Eye mojo, domo!
January 22, 2012 11:26 PM   Subscribe

pediatric ophthalmology; child had surgery for Infantile Esotropia, now the glasses thing.. and general questions on things around eyes

So, 2nd son was born with "Infantile Esotropia" and it was pretty bad. Hard not to laugh, even now when looking at photos (with a loving smile, of course). The Hospital for Children here was fantastic, and the Dr we had/have, who was also the surgeon, was/is nothing but fantastic, and professional. The son had surgery at 7 months or so, and that all went well.

So, now he is 4 years old. Speaking as me, a layman, his eyes are generally aligned (not cross-eyed looking), except when extra tired, or "looking up" (eyes up, head forward). He clearly sees better with his left eye, as he turns his head when looking at something at distance.

The Dr check-ups go as expected, I have no complaints about that. Last report was 0.4 and 0.2. And we bought him some glasses, per Dr orders.

There is somewhat of a language barrier though, certainly with more medical terms. So some general questions;

If I understand it correctly, there is a chance that while the child is young, his eyes can be "trained" better, but not once he is past "some age". Is that correct?

So we had better be on his case early, than letting it slide until he understand the "out come" himself?

With his glasses; he does not appear to see better with them on (like I would expect from putting on my own glasses on). Is this as expected? Can I put aside such concerns that they are wrong? Sometimes if I test his vision on something, he will tilt his head back until he can look under the glasses, to attempt to see it. Typical behaviour?

Having said that, his vision seems pretty random ;) (Possibly "interest inspired" like most children, and I'm hardly qualified) He did no better, no worse, when I printed out an eye-test and hung it on the wall, with or without glasses (at 3m). But he could read the blackboard from the back of his older brother's classroom, without glasses. Certainly loves to play minecraft on ipad, and sometimes with glasses on.

If someone has already gone through this all, or even is a professional, it'd be interesting to hear something about it, and what to expect.

I do wonder if 0.4/0.2 is a life changing situation, what about driving a car? special needs in school? and all that jazz. So far he is as chirpy as any child.
posted by lundman to Health & Fitness (9 answers total)
Here's my anecdata:
My younger sister had infantile esotropia. She never had surgery; she had to wear an eyepatch for a few months and then she was given glasses for a few years around age 3-5. She didn't seem to have anything wrong with her vision and the glasses didn't seem to improve her focus, but wearing the glasses did help her overcome her esotropia. She grew up to have perfect vision as an adult. She is now - I think - becoming farsighted, but I think that is unrelated to the esotropia (everybody in our family is farsighted). Her esotropia is now visible only when she is very tired, and only if you're looking for it, really.

So, the early treatment seems to have worked. Unfortunately, she HATED her glasses with a passion and many of my funniest early childhood memories are of my sister finding the most marvelously creative ways to throw away or hide her glasses.
posted by Cygnet at 4:19 AM on January 23, 2012

By farsighted I mean nearsighted, sorry. The kind of poor vision where you can see closeup stuff but not far away stuff. I always get those backwards.
posted by Cygnet at 4:20 AM on January 23, 2012

yep. I went though this when I was a kid. Not sure what the exact diagnosis was other than "strabismus" though what ever it was it was interesting enough that every single resident at a big teaching hospital wanted a look. I remember walking out of my every two weeks doctor visits and having cuts from the fingernails around my eye. Still hate the eye doctor. I'm 35 and the only thing health wise my wife and mother yell at me about is going to the opthamologist as I'm at greater risk for a few common complications.

No surgery but patches every night, eventually moving on to very large print books - I was extremely myopic in my bad eye as well. Like so bad that the lens on my bad eye put my glasses permanently at a tilt in every candid picture of me from 3 to 7. In hindsight comic. But early intervention is pretty important AFAIK.

My bad eye was not fixable 30 years ago, so I have very limited vision there, but my eyes track pretty much perfectly unless I'm exhausted, and even then it is quite minor. I have pretty shitty depth perception, but not so bad I can't drive - sidearm pitchers scared the shit out of me in little league though. Same with curveballs. Obviously I have pretty limited peripheral vision to one side. But at the end of the day no can tell what I had to go through

The only thing that sucked as I got older was that my high school made me wear protective eye wear for any physical activity.

As for your other questions - that's what the doctor is there for. Ask them.
posted by JPD at 5:47 AM on January 23, 2012

oh and I'm nearsighted in my "good" eye - but nothing unusual in terms of magnitude.
posted by JPD at 5:50 AM on January 23, 2012

Sent you a MeMail.
posted by wiskunde at 6:08 AM on January 23, 2012

My daughter was diagnosed with strabismus early and we went through a conservative treatment. Her eye would drift occasionally and when she was tired it would wander a lot more. We saw many specialists and considered surgery. She went through several years of exercises and eye patching, without a huge improvement.

Over time it lessened a bit, but we stuck to listening to her and very regular trips to the ophthalmologists and optometrists.

In time she got glasses for myopia but didn't wear them a lot. She said they would make her eyes more tired. Over time and as the prescription increased, she wore them more and more. We never made it an issue of forcing her to wear them. Probably by around second grade (age 7) she was wearing them full time of her own accord. Be prepared that the lifetime of a pair of glasses at that age is 3-6 months between destructive events.

As she got older, she was able to express much more about the nuance of her issues. Two years ago she moved into contacts (as teenage girls are known to desire) but she only wears them about half the time.

This last summer (she's 13 at this point), we went in for new prescriptions and she was able to articulate what was bothering her and the optometrist was able to add a slight prism to her glasses which she said was remarkable and dramatically changed how well she saw.

So I guess my point is that a child's ability to express what they see and feel continues to get better over time. It's not something you can do a tremendous amount to make correct. I found that our optometrist was best at discussing the issues with her, far better than the ophthalmologists. He has a good skill of interpreting what people say and turning it into something he can test to correct vision.

So overall, don't force anything one way or the other. Children want to see well and will wear glasses when they decide they need it. We'd see her squint at the TV and ask if she wanted her glasses, sometime yes, sometime no, we didn't make a big deal no matter how strong the desire to have her wear them was.

Good luck, I'm sure it will all turn out good!
posted by Argyle at 7:07 AM on January 23, 2012

My husband is a pediatric ophthalmologist. I've sent you a MeMail!
posted by mothershock at 7:21 AM on January 23, 2012

I started wearing glasses at 4 for severe astigmatism. I still remember the difference between no glasses and glasses, in terms of clarity of vision. I think your son would tell you if they were helping him to see better.

I had a strong prescription and an eyepatch (for a weaker left eye) when I first started with the glasses... my parents were all over me about it and as a result, I think, my prescriptions got weaker and weaker. By the time I was 10-12 the glasses no longer made a difference in my vision, but my parents still bugged me to wear them, and I pretty much did. I stopped wearing them at 16, when my right eye hit 20/20. (A few years later I started wearing a mild prescription again, because while my right eye is still perfect the left is not, and I get headaches when the difference isn't corrected.)

Obviously my case is very different from your son's, but: my parents were told that my vision would get better if I wore glasses. They made me do it, and it worked.
posted by snorkmaiden at 5:23 PM on January 23, 2012

Thank you everyone for your replies, including those in MeMail! Quite a few of you also mentioned eyes "off-tracking" when tired, so that is interesting, and perhaps "as expected".
posted by lundman at 12:23 AM on January 24, 2012

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