Q&A about children's eye health with optometrist Simon Kay - ANSWERS BACK

[RachelMumsnet]

We're inviting you to send your questions on children's eye health to optometrist Simon Kay this week. Send your questions before Monday 10am on Monday 22 April and we'll post up his answers on 2 May.

Simon Kay BSc(Hons) MCOptom has been a qualified optometrist for over 30 years, and has a vast experience of almost all aspects of optometry. He joined Specsavers Opticians in 1993 first in Liverpool and for 15 years as a director of Lancaster and Morecambe. He served on many panels and committees whilst a director, including those responsible for IT design and professional advancement. He was regional chairman of the North West directors of Specsavers for over 12 years and as such was involved in almost all aspects of optometry on a business and professional level. He has been involved on the Local Optical Committee for many years and is currently Vice Chairman in his area.

This Q&A is sponsored by specsavers. Read more about children's eye problems.

[SimonKay]

@BreadAndJamForFrances

My DS is 9 and has worn glasses since the age of three. He also has Ehlers Danlos Syndrome Hypermobility Type (a collagen disorder which affects his muscle tone as well as his joints and skin). He has a very slight squint in one eye when he is tired.
His prescription is -9 and -8.5. I have been told this is 'significantly short-sighted for a child his age' in a concerned voice by his ophalmologist.
At the moment, his sight loss seems to be slowing down, but he is really struggling to see well close up (with his glasses on) so he is holding books/DS/Lego/etc 2 inches from his face. Although his distance vision is okay (with glasses).
I feel he would benefit from wearing reading glasses/varifocals/bifocals.... however, I am told this is not an option for children. We are currently waiting for another appointment, where I'd like to try and find a solution. I am wondering if the eye muscles are maybe to blame for him not seeing close up even with glasses - you can see he/his eyes struggle to focus, but on examination this is not seen. He lifts his glasses up and down, trying to find the best position, and is now resorting to looking under his glasses rather than through them. I should also say, he gets awful headaches which have been suggested to be Suboccipital headaches, and, is being investigated for a kyphosis/lordosis in his spine due to the hypermobility, I have two other children, one with perfect vision, one with -4 and -4.5 who has 2 yearly examinations, with hardly any change.
Thankyou.

Ehlers Danlos Syndrome can affect the eyes in many ways, so I am pleased he is under the care of an ophthalmologist. Accommodation, that is, the ability to focus at near as well as distance is usually very active in children, and is where the natural lens in the eye contracts and relaxes subconsciously to focus at all distances. Reduced accommodation is therefore very rare in children but is not unknown, and I have come across a few children that require a different prescription for reading. However, this problem can be associated with your son's syndrome. So I think you could be correct in at least investigating the possibility that he may well benefit from a different prescription for reading, either a separate pair of glasses, bifocals or varifocals.

[SimonKay]

@frankie4

My ds aged 8 has been diagnosed with a fat prolapse on the edge of one eye. This seems so rare that I can't seem to get much information on it. Have you ever seen one of these on a child? And do they lead to any problems in the future?

They are not uncommon in adults but I have never seen this in a child! From what I understand it should not cause any major problems in the future, however you do need the opinion of an ophthalmologist for the prognosis and possible treatment.

[SimonKay]

@CheeryCherry

Hi my 12 year old DD was diagnosed with astigmatism and was given glasses which do not seem very strong. The first optician said she should wear them whenever she reads, uses screens etc. Recently a different optician said she should only use them when she needs them. Who is right? And is it true that this condition may be corrected as she grows up? Thank you.

This is difficult to answer without knowing her prescription. It is important to inform very young children and parents as to when to wear the glasses, but at her age now she may be old enough to decide for herself when it is most appropriate. Prescription?s for astigmatism will blurr the distance as well as near and if the prescription is only small it may be appropriate to wear them when she is concentrating on more visually demanding tasks, like reading and computer work and perhaps for television.

[SimonKay]

@thornrose

My dd is 13, she has glasses but it is a daily battle to get her to wear them, except at school where she has no choice as she can't see the board!
She has AS and dyspraxia and she would love contact lenses but will struggle to manage them herself (poor motor skills, poor organisation and memory)
I've worn lenses for many years and would happily take over her lense care until she is able.
She has very low self esteem and lack of self confidence, she is so very unhappy wearing glasses. By refusing to wear them she is restricting her independence, crossing roads etc.
Would any optician allow her to wear lenses without being able to insert and remove then herself?

Obviously this is not ideal as if she was out and about and on her own and needed to remove them because of irritation, she may run into difficulties. However, in her case the benefits may outweigh the disadvantages and it would be appropriate to discuss this with the contact lens practitioner to see how he or she feels about trying lenses with you inserting and removing them for her.

[SimonKay]

@alwayslateforwork

Dd2 had a squint dx at 3 mos (she was an HIE baby and was later dx with cerebral palsy). At the time, the consultant said this was nothing to do with her developmental delays, and it would be monitored, and the earlier she had surgery (probably around 18mos) the better, to ensure her vision developed correctly. (Alternating converging - and you can't patch alternating, which is why patching not an option).

However, as her disability became more noticeable, the eye folk became less and less interested in corrective surgery, and actually told me that it wasn't worth it, would be largely for cosmetic reasons, and essentially that her squint would return after surgery, as it was largely connected to her cp and motor difficulties.

We believed them, because, well, you do, don't you. She has worn glasses since she was a baby.

We emigrated when dd2 was 7, and the ophthalmologist that we registered with was frankly horrified. He was at a total loss as to why she hadn't had corrective surgery years before, said the treatment should have been the same regardless of disability, (barring any expected complications with anaesthesia - which we didn't have in dd2's case) and booked her in for the surgery as soon as possible, explaining that we were pretty much out of time for her to ever develop normal binocular vision as the surgery had been left far too long.

The surgery was a complete success in cosmetic terms - her eyes are now straight and move together. We are hoping that binocular vision is developing.

I would be interested in asking Simon Kay whether he feels that children with disabilities are left with a second-class service in terms of treatment of vision issues in the UK?

Certainly I was left feeling rather short changed by the NHS in this regard, in comparison to a country where the same treatment guidelines were in place regardless of disability... And would urge other parents to query similar decisions. If we were still in the UK, dd2 would be entering her teens with eyes pointing in different directions. Thankfully, we left in time.

I am uncomfortable with the idea of cosmetic surgery to conform to a norm - but I am even more uncomfortable that children with disabilities are not afforded the cosmetic option alongside their nt peers.

I am disappointed to read that your daughter did not appear to have the appropriate treatment when she was younger, and am very pleased that her operation has been a complete success. As with any health related condition, the opinions of specialists can vary from one to another, and it is natural to put your faith in the hands of a professional. In my experience I have never personally come across any deliberate poor treatment of children with disabilities.

[SimonKay]

@KathySeldon

HI
When ds was discharged from eye hospital care into regular optician care at age 8, his binocular vision was just starting to develop. Can binocular vision continue to improve past this age? He is now nearly 11.
thank you.

The development of binocular vision is dependent on the two eyes working equally and together at an early age. It is generally regarded that by approximately the age of eight no further significant improvement can be made. The degree of binocular vision, measured using stereo (3D) tests can however, in some children, often improve beyond this age. At his next eye test you could ask the optometrist to measure this as they all have the required equipment.

[SimonKay]

@Queenmarigold

My little one had a squint caused by brain surgery. It hasn't improved despite trying to patch in 2 years, although surgery has straightened it the vision is poor. Should we continue to patch, we are only just now getting to the point where we are achieving weartime recommended by hospital with the help of school. Patient compliance (aged 5) is a major problem and makes us all totally miserable, I'm wondering whether we have to make the decision to live with it

I sympathise as patching can be quite a chore and very frustrating, and when the child is old enough to cooperate it may be too late! Also if the eye is very poor, they may not accept the limited vision even for a very short time. You decision should be based on how much improvement has taken place in the last two years, and the balance between the relationship and family life with your child and the potential benefits, which may be limited.

[SimonKay]

@AnonYonimousBird

My DD had her tear ducts cleared aged nearly 3. It was quite successful, in that it meant she wasn't constantly streaming from her eyes (which was both uncomfortable and causing her skin on her cheeks in turn to become sore). She teared a bit for a while and then it massively slowed down.

However, she is now 7.5 and she mentioned something the other day about needing to wipe her eyes regularly. Clearly, with her being at school and so much more independent, I haven't really noticed this - but if it is bothering her, should I take her back to the specialist? I had assumed that as she grew, her ducts had also grown and would make tear flow easier? I wonder what might have triggered it again.

Thanks.

It is possible that her puncta (the little holes in the corner of the top and bottom lids) are narrow or perhaps the tear ducts have again become blocked. She of course, just has very sensitive eyes with more water than average, but if the problem persists I agree it would be beneficial to have a specialist?s opinion. Her optometrist or GP can arrange for a referral.

[SimonKay]

@impty

Hi,
Dd1 is 15 and would like contacts. Her first fitting wasn't very successful, and she has gone off the idea. I am inclined to encourage not going back as I am concerned about contacts and eye health! Should she persevere? Or is waiting until she's older better? The contact lenses are just for vanity, not for sport or anything.
TIA
Impty

I think that at her age the decision should be hers alone, provided she is well informed about the risks and benefits. Contact lenses are generally very safe, providing the child follows all the instructions on handling and is willing to adhere to the strict hygiene necessary to minimise the risk of discomfort and infection. If she has gone off the idea, I don't think it is worth perusing for now!

[SimonKay]

@Jux

dd has been wearing contacts for 2 years now, since she was 11. Her reason for avoiding specs was that she would be bullied (true). I asked the optician about contacts for one so young and the only concern was cleanliness. As I knew dd would be very careful, we went ahead.

Now I have done a MN questionnaire which implies that contacts carry much graver concerns than that (I might be adding 2 and 2 and making 5 though).

What are the problems with contacts?

Children usually do very well with contact lenses, which over the years have become safer because most are now disposable, the materials better and the contact lens care solutions more efficient and easier to use. There are of course risks, but these can be minimised by adhering to the prescribed wearing schedule and strict hygiene to minimise discomfort and the risk of infection. She should have regular contact lens check-ups according to her practitioner?s recommendations which are designed to spot issues with the eye before they become a problem. This will all ensure that her eyes should remain healthy and that she continues to enjoy wearing her contact lenses for many years.

[SimonKay]

@Racers

Hi Simon, you were my and DH's optician until a few years ago - clue is in the nickname if you're good at remembering your clients/patients. :-)

My only question is if our children's sight tests in Reception year at Primary School came back as normal and we have no concerns about their sight, at what age should we start taking them for full eye sight tests, bearing in mind DH's poor eyesight from a youngish age?

It is nice to hear from past patients! It is reassuring that the results of her eye screening at Reception have come back as normal, but it does not cover all aspects of her vision and eye health, so I would recommend a full eye-test at your chosen opticians and then on going check-ups as your practitioner advises. Eye tests are free for children through the NHS.

[cheekyginger]

Well said barleysugar!!!!

Thats really really really sneaky advertising [shocked]!!!

If you would like a non-sponsored opinion from an Orthoptist please go to my thread on lazy eyes, squints, glasses etc... I have 13 years of experience and work closely with one of the top Ophthalmologists in Scotland.

No offence to Simon Kay

[BreadAndJamForFrances]

Thank you so much Simon Kay for taking the time to answer my question, the information is very helpful.

[Jux]

Thank you, Simon Kay. I am much reassured!