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 "Helly54",

Try not to panic. The GP will have had a quick look at your LO's red reflex, and if he/she had any major concerns then you would have been seen on the day by an ophthalmologist.
Just be patient and know that you've done the right thing and got the ball rolling

Hi "puzzlejig",

In Scotland a patient has to be seen within 16 weeks from time of referral, as part of the waiting time initiative. Definitely worth getting his eyes checked. We see kids quite regularly with these kind of complaints. If there is a family history however i would recommend that you prepare yourself mentally that he may need glasses. I always advise to keep your hospital appointments, however if you want an immediate answer you could take him to a local optometrist. Do you know anyone that could recommend an optician near you that is particularly good with kids?
Hope it all goes well

Hi "Orange32",
Thats a tricky one as your DS has quite a unique prescription. The contact leanses can make the vision sharper and improve the overall quality of the vision. However due to the extreme level of his prescription he may never have 20/20 vision. But dont panic many many many people dont have 20/20 vision and function completely normally. As for the headaches/eyestrain etc, has your son ever been tested by an Orthoptist? They would be able to asses the muscle control of his eyes and rule out any muscle imbalance that can cause eye strain etc.

Hi "goldenlula",
It unusual that this has never been suggested before now at age 7 , as this would have been picked up at previous eye tests.
Do you have his prescription? You could post on another msg and i would be able to tell you more once i knew the prescription.

Hi nroger,
No wonder you are confused!!! Its not a massive prescription, but even small longsighted prescriptions can make convergent squints smaller.
When we prescribe glasses we ask that the are worn full time, with no exceptions. Its just much more consistent, and will give the orthoptist much more of an idea if the glasses are making any difference to the squint or not. Sorry that's prob not helped much . Do you have a contact number for the eye department. Could you phone and speak to someone and ask about the glasses?

Hi Lucy1001
An orthoptic referral is very normal. Your DS has slightly reduced vision in both eyes, more so in his left eye. The higher the number on the bottom the poorer the vision (The top letter on a standard eye chart being 6/60 and normal vision being 6/6). Have the glasses been prescribed? Is your son wearing them?

Hi Summer96
Your little one may see 2 people at the appointment. First being an Orthoptist to attempt an assessment of her vision and eye movements. If she is seeing the Ophthalmologist on the same day then she may have drops in her eyes. These drops will dilate the pupils and take around 30 mins to work. This allows the Dr to have a look at the back of her eyes to make sure they are nice and healthy and to get a reading from her eyes to see if she needs glasses. I know that some of our Dr's have spent some time at Moorefields and always have good things to say about it . Good luck.

Hi cheekyginger. The optician has mentioned before that he is slightly long sighted, as they have with ds2 who is almost 5 (he has been seen at a vision training clinic too and they said the same) but that that is normal for a young child. This is a different optician (at the same independent opticians though). The prescription is right eye sph +0.75 and the left is either sph +0.25 or 0.75, the middle number is a little unclear. I am short sighted, so the opposite to them.

Hi

Great thread! We are very much at the start of this but have a good few months to wait for a referral so any advice appreciated. I noticed my 3 year old daughter turns her left eye in slightly at times. I left it a couple of weeks and noticed it persisted so took her to the optician. The optician has tested her sight and said that it is very good. When she tested with drops to dilate the pupil she did detect a slight prescription on the left and noticed a slight turning in of the eye which she described a mild. She has referred us (she said principally due to her age) but said it will be about 4 months so in the interim she has given my daughter glasses with the hope that it won't worsen while we wait. I suppose that we will just to have to see but any insight into what might happen next would be good. Are we likely to be looking at her having glasses long term? It concerned me that she was so worried that it might worsen so much in a short period - is there anything else we should be doing whilst we wait? Any other advice/ insight greatly appreciated!

Have also very much enjoyed allow the positive stories on this thread.

Hi Cheekyginger, I cant believe someone was kind enough to setup a thread like this. Its not always easy to find out info on eye problems as each case can be so specific, so thank you again.

my daughter is 26 months old and we first noticed her left eye was occasionally turning out when she was 3 months old. Her first appointment was at 6 months and they said that both her eyes were drifting out (left worse) and that she was doing it more for distance than near, but that her eyesight was actually quite good. Over the months it got worse in terms of how far out her eyes would go and how often she was doing it, so when she was 18 months old she had botox. The results were initially excellent but unfortunately only lasted about 6 weeks. Her eyes are quite bad at the moment and we have surgery planned for august/september. Her eyes have also started going upwards as well, but again they say her eyesight isnt bad. Her right eye tends to go up more and her left eye goes out more. There is a strong family history on my side and no one got it fixed.

There are just a few questions I would like to ask which we dont really get a good chance to do at appointments because my daughter gets so upset and I get stressed and forget what I should ask.
Firstly even though both eyes go up and out the doctor said he would only operate for the outwardness on the left eye and the upwardness on the right and he said it would even out, whereas with the botox it was to both eyes
Secondly he said it would more than likely come back in the future, why is that? From what I understand its a problem in the brain, so if her brain learns to keep her eyes straight after the op why should it stop working in the future, will she forget
Also I just wonder if you had any ideas of the cost to do such an operation privately, I looked on the net and it says about £2-3000

The doctor says it will definately work, but me and my husband have gotten so used to seeing her with her eyes deviated that we cant imagine it is going to work, stupid question I know but do you think it will work?

Thank you so much

Hi Goldenlula,

That is a very mild prescription. If your son likes them then fair enough, however if it is a daily battle to get him to wear then i would discontinue these IMO.

Hi Edgossy
for your lovely comments.
Depends on what type of squint your little has. This will decide whether the glasses are full time/longterm or not. The glasses may do nothing to the squint, they may make it smaller or they may full correct it. If it is partitally or fully corrected then the glasses are more likely to be required longer term. You'll know much more after your first visit with the orthoptist. The only thing you need to do at the mo is get her to wear her glasses full time . Hope that goes well.

Hi Amelia23,
Thats really difficult to decide on your LO's management without seeing her . You can safely operate on a horizontal muscle and vertical muscle at the same time and have the desired effect.

Longterm effects of squint surgery really depends if you child has binocular vision (Some form of 3D vision that should be tested by the orthoptist at you appointments). If yes. then the aim of the surgery is to make the eyes as straight as possible and allow the brain to use the two eyes together more comfortably. If no or very weak, then the aim of the surgery is purely to make the eyes "look better", but there is a risk that the eyes can drift again as the 3D vision is what anchors your eyes in a straight position , so if you don't have any or its weak then they can squint again. (Not sure that will make sense!)
I have no idea with regards to the cost to go privately, but i have to really truley believe private does not always mean better. Where are you in the UK? Would you be able to ask for a 2nd opinion from another consultant if you have having doubts.
There is a limit to how much eye surgery can be carried out on one patient. We tend to try and avoid doing too much too soon.

Thank you. At the moment he is happy to wear them, but I wonder how long that will last!

Hi cheekyginger, thank you so much for the quick reply, it was very informative and helpful.
I think I understood the concept of what you were saying about the binocular vision, if she has it, its more likely the operation will be successful. I am not sure whether her binocular vision is good or not as she does make a fuss when we go to appointments and so I think they have to pass on some of her tests, all I know is that they said to us that her vision is good, but I'm not sure if that is the same as having good binocular vision.

I think my husband and I have resigned ourselves to her having the operation, we had hoped for another round of botox as we didnt want to start operations at such a young age, when she might have to have many in the future, but her eyes are quite bad now and the consultant said to us that it is not advisable to keep putting her under anaesthetic when the results are short term.

The reason I was asking about a private operation is because we are due to go for our first holiday with our daughter in september, it will be the first time she will meet one set of grandparents and extended family. We had hoped she would have the operation before we went just so it wasnt hanging over us and so we could fully enjoy the holiday knowing her eyes were on the mend.It seems unlikely that they will fit us in before then so I was just wondering what the costs might be to go private.
We live in the camden area of london and really the doctors we have met have been lovely, but you do always get the sense that they have no time for any questions especially if the answers are a bit confusing.

Thank you again for your help

Hi! I'm new to all this but thank you so much for starting this thread. Also sorry if you have answered something like this already, I have read quite a lot of the posts on this thread but not all of them and i haven't yet found one about a baby so young (without some kind if history of known about condition).

My daughter was three months old on Monday and on Wednesday the Dr said that she had a quint and has referred her to the orthoptist. Neither my husband or I have a history of this kind of thing, or any sight problems from a young age. The Dr first picked it up at her six week check and therefore asked that I book an appointment in for the three months mark. He asked us to monitor it but honestly I thought a bit of a squint was normal for this age. In fact our son has photos of him looking like he has a squint as old as six months and he's fine now so we hadn't thought anything of it. I should also add the HV looked at her eyes at eight weeks old and said she could see that the reflections were in the same place on her eyes so she didn't think she had a squint.

So my question is what tests can an orthoptist perform on a three month old? And how likely is it to be a squint due to her age and our lack of history? I know you have mentioned in previous posts about pseudo squints, I found some good information about it and some photos and I suspect that is what she has but the more I look at her the more I lack confidence (I feel like I am staring into the poor girl's eyes all of the time!!)

Thank you so much for your help.

Hi cheekyginger. I'm so glad you've started this thread and I'm sure you've given comfort to lots of parents. Shortly after my daughter was born, a nurse noticed at a routine check-up that both of my daughter's eyes were turning inwards. We also noticed it in a few of her pictures but that was when she was less than a year old. We were referred to a local hospital where they tried to do tests on her but with not much success due to my daughter not co-operating. She did not have vision problems and after 2 years of going back and forth to the hospital they finally told us there was nothing to worry about but that we constantly needed to bring her to the hospital just in case she might need glasses or patching. I never went back. She's now four and soon to start school. Her condition improved as she grew and I hardly see problems with her eye except for when she's tired, excited or when her head is tilted at a certain angle. I'm thinking about going for a second opinion before she starts school. Will an optometrist be able to help or should I go to an ophthalmologist? I've also heard about pseudo strabismus and noticed that the bridge of my daughters nose is wide. Could this also be an issue? Thanks so much!

Hi Amelia23,

Could you phone your eye department and ask if they would consider carrying out the surgery privately?
The other option is that you might be able to get a cancellation.

Hi sparkledim,
Your HV was quite right to look at the reflections! The corneal reflections can give a good idea is a child is truly squinting or not. Sounds likely to be a pseudo squint. Squints that appear under the age of 6 month tend to be very large squint called infantile esoptropia. The orthoptist will have a look at the reflections again and try and get your LO to follow a light. Fairly basic tests and a lot of observation of her eyes while she looks at various toys, pictures etc. The eyes aren't fully coordinated for the first 6-9 months.

Hi Tarona,
Most high street optometrists would be happy to test a 4/5 year old, and it would be much quicker for you. If they find anything they may refer you on to an ophthalmologist but at least you would know fairly quickly if there were any issues.

Thank you cheekyginger. I really appreciate your reply. We shall await the appointment with the orthoptist!

Thank you for the reply. The consultant who will do the operation on my daughter works privately most of the week so our idea is that we would go to him if the op cant be scheduled quickly.
A summary of her condition was sent through the post recently and in it, it says that she alternates well, would that be an indicator of strong binocular vision or are the two things unrelated.
Thank you again for your time, your help is much appreciated when dealing with a stressful subject.

Hi Amelia23,

"Alternates well" suggests that she doesn't have a particularly dominant eye. Cant tell binocularity just from that statement im afraid. Did it say what her actual diagnosis is?

Hi cheeky ginger, thanks for getting back to me so quickly, its nice to be able to understand things a bit better. I do have a summary of her condition
"She has a marked left divergent squint which she can alternate well and this measured about 40 prism dioptre for distance with bilateral inferior oblique overaction. I have therefore listed her for bilateral inferior oblique myectomy and then left recess resect procedure"

Although both eyes alternate the left is definately worse in terms of how how often she does it and how far out it goes, but i think the right is worse drifting up, sometimes it can be confusing knowing which eye is looking at you.

Thank you again

Hi cheeky ginger,

I found your post through google and was amazed and grateful in advance that you have continued to offer your free advice for so long. I have a few questions about my twin boys. ID boys born 2mths prem, now 2yrs 9mths.

DB1 eye started turning in acutely at 15mths old. Several appointments later in, June 2012, aged 21mths he was prescribed glasses, +3 in both eyes. Took a few weeks to get him to comply but then worn all day. Seen by consultant/orthoptist in September 2012, aged 2yrs, conclusion was glasses had helped a little but mainly non accommodative esotropia which could only ultimately be corrected by surgery. At this stage not very good measurements of vision or squint in the eyes but orthoptists view was that he could see very little out of squinting right eye, he was extremely reluctant to have left eye covered up etc. We were discharged to local orthoptist for patch therapy with message that consultant was happy to operate as soon as she had some good consistent measurements.

Nearly a year on, patching has had mixed success and after several visits to the orthoptist I am starting to question what the strategy is going forward. Patching for 4+hrs a day has improved vision but on both official attempts to reduce patch time to 2-3hrs and periods of us being a little less vigilant or having less cooperation has lead to quite rapid deterioration, both measured by orthoptist but also evident from my observations and his behaviour etc. Also, have observed significant fluctuations in his vision (I,e, sometimes it is evident he is peering close to books or taking little interest in tv as cant see it properly when patched, other times he seems to function perfectly normally) and after periods of more intense patching we observe left eye turning in on occasion and when this happens he seems very unhappy and I am suspicious he has headaches and/or migraine..we have had at least 4 occasions of screaming, no other obvious illness etc., vomiting and strange behaviour..desire to be in darker room away from noise etc.. Improves with sleep..so it is difficult to diagnose migraine at this age but this is my suspicion...orthoptist seems surprised and unsure of what to say on reports of this.

Anyway, my problem/query is that it seems evident to me that he cannot use his eyes together, and if this is the case I can't see how we will ever be able to stop patching as I am sure as soon as we do the amblyopia will get worse in right eye. Also, is it possible that by patching we can give him double vision and headaches? Also, at what point should we push to get back to see consultant, I asked at most recent appointment as I felt surgery might increase his prospects of being patch free and developing binocular vision...or as seems to be more common view, surgery is purely cosmetic...orthoptist believes that consultant expects vision to have been improved by patching before surgery and that this is just cosmetic, is that always the case?

Finally, DB2,twin brother appeared to occasionally be squinting but only slightly so I got him checked. He is confirmed to have some 'movement' and possibly slightly reduced vision in one eye. Optician prescribed glasses, only +1.5. There was some seemingly unscientific debate over whether they should bother giving him glasses but he ended up with them as it may help to control the movement in his eye. As it is intermittent, we haven't seen consultant. This is all info I have...can you interpret this forme and give me your view on whether he really should e wearing glasses? Does movement constiute a squint? I felt very unconvinced, I don't have any desire for him to be treated unnecessarily. Also, can you explain why he doesn't need to see consultant.

Any help, advice, or best opinion you can offer would be much appreciated. Sorry the post is long.

Hi cheeky ginger. Thanks for your reply. I just wondered. Amelie s prescription is 1.75 in her right eye. With a squint and astigmatism of 1.25. The optometrist said that often children of her age (18m) are long sighted though. So I just wondered are the glasses corectative or permenant? Im worried that by making her wear the glasses 1 said she needed them. 1 said it needed monitoring. ..could we be damaging her eyes if she shouldnt be wearing them? My partner and i both had squints operated on.. no glasses since.Thanks

Hi Ginger. Thanks so much for offering advice on this thread. I've got two queries.

DD1 aged 7 has been diagnosed as having convergence insufficiency by the (generalist) optometrist. It's affecting the fluency of her reading (which is good / above average but she looses her place / inserts words etc). He's recommended eye exercises, that we've been doing, but it's heavy going and from what I've seen online they have limited effectiveness. I've been told the NHS orthoptists don't have the time to deal with this condition. Our only other options would be behavioural orthoptist (which is £££££ and very time consuming with a long journey), or to use an online computer programme. I'm reluctant to do this without one being "prescribed" and the only place I can find that does this (a specialist optician) is a very long way away which would make follow up difficult. What are your thoughts on this? I'd really like to do the best for her as she's finding reading harder as she progresses due to denser text etc. and I think it's affecting her confidence.

DD2 (5) has been prescribed glasses for close work as she's a bit long sighted, and this is causeing her eye to turn when focussing on close objects. Is this likely to self-correct as she gets older.
Thanaks in advance.

Hello, I must echo the sentiments of thanks for having this thread going for so long and offering this advice!

My dd is 18 months old. She started having a convergant squint in her left eye at 10 months. I took her to the GP right away but was held off as her bridge is quite wide until a year. At that time I got a referral for the hospital and have just been seen (6 months later and after pushing GP to send in another request).

It turns out she is far-sighted with a prescription of +2 in the right eye and +4 in the left eye.

My questions are:

Does the squint mean she doesn't have binocular vision?

If she doesn't, will she be able to attain it?

Is binocular vision the same as depth perception, or can she have depth perception without binocular vision?

We do swimming once a week, should she get prescription goggles for her swimming?

Thanks again :)

Hi cheekyginger, thanks for this thread!

My DS, 5, has a prescription of:
Right - sph +300, cyl -050, axis 180
Left - sph +250, cyl -050, axis 180

This was prescribed without dilating drops etc, apparently our area don't do that anymore.

Does this mean he is long sighted? I am sure the optician said short sighted! What do the various aspects of the prescription mean?

Also, he is complaining that vision is worse with glasses on, that things look too big, and reading is easier without them. Is this just a case of getting used to the glasses?

Hi squintyboys,

He he he, cant believe you found me on google! I feel all famous

DB1 I can say what they are doing is right or wrong. Our protocols are fairly standard.
This is our standard practice.

• All children need to be seen by optometrist OR Dr to have their glasses up dated at least once a year.
• Once Vision has stabilised over 2 visits we would tail off the patching and stop. If the vision drops back more than one line of letters or pictures then patching may be re-started. But if vision drops back again then we accept that this is what is going to happen. If something bad was to happen to the good eye in the future then the likely hood is the vision would come back up to the best achieved level. The visual system is changable up to the age of 7-8, are they planning on patching your LO till then?
• It sounds as though your sons squint is constant therefore surgery would be cosmetic, therefore wouldn't affect his vision. Accurate measurements are important to allow for accurate surgery.

Surgery can be carried out at any age, whereas the younger the better for treating the vision.

As for your other son. People can have what we call a latent squint. This means it is a hidden squint and we test for it by covering one eye. If the eye drifts under the cover (we see a corrective movement when we take the cover away) then this shows there is an underlying squint. This is very normal. However, if it is an inwards drift then there is a risk that this can get bigger and perhaps break down into a constant squint if any longsightedness is left uncorrected.
You don't have to see a consultant, as long as you are being seen by an orthoptist and an optometrist. However, i would imagine you could request an appointment with an Ophthalmologist if you weren't happy.

Hi nroger35

It's not a massive prescription. Is she wearing them?
If she has an inward turning squint (convergent squint), then its always worth tying the glasses as they may straighten the squint or make it smaller. You will not damage her eyes

Hi diplodocus
I am openly against behavioural optometrists. They cant actually provide evidence for a lot of their practice. (Sorry if any offence caused to anyone but i have dealt with many upset parents that have spent a lot of money for nothing ).
If you havent already you could try simple tracking exercises. I found this website online. Have a look and see what you think. Tracking problems can be treated quite effectively and make quite a difference to a child ability to read.

We have a specialised clinic that deals with tracking problems and assess children for coloured overlays. Tracking problems are surprisingly common but not always tested for.

As for you other daughter. Squints dont tend to go away by themselves im afraid, but the glasses may fully correct it.

Hi domesticatedhuman,

Just trying to help mums and dads understand their kids eye conditions a bit better. The NHS is generally a great service but the one thing you dont get is lots of time with the Ophthalmologist as they are so busy, so i like being able to help out when i can

If the squint is intermittent (not there all the time) and/OR the glasses help straighten it, then she may have binocular vision. Binocular vision = 3D vision/depth perception. If the glasses make the squint smaller then there is chance that the brain will develop some binocular vision. She is still very young so you will know more and more at each visit as she manages more and more of the tests. All you can do is encourage her glasses to be worn full time . Wouldn't worry too much about swimming goggles just now. Wait till she is 3 or 4 and going to swimming lessons on her own.

Hi jedwardscissorhands

I have TBH and say that i am really shocked that your little boy didnt have drops in. This is standard practice in our department. It's the most accurate way to tell what prescription a child requires .
the sph is the longsighted/shorsighted section of a prescription + means lonsighted - means short sighted. cyl is the part that means astigmatism.
So in summary your little boy is longsighted with a minimal amount of astigmatism.
It can take kids a while to get used to the prescription. Persevere for a while. When is your next appointment?
If you don't mind me asking, where is "your area"? Was that at a UK eye department?!!

And thanks for all your lovely thank you's!!!

Do you think mumsnet will give me a prize when i reach 1000 messages?!!!

Thanks cheeky ginger :-) she is wearing them about 10 hrs a day... she has taken to them well only taking themoff for bed and naps really... are they likely to be a forever thing?

Thanks for your response ginger. Really helpful. Do you recommend any computer programmes to help tracking as I think these might hold her attention more?