if the eye drops to dilate a childs pupils didnt work the first three times they have tried, would you attempt it again?

[misdee]

DD3 has eye clinic today. she is due back in three months and they want to possibly dilate her pupils to check her perscription. she doesnt like the drops and the first three times they have attempted these, they havent dilated her eyes at all. last time they tried a double dosage and that didnt work.

what can we reasonably do? our lovely eye nurse (who has seen all my dd's over the years and always asks after dh), has said there are other drops we could use but they need to go in a couple of days before hand, and the effects do last upto a week, so wot be nice at all.

Can the opto-wotsit(cant remember his full title) get a good look at her eyes without any dilation at all? will thius be accurate? he has done all her previous checks and she can actually see now (+9 perscription, very long sighted), but will it be perfect?

chipmonkey makes some interesting points in her post here...

I was going to say you need Chipmonkey - way out of my league.

Poor dd3 Being dilated is not nice at all.

thanks.

just really dont know what to do. she hatres having them put in, and they have never worked before now, would they work now a year on since the last attempt?

her eyes are very dark, and someone mentioned this could be why they dont work.

ds (6) has to have his eyes dilated and when he had them done last year the nurse said as he has blue eyes they should work quickly so it couldbe because they are dark.
He has another appointment in a couple of weeks I can ask if that has anything to do with it if you want?

i asked todays whoops. i just want to know whether or not to say no completely to a 4th attempt at dilating.

her eyes are almost black. i had one woman ask me in eye clinic what was wrong with dd3 eyesight, i said she was longsighted, she said she thought it was something more as her eyes are so dark. it does look like she has no iris sometimes. i laughed, and said no, her eyes are just dark.

bump for chipmonkey if she is about

bump for anyone?

My ds (6) has eye drop allergy. We found this out at his first appointment when his eyes swelled, ran and were almost shut for 24 hours. We have to have eye test every year, and the orthoptist juist sits us in the corridor in very low light for about 20 mins before the exam and this sems to work just fine without drops. Ds has blue eyes, and a right side squint.

Hi Misdee! TBH, the stronger drops which were mentioned really are not pleasant and not only would the pupils be dilated for that length of time; it's likely that her vision would be blurred for days as well. Now, on the plus side, the fact that she's so difficult to dilate could potentially mean that she'd recover more quickly than the average child so she might be back to normal in 48 hours but no-one would be able to promise you that.
I find with a prescription of + 9.00 you can actually get a better view with an ordinary direct opthalmoscope than you would with a person whose prescription was +3.00 as the retina appears smaller so you can see more of it IYKWIM.
But it sounds to me as if that's not the issue here, that it's not the dilation they're interested in so much as the relaxation of the muscles, which makes the ophthalmologists job easier as they don't need to depend so much on the co-operation of the child! I personally don't like dilating, as I think it over-relaxes the muscles and will always give a higher prescription for a longsighted child than you would get if you didn't dilate them. And I'm not convinced that prescribing these higher prescriptions is beneficial to the child as I think that it possibly hinders the eye's ability to correct itself as the child gets older. But although know a lot of optometrists who would agree with me, a lot of ophthalmologists would disagree.
If it were my own child, I would prefer not to dilate so long as the vision continued to improve but your ophthalmologist might have other ideas!

thank you chipmonkey.

she is 3years old. and quite co-operative with eye checks. her eyesights is improving with her specs, even her squint isnt affecting her sight with her specs on, so am happy in that respect. think i wil lturn down the drops completely

Sorry Chipmonkey but as a fellow optometrist I have to disagree with your advice.I have read your previous posts and agreed but a 3 year old +9.00 accomodative esotrope you are recommending to do non cycloplegic refractions on? see here This would not be considered good practice.

Misdee, I do think you should ask the advice of your own ophthalmologist/orthoptist as to why the drops are useful.The drops as chipmonkey correctly states will be to relax the muscles of the eyes which is definately the recommended way to check a prescription with your daughter's eye condition and age.Would want more information about the stronger drops that your nurse was considering though as it could be atropine which needs to be used very carefully.

stil lreading, at ther first appintment at 18months old, the drops didnt work and she was given +7 specs IIRc, and then reassessed 6months later. the next time the double dosage didnt work. 3rd time, we attempted ahain, and they didnt work.

we have to go back in 3months and see what they suggest.

it may have been atropine they mentioned, she said they need to go in a couple of days before hand, and would effect vision for around 1 week.

would you do this to your own child? i dont think i could cope with fuzzy eyesight for a week.

is there any other options?

are why dont the drops work on dd3?

Hi Misdee,

I know it is hard when people give different advice.

I would definately want my dc's to have a cycloplegic refraction in your situation (but not necessary yet as both have good vision so far despite having a very shortsighted mum!) .

Your hospital wouldn't do this unnecessarily.It is strange the drops don't work and atropine is usually a last resort because it is so long lasting and being derived from belladonna has to be kept and administered really carefully.I would want to speak to the ophthalmologist (the person in charge of your daughter's hospital eye care) about why the drops haven't worked and whether they feel atropine is the best thing for your daughter bearing in mind what is mentioned above about it.

Ring the orthoptist at the eye clinic if you can and give her your concerns and the fact you are considering having no drops and ask if they can get you an appointment to speak with her ophthalmologist.High plus prescriptions in a young child with a squint are definately recommended clinically to have a cycloplegic refraction so you are doing the best for your daughter despite the discomfort of the drops and blurred vision but your ophthalmologist will be in the best position to speak to you about it.

Is the squint fully corrected with the +9..00's Misdee? Or is there still a slight squint with the glasses on?

can you explain in v v simple terms what a cycloplegic refraction is please. am assuming this is the dilation process which the drops are meant to achieve?

its fully corrected witht he glasses on, and she passed the tests yesterday with her glasses on, with both eyes. which is good as last summer she wasnt using her right eye at all even with the glasses on, and we patched for a while.

Yes, a cycloplegic refraction is where drops are used to completely relax the muscles which control focussing. They also dilate the pupil. Children usually have a strong ability to focus , much more than adults and also often don't have the understanding or the concentration to keep looking at a distant object which is the way we get adults to relax

IF we decide to go for the longer lasting drops, will it make her eyes more senstive to light? will i need toput sunglasses on her for a week?

am just concerned at it co-incides with roughly when she starts nursery in a light and airy building.

Yes she is definately likely to be more light sensitive. See here.

tbh SRWAP, I would normally agree but given that she is already wearing +9.00's and that her squint is fully corrected and vision improving, what is likely to be achieved by atropine? ( If atropine is what the nurse meant) You would more than likely find another couple of dioptres of hypermetropia but would you actually prescribe that? I would be dubious only because no healthy eye would normally be that relaxed. ( also sceptical after some children recently came to our practice for glasses they couldn't see with or tolerate as they were overplussed, so I may have a slightly jaundiced view!)
Misdee, I agree that it probably would be worth phoning the ophthalmologist in question beforehand to see whether they feel the stronger drops are crucial.

and would those definatly work?

and the effects could last for 14days?

cani ask, if it was your child, would you do it? or is there any other alternative to these?

chipmonkey, i think they may be considering one last attemopt with the normal drops. which i dont see the point of, because if they havent worked three times before, why would they suddenly work now?

it will all be discussed at the next appointment. but need to be armed with information before i go.

this is so confusing.

Sorry, keep cross-posting! Misdee, usually the light sensitivity is worse outdoors than indoor but the main problem would be that she would have virtually no ability to focus, so normal nursery work like colouring etc just wouldn't be feasible. If it does coincidee with the start of nursery, I would be inclined to keep her at home tbh.

actually, misdee, are they sure they got the drops into the eye? Because that can be very difficult with a reluctant, squirming toddler! If they were unsure as to whether they went in, then it might be worth another attempt.

Hi chipmonkey have to still say I would recommend a cycloplegic refraction - how can you can be completely sure of the prescription otherwise?
Misdee's dd was previously underplussed at +7.00 and hopefully +9.00 is correct now but can't be sure without cycloplegic.Yes there is a risk of over plussing but have also seen plenty of prescriptions where the child hasn't had a cyclo which were basically incorrect.BTW am same age as you (had a quick look at your profile) so equally jaundiced