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.

if the eyesight is the same in both eyes then patching is pointless as it is used to improve vision. DD had an eye op around age 4 as her squint was still noticeable while wearing her glasses. I was nervous about the GA but everything went well and thankfully she wont need another op.

Hi, thanks for starting this thread. I have a question for you. I have a 4 year old DS who wears glasses for long sightedness. He has no problem with this the vast majority of the time. The issue we have is he plays football twice a week, and every time without fail, his glasses get knocked off, or a ball hits them, and he gets hurt.

We have thought about getting contact lenses , just for football, so today we asked the optician, and were told that contact lenses are not suitable for children under 13. The reasons given for this, were that young children are not mature enough to look after contact lenses, and there is a risk of infection if they are not kept clean. This did not make sense to us. Both DH and I wear contact lenses, and have no problem with them. Obviously we would look after them for him, and if necessary assist DS with putting them in and taking them out. We are tempted to order some daily disposables over the internet, and give them a try, but obviously don't want to do that, if there is some medical reason we shouldn't. What are your thoughts on this?

Apologies, I have just read back and realised that was almost the same question as Priorknowledge asked

Hi Priorknowledge,

Its really up to the optometrist (optician) to decide when a child can wear lenses, as it depends on each child. It is all to do with the getting the CL's in and out of the eye safely and having strict hand hygiene to reduce the chance of infection.
The other risk is over wearing the contact lenses and therefore causing damage to cornea (front part of the eye).
CL's are just as good as glasses for the vision.

Hi Whyriskit,

As Seona said the patching is purely treat the vision if the vision is lazy.

Your DS sounds as though he has what we call an intermittent exotropia, intermittent meaning its not there all the time and exotropia meaning the eye turns outwards. If a squint is intermittent then generally the vision does not become lazy and therefore patching is not required.
By leaving your son till he is 5 for an operation they are just making sure that they are giving his eyes some time to work by themselves and see is he gains better control over time. If it was to happen much more often or he was starting to complain (with out being asked!) of headaches, sore eyes etc then surgery may be carried out sooner. Surgery for this type of squint is generally not cosmetic it will improve the function of your child's 3D vision. It would only affect his actual eyesight if it was to become constant and therefore the squinting eye would become visually lazy.... Hope that helps

Hi Notinmykitchen,

I have no issues with people ordering lenses over the internet, as adults have a fairly standard size of cornea (front part of the eye).BUT for young children the fit would not be correct, as the cornea would be much smaller then the standard size of lens. The after care appointments with your optician are really important to ensure the eye is healthy and the eyes are tolerating the lenses.
IMO your DS is way too young for CL's even though you and your DS are obviously longterm lens wearers. How about sports goggles for the meantime? And by the time your DS is 8 or 9ish, you may have managed to persuade your optician!!!

Thanks for that cheekyginger. Its nice to have a definitive answer that makes sense. We have ordered some sports glasses today, and hopefully that will solve the problem, until he is old enough to give lenses a try.

No probs Notinmykitchen, good luck with the sports glasses

This is great cheekyginger, really pleased to find this.

My son 4 has come home from school with a letter to say that his eyes have been tested and he has reduced vision in both eyes and has been refered to the hospital.

He has delayed speech and so has trouble understanding instructions, is it possible that he has been asked to identify a picture for instance and hasn't understood what was being asked of him or not known what the picture was.

Is this how the test works or does it not rely on the child answering correctly?

thanks cheeky

Hi buriedunderchocolates,

In Scotland the screening is done using a picture test OR a matching letter test. But in my department we would always practice the "game" first so that we know what a child can and cant do. With the picture test we make sure they can name all the pictures before we start.

You might find once you go to the appointment they just wanted to recheck your LO's vision. There is always a number of kids that just need another go at the test a few weeks/months later to get the hang of it.

Bump

Cheeky, I have a question but it relates to an adult.

Monocular diplopia but there isn't a firm diagnosis. Nothing appears to be wrong with the eye nor is there any sign of underlying illness e.g. nerve etc. Definitely in one eye, does show some variation in the degree of severity (i.e. the extent to which double vision occurs), loss of ability to do fine-detailed work as cannot visually resolve the detail.

Original diagnosis was possible cataract as nothing else could be seen, then became the lens is ageing faster than is should and is less flexible.

Do you have any suggestions? I am at my wits end some days... it's frightening to suddenly lose good eyesight. I am dominant in one eye (the one which is giving all of the problems), to the point that I cannot read with the other eye alone, and have no stereo vision.

Forgot to add... great thread and so helpful to many, many parents

and

Hi again, the hospital now want DS to wear a patch for 2 hours per day over the squinting eye. This is proving very difficult, we are managing around 20 mins per day tops. he's only had it a week, but any good tips? Have tried bribery!

Another question I have is, if DS has his glasses on can he see perfectly faraway with them? The reason I ask is that if I look through them, I can see close up things ok but far away is very blurry.

are you sure it is supposed to be worn over the squinting eye? DD's squinting eye was the one with poorer sight and she had to wear a patch over the non-squinting eye.

Oh yeah, sorry that's what I meant!! It's the good eye that the patch goes on.

Tired today!

Hi cheekyginger

I posted earlier on the thread about DD who was undergoing patching and you gave some good advice. We had our final visit to orthoptist this week and after 3 static visits have now stopped patching with her weak eye only able to see the 4th line on the chart and no BV. We have accepted this and were quite glad to be finished the patching after 9 months or so.

Unfortunately we had DS (just turned 3) at the optician for an eye test yesterday and his vision has deteriorated since last year (around +4 in both eyes), and he is now showing signs of a lazy eye :(. We have to go back in a week for drops to get a proper prescription which the optician is estimating as + 6 in one eye and +8 in the other. We have resigned ourselves to having to go through the whole process again with DS, who hopefully will adjust to glasses/patching with few problems as he's seen DD go through it.

I am really hoping that as he has been caught earlier than DD we will be able to achieve BV (which he doesn't now have but we think he might have had it earlier as he has developed balance which DD never had).

In your experience do children treated earlier and with a smaller gap between the 2 eyes have a better chance of achieving BV with patching?

Thanks
BB

Hi Mamakoukla,

DO you mind me asking what age you are?

Cataracts can cause monocular double vision. The light going into the eye gets "split" as it passes through the lens and can result in double vision.

You say you have no stereo vision. Have you had problems since childhood? If you have a dominant eye you might be able to get referred to discuss cataract removal if it is interfering with your everyday life. Their are risk associated with cataract surgery but if you feel it is stopping you functioning then the Dr's may consider removing the lens???? If you want more information please PM me anytime...

Hi Wanksock,

Patching.....Patience is really important!!!!! Try and gradually build up to the 2 hours over a couple of weeks. Each day try and do 5 mins longer. Get some kind of silly timer that will count down for him, and make a big deal when time is up.

Try and have "patch time". Have a box of toys that he only gets when he gets his patch on and make it a fun time. Colouring in/aqua draw mats anything that is a distraction will help.
Cant remember what age your DS is, but you could let him watch TV with it on . TV doesnt damage your eyes as some people seem to think!!! (Some of the crap i watch might damage my brain though! )
A sticker chart?

Main thing to remember anytime with the patch on will help....dont get too disheartened is you dont manage your goal everyday

Hi cheeky
An update to my previous post regarding my one year old son,he has had his first appointment and the woman said yes it is very likely to be Duane's Retraction. He will have further tests in March to rule out unlikely possibilities etc.
Thanks again :)

Oooo forgot to add....yes wanksock he will be able to see faraway with them, its just that you probably have normal vision therefore they will blur your vision!!

Hi BirdyBedtime,

Bet you are glad you DD has finished the patching!

As for your DS. Does he attend the hospital eye service? (In Scotland we have opticians in the NHS and private that's why i ask). If not he should really be referred. Children at this age need to monitored by orthoptist's who specialise in squints/lazy eyes etc. If children have an underlying squint they have to be in their strongest prescription to prevent the squint from breaking down and losing their 3D vision. The prescription sometimes reduces with age. Just to add i really dont anything against opticians my DH is one!!

Was your DS given the +4's last year? Hopefully your DS might get away without needing any patching....fingers crossed.

Hi IQuiteLikeVodka,

Thanks for letting me know. It's good know i'm making some sense!

It will become a party trick when he is older!!!

Hi MrsPort TMI ALERT!!!

Your poor wee DS has been through the works!! A sixth nerve palsy at his age is very rare therefore the Dr's may have limited experience with managing such conditions.

Here are my answers for your questions:

1. Surgery is carried out for one of two reasons. To make the eye look better OR to make the eyes function together and strengthen 3D vision. Surgery does not improve the vision.

2. There is only a certain number of time an eye muscle can be operated on, as they are so small even in adults. After surgery some degree of scar tissue will build up making future surgery on that muscle unpredictable. So I have to agree with the orthoptist. (And our consultant would say the same thing as me!)

3. We would reduce and stop the patching, and monitor the vision. If it drops by less then one line of pictures then it stays off. We would only restart patching if it dropped significantly.
   Patching can be done up until the age of 8 when the visual centre in the brain becomes less "plastic". Have you been given a rough verbal treatment plan? When do they plan to stop the patching?
   
   As for double vision, does your DS complain of double vision??? I would have thought he wouldn't experience double vision. The brain does "shut off" the eye but this is temporary and it's called suppression. The suppression prevents children from getting double vision when the eye squints and this can cause the vision to get lazy in children. If you have a nerve palsy as an adult you get double vision but the vision doesnt get lazy as the cells in the brain are fully developed.

4. He should be able to have further surgery to straighten the eye. If he does have double vision then he should adapt to it and it shouldn't affect him to much in day to day activities. Unless he has something wrong with the eye itself he should not go blind!!

IMO you might benefit from a 2nd opinion. When you describe the surgery it sounds as though only one muscle was operated on. If this is the case i am really surprised. It not wrong it just wouldnt be enough....
In nerve plasies that do not recover, transposition surgery is required to help maintain the eye position. This type of surgery uses other functioning muscle in the eye to help the weaker one. It is not a surgery often carried out on children.

You can pm me if you want any more info. Do you live in Scotland? Our consultant receives referrals from all over Scotland for 2nd opinions if you are...