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.

Thank you so much ginger!

We are North Tyneside, the eye test was at a high street optician following the school eye test. We were given a list of opticians with a letter explaining they participated in the NHS scheme and would use drops etc. However when we attended we were told by the optician that the NHS scheme no longer exists and the letters shouldn't be sent out any more. Very confusing!!

Anyway... we have now been retested at a different - helpful- optician with drops used. Prescription has changed, but still LS with astigmatism, as you said. I had a feeling the drops were needed, thank you so much for your help!!!

Hi nroger35,

A general rule of thumb is, if the prescription is higher then +3.00 then the glasses will be full time forever, unless they are controlling her squint.

If the glasses make no difference to her squint then these glasses may not be forever. Im afraid there is no immediate answer at the moment it will depend on how and if her prescription changes as she grows.

Hi diplodocus,

I'm not really a specialist in that particular field. But see what you can find for free on the internet, and if you dont find much, try starting a seperate thread on MN and see what other parents suggest

Hi jedward,

So glad you got a second opinion! Good luck with the glasses

OK - will do. Thanks cheekyginger for such a useful thread.

Wow, I can?t believe how long this thread has been running! Thanks very much in advance for listening, cheekyginger.

We just recently discovered that both of our sons needed glasses. My older son?s problem was picked up in a routine school check. We had no idea he had a problem and it came as a shock. We knew that my younger son likely had a problem because he had started to develop a squint (I wore glasses and had a patch as a kid). Apart from the squint though there was nothing to indicate that he had a problem, so were astounded to discover just how bad his vision is. Here are their prescriptions:

DS1 (almost 6 years old)
Right: Sph. +6.5 Cyl. -0.5 Axe 115
Left: Sph. +6.25 Cyl. - Axe ?

DS2 (3 1/2)
Right: Sph. +9.5 Cyl. -1.5 Axe 175
Left: Sph. +10 Cyl. -1.25 Axe 20

They started wearing their glasses about a six weeks ago and they took to them straight away, thankfully. They went for a check-up after they had been wearing them for two weeks, at which point the ophthalmologist said that DS1?s vision was being fully corrected with the glasses. We have to bring him back for another check in one year. However, she said that even with the glasses DS2?s vision was still below an acceptable level. He has to go back again in one month for another check and she said that he will be closely monitored over the coming months/years. The ophth said that it?s still very early days and that hopefully over time the glasses will have the desired effect, but she didn?t hide the fact that there was a chance that they might not and that this could pose a serious problem when he starts to learn to read and write.

Needless to say I am annoyed at myself for not having him checked earlier, but there?s nothing we can do about that now.

So I would really just be interested to hear what you think of DS1?s prescription... At least we have been told that his sight won?t deteriorate, but I guess that 10 is already pretty awful? Do you know if the vision can generally be adequately corrected with glasses after a time? Could you tell me what the Cyl and Axe numbers mean, please? It is just incredible to think that his vision could be so bad and we had NO idea.

Thanks a million for your time.

What a fabulous thread - I can't believe that I've only just found it! Our DD was born with a conjenital cateract and a malformed retina in her left eye. We have already had a lot of treatment, she has had the cateract and lens removed (and a growth that was lurking in behind) she wears a contact lens and we are currently patching her for 6 hours a day.

Do you have any top tips for how to keep the patches on?! She is 18months old and it really is becoming a battle! She is at a childminder for four days a week and wears it really well for her, but for us we're lucky if she'll keep one on for half an hour! Although her vision is poor when she is patched she seems to cope remarkably well and navigates the park/slides/swings very well - Is it just a battle because she has to work really hard when she's patched and she'd rather an easier option?!

Thank you in advance!

Hi cheeky ginger,

Many thanks for your response. I think if I have understood you correctly that DB1 will never have binocular vision so surgery will not improve his chances of this? But, from reading your other posts, many people function perfectly normally with monocular vision so I maybe shouldn't be overly concerned...I assume he will still be able to drive? As for patching, I don't know how long we are going to go on...I think this is why I started getting a bit stressed out and wanting to understand the strategy. I guess if his vision tails off again this time then I am unclear if we should continue with patching or not? If we stop does that mean he will lose vision in that eye permanently? If we continue, is it guaranteed at age 7-8 he would preserve some vision in that eye? Or is vision in that eye irrelevant as he can't use them together? And would only become relevant if he were to damage the other one?

As for DB2, your explanation helped enormously. Thanks so much for taking the time to reply.

Hi TaraMc,

Scotland really offer the gold standard for screening. We screen all pre-school children in the hope that any visual problems will get picked up prior to starting school. Children dont know any different. If they have rubbish vision they dont know this as they have never had good vision!!

One thing is for sure your boys will love their glasses once they get used to them . Spectacle adaptation takes up to 16 weeks (Did u say you were seen back in 2 weeks?!) We tend to give the kids their glasses and send them away for 2-3 months and allow the eyes time to improve.

Your DS2 will likely have bilateral amblyopia (lazy vision in both eyes), and this can take a number of months or even longer to improve completely. This is very unlikely to affect him by the time he is going to school

"cyl" means cylendar (??spelling ) "axe" means axis, which is just the fancy term for the part of the prescription that corrects astigmatism. The cylendar gets corrected at a certain axis (angle) . So in other words DS1 has a minimal amount of astigmatism, and DS2 has slightly more.

And you never know DS2's prescription might reduce a little bit as he gets older as his eye will physically get a little bit bigger which in turn might make the prescription a little bit less.

Hi onesliceortwo,

Well done for getting the patch on at all!!! What is the child minders secret....superglue?!!!!

18months is tricky as she is almost too young for bribery or a reward chart. The frist 400 hours of patching is the most effective so even if you can get an extra coupld of hour here and there it all counts.

If she has a particular programme she is allowed to watch. You could pop the patch on then. If she takes it off then TV goes off. I was amazed at how young my little boy understood this threat. Other extremes are arm splints [shocked], dont think i could bring myself to actually advise that though. Gloves??? Stop her getting at the edge of the patch??

Good luck and it sounds as though you are doing a good job so far. Are the Dr's hoping to achieve a significant improvement? SOunds like you LO's eye will have a limit it can achieve with the retinal probs and well as the cataract.

Hi squintyboys,

From you original post is your DS1 almost 3???

Surgery would make the squint smaller and he may develop some very basic levels of binocular vision (BV), but this is by no way guaranteed. Sorry thats a bit vague, but BV is so variable with every individual child. If your LO has never had it before he will not know any difference so will not cause him any problems. Might not be an RAF pilot but driving will not be an issue.

My gut feeling as an orthoptist and a mum, if his vision tails off again i would stop patching and accept a drop in the vision. This eye is always there as a "spare eye" for the future, and studies have shown the amblyopic (lazy eyes) can improve in adult hood in the event of loss of vision in the dominant (good) eye. At this moment in time when you LO has both eyes open he is only using is good eye the squinting one is temporarily suppressed (ignored) to stop double vision. This is why children who have squints develop (amblyopia/lazy vision), its not getting used therefore it gets lazy.

Hope that helps

My DD has had her eye check in reception and has to have a further check for esophoria - I can't actually see her eyes crossing, is this a big deal or is it something she might grow out of? Any advice please would be most welcome!

Hi Cheekyginger,

Thanks very much for your reply.

I don?t know why Scotland?s screening routine isn?t in place everywhere! We?re based in Switzerland and we were given a little health book when each of our kids was born to make sure that we knew when they needed routine medical check-ups, vaccinations, etc., but there?s no mention in it of having their eyes checked! I don?t know why. Although why it didn?t occur to me when I had been patched myself as a kid is beyond me. Oh well.

Anyway, thanks very much for your encouraging words. It?s great to know that this problem is unlikely to affect him by the time he?s going to school. And it?s really good to have something positive to focus on, rather than worrying about the what-ifs.

I may well be back again in the future to pick your brain, if you?re still here..! I think it?s a really lovely thing that you?re doing taking the time to answer these endless questions and I very much appreciate it.

All the best,
Tara

I thought I ought to join thid little quiche, although my back story is so similar to workshy's it is as if she were telling my history, not hers. Ops at 5, 11, 12, 13 and still squint - originally in but out after the original operation. Started to really swing wide after pregnancies. Had it operated on in April 2011, and although my consultant was a little disappointed as far as I'm concerned it is brilliantly straight.

Never had binocular vision, use right eye almost exclusively, left only contributes peripheral vision. This can be entertaining as I am left handed

Interesting aside though - my hand eye co-ordination is a billions times better since my last op. I have several times be staggered at things I've caught or hit, and asked if I can please have my childhood back

onesliceortwo

We started patching at 2 so a bit older but the best thing I did was round up whizz bang flashy light style toys that were a bit young for her from friends and charity shops that only came out for patching. Her normal toys were too hard or fiddly for her with the patch on as her vision was so bad in the exposed eye. Also, in order to achieve 6 hours a day we almost had to think like we were aiming for all day and put it on as soon as an opportunity arose after she had taken it off, then by bedtime it would have amounted to 6 hours.

She's 5yrs 7mths now and it looks like we'll be doing an hour a day until she's 7 and her vision is fixed as it slipped back when we tried stopping.

Hi cheeky ginger so would you say the glasses are corrective cyp +1.75
Cyl. 1.75 axis 150
Im really confused as I know the optometrist is busy. But we just got told she has a squint and astigmatism needed glasses.. nothing else so iim not sure what they are doing?. but the optitian we used said there was no squint correction in her glasses...sorry I know im probably asking

Pointless questions I just want to understand!

Hi Cheeky Ginger, sorry if this sounds like moaning but you missed me out in your answers. You asked if I had a diagnosis and I posted it above.
Just to give a little update we are going to go private sometime in August as the nhs hospital got back to me and said the op would be sometime in October. Thank you again for the valuable information

Hi Gintastic,
It's an underlying drift of the eyes. The risk is esophoria's can be a sign that a child is longsighted and if it left uncorrected the "dirft" can break down and become a squint. So she will need a glasses check and you'll know more after that

No worries taramc, if im still on here then you are welcome to pick away

Hi beehavingbaby, we accept that the vision will drop in some cases. We ensure that it can come back up again once, then we stop patching. We do not continue with patching if vision is static.

Hi nroger35,
The glasses may help reduce the squint and also help improve her vision. They should be worn full time and then you will know more at your next visit.

Hi Amelia23,
It doesn't sound as though she has binocular vision, so the surgery will be classed as cosmetic. You will likely notice a massive difference after her surgery. If she doesnt have binocular vision then there is a small chance that her eye will re-diverge over time. But this could take anything from 2-20 years, there is no way to predict when this may happen. Further horizontal muscle surgery could be carried out to the right eye in the future if it was ever needed. Sorry i missed your last post ! Good luck with it all hope the surgery all goes smoothly

Thanks for that, I guess we just have to wait for the referral to the hospital to come through.

Hi cheekyginger, my daughter is turning 3 next month and ever since last July I noticed an alternating squint, she was tested at the hospital in March and told there was no vision problems only maybe slightly short sighted. She is going back next month and the optometrist said they may try glasses but the prescription would be very mild. They have mentioned surgery too but said it would only be cosmetic. Will my daughter have any binocular vision and is there anything else that could be done?

Hi dawizzy7,
R u sure they said short sighted? Most convergent (inward turning) squints are linked to some degree of longsightedness. The routine practice in most departments is to correct any longsightedness to see what affect the glasses have on the squint.
If they fully correct it or make it smaller = gls will be longterm and no surgery
If the gls make no difference to the squint = the gls may be discarded and surgery carried out.
If they r saying the surgery is purely cosmetic then that tends to suggest she has no binocular vision. However has she been assessed by an orthoptist? You will know more once she has had the glasses check carried out.

Hi, thanks for your reply. I did mean slightly long sighted (its me who is short sighted) they said it would be a mild prescription but glasses are worth a go. Does not having binocular vision cause many problems or obstacles and can it not be restored with this type of squint?

Yes she has also been seen by an orthoptist but just said they couldn't find anything. There is a family history on her dads side of lazy eyes and glasses too.

Hi dawizzy7,

If the squint is constant then there is less likely hood of a child having any binocular vision.

Not having binocular vision means that you will save money by not going to 3D movies ! But seriously, she she will be able to drive fine and do pretty much any job out there except perhaps fly fighter jets or be a neurosurgeon. Children just adapt to what they have, the human body is quite a miraculous thing!

I seem to notice it at times then not others but it definetely alternates when visible. Sometimes her eyes look straight but maybe my wishful thinking. Thank you so much for putting my mind a bit more at ease as I was worrying bout the total loss of binocular vision if that is the case.