How to decide if glasses are needed for children?

How can a Doctor tell if a child has amblyopia?

Is there a test for that? Does the Doctor actually see any changes in the eye?

Would you recommend a 5 year old child with the prescription below for astigmatism to start wearing glasses? Or it may not be needed?

The prescription is the following:

      sphere     cylinder      axis
R=     PL          +0.75       090
L=      PL          +0.75      100


Can it be harmful not to wear glasses in this case?

Thank you!

[Sandra M Brown, MD]

I am a pediatric ophthalmologist. Those glasses are not necessary for a 5 year old child.  The prescription is not high enough to cause amblyopia.  This reply assumes that there is nothing else wrong with your child.

[JS3]

Dear Dr. Brown,

Thank you very much for your answer!

What happened was the following: my 5 years old son who was diagnosed with a 20/40 vision at his pediatrician annual exam, but otherwise he does not show any vision problems and is attending Kindergarten and starting to read normally. He was then referred to a pediatric ophthalmologist. He just had an exam with the pediatric ophthalmologist, who diagnosed him with astigmatism in both eyes, and 20/40 on the R eye, and 20/30 on the L eye. The pediatric ophthalmologist said that my son has amblyopia and prescribed glasses to be worn all day long for 6 weeks and return for re-evaluation and then she will decide if a patch is needed. She requested transitions lenses. The prescription is below:
      sphere     cylinder      axis
R=     PL          +0.75       090
L=      PL          +0.75      100

The doctor told me that with glasses my son's vision will be 20/30 on the R eye and 20/25 on the L eye.

I don't understand why the prescription for both eyes is the same (+0.75) since the L eye sees better than the R one. Can my son already have amblyopia with such low prescription? Considering that both eyes have astigmatism, wouldn't that exclude the chance of having amblyopia at all?

I am really very concerned and would like to know your recommendations in this case.

Many thanks in advance!

[Sandra M Brown, MD]

The prescription is not enough to cause amblyopia.  For one thing, as you point out, it is the same in both eyes.  Also, there is nothing particularly abnormal about a 5 year old child having a recorded visual acuity of 20/30 to 20/40 and not being exactly the same in each eye - it's an age and attention thing.  Given only the information you provided, if I saw your son, recorded the initial visual acuity, got that refraction, and found nothing else wrong I would give him sunglasses and 2 stickers and tell you to relax.  Did you see a pediatric Eye MD or a pediatric optometrist?  Are you sure nothing else is wrong?

[Sandra M Brown, MD]

I think it is time for a "real" second opinion, not a virtual second opinion.

[JS3]

Dear Dr. Brown,

Thank you for your answers!

We actually saw a pediatric ophthalmologist (not an optometrist).
I will be taking my son to another pediatric ophthalmologist next week, as you suggested.
You mentioned that something else maybe wrong. What could it be?
Any specific recommendation of what we should be looking for (and asking the pediatric ophthalmologist) on this upcoming second opinion appointment?

I'd love to have my son checked by you, too bad we are in another state.

Best Regards,
Worried mom

[Sandra M Brown, MD]

I wouldn't say anything at all except "failed vision exam at pediatrician's office".  See where you end up.  Take along the glasses prescription from the other office but don't show it until after the doctor has given you his/her opinion.

[ammuappu]

hello dr,
my sister dont have one of her eye's vision since birth. Many told me that if its since birth, it cant be cured. Is it true..???
is there any possibility to get her vision???

[JS3]

Dear Dr. Brown,

Thank you very much for all your advice!

I took my son to another Pediatric Ophthalmologist for a second opinion this week.
She said that my son has a little bit of hyperopia and astigmatism, but has 20/20 vision, and glasses are NOT needed. She said that glasses can actually worsen his condition. She said that there is no amblyopia and was very surprised with the first Dr.'s diagnosis.

According to the Dr. the prescription for my son is:

R=     +25          +50      x100
L=      +50         +25       x90

The Dr. said that my son has blepharitis and the oily secretions might have blurred his vision during the vision exam at the pediatrician's office. My son does not have any symptoms of blepharitis though, like crusting, redness of eyes/eyelids, itching, irritation...
The Dr. recommended careful and consistent lid hygiene and return in 1 year from now for follow up. And NO glasses.

Dr. Brown, do you think that my son has blepharitis (even without having any symptoms)? Do you have any recommendation for my son based on this appointment?

Thank you so much for helping us!
We REALLY appreciate it!!
All the best,

Worried mom