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Eye Care Archive (Expert Forum)
Accommodative Esotropia - Lazy Eye in Toddler?
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Accommodative Esotropia - Lazy Eye in Toddler?
by rcf0106, Jul 05, 2006 12:00AM
We took my 35 month old daughter to the pediatric opthamologist, who diagnosed her with accommodative esotropia. She seemed to have a lazy eye for the last 2-4 months and we wanted her evaluated even though the pediatrician thought it was not a problem.
Apparently she is quite farsighted in her weak (left) eye. The doctor prescribed bifocal glasses (+3.50 OD, +4.50 OS, Add 12.50)
My question is - will the glasses correct her eyes? Or is she looking at a lifetime of glasses from here on out? Will she always need bifocals? Is it too late to make the correction permanent or will she suffer binocular vision loss? Will she always have the lazy eye? The glasses seem to make the lazy eye go away.
Is her vision now 20/20? 20/80? 20/200? What was it before?
We are due to go back in 2 months for a follow up. Perhaps most surprising to me is that she LOVES her glasses! It makes me think her vision must have been so terrible before that these are providing a real benefit to her that she does not in any way resist wearing them.
Apparently she is quite farsighted in her weak (left) eye. The doctor prescribed bifocal glasses (+3.50 OD, +4.50 OS, Add 12.50)
My question is - will the glasses correct her eyes? Or is she looking at a lifetime of glasses from here on out? Will she always need bifocals? Is it too late to make the correction permanent or will she suffer binocular vision loss? Will she always have the lazy eye? The glasses seem to make the lazy eye go away.
Is her vision now 20/20? 20/80? 20/200? What was it before?
We are due to go back in 2 months for a follow up. Perhaps most surprising to me is that she LOVES her glasses! It makes me think her vision must have been so terrible before that these are providing a real benefit to her that she does not in any way resist wearing them.
Doctor's Answer
by Forum-OD-MP, Jul 05, 2006 12:00AM
"My question is - will the glasses correct her eyes?"
um, thats a trick question. i am not trying to be nitpicky, but it depends on what you mean by "correct her eyes". what the glasses *will* do is give her a clear image in each eye with the same amount of focusing power and the correct ALIGNMENT, so that each eye can go through normal retinal development and hopefully avoid having one "weak" eye ("refractive amblyopia") later. what the glasses will NOT do is make her less farsighted. in fact, they may even make her *MORE* farsighted at the beginning, but believe it or not that is a good thing. its called making a "latent" Rx into a "manefest" one, and trust me thats what you want.
"Or is she looking at a lifetime of glasses from here on out?"
you are likely looking at full time glasses from now on. she may be able to have a refractive surgical procedure like LASIK after she's 18.
"Will she always need bifocals?"
possibly. she will probably always need glasses, but maybe/maybe not on the bifocals. as an aside, i think she's probably wearing a +2.50 add power, not a +12.50...
"Is it too late to make the correction permanent or will she suffer binocular vision loss?"
no, not too late. she's not even 3 yet, right? plenty of time. the generally accepted "critical period" for retinal/eye development is up until age 8. as long as she wears them 24/7
"Will she always have the lazy eye? The glasses seem to make the lazy eye go away."
again this is kind of a trick question. agreed that with the glasses on she is probably ALIGNED (eyes look straight) and with them off the left eye turns in, but wearing the glasses does not make her any less farsighted in the left eye. she will probably always be more farsighted in the left eye and less farsighted in the right eye. but again, with full time spectacle wear she'll at least have normal retinal development and likely 20/20 in both eyes. no way will the left eye be 20/20 later if she doesnt wear the glasses now. the left eye will very likely end up with refractive amblyopia if she does not wear the glasses full time.
"Is her vision now 20/20? 20/80? 20/200? What was it before?"
i have no idea. it depends on so many factors:
1) what her "manefest" rx is vs what rx she is wearing
2) how "deep" is the current amblyopia if it even exists yet
3) how often and by what degree her left eye points "in" now
etc etc.
this is all stuff that was likely measured at the time of her exam so you'll have to ask the doc. i cant tell you unless i have examined her. and the doc may be just estimating some of that as well. 2.5 year olds dont generally help the doc a lot during the exam...
the reason she loves the glasses is b/c with them on she doesnt have to work nearly as hard to see, and she likely doesnt see double thru them (she likely does see double at least part of the time w/o them). having an Rx of +4.50 is like an adult carrying around a 50 lb weight all the time. just b/c you physically *CAN* do it, doesnt mean you like doing it.
um, thats a trick question. i am not trying to be nitpicky, but it depends on what you mean by "correct her eyes". what the glasses *will* do is give her a clear image in each eye with the same amount of focusing power and the correct ALIGNMENT, so that each eye can go through normal retinal development and hopefully avoid having one "weak" eye ("refractive amblyopia") later. what the glasses will NOT do is make her less farsighted. in fact, they may even make her *MORE* farsighted at the beginning, but believe it or not that is a good thing. its called making a "latent" Rx into a "manefest" one, and trust me thats what you want.
"Or is she looking at a lifetime of glasses from here on out?"
you are likely looking at full time glasses from now on. she may be able to have a refractive surgical procedure like LASIK after she's 18.
"Will she always need bifocals?"
possibly. she will probably always need glasses, but maybe/maybe not on the bifocals. as an aside, i think she's probably wearing a +2.50 add power, not a +12.50...
"Is it too late to make the correction permanent or will she suffer binocular vision loss?"
no, not too late. she's not even 3 yet, right? plenty of time. the generally accepted "critical period" for retinal/eye development is up until age 8. as long as she wears them 24/7
"Will she always have the lazy eye? The glasses seem to make the lazy eye go away."
again this is kind of a trick question. agreed that with the glasses on she is probably ALIGNED (eyes look straight) and with them off the left eye turns in, but wearing the glasses does not make her any less farsighted in the left eye. she will probably always be more farsighted in the left eye and less farsighted in the right eye. but again, with full time spectacle wear she'll at least have normal retinal development and likely 20/20 in both eyes. no way will the left eye be 20/20 later if she doesnt wear the glasses now. the left eye will very likely end up with refractive amblyopia if she does not wear the glasses full time.
"Is her vision now 20/20? 20/80? 20/200? What was it before?"
i have no idea. it depends on so many factors:
1) what her "manefest" rx is vs what rx she is wearing
2) how "deep" is the current amblyopia if it even exists yet
3) how often and by what degree her left eye points "in" now
etc etc.
this is all stuff that was likely measured at the time of her exam so you'll have to ask the doc. i cant tell you unless i have examined her. and the doc may be just estimating some of that as well. 2.5 year olds dont generally help the doc a lot during the exam...
the reason she loves the glasses is b/c with them on she doesnt have to work nearly as hard to see, and she likely doesnt see double thru them (she likely does see double at least part of the time w/o them). having an Rx of +4.50 is like an adult carrying around a 50 lb weight all the time. just b/c you physically *CAN* do it, doesnt mean you like doing it.
