Two Doctors, Different Prescriptions

I just found out this week that my two year old daughter needs to wear glasses due to her eyes crossing and being very farsighted. When I first heard the news I was a little bummed and surprised. I never wore glasses or neither has anyone in my family (except some of the older family members) so this was all a little foreign to me. Being surprised with the news I decided to take my daughter for a second opinion and got a completely different prescription the second time around.

The first doctor I visited was a pediatric ophthalmologist who prescribed my daughter glasses +5.50 for both eyes. However, the second eye doctor was a general eye doctor who prescribed: O.D. +3.00 , cylinder +0.50, axis 90; O.S. +3.50.  Does this make sense? Is it possible one of the doctors made a mistake?

I don't know if this information is useful, but the pediatric specialist used modern equipment to examine my daughter’s eyes and was pretty quick with his diagnosis and figuring out the prescription strength. The second doctor used what looked like a much older system where she kept pulling individual lenses from a drawer to look at my daughter eyes. This second doctor took a much longer time with her examination before she gave her diagnosis. I'm sorry if I don't make sense describing this, I am not medically trained so I'm not sure how to explain my observations.

I just don't understand why such different prescriptions.

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

I suggest going with the pediatric ophthalmologist and the stronger RX. It is very important in her problem (accommodative esotrophia) to correct all the hyperopia.  It is very difficult to get these measurements on the child: depends on 1. drops COMPLETELY relaxing the eye focus muscle 2. the child's cooperation 3. the skill of the person doing the testing.

Imagine if you had to measure a child's height when they were combative and would not stand up straight. It would not be surprising if two people got different results.

Again the larger numbers are more likely to be correct. If you have other children, nieces and nephews have them checked, this runs in families does not mean other have had it but once its there all further blood relatives at risk.

JCH MD

JCH MD

[ODOSOU]

It is common to  give less than full correction, usually just enough to correct the accommodative esotropia if there is one , and than increase in future. It will be more comfortable wearing the lower prescription. No real benefit to overplus(overcorrect) at this time.  i would fill the lower prescription and follow up in 6 months.

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

The above statement by ODOSOU in incorrect. In a two year old with accommodative esotrophia the full cycloplegic refraction should be given; often the child will additionally need bifocals.

Giving less than the full cycloplegic correction would be appropriate in an individual that does not have a converging strabismus but is uncomfortable (asthenopia) due to the extra forcusing stress.

JCH MD