vision loss in my 7 yr old daughter

[karen0723]

My daughter is 7, very active and doing well in school in second grade.  Her vision screening last year resulted in 20/200 corrected to 20/40 in her right eye and 20/60 corrected to 20/25 in her left eye.  Her recent screening of a week ago shows she is now only able to be corrected to 20/100 in her right eye and 20/55 in her left.  There has not been any head trauma.  She had an EOP, retinal photogrpahy and examination 3 days ago- both were normal.  We are scheduled for a contrast study of the eye vessels 1/3/08.  What other tests should we be considering?  In my estimation the next thing we need to rule out is a brain turmor or circulatory disorder, do you agree?  If so what are the best tests for these diagnosis?

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

I would suspect seizure also and an EEG and neurological eval is now appropriate.

I think you're getting close here.

JCH III MD

[karen0723]

Happy New Year.  An interesting update.............I spoke w/ my daughter's pediatric opthomologist yesterday, we discussed the possibility of melingering and he suggested I stop by for a quick acuity test and that "I pump her her up a little bit, possibly offer a bribe for a job well done".  We talked about the importance of her really trying and that she could select a treat afterwards.  The exam was going well- she seemed to be getting some letterst that she missed previously but maybe only one or two then all of a sudden she was out- Out cold, totally unresponsive, I could touch her eye and no reaction at all, she remained out for at least five minutes, when she came to, she was very confused and had significant memory loss then within about 10 minutes got very upset, was crying saying she wanted to go home and go to bed and that she did not know why she was crying.  While she was out her body was relaxed- no flailing or muslce tension at all.  I took her to a nearby ER where they did blood work which was normal and ultimately and MRI w/ contrast that was also normal.  We are still scheduled for the contrast study tomorrow morning.  My brother is a P.A. and suggested that sometimes when people undergo stimulation directly to the retina it can evoke seizures.  The ER physician said she thought it was more of a passing-out episode rather than a seizure.  My personal feeling was that is was more like a mild seizure but I don't know how the two are differenciated. As a side note, I did request that the ER physican also add a Lyme test, they still had enough blood in the lad and we expect these results in about a week.  Any comments are welcome.

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

If the tests all prove negative and she's still not seeing normal then you should consider seeing a neuro-ophthalmologist. Your present physicians will be more than happy to get another opinion.

This is a place to start on learning about visual malingering:

http://archopht.ama-assn.org/cgi/content/full/120/6/756


JCH III MD

[karen0723]

I spoke to the Optometrist that saw my daughter last year, she mentioned the "malingering" to me but also said she "really felt she had pushed my daughter to get to 20/40" in the right eye.  I spoke to my ex-husband at lenght about this issue last evening, he feels very strongly that this is not the case- not that I am willing to rule it out based on his input, but we do feel we need to rule out any physical issues.  Are you aware of any specifc tests that are emplyeed to "fool" the person into reading normally?  I will also ask her pediatric opthomologist and the specialist we are going to see this Wednesday for the contrast study.  I was mistaken and the test they performed last week was an ERG not an EOG.- as mentioned previoiusly, results were normal.  I sincerely appreciate your comments and insight.

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

Yes there are some tests that can be done to determine if glasses are needed are not done independently of the child's response ie automated refractions and keratometry. Also there are so-called "malingering" tests that can "fool" the person into reading normally. Sounds like they want to be sure that there are no health issues first.

JCH III MD

[karen0723]

I agree that this could be more of an "emotional" issue although she was spending a lot of time reading- 1 to 2 chapter books a week, then complained of "aching" and wanted to hold cold compresses on her eyes begining last week.  Are you aware of any tests or situations that have been used sucessfully to "weed out" the psycholocial aspects?  I have been careful to not become a situation whereby she is getting all of the attention as a result of what is going on.  

Thank you for your repsonses.

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

Most likely "EOG" electro-oculogram" there are a lot of these tests VER or visually evoked response, ERG an electro-retinogram.

Evaluating young children that don't see normal is often difficult, time consuming and expensive. More tests and evaluations are needed but brain tumor and circulatory disorders are not the most common.

High on the list of things that can cause this is a child that is not trying to read the chart for reasons that vary (likes the attention, controls the parent and doctor, is afraid or frighented, wants glasses, is fearful or intimindated). I'm not saying this specifically of your child just studies done on a large number of cases like your child.

Please post when you find a cause and it could still be something not serious.

JCH IIIMD

[karen0723]

Sorry if I am not using correct terminology.  It's "like" an electrogram of the eye.  They attached a suction cup like device to her most affected eye (20/100 corrected) and measured the electical impulses based upon light stimuli to varying frequencyf and intesities, the results of this test were normal.  The Pediatric Opthomologist she saw a week ago referred us to the Hoover Eye Clinic at Greater Baltimore Medical Center where these test were performed,  which is also where we are going Wednesday 1/3/08 for the contrast study.  Thank you for your response.

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

What is "EOP"

JCH III MD