3yr old vision

Hi
My son is almost 3. During the summer I noticed his right eye turning in, especially when he was tired. I have never noticed any deficiency in his eyesight at all. When I brought him for an assessment I was told he was long sighted (+3.75) and had an astigmatism (+1.5) and a squint. I got him the prescription but he really fought against wearing the glasses, becoming almost hysterical and claiming that he couldnt see with them. Today I brought him for a second opinion. This time the prescription was +4, but the doctor said there was no evidence of the astigmatism whatsoever, and she was really happy with the test she did. She said he will have to wear a patch on his good eye when he gets used to wearing his glasses. The first doctor said the glasses alone would help to correct his squint.
So what should I do now? Does he have an astigmatism or not? Could the astigmatism part of the prescription make the glasses really difficult to wear- will they be easier for him without it? I'm really confused
Ppolly

[John C Hagan III, MD, FACS, FAAO]

Your son needs to under the care of an Eye MD physician (ophthalmologist). He should not under the care of a non-physician, limited scope eye care provider (optometrist).

He has accommodative esotrophia, the age of onset is classic and it often causes poor vision in one eye (amblyopia) and/or degenerates into a non-accommodative esotrophia that requires sugery AND glasses.

This conditions often runs in families. All your children should be screened for it by an Eye MD. If your have more children they should be check immediately if you see crossing of the eyes and if all seems normal at age 3 for a screen.

It is often difficult to get a good repeatable refraction (glasses test) in a three year old (many children in general), so that the difference in the refraction may have been that one visit the child was more cooperative. In any case your child needs glasses, probably patching and close observation till early teens.

Getting children to wear glasses, especially for farsightedness is often difficult and sometimes requires putting them on atropine drops to relax their over-used focusing muscle.

Hopefully both the "eye doctors" the child saw were ophthalmologists. If neither was take the child to a ophthalmologist (Eye MD) perhaps even a pediatric ophthalmologist. If one was an Eye MD and the other wasn't, return to the Eye MD.  If Both were Eye MDs go to the one you feel the most comfortable with.

Above all keep the child under close care of an Eye MD. Things change fast at that age. You don't want your child to become an adult with crossed eyes and bad vision in one eye.

JCH III MD