Whats the prognosis for a -13.0 in one and and a 0.0 in the other?

[HannahNK85]

We recently found out my 4.5 year old son has -13.0 in the right eye and a normal left eye. The optometrist and ophthomologist came to the conclusion it was probably congenital and recommended a contact for the right eye and to patch the left eye. They said it may not work but are willing to try it. Does this sound like appropriate treatment and are there any other recommendations or things to watch out for?

[JohnHaganMD]

This is a huge problem and is called unilateral pathological high myopia. Fortunate he does not have in both eyes. Your child needs to be under the care of a pediatric ophthalmologist. If you have other children be sure they are tested also as this has a hereditary component.  This will be a huge ordeal for you and your son.  Wearing contact lens, patching the good eye or 'penalizing' it with atropine drops.  An eye that long (-13) is often abnormal inside and may have other problems: congential cataracts, higher risk glaucoma, higher risk retinal detachment, myopic macular degeneration. Glasses need also to be worn to protect the good eye from injury. Special precautions to avoid injury to good eye: need to discuss avoiding contact sports, eye safety in general, wearing protective glasses.

Children's Mercy Hospital in Kansas City, MO has the first pediatric refractive surgery center in the United States. they often do under general anesthesia LASIK or PRK on the eye. There are other pediatric refractive centers in the US now. Ask your pediatric ophthalmologist about that option.  

[HannahNK85]

Thank you sir. I appreciate your time and knowledge about this subject!

[JohnHaganMD]

Best of luck, this is so difficult. Your child is fortunate to have committed parents.

[HannahNK85]

My son had an mri of his eyes done this week and it showed axial myopia in that right eye with an AP measurement of 2.75cm compared to 2.2cm in the left. And a posterior staphyloma in the right eye. Is this a consistent finding with high myopia? We have an appointment with ucla Jules Stein eye institute on June 18, as a second opinion since there are no pediatric ophthalmologists in our insurance group.

[JohnHaganMD]

These are standard measurements:  The average eye axial length is approximately 23.30 mm. Assuming the central corneal power is the same for each eye at normal axial lengths, for every 1 mm of axial length difference you can anticipate a 3.0 D difference in the refractive error.