Vision/squints/ deciphering Moorfields again ...

[skewiff]

We've been to Moorfields again today with DS.

They are getting busier and busier with less and less time for each person. So I come away even more confused each time.

What i would like some help with is the fact that DS who has left sided hemiplegia and a squint - has always been able to see better out of his right eye than his left.

At times they have got us to do patching, at other times not. Today it was very clear to me that he could see a lot better out of his right eye. However they've said not to patch yet. To check again in 3 months time.

What I am most confused about, however is the fact that DS's prescription is exactly the same in each eye. So its +2.50 in each eye with a tiny adjustment for astymatism in each eye (again exactly the same for both).

Why is the prescription exactly the same in each eye when it is so clear that he is seeing better out of one eye than the other?

Have you got a number for them? PALS maybe?

I go to Moorfields for my contact lenses where we are given plenty of time but I know that the main clinics are nightmarish. I don't know anythign about patching but I know that I see better out of my right eye and that is -14 and the right -15. I can see a clear difference between the vision between the two.

Yes, I do have a number for them and will call. I just was impatient and wanted a quick answer!

However I'm going to complain to PALS anyway because we were treated very badly today. We spent from 10am there and left at 3pm. During that whole time my son must have spent about 10 minutes in total with professionals. If that!

At the end they tried to give us our final summary of information in 30 seconds standing next to the reception. Normally they take you into a room with a doctor, check the back of the child's eyes and tell you what you must do when you go home.

I complained and said I could not go home without proper advice - so the doctor took us into her room and ranted to herself throughout rushed checking that she was going to leave her job, there were too many patients in the hospital and that she didn't know what the aim of it all was!

if I've got this right . . .

the prescription for the eye is nothing to do with the squint. The problem is that the not so good eye can send a conflicting image that doesn't match the picture from the good eye so the brain starts ignoring the not so good image which is why he can't see so well from it, however much you change the prescription it will have no effect on the actual vision because that relates to the shape of the eye not the way the brain processes it. Have a google of amblyopia.

Thank you Ninja - that does make more sense.

I know the glasses were just there to relax DS's eyes which would stop his eyes straining and therefore reduce the squint.

I still wonder whether we should be patching though ...

Has patching worked for any of you who've tried it? Perhaps I'll start a different thread. We've seen behavioural optometrists in the past and they say patching is a waste of time.

I find this eye business so confusing.

sounds like they've prescribed the glasses to compensate rather than patch from what you've said, sometimes the glasses can work just as well as patching. Patching didn't work for dd3 but then she has a lot going on with her not so good eye so that was no surprise. Patching worked a dream for my dd1 and she's had no problems other than a bit of long sightedness since she was 5. Couple of my friends have had good results with glasses and their kids haven't needed them long term, although they were just for the squints rather than any short/long sight issues.

DS would not be wearing glasses if it was not for his squint. The long sightedness is not significant enough.

However glasses are not changing anything with his squint. Its not getting worse though. He's been wearing glasses for about 3 years now.

I agree that contacting PALS or writing to your sons specialist to explain present management of your sons eyes is the best way forward.
I can try and guess from what you have said but of course could be guessing incorrectly. I presume that your sons eyes did or do not work fully as a pair and the eye that originally turned in(or out) does not see as well because that eye has not learnt to see fully yet. So there may be two issues to take into account. The poorer best corrected vision in the left eye and getting the two eyes to fully work together (if possible). Patching the better eye is used to give the uncovered poorer eye a chance to learn to see better. However if the two eyes are tentatively working together as a pair they may want to build on binocular vision and not want to disturb this with patching at present.
Hope you get answers and future appointments are speedier!

Thank you Magso,

How do they work at building on binocular vision? I would much rather do this, but Moorfields don't consider this at all - its just glasses, patching and operations.

Have you done the above with your children? And is it something we must see a behavioural optometrist for?

can you phone who you see for a chat?

dont worry about binocular vision, if he has a squint he will never have had and therefore will not miss binocular vision. The brain doesnt need this to get depth perception. Even if his squint were eradicated he probably would not get binocular vision, in fact impossible.

A lot of people are led to believe binocular vision is important, it isnt.

What I would be trying to find out is how much good the glasses are doing.

If there are not , then I would be patching and if you wish asking for cosmetic sqint surgery.Patching works for improving the vision but will do nothing for the squint.

Behavioural optometrists will in my opinion carry out treatments with no scientific basis bamboozling parents with a lot of jargon and charging a fortune for it.

It sounds to me that moorfields havnt taken the time to explain everything to you in terms of amblyopia. your son has strabismic amblyopia.

Hope you get somewhere!

Skew, what sort of squint does he have?

Is it completely fixed, or does it alternate? If it alternates at all, then patching is completely useless. The brain just 'sees' with whichever eye focuses on a target first. The other picture just gets ignored.

Dd2 had an alternating converging squint (I'm guessing ds's is converging), and similar prescriptions in both eyes, and cp.

In the uk, every single eye dude said it wasn't worth surgical correction because it was caused by a neurological condition (you know squints are x% more common in kids with cp, yada yada). When we moved to Canada just before she was 7, the first eye specialist was utterly baffled why she had not had the squint surgically corrected. So he booked her in for the surgery and did it. Up until the age of about 8, the brain may be able to build new pathways to get a degree of binocular vision (which we had always been told was going to be impossible for dd2 in the uk)

So, she still wears her glasses (which are obv a similar prescription to ds's - she is slightly longsighted but only wears them because of the squint - it shortens the point of focus or some such nonsense, without the eye having to do it) but her eyes are pretty much straight thanks to the surgery.

The first few days after surgery were v funny whilst dd2's brain rewired itself to the new focus. She would be desperately trying to push lift buttons four inches to the left of where they were, putting things on the table, which missed completely and sailed straight to the floor, etc etc. but of all the cp related conditions, the squint in the end was the easiest fix by far (if you exclude the 6 years of eye hospital tests and visits, and glasses, and blah. The surgery itself was fast, day case, and within a few days she was back to normal but with straight eyes.

I have a suspicion that the cp was the sole reason she wasn't offered surgery in the uk. And not because of the anaesthetic risk, but more 'why would you bother'...

Give me a shout if you have any q's.