My baby's eyes.

[wantanswers2day]

My son is 8 months old with either delayed eye development or strabismus etc...(the pediatric ophthalmologist won't say exactly)  The problem is..she is looking at his eyes through the knowledge that he has development delays.  She never asked the severity of the delays.  I have since found out from the ped and physical therapist that they aren't super severe.  Mostly in gross motor skills.  My son's eyes wander, and he will sometime focus with just one or the other...he tracks better than he used to though.  His eyes are just "off" so to speak from time to time.  There is family history of amblyopia and strabismus.  The eye doc said the eye structure is good.  She feels that my son has a neurodevelopmental disorder and that is the cause of his eye problems.  He seems so normal to us (being our third kid), laughs, babbles, plays etc..just has trouble moving as easily as others his age.  And not quite sitting on his own...but almost. Neurologist isn't sure...MRI of head is normal, and he ordered a few more blood tests.  He pretty much ruled out a bunch of stuff just by looking at him though. Couldn't his slight delays with gross motor be because he cannot see very well?  Is it possible his only condition is an eye condition and once that is resolved it would help him with his being able to crawl etc..?

[John C Hagan III, MD, FACS]

Given what we know about strabismus and what information a pediatric ophthalmologist can obtain with serial eye examinations it is far more likely that your child's strabismus is caused by he developmental delay rather than vice versa. Even blind children otherwise normal develop motor skills like normal children.

I think it very unlikely that your childs eyes are holding him back.

JCH III MD

[wantanswers2day]

Thank you for your reply.  I appreciate that.  So would that be considered a delay in vision then?  The reason I ask is although it is slow, he makes progress with his eyes.  My husband and I and those close to my son have noticed a big difference in them in the last three months (not normal yet by any means...but much better)  Is the eye thing the same as the gross motor in that they really don't know how far he'll develope..??  She mentioned surgery to correct or fix his eye muscles later.  Would this help him see better?  Or is it just for appearence to those looking at him?

Oh and one more question, what does "serial eye exam" mean?

Thanks again.

[John C Hagan III, MD, FACS]

The body motor problems and the eye problems are separate and independent. Surgery will be to help him see better not cosmetic.

Serial eye exams means that he will need to be seen by a pediatric ophthalmologist 2-4 time/year untill he's a teenager.

JCH III MD

[wantanswers2day]

THank you for your time.  I truly appreciate it.  

[John C Hagan III, MD, FACS]

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[wantanswers2day]

Hi, another question.  I was reading your response to someone else regarding cataracts.  Would it change your opinion about my son if you knew I had congenital cataracts and amblyopia, and now blind in one eye. (was not discovered until I was 7)  The other family history, is my MIL (my son's grandmother)  She had exotropia as a baby and several years of therapy and then surgery on her eye muscles to correct.  With such significant family history of eye problems, I just don't see why the docs won't consider this all related to vision as opposed to something more.

His physical therapist has been working with him now for several months and seems to think this is more a vision issue rather than a bigger neurological issue.  She is encouraging me to get a second opinion with regards to his eyes since all his tests to date have come back normal.  He makes progress in therapy and the gap of delay is not getting bigger like the specialists said it would.  It has stayed the same (between him and his peers)

I told her what you had said earlier about even blind children not having gross motor delay etc...She said being completely blind would be better for a child with regards to development, but having vision problems and "mixed messages" about what he is seeing can most definately have an impact on him sitting without support and crawling etc...  The strength to hold himself up is there, but the initiative to put his hands out and stay balanced is what he struggles with.  The PT who works with him said she has seen this type of delay in kids before that have vision problems.  

I don't mean to beat a dead horse, but I cannot help but think the specialist we saw is looking at it the wrong way, and Im afraid my son might not be getting the help right now he needs with his eyes, because we are too busy trying to find something else that isn't there.  Even the genetic councelor we met with (pre visit before seeing the actual genetic physician) seemed most interested in the family history of vision issues.  Even my husband has significant vision problems and cannot see a thing without glasses.  (He doesn't know what he has though....ughh...some men...)  So my poor boy is getting bad vision genes (if there is such a thing ) from me and from my husband and his family.

Another thing...if you look at him, he looks completely normal and adorable...no odd facial features (except for the eyes not working together), no wierd ticks or twitches or extra behaviors indicating a problem.  He smiles, laughs, babbles "dadadada..lalalalalal ...blahblahblah...." and so on.  The ONLY things are his eyes and slight gross motor delays...especially when it involves putting his arms out a ways.  Oh and one more thing, he shakes his head back and forth when he gets tired and blinks and rubs his eyes as if his vision is worse during those times and he is trying to compensate somehow for it.  He gets really frustrated like he is trying to see better.

There is a childrens hospital that has a really really good eye clinic with an eye lab and all sorts of newer diagnostic tools etc that I was thinking of taking him to.  (5 hours away from where we are).  Do you think a specialist in a bigger city with more resources available to them would be a good idea?  Im in a small town.

[John C Hagan III, MD, FACS]

I think it would be worth while to have the child seen at the children's hospital eye clinic. Be sure an take his medical records to make it as productive as possible. I do encourage you to do this.

I'm comfortable that the pediatric eye specialist will likely find that the eye problem is a separate problem and not causing the developmental delay.

In any case I don't think you'll rest till your theory is put to the test of a pediatric strabismus Eye