Astigmatism

Hello, we recently found out that my 2 yr old son has astigmatism in his right eye, his left eye seems to be perfectly fine. We actually went to two different doctors, a pediatric ophthalmologist and a pediatric optician. The first doctor said that he has refractive error and that he needs to wear glasses so that his eye can be prevented from turning into amblyopic, but the second doctor said that he has amblyopia and that patching is also necessary. We actually went with the second opinion of patching his eye and have been patching for a week now, but we are totally confused with two different prescriptions, and also whether we should continue with the patching or not. Here are the two different prescriptions:

1.
      O.D. spherical PL , cylindrical +2.50, Axis 100
      O.S. spherical + 1.00, cylindrical + 0.50, Axis 150 (No patching required)

2.
      OD Sphere Plano, cylindrical -2.50, Axis 180
      OS Sphere Plano, cylindrical -0.50, Axis 180 (patching required 2 hrs each day for 3 months)

If his left eye is totally normal than why there is a prescription for it? Also, he has been suffering from chalazia on both his eyes for couple of months, two in left and two in right eye (they are pretty small in size), I have been doing warm compress twice a day for a month now, and doctor has prescribed antibiotic drop Tobramycin, it doesn't seem like getting any better, only the redness has subsided little bit. I would really appreciate any advice on this matter. Thank you.

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

1. There's not that big of difference in the glasses. The first RX is in PLUS cylinders the second in MINUS cylinders. think of them as looking at your weight in pounds and in kilograms. The numbers are different but the weight is the same.
2. I would go with the pediatric ophthalmologist. The training and experience and scope of skills is vastly superior to the optician.
3. Generally glasses are worn for a month or two then a decision is made on patching. The schedule you were given in not adequate for treating amblyopia. If patching is done for amblyopia it is for much longer, sometimes all waking hours.
4. Chalazia can cause some shifting of the glasses RX especially if large
5. Use the search feature and archives to read about treatment of chalazia in young children.

JCH MD
6. Don't forget to have your other children checked if you have any as well as nieces and nephews (and way down the line grandchildren).

JCH MD

[My_kids]

Thank you so much for your response. I wanted to go with the ophthalmologist, but my concerns are that she herself mentioned that his left eye is perfectly normal, but she still ended up prescribing a +1 spherical to it, and the optician just prescribed pl to the sphere. Is there any specific reason for prescribing this to the left eye. I do not understand many technical reasons. Also when I mentioned about the chalazian, she said that chalazians never effect vision. She was trying to rush us out of the room, never explained anything, also my son complained that he couldn't see with the glasses she prescribed, but he seems to be perfectly fine with the opticians one. The optician was good with kids, explained everything thoroughly and was very calm. May be I should find another ophthalmologist. Thank you.

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

I would suggest finding a different pediatric ophthalmologist. Ask some of the mom's whose good with children. Or if in USA go to www.aao.org

JCHMD

[My_kids]

Thank you.

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

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[My_kids]

Is the astigmatism in his right eye considered really high? Does he need to wear glasses throughout his life?