Thank you so much for your additional response.
It really helps to have a more clear understanding of the goals are for ET vision. I wish her Ped OP had said this to us at the onset of treatment. This also helps me to understand how my vision ended up poor in that eye but my eye strait. I will seek a second opinion. Thanks so much Dr, Hagan!
With strabismus the first goal is to have good vision in each eye with whatever glasses RX that are necessary.
The second goal is to have cosmetically straight eyes with or without glasses as need be.
The third goal and the most difficult and often unachievable is to have good vision in each eye, to have them perfectly straight (both of these with glasses if needed) and to work perfectly together to give 100'% depth perception (which we call stereopsis)
My suggestion is to find the best pediatric ophthalmologist you can get to reasonably easy for a second opinion. Your pediatrician may be able to refer you or you can go to www.geteyesmart.org to find one that, if you like better, you might continue care with.
JCH MD
Dr. Hagan, thank you for your response. I want to clarify something please. I do understand completely what your have said about the ET and focusing. As i said, i have lived (almost 50 years) with the same vision. Many in may family have as well.
I may not have been clear that my daughter does NOT routinely go without her glasses. I do know better than to allow that and she does as well. She puts them on first thing in the mornng all the way til bedtime and has always embraced them.
She went without only to see in school when she could no longer seethe chalk board writing with with them on when that pair became problematic within a few months (NOT WEEKS) of getting them. That was unusual for her and she knows what to expect in getting used to a new pair after 7 years. While awaiting her appt that time, she wore them for general use but took them off to read the chalk board in class since she had no alternative until the visit and new prescription was issued.That was for about a week.
This time, those glasses lasted about 8 months before she again said she can no longer see the chalk board writing. This time she ALSO now cannot see to read without them - which was NOT the case last time.
What concerns me is that her vision without is worse and that in 8 months her prescription has needed to be reduced so much...2 diaptors. Also, the way her Ped OP reacted to the extent of the decrease in her new prescription as he kept saying how odd this is this soon and he seemed puzzled by it.
When she first saw him he predicted that when she entered teen years she may not even need glasses. She is nine. Now he says she will most likely need them as an adult.
I also failed to mention that now her former dominant eye it is the eye that is turning in not the eye that was weak. I have wondered it that is why she cannot see without them now. She has no "dominant eye" and they are both weak?
Several folks in my family have had this vision and I know that with me, my brain has always allowed my dominant eye (which was 20/20 until i reched 40) to make up for the weak eye since I cannot read anything smaller than that big E on the chart with it.
Until i reached 40 I had 20/20 with my "good eye" and never had problems seeing in general even with the lack of depth perception caused by it as it compensated for the weak one.
My eye does not cross because i did wear my glasses but i cannot read with it. I do not want to find out in a few years that my daughter has great looking eyes that do not cross but she is hard pressed to see if she finds herself in a situation without the glasses. I did not expect her to be that dependent on them based on my family history in dealing with this.
Right now, that seems where we are headed. My daughter seems to have lost that ablity. Should that be the case?
Thanks you for reviewing my clarification. I hope this sheds addtional light on my queston. Thanks again Dr.
You do not have a level of unerstanding of accommodative esotrophia that a parent should have. I suggest you read the sections on wikipedia and emedicine.
The child with accommodative ET is hyperopic and can see without the glasses. The problem is when the child focuses to see clearly it pull one eye out of line. The brain then sees double and the brain suppresses the vision in one eye (central vision not peripheral vision) and the eye become amblyopic. This may be permanent if not corrected early with glasses, patching, often bifocals and sometimes with surgery which DOES NOT eliminate the need for glasses.
Vision is always tested each eye separately. With accommodative ET is is the vision with glasses that is the most important and on follow up visits the vision may not be tested without glasses.
The eye can become less hyperopic as it grows especially in adolescence. Often a child will have blurred vision when they first get the glasses because the focus muscle cannot relax completely. Often it will take several weeks for the eye to let the glasses do the work. For that reason going without the glasses is generally a very bad idea and makes adjustment to the glasses, crossing and vision in one eye worse.
You should understand this by now. Since you seem to have lost confidence in your peds ophthal consider getting a second opinion from another peds ophthalmologist.
Also realize this condition has a STRONG tendency to run in families have other children checked ad all blood related nieces, nephews and eventually grandchildren. the most common age of onset is age 2 to 4.
JCH MD
The bottom line is that all physicians are under huge time pressure to see more patients and spend less time with them. I find this terrible both as a physician and as a patient. My fear is that Medicine will become so unattractive to our best and brightest young women and men that doctoring will be 'dumbed down'
Best of luck and be sure, as I said that all blood relatives have their childred checked at young age say no later than age 3.
JCH MD