4 year old with mild astigmatism ... need for glasses??

[Pamcakes515]

My daughter just turned 4 this month and was referred to a pediatric opthamologiat for recurring chalazions..... after a check up visit to make sure the compresses has worked they did an eye exam. After refraction with drops she found an astigmatism of .75 in left eye and 1.5 in right eye. She wrote a script for the right eye to address the astigmatism . Do you think this is necessary? Or can my daughter still be growing and be reduced naturally toward 1 or lower diopter ?

[Pamcakes515]

Thanks for your response. Typically how long can a chalazion affect
Astigmatism. It was beginning of May when it was pretty large closing half of her eye almost. It has since resolved witthba small circle still slightly visible. I’m concerned what if this astigmatism of 1.5 is due to that. Would waiting 6 months and retested be ideal?

[JohnHaganMD]

There is a limitation to what we can and can’t tell in this forum and that is one of them.  It would take looking at the size of the chalazia  and evaluation of things such your child’s tendency to favor one eye over the other, any minor strabismus problem. That’s the long answer, the short answer is I can’t tell.

[Pamcakes515]

After today  I’m still confused
My daughters script is
OD +1   - 1.25    5
OS.   0     -0.75.  136

Doesn’t this seem mild to be prescribe a 48 month old glasses?
Is the difference between eyes large enough that it can correct as she grows naturally??

[JohnHaganMD]

Without glasses the vision in your child’s eye will be much more blurred then the left eye and she is at high risk of  amblyopia or the eye not seeing well the rest of her life. Since you have seen 2 ped ophthalmologist and they both agree she needs glasses the question is not whether she needs glasses but what the correct RX is.  Since one felt no astigmatism in one eye should be prescribed the one (you posted) is likely correct. Your child will need glasses for many years to grow up with healthy eyes. You should be glad you caught this early.  Waiting on glasses is not doing your child any favors.  

[Pamcakes515]

Isn’t the second number the astigmatism? Isn’t the RX for 1.25 astigmatism and the left eye .75 astigmatism.  I thought the right eye was 1 Sph and the left has none

[JohnHaganMD]

That is correct. What you said in a previous post is that one of the ped ophthalmologist wrote RX for no CYLINDER  NOT SPHERE. You did not post full RX until now.  Nevertheless if both Peds Eye MD wrote same RX for RE and LE astigmatism (cylinder) and the spheres were different then there is a significant difference in the two prescriptions.  The astigmatism is the second number (cylinder) and the third axis.  Also makes a big difference if the cylinder is written in plus cylinder or minus.  So if the two prescriptions are written in different forms ( one plus cylinder and the other minus) the RX could be almost the same if both written in the same form (Think of it like your weight in lbs and your weight in kilograms. The numbers look different but the weight is the same).  

[Pamcakes515]

These are the three scripts I received from 3 different drs. I sought 3 opinions..

OD: Plano =+1.25 x100
OS: -.75 =+O.75 x080

OD : +1.50 -1.75  180
OS : Plano

Third was one I posted today
OD:  +1.00  -1.25. 5
OS: 0.o   -0.75    136


What do you make of these three RX? Are the similar?

One RX the dr wasn’t not prescribing anything for left eye

[JohnHaganMD]

There is very little difference in the glasses RX between #1 and #3 when you convert #1 to minus cylinders. It looks like this. RE +1.25 -1.25 X 10.  LE 0.00 -0.75 X 170.     Give your child’s age and the difficulty examining an infant these are very close.  Even # 2 is ‘in the ball park” if the child was extremely non-cooperative.   All 3 agree your child needs glasses and its time for you to get on board if you are serious about your child’s vision. All 3 felt glasses are needed.  You should make up you mind you are going to be spending a lot of time over the next 10 years in one of their offices. Suggest you pick which of RX # 1 or 3 you like best. Get the glasses and work with that pediatric ophthalmologist.   Also if you have other children they should be checked by the Peds of your choice.  If you have subsequent children they should be checked very early 6-12 months as these problems tend to run in families.

[Pamcakes515]

Thank you for your time and response. Based off the scripts I showed you would you say this is significant ?

[JohnHaganMD]

Yes I would be the 4th ophthalmologist that says you should not ignore this.

[Pamcakes515]

Thank you for the reply. I don’t plan on ignoring .  I’m looking to better understand the issue. One eye is good and the other is weaker. In isolation the weaker eye wouldn’t qualify for glasses at this age independent of the difference between each of the eyes?

[JohnHaganMD]

Pancakes: I don’t have much more sto say. You have been over this with 3 pediatric ophthalmologists and this is a long timecomunsuming  discussion.  BOTH EYES NEED GLASSES.  At this point I’m signing off. Best of luck.

[Pamcakes515]

Thanks

[JohnHaganMD]

You are welcome.

[JohnHaganMD]

The amount of astigmatism may increase or decrease with time not possible to tell. If the eye doesn’t get a clear image it may not develop full vision *(amblyopia)

[JohnHaganMD]

The amount of astigmatism may increase or decrease with time not possible to tell. If the eye doesn’t get a clear image it may not develop full vision *(amblyopia)

[JohnHaganMD]

I can’t really determine if the glasses are necessary. It is important to know that chalazia if large can themselves cause astigmatism.  Second if glasses were prescribed than the normal thing would be to correct the astigmatism in BOTH eyes.   If you have access to a second pediatric ophthalmologist you might seek a second opinion.   If there is a family history of strabismus and amblyopia in your family (or the child’s father) then it is more likely the glasses would be indicated.

[Pamcakes515]

Thanks for your reply. The chalazions would alternate back and forth between eyes. The most recent was upper right eyelid and had her eye half shut for about a week. It pretty much went away a few weeks ago. I still see a small circle where it was. Not sure if this can still have an effect on astigmatism.
I did go for a second opinion and the astigmatism was noted to be around the same .75 left eye and 1.5 right eye after the drops and refraction. This second opinion did say to treat both eyes even the .75... the first doctor said .75 wouldn’t  alone warrant glasses for a 4 year old and  she was concerned with treating the weaker eye with 1.5 astigmatism. Any guidance would help. I may go for a third opinion. Not sure if this is premature as she writes well , knows her letters not numbers and has not shown any vision issues.

[JohnHaganMD]

Both the Peds ophthalmologist get about the same reading in each eye. That’s a good thing because it’s hard to get accurate exams on babies.  Both agreed treating the astigmatism in the RE should be done. NOT treating the amount in the other eye doesn’t make sense at all so the RX that the second Peds would write with astigmatism RX in BOTH eyes is what makes sense not only one eye. If you need a third opinion that’s fine.    Ocusoft eyelid cleaner wipes (over the counter) or foam are good for chalazion prevention.