7 Year old seeing spots and flashes

[eyehelp]

My son just turned 7 years old.  Over the last two weeks, he has stated that he sees spots and flashes.     During a vist our optomotrist, she asked him further questions.  He stated that he sees spots, of various colors. SOmetimes they blink on and off rapidly. They are too many to count.  When he moves his eyes to look to each side, and especially to the outside and down, he says he sees flashes.   It appears from asking relative questions (age appropriate) for how long that he has been experiencing these flashes and spots that it has been for many, many months, possible years.  

During the last 3 months, his eyes have been examined and dilated by both an opthamologist and an optomostrist with findings from both that the eyes are "normal".     They were also dialated over 2.5 years ago with findings that eyes are "normal"

Please, please, advise me where i can go from here.  I am very concerned about my sons vision, and have been to several top notch opthamologist and optomotrists in the area during the last 3 years.  Reports are the eyes are normal.  Optomotrists have recommended vision therapy for convergence. We have done this, but the discussion of spots and flashes is new.  I believe as he is getting older, he is more capabable of explaining what he is experiencing.

Thank you so very much for any guidance you can provide on next steps, additional testing, etc.

[John C Hagan III, MD, FACS]

The evaluation of children and teenagers is often very difficult and requires skill, expertise and experience. Nevertheless the fact that at least a couple of years have gone by and nothing serious has developed and that several eye examinations have been normal should be very reassuring.

In my opinion 'Visual Therapy'-- almost always done by non-physician, limited scope providers (optometrists)--  is ineffective, for the most part scientifically unproven and inordinately expensive (I have had parents come to me after spending over $10,000 for visual therapy--usually for 'reading disorders', without benefit). In any case visual training is totally inappropriate for you child.

The 'full court press' for evaluating reduced vision in children and unusual visual complaints can be extremely expensive, time consuming and intimidating to child and parents. This evaluation might include neurological consultation, EEG, MRI, VER, ERG, etc etc.

This is a generalization and not specific to your child. Many problems and complaints in children and teenagers come from conscious or unconscious efforts to get attention or manipulate their parents. Another is acute awareness of entopic phenomena (as discussed on these eye forums many times).

I would recommend you discuss this problem and the previous eye examinations with your pediatrician or family doctor. One course of action would be 'watchful waiting' to see if anything new developed or the present complaints worsened. (in that case it might be good to not dwell on the childs observations).

The other course would be to see a pediatric ophthalmologist, either one in private practice or on the faculty of a near by medical school AND a neurologist.

Your child does not sound like a classic case of anything but some of the considerations in children with strange visual symptoms: childhood migraine, atypical seizure disorders, heart/brain circulation disturbances. Again not to worry you, your child is not typical of these problems.

The most likely causes for children with these complaints are usually: 1. hyperacute awareness of entopic phenomena  2. vivid imagination/conscious or unconscious manipulations of the child-parent-physician relationship by physical complaints.

Hope this helps you.

JCH MD

[eyehelp]

Thank you so much for your thorough response.  

I do believe that my son is experiencing abnormalitites in his vision.  He is not a child who complains, looks for excuses not to do things, etc.  He never complains about his vision or eyes, or is disagreeable.  He is reading at least at a second grade level.  

I have observed for years however that he seems to struggle at times with his vision.     I do not want to subject him to MRI etc. that can be very intimidating for an adult much less a child and have him feel there is something really wrong with him.  However, I do want to get to the bottom of this.   The opthalmologists we have been to have been pediatric opthamologists.  I have read a bit about pediatric neuro opthalmologists.  Would this type of physican be able to address our concerns in more depth than a regular pediatric opthalmologist?  

[John C Hagan]

Pediatric ophthalmologists have special training in addition to the arduous and extensive medical training every ophthalmologist ( Eye MD) must accomplish.

If you are determined to seek more opinions/consultations then you can try a neuro-ophthalmologist.  There are not too many pediatric neuro-ophthalmologists. If you can locate one it might be worth some more peace of mind to consult the individual. Probably you will need to look at a tertiary pediatric medical care facility.

If you find something in the way of definite diagnosis please post to my attention (JCH MD). I'm not a better person but if I was I would bet things turn out just fine for your son and nothing of consequence shows up.

JCH MD

[James4emily]

A related discussion, colored spots and flashes was started.

[MTMD]

A related discussion, UPDATE FROM DAD  *** WITH DIAGNOSIS *** was started.