amblyopia strabismus and hyperopia in my four year old

[jennifer233]

My daughter is four years old. She has been diagnosed with amblyopia, strabismus and hyperopia. Her visual acuity is 20/63 in both eyes. She has been wearing a plus 9 prescription in both eyes for a year now. She was just accepted to the Alabama institute for the blind in Talladega, Alabama. She will begin there this fall. I moved me and my other 3 children so that we could be closer to the school. I did not feel any of us were prepared for her to go and live there so this way she can ride the bus to and from each day. One of her doctors did not feel that she needed to go to the school for the blind. However, others did. I just want her to have the best education possible. After meeting with many doctors and staff, I made the decision to place her in the school. She will have a cosmetic surgery for the strabismus this year. I have researched and asked questions to where I understand the principle conditions. I just still feel like I don't understand how bad it can get. Who could be overexagerating? Who could be underdramatizing? I feel very confused. Can you please explain your opinion of the conditions?

[berrywoo]

Don't keep her too close, as you might inadvertently instill fear of exploration, and independence. She ought to be able play and enjoy the same activities as other four year olds. If safety is a concern you might want to speak with an orientation and mobility specialist who can give you advice (or other parents of children with low vision).

I definitely think that a good screening by a low vision optometrist will be helpful.

If she can currently read/write print, then it should be taught. However, do NOT neglect braille. Both can be taught together and it's best to start young. (I'm a big proponent of literacy and braille use is literacy for the visually impaired. If audio devices are such greats tools, why is print reading/writing stressed in schools, everyone should learn through auditory means *being sarcastic*.)

Getting a proper diagnosis of your daughter's eye condition is important as is treating the condition. However, it's even more important to think about how the condition impacts her vision now and in the future. As a child she will more quickly adapt to life as is, partly because she has no other perspective, but also due to her youth and the brain's plasticity.

Yes, patching and/or drops may be used in some cases of amblyopia. However, in your daughter's case it may not be helpful, because both eyes have poor vision and the prognosis does not seem good, there is a greater chance that a successful outcome will not be obtained. By successful I mean that both eyes will be able to be used together to achieve normal stereopsis (depth perception). However, you did mention she's got glasses, so maybe they have prisms to help with the strabismus which would also help a bit w/the amblyopia.

[jennifer233]

also, I have heard of using drops or patching to force the brain to use her eye. But, the doctors have just treated her with glasses.

[jennifer233]

thank you both. Her IQ tested at 119 and she can write her name. I was told that her vision will deteriorate more. I was told that she could be blind by 12. Pretty scarry for a mother. I have never heard of that other condition and will definintely ask. I know on her school assessment and with 2 other doctors I have only heard of ambliopia, strabismus and hyperopia being the diagnosis. But I will definitely ask. I was also told surgery is not an option for correction. We have a family history of blindness for a condition called tubersclerosis. She has not been tested for this. It is a condition in which tubers grow on different parts of the body and brain. There are soo many things I am confused about. She is also a carrier of strep. I have heard this can affect the eyes. Also, shortly after birth she had eye infections from a clogged tear duct. I am not sure what caused this or how it can be fixed. I know she is very smart right now. The problems we have are her being a hyper four year old and having distance and depth perception problems which can be a dangerous combination. I just have to keep her close.

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

Indeed good advice from berrywoo.

JCH MD

[berrywoo]

Wow, sending your daughter off to a school for the blind is definitely a big step. There are both pros and cons to sending her to a school for the blind.
I think a case could be made that if her condition is not progressive, than she could be mainstreamed, as long as her IEP plan is sound. But this again can be problematic.
Any child with low vision faces unique challenges that belong neither in the realm of profound/severe vision loss (visual acuity of 20/200 or worse) nor of the normally sighted. There are issues such as which medium to teach for reading/writing, when should you consider orientation and mobility, etc.
Take Dr. Hagan's advice, but also make sure she gets a good low vision exam, usually from an optometrist who specializes in helping those with visual acuity that can not be corrected to 20/20. This would probably help you a lot in determining whether or not she can handle age appropriate tasks given her current vision and what sort of aides if any can be useful.

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

Your daughter's condition is not typical of strabismus problems. Even children with crossed eyes (strabismus) and poor vision in one eye (amblyopia) who need glasses  (hyperopia) often do fine in school (one reason parents and teachers often don't notice the problem).

With something so drastic as to recommended "blind school" education she must have another diagnosis likely congential nanophthalmos which is a malformed, abnormally small eye and that is associated with poor levels of vision i spite of therapy.

Confirm that with the ophthalmologists that treat her.

JCH MD