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.

[cheekyginger]

Hi WhatWouldLeoDo,

TMI warning

Up to 6 months the eyes are really not very well co-ordinated at all. So many parents notice squints at this stage and are rightly told by HV/GP that this will settle. By 6 months the eyes are working together much better and any squints that still persist should be referred on to a specialist.
OR
Many babies have the appearance of a squint when they are very little due to a flat/wide bridge of the nose or slight facial asymmetry. This is known as a pseudosquint. As it is not a true squint, it should get less as the child gets older.
True squints if left untreated would tend to get worse over time and become more noticeable. And children don't grow out of true squints.

If you think you are still noticing a squint it would definitely be worth going to your optician to have him checked. If there is nothing then your son has had the benefit of an eye test, and if the optician does find something then he/she can refer on to your nearest eye clinic for any treatment/follow-up. These things are best caught early.

[WhatWouldLeoDo]

That's really helpful cheekyginger, thanks. I think his nose is still quite wide in that babyish kind of way, but I'll take him to the opticians to be on the safe side.

[tooloudhere]

Thanks, LO has many other problems too but you are right everyone is trying to help. We knew there were eye problems but did not expect glasses so early. The glasses haven't been taken off once today so I am assuming that is a good thing and means they are helping!

[cheekyginger]

Thats a very good sign tooloudhere. Well done you and your LO.

[BirdyBedtime]

Hi again cheekyginger. DD (6.6, lazy right eye, patching since June) had an appointment today and for the second in a row (end July-Oct patching 4 hours Oct -now 6 hours) she hadn't improved at all. The orthoptist has recommended another 2 months as their practice now is to do a third block where no improvement just to be sure no more vision can be gained. DD is quite disheartened as we'd been told at last visit that if no improvement this time we'd stop and she was prepared for this. It was a different orthoptist today and we are keen to do as much as we can, but if she has not improved since end July (over 4 months) I can't see how an improvement could be expected in the next 2 months on the same level of patching. What are your thoughts? They also want her to see the opthalmologist next time to ensure there is nothing they've missed but I can't think what that could be?

[cheekyginger]

Hi BirdyBedtime,

Has your LO had been patching since June this year? If yes then that's not actually that long. Go with the flow just now as there may still be potential to have some further improvement. But i think i said before that if the vision is stable over 3 visits then this is our dept's cut off. It's the brain telling us that their is no further improvement to be had.
It's a shame to be getting told different things by different people though.
They will be bringing her back to see the Ophthalmologist to ensure that they arent missing mild optic nerve hypoplasia (ONH). Some children are born with a mildly underdeveloped optic nerve and patching has no effect on the vision. They will be making sure that this isn't the case.
Keep going this time. You will hopefully stop the patching next visit and if not ask why not?!

[EustaciaVye]

Hi there,

My daughter is 5, and 18 months ago she was diagnosed as follows:

Her prescription was
Left
sph +2.5
cyl -
axis - blank

Right
sph +2.00
cyl +1.00
axis 90 degrees

A bit longsighted with an astigmatism in her squint eye. She was given glasses to correct the squint. After about 6 months it was obvious the squint was worsening so they started to patch. We did that for 4 months and the weak improved very slightly but her 'good' eye started to squint so they stopped.

She now has new glasses (same weak eye and slightly stronger for good eye). When she doesnt wear her glasses the eye movemy is so obvious :( The orthoptist as said they wont commit to future treatment yet as she is still growing etc but as it is fine with the glasses an Op would be considered cosmetic.

Any advice?

[mazza227]

Hi, I would just like to share my daughter's experience too, age 5

Back in July, I took her to opticians for eye test, no concerns just thought I would get her checked. We discovered then that she had a lazy left eye, I felt so awful when she couldn't read the letters, I thought she was messing around to start with :-( I was told that she was a 3.5 and 5.75 and needed glasses straight away, and was referred to hospital to discuss further options.

When I got home I was so upset that I had no idea, but nor had her nursery teachers or anybody else around us. Children obviously don't realise what is 'normal' and so don't say anything. I kept having so many sleepless nights about how terrible a mother I was....now months on I realise there are so many children with the same condition, but you don't realise that at the time, you think it's just you!

Anyway she went to the hospital and was started with patching straight away, 6hrs a day. The first day she just kept crying saying she couldn't see. Luckily for us all, she was at nursery that day, which took her mind off it, and when she got there she was fine, she obviously struggled to start with, but coped really well.....again it was me who cried as I got to nursery to drop her off, and the children were asking why she had a patch, but they weren't being nasty, just interested. I discovered meyepatch.co.uk who do patches that fit over the glasses (rather than sticky ones which made her sore after just 2 days) so she now proudly wears her Tinkerbell one, and is the envy of her classmates!!

She had her next hospital appointment 2 months later, where she had improved by 2 lines, which I was really pleased with (but the orthopist had noticed she kept trying to peek looking over her patch!) So got her glasses adjusted slightly and she stopped that.

Then this week she had another appointment (3 months later) where she improved another 1.5 lines. So they are really pleased with her progress, she has another 3 lines to go now to be equal to her good eye.

So if anyone is worried like I was, please try not to, patching really seems to be helping, and there is certainly no need to worry about bullying :)




I do have a couple of questions though if you can help please?

Is it likely that she will acheive the 3 line difference?
Will her eyesight get worse again once patching stops?
Should I ask about vision therapy, would this help even further?
Is her sight in her 'good eye' being made worse by patching?
Do you think 6 hrs a day is too much? I read that 2hrs is now as good as 6+ ?

[cheekyginger]

Hi EustaciaVye,

Your DD sounds like she has a fully accommodative OR partially accommodative squint. Meaning fully or partially straight with the glasses. If thats the case then unfortunately surgery may not be an option as the surgeons would aim the correct the visible squint you see when the glasses are on, and if this is really small then there would be a risk of overcorrection (the eye turning outwards after surgery). But don't be disheartened contact lenses will have the same effect that glasses do when she is older.

Hi Mazza227, nice to hear your daughters patching is going well.
As for your questions.
If the amblyopia (lazy eye) was caused purely by the stronger prescription in that eye, and no squint, then there is no reason she cant achieve equal vision. Once patching stops she should maintain this level of vision.
Patching is the gold standard form of treatment for amblyopia (lazy eye). No other vision therapy is needed.
If your daughter is coping ok with 6 hours keep with it. If you were doing less per day the overall length of treatment would be longer, for example patch for 6hours per day for 6months OR 3 hours per day for 12months. So technically people could agrue it is just as effective, but it is over a much longer period of time. As long as you are not patching way over 6hrs per day then there is no risk to the good eye.

[EustaciaVye]

Thanks cheekyginger - they did talk about overcorrection being a risk of surgery so it sounds like you may be right. :(

[mazza227]

Thank you cheekyginger, that is really good to know that she could get equal vision. She has no squint so fingers crossed she will get there :)

[cunexttuesonline]

Really glad to have found this thread. I feel so confused with it, and I seem to get differing responses from the eye clinic at the hospital. DS has had glasses since he was 20 mo. He squints when tired or looking at things close up (first noticed this while he was eating which prompted me to get him tested).

My questions are -

He has a +3.5 prescription in both eyes. This is what was originally given to him at specsavers, as we went there before they referred to orthoptist. At the hospital, they do not seem sure what prescription he should have and always decide to leave him in the same glasses. Last visit he had improved by 4 lines (iirc) on the chart, but still they said keep the same glasses. Why is this?

Despite having the specs for 14 months, DS is STILL removing them, many times a day. They are mainly discarded if he is chilling out watching tv. But also he chucks them off sometimes if he is running around etc. What does he see like with them off? I can't understand why he would take them off if he can't see well without them. i think my main question is - because he is longsighted I understand that he sees close up better with the glasses on, does he see things far away worse when he has them on and is that why he takes them off?

Lastly, should I be forcing him to wear them when he has taken them off? At present, I just leave him without them for a while then pop them back on when I get a chance!!

Thanks

[mazza227]

Sorry I have one more question I forgot before.
I am now hoping for the 3 lines difference to reduce or hopefully become equal, and have been told her prescription will change as she gets older anyway. But are her eyes likely to become more equal regarding her prescription. She was 5.75 and 3.5 but her glasses are 5.25 + 3 as she has no squint, this was in July and has not had prescription checked again since then. Is it possible that her bad eye will reduce from this to become nearer to the 3 in her good eye? Or would it automatically have reduced already with the help of the patching?

[TheGoddessBlossom]

Have not read whole thread so sorry if you have already answered this question Ginger:

My DS woke up with his eye practically against his nose one morning when he was 18 months old. He was diagnosed with a lazy eye and he had patching and then an operation to correct it - but because he also needs glasses they only corrected his vision enough to be straight once he has his specs on. Will it be possible for him to have straight looking eyes ever without having his glasses on at the the same time?

[brilaunt]

Hi Ginger... I'm not sure whether or not you will get my post but I will give it a try as I'm worried about my LO. My baby is 6months and I have recently been noticing that when she is tired her eyes tend to vere outswards for a split second when she is adjusting on an object that is above her. I.e when i wave something interesting above her head her eyes dont move fluidly before focusing on the object she can tend to look a bit drunk so to speak!? I can't decide whether or not her right eye is slightly worse than the left. l'm fretting terribly and I have made an apt with my GP to discuss it as I'm worried that it may be a symptom of something more sinister. My sister's little boy has a severe turn in left eye and my grandfather also had a squint. I would just like to know if you could give me any advice and some pointers on what to ask the dr? Thanks

[cheekyginger]

Happy new year everyone!!

Hi Wanksock (great screen name by the way!),

Your sons glasses will be the required strength that gives a clear image to the back of the eye. Once a child is wearing the glasses the cells in the brain then adapt to this nice clear image and therefore the vision improves. The vision can take a little while to reach its maximum level, but this does not mean the strength of prescription has changed.....it means the cells in the brain are working well and the glasses are doing their job. (Hope that makes sense!)

When kids are longsighted they can see surprisingly well without them BUT they have to over focus their eyes to do this and this can lead to sore eyes sore heads or squints becoming worse. Therefore for any child that is longsighted glasses are an absolute must for close work (reading writing etc), and if they have a squint they should be worn full time otherwise there is a risk of the squint becoming worse.

Try to avoid getting into a battle about the glasses. Let him take them off now and again when chilling out at home. But make sure he has them on at school/nursery and when looking at books etc.

Good luck

[cheekyginger]

Hi Mazza227,
The patching will help the eye see better but will not change the actual optical power of the eye.
The difference between her prescription may vary as she grows but it is unlikely that they would ever become completely equal. Sorry....

[sitsyou]

just came across this - don't need any advice (DD had suspected squint when v young and due a check up soon but I think she's fine) but just wanted to say THANK YOU, what a nice thing to do!

[cheekyginger]

Hi TheGoddessBlossom,
Unfortunately the answer is no. He still squints when he takes his glasses off because of the longsightedness?!?!? I shall try and explain . When your son accomodates to see without his glasses on, this "extra" focusing causes the eye to turn inwards. There is no way to switch off this relationship between accommodation and convergence.
Contact lenses will do exactly the same job as the glasses when he is older.

Hi brilaunt,
Dont panic....its unlikely to be anything sinister, the eyes are still becoming co-ordinated over the first 6-7 months.
Some squints do start off that way....but again these are not sinister. There is a type of squint called an intermittent divergent squint, which means that one eye has a tendency to drift outwards at times. This can sometimes be worse when looking upwards. Your GP might refer you to an eye specialist (orthoptist or ophthalmologist) and your GP should be the one asking you all the questions! They might even tell you to come back in a few months if you are still noticing it.

Hi sitsyou, thanks for the appreciation!!!

[psketti]

Hello cheekyginger I was wondering if you could shed light on my dd's sight problems. She started having a squint around age 2. We were told she was long sighted with rugby ball shaped eyes. They started her on +5 lenses in both eyes but over the past few years they have gradually increased the prescription (now a +7 in both eyes). When I ask if her sights getting worse, they say no. But surely it must be if they keep increasing the prescription. I'm worried about the future for her as I know this is a v strong prescription. Also I find different staff tell me different things so I'm never really clear. Is it the shape of her eyes that causes the long sightedness? And is this astigmatism? Any advice much appreciated.

[cheekyginger]

Hi psketti,
Even though the prescription has increased that does not mean that her vision is getting worse (i.e her vision is always 20/20), it just means the eye is changing shape as she grows resulting in a change in prescription. When you were told she has "rugby ball shaped eyes", this means she has astigmatism along with the longsightedness, which is common. Its not the whole eye that's a rugby ball shape just the front part known as the cornea, but its easier just to say "the eye".
It is a combination of the length/shape of the eye and the power of the lens in the eye that determines what prescription a person is.
+7 is strong but there are lots of people out their with that prescription. The lenses these days can be thinned down alot so glasses are not too thick, and contact lenses will be an option for her when she is older.

Hope that helps

[cunexttuesonline]

Thank you, that is really helpful!! He wears the specs all the time at nursery at least so that is good!

[johnworf]

Hi cheekyginger. Do you remember I asked about my DD's maybe squint back in December last year?

Well, on your advice, I rang my HV who got her referred to an orthoptist. We saw her last week and she has undoubtably got a squint in her right eye. I feel awful that I didn't pursue it sooner but hey ho.

The orthoptist has now made me a further appointment with one someone else there (her boss or an eye specialist, not sure) to have DD's eyes dilated and tested to see if she needs glasses and patching or just patching.

I am just wondering if you could give me an idea of what they will do at her next appointment i.e. how will they test her eyes? She's only 3.5. How will they decide she needs glasses?

Many thanks.

[PuffofSmoke]

Hi Ginger, I last called for your expertise when DD first got glasses 6 months ago when she was 16 months. She loves her glasses now and keeps them on no trouble at all (hope that gives hope to those of you with dc going to get glasses).

Anyway she had a hospital appointment on Friday, the hospital were thrilled that she had kept the glasses on and that the squint was much improved with the glasses on but worse with the glasses off. They tested her eyes again an said because there is no difference in the sight out of the two eyes patching wouldn't work and to continue with her glasses. I didn't ask but meant to, will she ever be 'cured' as such or will she always squint so badly (her eye pretty much disappears) when she takes her glasses off? I don't mind, she doesn't look right without the glasses now but I'm sure she wont be happy about it when she is a bit older! Any advice welcome! Thanks

[DestinationUnknown]

Hello - what a lovely thread, thank you cheekyginger .

I have a question about my 4.8 yo ds, who I think may have a small squint. He's had his standard sight tests at school and no concerns came back from that, however I noticed in a picture I took of him last week that when he's focussing on something a little way beyond him (in this case looking up at the monkey bars as he stretched up to them) that his left eye turns inwards more than his right eye.

Is this ok or should I get him seen by an optician? I've noticed this before but just from photos not really in person. None of this would have been mentioned at the sight test as I wasn't there, I don't know if it would be picked up on or not in that case?

If helpful and you have time we could PM and I can email you the pic!
Thanks very much.