hyperopia and astigmatic anisometropia in 3 yr.old

[lovemykiddos52]

My daughter failed a vision screening and then saw an optometrist that our pediatrician referred us. I doubted the optometrist's medical opinion for several reasons, one being that although she does see a lot of pediatric patients, she doesn't see many preschool aged patients.  My vision insurance does not cover ophthamologists.  My medical insurance does but only for strabismus, amblyopia, or eye injury.  From my research from articles from the American Academy of Pediatric Opthamology and Strabismus, the American Optometric Association, and American Academy of Ophthamology I have found several things.  The AOA states that astigmatism up to 2D is common in children under 3.  My daughter's was 1.25 & 0.50.  She had just turned 3.  The AOA states that those with hyperopic anisometropia with as little as 1D difference between the eyes may develop amblyopia.  My daughter's was less than 1D at 0.25 difference between the eyes.  Her difference for astigmatic anisometropia was 0.75D. The AAO's preferred practice pattern guidelines for Pediatric Eye Evaluations:  Consensus Guidelines for Prescribing Eyeglasses for Young Children.  For hyperopia it is >+4.5 (My daughter's was +1.50 & +1.75) and for astigmatism with anisometropia it is >2 (My daughter's was -1.25 & -0.50).  She had no other factors such as strabismus or amblyopia present and no developmental delays.  She was also asymptomatic.  Her eyes were dilated before the exam.  I don't have the printout from the refraction yet.  I requested my daughter's medical records and am waiting for those.  I know that the printout for the refraction was different than what she ended up prescribing, and I remember her using some type of formula to determine the exact prescription.  My daughter's prescription is as follows:

          Sphere        Cylinder      Axis
OD      +1.50           -1.25        085

OS      +1.75           -0.50         090

[Doreen Fazio, M.D.]

Your daughter may not need the glasses if she has equal vision in both eyes, and no sign of esotropia (eye turning in).  I would insist that your insurance cover a visit with a pediatric ophthalmologist for a complete exam.  A prescription in a child of this age has to be obtained after the pupils are dilated and the focusing muscles are relaxed.  The optometrist apparently dilated the pupils, but I don't know if the drops were strong enough to prevent the eye muscles from focusing (accommodating), which could lead to an incorrect prescription.

[lovemykiddos52]

Oh, I forgot to ask my question!  Does my daughter actually need glasses?  Obviously, I don't want to deal with the daily annoyance of her bending her glasses out of shape and getting fingerprints on them if she doesn't actually need them.  If she needs them, then fine, no big deal.  We'll continue wearing them if that's the case.