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Medical Forum / General / Vision / December 2004

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cross-eyed again

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Mr. X - 08 Dec 2004 15:32 GMT
May I ask some followup?
(see initial post: suddenly cross-eyed)

Please criticise these thoughts...

It seems to me that some children have a slowly deteriorating vision.
I, myself, have bad eyes and it became obvious by fourth grade.

My daughter has two issues: 1) mildly bad eyes (+1., +1.75); and
2) an asymmetry in her vision.

Now as I understand (assuming on neurological disorder - a separate
issue that will be investigated with MRI shortly), there are two issues
then.

1) My daughter compensates by removing one eye from the focus
   (going cross-eyed)
2) Does she need glasses.  And if she needs glasses, what for?
       a) to balance out both eyes to reinforce the occular fusion
       b) to see better.

If she needs glasses for the occular fusion, are there not better ways?

Is it possible that the give and take and the beaurocracy of health care
is such that the easy and fast track were the glasses?  Is it possible that,
if the opthmalogist were fully aware what activist parents that my wife
and I are, that perhpas there are other interventions?

Second, if the glasses are for bad eyesight, I must then weigh:
1) cost in regard to my daughters impatience and frustration
2) benefits in how well she will see.

Naturally, we will persue the MRI.  In the next few days.  So...

What would all of you advise?  Try to force the glasses now and wait
for the MRI at the same time?  (We are talking here about a very stubborn
2 year, 9 month little girl)

Let the doctor know we are intersted in eye exercises?

Please advise.

(and again, if you MUST email, please email to:
impelluso@engineeringREMOVETHIS.sdsu.edu

thanks
Tom
Scott Seidman - 08 Dec 2004 15:38 GMT
"Mr. X" <greenbaboon1@cox.net> wrote in news:P7Ftd.417012$a85.6604
@fed1read04:

> Let the doctor know we are intersted in eye exercises?

What would compliance with exercises be in a 3 year old?

Scott
Mike Tyner - 08 Dec 2004 18:45 GMT
> It seems to me that some children have a slowly deteriorating vision.
> I, myself, have bad eyes and it became obvious by fourth grade.

The most common cause for "deteriorating vision in children" is
nearsightedness. That sounds like the problem you developed, since the most
common age of onset is around 9 or 10.

Your daughter is farsighted, quite a different problem, where instead of
blurry vision far away, her vision tends to blur up close. Most children who
are farsighted (in the range of +1.00 to +1.75) don't "tend to blur up
close" because they have vast reserves of accommodation to compensate. They
have no symptoms and require no treatment. Those who are more farsighted
(+3.00, +5.00) exert so much effort focusing up close that their eyes cross
in the process.

If this is why your daughter's eyes cross, then glasses will give immediate
relief and allow the eyes to align, and develop normally. It can usually be
demonstrated in the doctor's office, just by putting individual "trial
lenses" in a temporary frame.

But when the better eye is only +1.00, children seldom develop crossed eyes.
+1.00 is essentially normal for a 3-year-old.

> 1) My daughter compensates by removing one eye from the focus
>    (going cross-eyed)

Children's brains will not tolerate double vision. There is a neurological
mechanism for "shutting off" one eye, called suppression, and at her age
it's important not to allow this because development is arrested in the
suppressed eye and normal acuity and stereo vision can't develop. The
under-developed eye is said to have amblyopia. When it's due to one eye
turning in, it is called "strabismic" amblyopia.

Suppression also occurs if one eye is vastly better focused than the other.
Usually it requires more than 0.75 of difference. If one eye is +1.00 and
the other is +3.00, and this goes untreated, we expect to find some degree
of "refractive" amblyopia in the adult.

> 2) Does she need glasses.  And if she needs glasses, what for?
>        a) to balance out both eyes to reinforce the occular fusion
>        b) to see better.

Glasses _may_ allow the eyes to fuse and develop normal acuity and stereo
vision. As I mentioned, it should be obvious, right away. However, in this
case, they _may not_ since crossed eyes (and amblyopia) are unusual with
only +1.00 and +1.75.

> If she needs glasses for the occular fusion, are there not better ways?

Not at age 3, well, nothing short of surgery.

> Is it possible that the give and take and the beaurocracy of health care
> is such that the easy and fast track were the glasses?  Is it possible
> that,
> if the opthmalogist were fully aware what activist parents that my wife
> and I are, that perhpas there are other interventions?

More likely it's considered important to cover all the possible causes of
her strabismus. Nobody likes looking back and thinking "if only we had done
that..."

> Second, if the glasses are for bad eyesight, I must then weigh:
> 1) cost in regard to my daughters impatience and frustration
> 2) benefits in how well she will see.

Again, if glasses are important, it would be because her eyes align
immediately when she puts them on.

> Let the doctor know we are intersted in eye exercises?

He will likely discourage exercises, for good reason.

If she doesn't fuse with glasses and the MRI finds no neurological cause for
the strabismus, he will likely suggest muscle surgery. He may recommend
glasses with prism for a year or two, to provide artificial alignment while
waiting to be sure the strabismus is stable.

-MT, OD
laurenleigh777@gmail.com - 09 Dec 2004 14:40 GMT
Good words Doctor.

I had eye surgery when I was 2.  I am glad I got it over with, because
I could have ended up with Amblyopia.

Even as an adult, I am 20/20 OU.  I occasionally need glasses with
prisim.  They are around 2up 2in.  It is very hard for me to take them
on and off.

Sounds like your daughter has a few options.

MAKE SURE YOU TAKE HER TO MULTIPLE DOCTORS TO GET ADVICE!

I have tried vision therapy as well.  You really need to be able to
understand the training in order for it to work.  You have to focus on
certain colors and merge the red-green together.  I had a TV trainer
and it took a lot of work.

They might have her patch her good eye so she can train the bad eye to
see better.
Yes, the farsightedness is very common for children.
They can administer some dilation drops called "cyclo".  It will fully
bring out her prescription.
It is very hard to keep a child at that age wearing glasses all of the
time.  Might want to get some glasses straps to keep them on.

As far as surgery, it really depends on how the other treatments are
working.

Good Luck!

Lauren
 
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