Farsightedness in 4 years old girl

[mila7373]

My 4 years old daughter was diagnosed with farsightedness by O.D. Prior to her first eye exam she occasionally was crossing her right eye. A few tests of recogniazing pictures were done with her and some more after her puppils were dialeted. The O.D was measuring her eyes with some lenses and looking ino here eyes with a hand held instrument only(not the big machine). He concluded that all her life she will wear eye glasses. He said that the right eye is +5.00 and the left +3.00 but he said he is giving her a prescription for +3.50 right and 1.50 for left eye. The actual prescription reads:
Sherical           Cylindrical       Axis
+3.50               +1.25             0.90
+1.50               +1.25             0.90

My daughter has been seeing just fine, in my opinion, prior to her eye exam. We bought the glases but I keep wondering, did the O.D. actually diagnosed correctly. During the actual exam she was eager to visit the rest room and  I can not be sure if she was able the concentrate with her answers. I do not want her to wear glases unless and only if she really needs them.
The O.D. wants to see us in 5 weeks after my daughter wears her glasses for that long. If she has an improvement, he said, she might not have to patch her strong eye.
Please help me understand what is the right thing to think about the eye exam and the eye prescription. I really have so many doubts. I know MD is the way to go and not OD, but that was her refferal. Please help!


This discussion is related to 3 1/2 year old just diagnosed with +5.75 farsightedness.

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

The eye can correct for hyperopia (farsightedness) by focusing whereas it cannot correct for myopia. So when one eye was covered your child could have read 20/20 in the peds office.  There are new screening techniques some developed by the Missouri Society of Eye Physicians & Surgeons that allow pediatricians or school nurses to include screening for high hyperopia (your child's problem).

If you have other children they need to be seen by an Eye MD ophthalmologist and same with your nieces and nephews.  The typical age of onset of this problem is ages 2-4.  All your children and blood relative children should be seen by ophthalmologist about age 3.

Your child is unlikely to outgrown that degree of hyperopia, glasses are likely to be necessary all his life,  may need bifocals, likely will need patching, could need surgery but surgery would not remove the need for glasses.  When older hyperopic lasik or contact lens may be helpful.

Strabismus or eye muscle problems are more common in autistic children something noted quite some time ago   http://www.autism.com/ari/newsletter/133/page6.pdf

JCH MD

[Xaidie]

I'm sorry to jump into this conversation uninvited but I was wondering about my son. He has a sever prescription +7.5 right now and the eye doc says we will most likely need to move him to a higher prescription as he adjusts. The glasses are helping and his reading is improving. My question is this.

I didn't notice any problem until he was 7 years old. When he was tested at the pediatrician's when he was five, he tested normal. What could have happened to have caused such a dramatic change in his eyesight.

my son stutters too and his speech therapist recommends we get him tested to see if he is on the autism spectrum. Could this have anything to do with the eye problem?

Thanks,

X

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

Most women your age would not need the glasses which could be made as either bifocals for near or reading glasses. In 5-7 years you will need them.

JCH MD

[mila7373]

I am sorry I missed to mention, I am 35 years old. I've had migranes with auras during pregnancy which have improved significantly in recent years(if that helps). Thank you so much.

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

What is your age?

JCH MD

[mila7373]

Dear Dr. Hogan,

So valuable to me to have your opinion here.
I took my older daughter,7 to the same D.O. that my 4 year old girl is seeing too and my older kid showed 20/15 vision. I am so happy and relieved.
My self had and eye glases prescription in Jan,2008. I don't experience eye vision problem except maybe when tired and this one time in a month for a woman. I did not bye glasses yet. My prescription reads
       shere     cylinder    axis    add   prism amt   prism dir   prism 2amt  

R     0.00       0.00         0        +0,00  1.50          O            0.00

L      -0.50      -0.50       45       +0.00  1.50         O             0.00.

Do you think I need glasses? Do I have to wait? This prescription and eye exam are dated from Jan.2008. Do you think my eyes have the same prescription today as well?
Thank you so much for your help here.
p.s. Does eye problem is passed to a girl in a family from her father?

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

If the ophthalmologist prescribed the full correction +5 and +3 the eye would likely not be able to accept them because it was so use to having to work all the time. Also very important to remember WITHOUT GLASSES YOUR DAUGHTER CANNOT SEE CLEARLY IN BOTH EYES AT THE SAME TIME. Without glasses at distance the normal eye does not have to any work of focusing (the cornea does it all) but your daughter has to focue 3 diopters and the other eye is 2 diopters out of focus.

Likely the plan of the ophthalmologist is to check how the eye is doing, get an idea how bad of amblyopia in the +5 eye and likely will need some patching.

When your daughter takes off her glasses the eye muscles suddenly have to start working very hard that's why they water. Your daughter will need glasses or contacts for many years maybe all her life. You are lucky to get her under proper care and give her a chance to have straight eyes and good vision in both eye WITH GLASSES.

I know you would like her not to have to wear glasses but that's not the way accommodative esotrophia works.

JCH MD

[mila7373]

Dr. Hagan,
I am sorry to bother you with a question again, but you are always right with your answers.
My daughter wears her eye glasses every day. She does not reject them in any way. She has to do it for 5 weeks till we see her D.O. again. Rigth eye +3,5, left eye +1,5(lower than her actual prescription of +5 and +3).
I am afraid, I observe my child having great dificulty using her vision up close when even for seconds we remove them. She covers her eyes and they seem like they wander. It is like there is too much light or something that bothers her to lift her head.
On her next appointment she has to be evaluated if there is any positive change with her vision. How this is possible? Will she be examined with no glasses? I feel she will not be able to recognize the pictures for her age 4 on her next eye exam.
Is there something wrong with this glasses? She also has told her sister she sees wavy things with the glasses? What does this tell you? I am so worried if this glasses are doing the right thing for her...How do I know that she sees clearly with her glasses when she gives me very mixed messages...

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

A farsighted eye is a short eye. When farsighted children enter puberty and get a body growth spurt many times the amoung of farsightedness decreases. However since she has different amounts in each eye it is likely she will need glasses (or contacts when older) all her life.  Also it is more likely she will need patching than that she won't need to patch.

Remember to have other children and blood relatives checked early (age 2-3 years old) for this condition as they have 20% chance of having the same problem.

JCH MD

[mila7373]

Dr. Hagan,
First, I want to take the chance to say how useful and comforting are your answers to all the worried parents and people with eye problems in general. I read with great trust your answers here.
Yes, my daughter is seeing a D.O.which should make me feel happy with her treatments. The farsightedness with my little angle happened so all over sudden and I still wonder is this problem with her eye vision is going to last forever...She loves wearing her pink frame glasses and to me they seem to enlarge her eyes quite a lot. Next month we are going to see the D.O. for further tests and see if her eyes have improved. He said that based on her next eye exam he can deternine if she has to patch or not her strong eye.
Do you think I can hope for an imrovement with her eyes? She got lower diopters than what she was diagnosed(as mentioned in my previous posts). As of now, even is she were 20 years old I hear chance for lasik surgery is slim. Is this true and why...
Again, thank you for your help. My husband and I are so greatful for having your opinion here.

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

I negelected to mention that if that testing is correct and your child is +5.00 and +3.00 then SHE DOES NEED GLASSES AND WILL NEED TO BE WATCHED TO SEE IF THE +5.00 EYE HAS ADEQUATE VISION (AMBLYOPIA) SOME PATCHING MAY BE NECESSARY.

jch md

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

I don't know where you live but I would not take my child, that might have crossing of the eyes, to a optometrist. Nor would I pay for any insurance that did not give me the choice of seeing an Eye MD ophthalmologist.

SO I would INSIST to the referring family doctor or to the insurance plan or if you have socialized medicine start appealing the decision and get in to see a PEDICATRIC OPHTHALMOLOGIST Eye MD.

IF the person was a DO or Doctor of Osteopathy then their training is satisfactory and they are physicians.

HOWEVER SINCE YOU HAVE DOUBT YOU CAN ASK FOR A SECOND OPINION WITH A EYE MD.

jch md

[mila7373]

I want to appologise for not poiting correct an important detail. My daughter had an eye exam with D.O. not O.D. Does this change should make me feel better and still, how do I understand my daughter eye prescription. Thank you so much.