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Medical Forum / General / Vision / November 2006

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Any thoughts about my daughter's eye complaint?

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whitkel61@earthlink.net - 04 Nov 2006 20:01 GMT
Hi: I have a 6 1/2-year-old daughter who is in first grade. Thursday
she told me the vision in her right eye was "smeary" and that it felt
like something was on the inside trying to push out. I immediately made
an appointment with her pediatrician and set up a later appointment
with an ophthalmologist, because four weeks ago she was accidentally
kicked in that eye by a little boy (she was with her father then, who
took her to the emergency dept. where her eye was pronounced fine
despite a red spot on the eye-white (pardon my lack of proper
terminology)). Prior to the Thursday announcement, she had evidenced no
other issues or difficulties with the injured eye, which no longer
showed any visible redness.

Her pediatrician checked both eyes. She could see a bit of residual
inflammation from the injury, but could see nothing else wrong. My
daughter's vision tested at 20/70 in both eyes (interestingly, in the
at-school screening conducted by RNs the previous week, her distance
vision was tested at 20/25 in both eyes). She did advise that she be
checked by the ophthalmologist anyway.

The next day (last Friday) she saw the ophthalmologist (a "grownup"
one, as the pediatric one was not available until after Thanksgiving).
My daughter told him that it felt like she was looking through a "solid
fog." He dilated her and checked out her eyes, also pronounced her
vision 20/70 in both eyes, then said that there was nothing medically
wrong with her eyes (other than the bit of residual inflammation), that
she did not need glasses even, and that if anything she was a bit
FAR-sighted. (She does seem to be able to still see really well at a
distance.)

A little additional information: I started wearing glasses at age 8 and
nearsightedness is quite pronounced in my side of the family. My
daughter is a voracious reader (middle-school level or above) and
spends better than an hour every day reading. She spends very little
time ( ~ 3 hours/week) in front of a TV or computer monitor.

Does any of this make sense? Wouldn't 20/70 vision require glasses?
What about the significant drop from 20/25 to 20/70 in a week? What
about the smeariness/fogginess? I don't want to doubt a long-time
board-certified ophthalmologist in a well-known practice, but his
findings left me with more questions than answers. I'm going to speak
again Monday to her pediatrician, and also to a friend-of-friend
professor of optometry. If it is not her eyes, I wonder about something
neurological or psychosomatic -- any feedback or advice is appreciated
--

Thanks.
Dan Abel - 04 Nov 2006 20:45 GMT
> vision 20/70 in both eyes, then said that there was nothing medically
> wrong with her eyes (other than the bit of residual inflammation), that
[quoted text clipped - 9 lines]
>
> Does any of this make sense? Wouldn't 20/70 vision require glasses?

I would think so, but I'm no doctor.  Be aware that farsighted people
can need glasses just as much as nearsighted people.

The important thing is whether she can see well enough to do what she
needs.  If she is farsighted, and isn't having problems reading, then
glasses are just a hassle.

Signature

Dan Abel
dabel@sonic.net
Petaluma, California, USA

Mike Tyner - 04 Nov 2006 21:10 GMT
> The next day (last Friday) she saw the ophthalmologist (a "grownup"
> one, as the pediatric one was not available until after Thanksgiving).
> My daughter told him that it felt like she was looking through a "solid
> fog."

If the "fog" is present in both eyes, it isn't likely a direct consequence
of the injury.

> He dilated her and checked out her eyes, also pronounced her
> vision 20/70 in both eyes

This part is puzzling and needs to be verified. With or without glasses,
20/70 isn't normal at 6 1/2. 20/25 is typical.

> then said that there was nothing medically
> wrong with her eyes (other than the bit of residual inflammation),

That's the most important part.

> that
> she did not need glasses even, and that if anything she was a bit
> FAR-sighted. (She does seem to be able to still see really well at a
> distance.)

Again, that's inconsistent with "20/70" so I suspect there's a
miscommunication somewhere.

> A little additional information: I started wearing glasses at age 8 and
> nearsightedness is quite pronounced in my side of the family. My
> daughter is a voracious reader (middle-school level or above) and
> spends better than an hour every day reading. She spends very little
> time ( ~ 3 hours/week) in front of a TV or computer monitor.

Reading and close work do contribute slightly to the tendency to myopia, but
she isn't myopic so that isn't part of the current problem. Computer
monitors and books aren't significantly different.

(Opening this door, you will likely hear from our resident troll(s), amateur
myopia therapists with their own ideas about wearing or not wearing glasses
to control this condition.)

The only "myopia prevention" suggested by modern research is to avoid
reading at very close distances, and to take "visual breaks" frequently.
Myopia is mostly genetic and, again, not really relevant to her current
problem.

> Does any of this make sense? Wouldn't 20/70 vision require glasses?

Normally yes. As noted, I don't think that's the true situation.

> What about the significant drop from 20/25 to 20/70 in a week?

Six-year-olds are notoriously variable, especially the farsighted ones. When
a six-year-old gives different acuity measurements in different testing
situations, mostly we assume the better response is more accurate.

> What
> about the smeariness/fogginess?

If you can confirm that it's only one eye, it bears further evaluation, but
be circumspect - it's hard to ask without cluing her to the "right" answer.

> I'm going to speak
> again Monday to her pediatrician, and also to a friend-of-friend
> professor of optometry.

Good to follow up but opinions are just opinions. I'd recommend you ask the
friend-of-friend for a referral to a good pediatric optometrist for
confirmation. That's the most efficient way to get peace of mind.

> If it is not her eyes, I wonder about something
> neurological or psychosomatic -- any feedback or advice is appreciated

Sometimes these complaints do signal a desire for attention or sympathy but
we give six-year-olds lots of leeway before labeling it psychosomatic, or
worse.

Neurological complications are a vague possibility but without concussion,
bone fracture, or loss of consciousness, and in light of the normal
examination, it's pretty remote.

MT, OD
 
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