High myopia at -14 in a 13 month baby

My son is 13 months old and is at -14 in one eye. The other eye seems perfectly healthy, at least for now. We noticed the problem one week ago. He was a full term baby (40 weeks). We were told that myopia can be hereditary, and I did have myopia myself at -3.75 in both eyes at the age of 36.  Doctors are suggesting contact lens (preferably) or glasses, and the covering of the healthy eye for a few hours (or more) everyday in order to overcome the laziness of the eye with severe myopia. They say this may be the only way to save his eye but can

[John C Hagan]

Hello Kayihan,   I am the Eye Forum Ophthalmologist (EyeMD). As I am able I answer select questions on the general forum.

Your child has a bad problem and the outlook for "good" vision in that severely myopic eye is not good. This would be the case no matter where in the world you go. There are a number of reasons for this. An eye that myopic is an extremely long/large eye. This high degree of myopia is often associated with congenital malformations in the eye. One in particuliar that comes to mind is posterior staphyloma. This is a weak spot on the back of the eye, often in the reading area (macula), that balloons backway into the orbit. The retina in this area is often malformed. Please do not blame yourself or your mate for this problem. It is not related to simply myopia (-3.75). It just happens every so often in every country. It could not have been prevented with a better diet, etc.

Your child needs to be under the care of a pediatric ophthalmologist and will need regular visits and monitoring as he grows up. Thus its important for you to find the best possible care that you have ongoing access to. In a large city like Istanbul you should this type of care, perhaps associated with a medical school.

Please remember this. Your child's most important eye is the OTHER apparently healthy eye. This good eye also needs close observation by the pediatric ophthalmologist. Impact resistance glasses will probably be necessary to protect the good eye. As your child gets older you will need to decide if you want him to play sports with high rates of eye injury, this includes baseball, soccer, tennis, squash, etc. If you do decide to let him do this he needs sports goggles to protect the good eye. Also things like lawnmowers, power tools, etc should be done with caution and if he does them "safety glasses/goggles" need to be worn. All his life he ( and you while he's small) need to think eye safety and injury prevention.

Good luck to you. Your child is lucking to have such a devoted parent.

JCH MD

[kayihan]

Dear Doctor:

I am most grateful for your prompt response, kind words and good advices. Could you please kindly let us know your advice|\thoughts on the following topics:
1- contact lens vs.glasses (we are confused, some doctors are recommending contact lens, others are saying for a 13-month old baby contact lens would not be feasible and glasses are the only option)
2- any medicine/treatment available that would help stop the worsening of myopia of such severity.
3- patching vs.some sort of eye drops that would blur the vision of the good eye so that his lazy eye starts functioning
4- if we do patching, what should be the extent of it in terms of timing (1-2 hours or more a day)
Many thanks in advance for your help.
Best regards.
Kayihan

[John C Hagan]

Hi Kayihan

1. In general unilateral pathological high myopia is treated better with contact lens than glasses. Because of the difference in the amount of myopia in the two eyes the brain receives a much smaller image from the high myopia eye. The brain usually cannot "fuse" the images and the brain ignores the more blurred image from the highly myopic eye. With contact lens there is considerably less difference in image size.   The contact lens is much more demanding often requiring the child to be put to sleep by an anesthesiologist to make measurements on the eye for the contact lens and to examine the outside and inside of the eye.

It's possible as I said previously that not all pediatric ophthalmologists and medical facilities can fit and follow infant contact lens.

There has been some interest and experience in treating these eyes with intraocular lens implant coupled with clear lens removal.  Again this is a highly technical area and not all ophthalmologists can do this type of surgery nor is there agreement on doing the procedure.

2. There is no treatment to prevent the myopia from progressing. In older children bifocals and prolonged use of atropine a strong eye muscle relaxant has been tried and not found useful. Some ophthalmologists have wrapped special tissue (banked sclera) around the back of the eye to try and prevent the eye from growing longer. It has not been very successful and I don't think its worth considering.

3. Patching and the use of atropine (described above) is often a good method for treating regular amblyopia especially in the older child. I believe your doctors wanted to do some patching. Atropine can be toxic to a young child and would probably not benefit your child. Remember this is not "regular" amblyopia.

4. The patching will need to be monitored closely and the schedule should be set by the ophthalmologists you chose to care for your child. It needs to be very closely regulated as if you patch the good eye for long periods of time you can interfer with its development.

JCH MD

[kayihan]

Dear Doctor:

Many many thanks for your explanations and insights. We very much appreciate your help and support. Best regards. Kayihan

[ravindraa83]

My son 5 years old having -14 and -14.5 please let me know how save this vision.
-Ravindra

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

Read the above post dated 6/7/07 to Kayihan.
JCH MD

[safa335]

I have the.same situation. How. Your. Son doing

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

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