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.

Sorry to be a pain I know he is virtually blind in his poor eye, could this be giving him problems seeing what is around him as school are convinced there is a problem? I will bring it up with hosptial we are due to go back next month. I have explained to school about drops and that my son may have his vision blurred for the next few weeks. I have heard about binoculor vision but not sure if this would apply to him thanks in advance. :)

Hello

You kindly offered me advice over the Christmas/new year period over my sons severe long sight, which was extremely helpful. He was given a prescription of R +8.75 L +8.5. I know that is really strong. He had since then seen the opthalmolpgist at the hopsital and the prescription I'd now R +6.5 and L +7.5. I was not at the appointment my husband took him so next time I will be clearer as I am more knowledgable than him and I am also severly long sighted. She said that is vision was so behind developmentally that if he were old enough to drive he would not be able to and that he has no 3D vision. Which I suspected. Is it likely my sons 3D vision will develop and that he will in fact be able to drive. I have a similar prescription and I drive? I am feeling very guilty I didn't get him I to his glasses younger. I am pregnabt so this next baby will be being tested as soon as possible x

Thanks for your reply Cheekyginger. Yes, the vision clinic did use drops to test her eyes and it was an op-something ;) who carried out the test.

Interesting to hear you say they may hold off with the glasses...

We have our appointment in a few weeks so will let you know how we get on :)

Thanks again for the reassurance.

Oh and yes a facebook page would be great imo.

Hi there

Amazing thread by the way...

Just wondered if you could give me some advice, my son had perfectly normal eyes until age 15 months when we started to notice one eye slightly turned in, then very shortly after the other eye also. He is now 20 months.

An initial consultation and eye test revealed +1.75 in each eye and we were given a diagnosis of infantile esotropia (large angle/alternating freely) Wearing glasses for a while made no difference to the eye turning and he has recently (last week) had surgery to straighten out the eyes.

My question is, will we be able to tell if he now has binocular vision restored? The eyes, although red, seem to be working together again (which they always did prior to 15 months). Does this indicate binocular vision has been restored? Do we have an increased chance of success in terms of this because his eyes worked well up to this age?

Also his eyes do not seem perfectly straight but they do seem to be fairly straight - will they stay like this or are they likely to return to alternating freely/ turning in? The surgeon has said this condition sometimes requires another operation but I am more concerned that his eyes work together as opposed to being perfectly straight. Finally will the glasses have any bearing on this at all?

Many thanks in advance

Daisy

Hi cheekyginger

Have finally got the doctors letter today and they think it may be a condition called megalocornea or glaucoma but have to wait for his diagnostic tests and reassessment before they make any decisions

Dear Cheekyginger

This is a great thread, thank you.

I just have a few questions about my son who is 5 in a couple of months. We noticed that he had an intermittent squint in his right eye from around he age of 15 months. He was found to be longsighted and started wearing glasses just before he was 2. His prescription has remained between +4.75 +5 in both eyes. Glasses helped a great deal, as he didn't walk until the week before his 2nd birthday, and we feel that wearing glasses really helped to give him the confidence to walk.

He has always had problems with the 3D tests and for some time has struggled seeing the smaller pictures, (now letters) on the distance tests. At his appointment this week they said that he has borderline sight (with his glasses) for driving, which is obviously a long way off, so not too concerned about this yet. But as they would like to improve his sight have asked us to commence alternate eye patching. We were also told that they feel it is likely that he didn't go through the developmental process between the ages of 3 and 9 months in developing 3d vision and that they think that his eyes are not working together.

They mentioned that people without this will move their head in order to see in 3d, and we have noticed for some time that he moves his head from side to side frequently, and when we ask him why he does this he says so that I can see everything.

My questions are:
I'm a bit confused about why we are patching both eyes on alternate days as everything I have read Talks about patching the good eye to improve the sight in the weak eye. I'm not too sure which of his eyes is worse as he has a squint in the right eye, but his vision is slightly worse in the left, that eye is also smaller.

Also we were not told how long to patch for each day, despite asking. I was given the impression the longer the better, but was also advised to do it in the morning when he was doing more reading at school. I did think it was going to be a struggle, but he has been such a star. On the first day he kept it on from when it was put on at he appointment till bed time - 9 hrs. Then I read your thread so I have done just six hours for the last 2 days using the sticky patches.

The other question I have is that he has plagiocephaly from around 4 months - flat head. He was born a month prem. He still has quite a degree of flattening at the back of his head and I often wonder whether as the visual cortex of the brain is at the back whether this has had any impact on his sight. Just wondered whether you have any thoughts about that.

Sorry for all the questions and long message.

Sooty 1467

Sorry me again, forgot to say DS squint is corrected with glasses and he also has a slight astigmatism.

Hi cheekyginger!
Quick one. My 6.5 year old boy had a check up with the clinic- he's had glasses for a year and the eye doc (can't spell the op....!), found that his prescription hadn't changed. All good... sort of... I was a bit surprised that he wasn't asked to read anything- no letter chart etc- all done by just looking into his eyes with various gadgets (sorry, lack of technical speak here!). Also, he didn't have drops this time either.
Hmmm... I do trust the experts, just this expert wasn't the most communicative so if you could enlighten me. Am half wondering if I should be visiting my local specsavers for a "proper" (ie reading the letters) test?!

Hi all...just time for a quick reply tonight before i hit my bed!

Hi freetrait,

Bit bizarre that he wasnt asked to read down any chart at all but not unheard of. Had he been seen recently by an orthoptist at all? Is your DS due back to see an orthoptist at all?
Specsavers might not want to test your DS if he is already under the care of the ophthalmologist. I would imaging the hospital would be thinking about discharging your DS soon anyway going by his age and if he isnt on any "active" treatment. May be best to hold off getting him re-checked till then...

I'll be on again soon to answer the other questions folks. Crazy how time flies!

Good to see you back ginger

Yes, thanks! He'd had an appointment more locally in January when my Mum took him.But this one was a yearly one- he had his first this time last year (with drops) and got his first prescription. Then he's been seen at the local clinic every 2/3 months re patching and reading from a chart to check sight.

Hasn't had any patching for a while but at the last appointment it was mentioned that his lazy eye had dropped back a bit (got almost to normal with glasses, a line above at best) and they might patch again but would see what this (just gone) appointment would bring re change of prescription or not. Mum was also told he wouldn't need drops at said appointment as he can read (well he could read a year ago, but I can understand that a 6 year old is more reliable than a 5 year old). So, that was why I was rather surprised he wasn't asked to read anything!

Ah well, we have another appointment locally in June when they might patch again. It just seems a bit bizarre to me as we are losing possible patching time all the time (from Jan-June) and as you say as he is 6.5 it might not be worth patching anyway- have they decided not to bother. Sorry for long ramble!!!! Thanks for your help.

DS first day back at school with his eye patch today, (he's 4). My heart broke for him this morning when I heard a few negative comments and saw a few funny looks in the playground. He ran back to me in tears saying my friends don't like my patch! He's been so good about it in the holiday, just hope it doesn't put him off wearing it. I suppose it's only natural that the other children had that reaction, I'm sure they will get used to it just like he has. Just hope the school deal with it ok. Even so can't stop worrying about him and how his day is going today.

Hi TTurnip,
Sounds like you've been given some pretty good info regarding the patching. It's not recommended to patch for longer than 6 hours a day unless very specifically told to do so by your orthoptist or ophthalmologist.

Sorry this one wasn't answered so swiftly !!

Hi cambabs,

Tricky one to answer. But i would go with what the hopsital are telling you. As ling as you are informing them of what the school are saying then you have to trust in what you are being told at hospital...

No long term damage will be done no matter what you do so try not to worry too much

Hi Shelvis,

Sometimes with high prescriptions like your sons children can have bilateral amblyopia (vision is lazy in both eyes). If this is the case as long as he wears his glasses full time then his vision should improve over time. As long as he has no other problems with the health of his eyes then there is no reason to suggest that he shouldn't meet driving standards in the future. People can drive without 3D vision so that isnt an issue. This may also develop over time as well.......just have to wait and see And dont feel guilty there are often no signs that a child needs glasses!

Hi DaisyDO,

They would have wanted to try the glasses to see if they made your LO's squint smaller. Is your DS still wearing the glasses?

Binocular vision is a bit of a mystery sometimes. If his eyes are straight or straightish...there is a chance that his eyes can work together on a more basic level than if his eyes had never squinted . Overall this will not make a huge difference to him if he doesnt have 3D vision then he will adapt, if he has some 3D vision then he will adapt to that. This can have an impact on professions, i.e he might not be able to be an RAF pilot, or a neurosurgeon. But try not to worry too much about this just now. Only time will tell. The straighter his eyes are the more likely he is to develop some 3D vision....

Hi Huffpot,

Sorry to hear about your LO's diagnosis . You are in good hands though. Big hugs and dont hesitate to post again if you have anymore questions

Hi Sooty1467,

First things first. Yes the visual cortex is at the back of the brain...but no, plagiocephaly cant cause visual problems.

Do you attend an eye clinic in the UK?
I can honestly say i have never heard of alternate day patching . If his vision is reduced in both eyes then we would recommend full time glasses wear.
If his squint is fully corrected with his glasses on, then he should develop some degree of 3D vision with his glasses.

No matter what they are hoping to achieve with the alternate day patching they should have categorically told you how many hours to do per day [shocked].

When are you back at the clinic?

Hi freetrait,
This can happen when the patching is stopped.
Each department will have protocols.......our protocol is that we accept a drop of one line or less on the vision chart. If more than that, then we re-start patching. Once the maximum level is reached again we stop the patching. If the vision drops back again then we accept the drop and just have to be confident that the potential is there if anything was to happen to the "good" eye in the future.
Good luck at your next appointment in June

Thanks cheeky! THat makes sense.

Hi Cheekyginger,
Many thanks for your reply. Yes DS been seen by orthoptists at our local hospital (Taunton) every 3 months since he was 1.

We have another appointment in June, but I may contact the clinic before then, just to get a bit more advice about exactly how long to keep the patch on.

He's been wearing glasses full time for the last 3 years, and patching wasn't really discussed until we saw a consultant earlier on this year. This was the first time he has seen a consultant, as they said they wanted to get the back of his eye checked to make sure they were not missing anything. That was fine, but she said that she wanted to improve his distance vision a bit more, so recommended that he had a sight test with drops to check his prescription hadn't changed and then the orthoptist see him in 6 weeks and if there was still no improvement to start alternate eye patching. Which is where we are now.

I am concerned that this is not a standard treatment, and even though he is very good with the patches, if its not going to achieve anything I would obviously rather not put him through it.

He has problems seeing the 3d pictures that they show him, (with his glasses on) the ones with hidden images. He has also has problems when the floor colour changes as he can't determine whether it is a step or not, but this is improving.

Many thanks again.

Hi Cheekyginger

Just to update you on my now 8.5 month old.

(we'd been to a vision clinic 6 weeks ago because I was worried about a possible squint and had been told that although she didn't have a squint she was very long-sighted and would need glasses asap).

We had our appointment at the hospital today...

You said that 'they might hold off on the glasses until she's older' - you were right!

However, they did not repeat the test for her prescription saying that there was no point as it would be unlikely to have changed in just a few weeks. But they told us that the test we had 6 weeks ago showed her prescription to be +10 and +11.

We are to go back in 6 months and hopefully her eyesight will have improved... they seem to be talking of her probably having glasses at around 2 years...

she again passed the squint test with flying colours and was described as being 'very visually active'.

Just wanted to check with you that this all sounds right/I have understood it properly. I know that +10/+11 is extremely long sighted and at our first consultation the optometrist seemed very concerned, but today they seemed to downplay it a bit and said that 'a lot of babies are long sighted and outgrow it'... should we be worried by the extent of her long sight or are we ok to relax for 6 months?!

thanks!

Hi Sooty1467,

I really dont want to tread on anyones toes! BUT it would be worth phoning the clinic and ask to speak to one of the orthoptists. Someone should be able to dicuss your childs case with you to help you understand WHY you are doing the patching.

The only time we ever use alternate day patching is

1. immediately after surgery in children that have double vision
2. a divergent (outward turning) squint, alternate day patching can be used to help the control slightly. But this would be a max of approx 2 hours per day.
   I cant say that what they are doing is right or wrong but they should be able to explain to you why they are doing it! If you are wanting to encourage binocular vision then he has to be using both his eyes at the same time so alternate day patching is not going to help this???? Hope you get some answers.

Hi mctrouser,

Relax!!! No point in worrying about something that you have no control over .
The reality will be that, yes your DD will probably need glasses is her prescription stays at this level however her eyes are going to do a huge amount of growing over the next 6 months so the prescription could have reduced a fair amount by then. (but unlikely to completely grow out of this level of prescription altogether).

Just enjoy your little girl and try not too worry too much (easier said than done).

Does anyone know of a good orthopist in Nottingham

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.

But someone else may be give you some more local info