Divergent Squint question

[Flossie44]

Dd (12) had a divergent squint appear a couple of years ago. She had surgery last year on it which helped for about 5 days. Her muscles then pulled it back sadly.
She’s been having measurements done.

The last measurement in May was 25 diopter out, today she was measured as 40 diopters out.

So in 4 months the measurement has changed a lot.

Is this a normal deterioration with a divergent squint or does this seem excessive?

Her measurements were:

May: near 25. Distance 16

Sept: near 40. Distance 20

Can anyone explain this to me?

An increase in the divergence to me would warrant being seen again by an optician. They can always re-refer. It is important to consider and understand eye exercises too, often I tell parents to encourage three times a day knowing their child maybe will do it once a day. Better than nothing haha! Ask the optician to demonstrate these exercises to you both while in consultation. Good luck OP

Ahh thanks for your reply.
She’s under ophthalmology and is having a second surgery next month. We’ve been told it probably won’t work but go give it a go.
We do the exercise with the stick, bringing it in until vision splits etc. Also tried prisms but the prisms didn’t help.

Is 40 diopter significant or moderate? I’ve no idea of the spectrum.

40 dioptres is stiil a large squint, the re-operation rate for divergent squints is relatively high often there can be a good initial improvement with the eyes diverging again over time. Measurements will also get bigger with tiredness and this type of squint also tends to be worse in bright sunny weather. There are different types of divergent squint and it is more common for distance measurements to be bigger than near unlike for your daughter where it is the other way around. I’m an orthoptist happy to answer any questions

Oh thank you so so much. The optometrist we saw today was very cloak and dagger and didn’t answer any of my questions.

I don’t really notice her squint unless she’s concentrating on something and one eye flicks right out!

My question was what happens next..presuming surgery doesn’t work. Her future..I understand she won’t be classified as having visual impairment, despite her walking into things due to double vision. But will it stop her driving etc?

Was surgery on both eyes or one last time. With a larger squint for near you need enough surgery to strengthen the medial rectus muscles to correct the squint as much as possible . For driving the DVLA rules changed back in 2016, if you have diplopia you must inform them and they will want evidence either that it does nor occur when driving or is corrected by a prism or patch, they will normally write to the ophthalmology team for information about this, as long as the double vision can be controlled when driving you can drive a car. The rules are stricter for HGV driving. For exercises using a dot card is often more effective than pen convergence exercises you are doing so I would ask about those

Thank you so much. That’s really helpful.
Surgery was on one eye last time. I think they are going to do the other eye this time.
I’ll enquire about the dot exercises. Thank you so much