides with new glasses prescription which it never has before. Fingers crossed. Thought a squint and lazy eye were same thing, her eyes are straight when you look at her but when shes tired one moves in a bit. Shes had her patches for two and a half years now. We know she needs a new glasses prescription when her school work becomes indecipherable! Would love to lose the glasses as she has a big head and doesnt fit kids glasses and has to pick from teen range. Theyre all a bit too trendy for a five year old !

My son is 6 years old. He has just been diagnosed with lazy eye. His vision in his lazy eye is very poor, in that he can identify how many fingers I am holding up. Due to his age, what are his chances of him regaining his vision? (He is wearing glasses now and is due to see the specialist in Dec) Not sure how they can patch his good eye when he can not see hardly anything out of his lazy eye?

Sorry meant to say that he can not identify how many fingers i am holding up!

Hi rowgtfc72,
"Lazy eye" just means that the vision is reduced in one eye. This can be caused by a squint or a stronger prescription in one eye. You can have straight eyes but the vision can be lazy in one!
Good luck with your little ones treatment

Hi minimoose,
If ur DS has a strong prescription then the glasses can help improve the vision prior to any patching. I have TBH though that your wee boy is on the older side for treatment so it will be hard work.....but go with the advice of your orthoptist. Good luck

Thanks cheekyginger . Dd has just been to pick some new glasses and as her head is too big for kids glasses shes come away with some teen FCUK purple ones and is over the moon !