View Full Version : Strabismus: Experiences with children
No informed commentary from me, just a word of support. good luck.
ZDL,
My son had/has it. It took us most of a year before it was diagnosed and then only after we drove a hour to a specialist. His was fairly mild, but we were catching it at age 2. He had surgury to correct it and now at age 4 we appair to be in the clear. He still has follow ups and may need additional surguries as he gets older. And he wears glasses now:(, but his vision is good.
Our GP and local optho guy missed it, the pediatric opto guy in Syracuse caught it. The specialist says it's good we caught him young. The older the kid the less successful the surgury is.
Shoot me a PM, I'm not good at getting back quickly, but I'll get back to you. It was hard leaving him in the OR and when he came two he cried like there was no tomorrow. TRICARE paid for the whole thing no problem.
My son had it, and we caught it fairly early. We tried using glasses to correct it, but wound up having to go the surgery route. It sucked when he woke up and started crying, but he is now 17 and has been good to go since his surgery at 4.
Cut no corners when it comes to finding a specialist. If you must go the surgery route find the Doc with the most experience, and still get a second opinion. The Doc that worked on my son was worshiped like a God by the other eye docs in the area. The Doc that gave us the second opinion was uncomfortable second guessing his work, and referred to him as Dr Shepard......Sir. My insurance company covered it no questions asked.
Good luck, I'm sure it will work out.
Let me know if you have any questions.
Thank you for responding. I've been reading surgery should be considered as a last resort treatment. Was this the case for you? Our daughter is 2.5yo.
Yes, surgury is a last resort. We started with glasses. He had an astigmatism in both eyes. In some cases the glasses will allow the eyes to self correct. I think he was in them for six months before we went for surgury.
Find a good doc. If they don't get it right the first time they will have to do it again. When he was assessing my son it reminded me of checking for you dominate eye. He would get Him to watch something then cover his eyes looking for his eyes to refocus.
After attempting to make the needed corrections with glasses, we had to go with the nuclear option....surgery. His glasses made some correction, but not enough.
Mo_Zam_Beek
11-19-09, 01:02
Yes.
We caught it in our daughter when she was probably 18 months old. Left eye would flop occasionally at first and then very quickly it was perma flop. Went to the eye doc - she didn't like the drops to dilate her eyes nor the refraction of light tests... pretty squirmy as I held her on my lap, but she got through it. She has worn glasses since. She is now almost 4. If she is not sleepy and her glasses come off her left eye will stay normal for a 1/2 hour or so now. She took to the glasses with no problem and wants to wear them.
I will say this - you will become quite adept at, and will have a pretty good sized collection of spare parts for repairing your child's glasses. The cable loop ear pieces are a good thing for little kids.
Also - not that you wouldn't, but treat these just like you would any other item of your preps in the event of a problem - keep a spare set and spare parts around - always.
Good luck
I got to this thread a little late...you've probably already been to the doctor by now, but, to observe the strabismus, if she has one, and is old enough to follow your directions, have her focus on the tip of a pencil, or a dim flashlight, approximately 40-50 cm from her eyes. Cover her left eye so she is fixating on the pencil tip with her right. Then instruct her to maintain her focus on the pencil and rapidly uncover the left and cover the right eye. While you do this, you need to watch the eye you are uncovering. If she has an eye misalignment, the now uncovered left eye will swing out, in, up,or down to reacquire the pencil. If you now uncover the right and then cover the left, the right should make the opposite movement. Repeat as needed to see it. I hope that helps to at least let YOU see it.
Age is critical here. Children caught prior to age 5-7 generally have the best prognosis. The problem with strabismus is that the eye that is not aligned will not develop normally and become amblyopic (simple explanation is having less than 20/20 vision fully corrected with glasses). You can correct this deficiency by patching the good eye and forcing the bad eye to work (fully corrected with glasses of course). You have to go to a good doctor to find out if the reason for the alignment issue (2 most common) is refractive (uncorrected large Rx) or oculomotor (natural alignment problem in the muscles). The level and ease of success will decrease as a child gets older. Let me know if you have other questions.
It is usualy more prononced when the child is tired.
We also looked into the theraphy method above prior to surgury with a differant doctor as a consol. After looking at my son he sent us back to the surgion.
30 cal slut
11-19-09, 07:06
My little guy has it.
It is usually very easily corrected with eyeglasses, and if that doesn't work, surgery.
It's not a big deal at all, as long as you catch it and treat it early.
-slut
Sorry to hear the difficulties; always worse when they happen with kids.
Our daughter had it and fortunately we caught it early, and her case might be different from what you are experiencing. Her eyes would not track together and one of them would "wander" or cross. Specialist we were recommended to, went with therapy first. For 6 months it was twice a day for at home "training" involving different eye movements, hand-eye coordination, depth perception, etc. We were able to correct the issue without surgery or glasses and now she has great vision.
you might want to see if the type of vision challenge your child has, can be impacted by therapy.
good luck
Everyone:
Thank you for all your input. My wife and I both have terrible uncorrected vision. I figured she was screwed when it came to that eventually. I just didn't expect it to manifest itself like this... or so early. I'll update with what I find out tomorrow from the pediatrician and/or specialist.
Another question: Is any cross-eye activity normal? Such as focusing on something for too long or due to exhaustion/tiredness? My wife has noticed it happening near bed time or just after getting up from a nap. I got her up early today, 0600 where she normally gets up around 0900. She took a nap around 1515 and awoke 1730. None of this resembles her normal routine; I just had to get some things done today. Moving on: I didn't notice it till she got up from her nap. She was in a bad mood which tells me she was tired. This is when I started noticing it. It stayed pretty constant till she went to bed around 2100. Anytime her attention was on something, the eye would drift inward sometimes to such a degree it seemingly disappeared into her nose.
Typically a person's eyes shouldn't cross unless they will them to. One of the more common reasons for an inward cross is due to an "Accomodative Esotropia". In this example/situation, the child is extremely "farsighted". As they attempt to focus on objects, especially near objects, they'll have to focus so much that one eye breaks fusion so they end up only viewing things with one eye, while the other eye turns in. This happens more noticeably when they are tired. You can see the turn happening if you do that earlier "cover test" I described.
If this ends up being the diagnoses, the correction is simple. Make her wear the glasses that she is prescribed FULL TIME. It shouldn't be hard being that she is so young, and her future vision depends on it. I've seen a lot of kids who were told to wear the glasses and didn't, causing them to have 20/20 vision in one eye and worse than 20/20, usually 20/40 or worse, in the other eye. Their depth perception and binocular vision do not develop normally at that point.
If the experts think vision therapy is a good way to go, do it. Many disorders can be corrected through good vision therapy so that you don't even to go the surgical route. Oftentimes, if surgery is needed, you can improve the surgical outcome if the child has had therapy first.
LegalAlien
11-19-09, 13:10
My daughter had it and it manifested more when she was tired.
We started off with corrective glasses - various experiments and various levels of correction. I think we went through about 4 different pairs of glasses in two years. At one stage we even had her good eye covered with an eye patch to force the 'lazy eye', but during her first school year we finally came to the conclusion that glasses were not providing the correction that was desired. She had constant head aches, was forced to sit in front of the class to be able to read what was on the 'black board' and she was just generally very unhappy with having double vision and head aches most all the time.
This was still back in the early 90's back in South Africa and we were able to find a top Opthalmology professor at the University of Cape Town that finally recommended surgery. She had surgery twice to get to the correct length for the muscle, and yes, it was extremely traumatic for both her and us (she was about 6yrs old by then) every time she came out of the anesthetics.
She is now 24, happily married, never needed glasses again after then 2nd surgery.
Eye excercises and corrective glasses work in many situations and very often the eye muscles will get the co-ordination and self correct, sometimes with some assistance, but, be prepared for corrective surgery if her eyes are not normal by the time she is ready to start reading and go to school.
Subscribed for info and wishing your daughter the very best! On a brighter note you're recognizing it early on and seeking treatment and by the time she's a teenager it'll be a distant memory.
Missed this thread earlier somehow. Real sorry to hear old buddy, but doesn't seem so bad after reading all these helpful, well informed replies.
Very best of luck.
Dr. referred.
Specialist rx glasses. He stated she was far sighted. I have no clue how he was able to determine that as he didn't do a vision test on her. Just looked in her eyes with his tools and barely that as she was not happy about the whole ordeal. Any further experience with similar specialist visits? Can someone tell near/far sighted without a vision test? How? etc. Thanks again.
There is a device called a retinoscope which allows the doctor to determine a baseline "estimate" of the patient's prescription, which can then be later refined to a final presciption. See below:
http://en.wikipedia.org/wiki/Retinoscopy
I do this time all the time with young and older patients alike. Especially with younger patients, you can't rely on them to give you accurate answers so you do other testing to get you started. The important thing for a young far-sighted child is to get their vision started on the right path. So ANY correction that gets them closer to perfect is better than none. The next visit should yield better, more accurate results and should probably be within the next 3-6 months. She needs to wear the specs full-time, like it or not (she'll probably hate the first Rx, even if it is 100% correct, especially if the doctor didn't do further refining).
By the way, I don't know if you looked it up, but I mentioned in earlier posts, that I thought by your description, that your daughter might have accomodative esotropia.
http://www.strabismus.org/esotropia_eye_turns_in.html
I am not affiliated with that network, but I thought that it will provide a good resource article to get you started on understanding things. Unfortunately, most doctors, will not give their patients enough of an explanation to understand things. You apparently got one of those. If you desire information, you might want to ask around for a doctor who will discuss things with you openly.
In this situation, I would recommend that you see a good PEDIATRIC OPTOMETRIST, not an ophthalmologist. Most optometrists will have a good pediatric optometrist they refer to when the problems exceed their ability to treat the patient. You can always find exceptional pediatric doctors at the Schools of Optometry depending on where you live.
**** this asshole. I'm finished with him. How dare he treat my family with such disregard. How dare he, in my opinion, provide sub level treatment and care for a potentially serious issue.
Agreed. The horror stories prevail.
Personally and as you may know, I would have politely but firmly grabbed the aloof doctor by the forearm and ask for a more detailed explanation. This with absolutely no guilt whatsoever. It is your child's health in question and he surely owes you better.
For reasons I won't detail, stories like this really disturb me.
Nathan_Bell
01-18-10, 18:37
Agreed. The horror stories prevail.
Personally and as you may know, I would have politely but firmly grabbed the aloof doctor by the forearm and ask for a more detailed explanation. This with absolutely no guilt whatsoever. It is your child's health in question and he surely owes you better.
For reasons I won't detail, stories like this really disturb me.
Don't touch the doctor, they have gotten to be as standoffish about being touched as police. Got threatened with having the latter called on me after grabbing a former's shoulder last time I was in getting stitched up.
Finger sliced wide open, ended up needing 20+ stitches, Dr has my hand strapped to working table and skin pealed back and pinned down, he is scrubbing it, stops, gets up and walks off without out a word. I use my right hand and grab him by the shoulder to ask him what I should do while he is off on his suddenly important mission. He takes umbrage and threatens to call police.
Sorry for the hijack ZDL, hope you get a non-jackass next try.
Don't touch the doctor, they have gotten to be as standoffish about being touched as police. Got threatened with having the latter called on me after grabbing a former's shoulder last time I was in getting stitched up.
Finger sliced wide open, ended up needing 20+ stitches, Dr has my hand strapped to working table and skin pealed back and pinned down, he is scrubbing it, stops, gets up and walks off without out a word. I use my right hand and grab him by the shoulder to ask him what I should do while he is off on his suddenly important mission. He takes umbrage and threatens to call police.
Sorry for the hijack ZDL, hope you get a non-jackass next try.
Doctors need to be accountable far more than the average "Joe". And as confirmed by this man's story as well as several I could articulate, they absolutely have a track record of being black hearted at the very worst of times.
By the way, I was not talking assault. Just demanding accountability.
Nathan_Bell
01-18-10, 19:12
Doctors need to be accountable far more than the average "Joe". And as confirmed by this man's story as well as several I could articulate, they absolutely have a track record of being black hearted at the very worst of times.
By the way, I was not talking assault. Just demanding accountability.
I agree with you, but just telling you my experience has been they get pissy when touched. All I did was put my hand on his shoulder to get him to stop and turn to look at me as he walked away, as I was stuck to the working table and couldn't get in front of him.
Not the only one who has reacted that way, and not just my scary mug being on the other end of the arm is getting that reaction. Won't hijack further.
I agree with you, but just telling you my experience has been they get pissy when touched. All I did was put my hand on his shoulder to get him to stop and turn to look at me as he walked away, as I was stuck to the working table and couldn't get in front of him.
I hear you buddy and I understand. No problem.
ZDL, the best thing you can do is call the doctor first thing in the AM and firmly but politely ask for a more detailed explanation. There is absolutely nothing to lose.
If he is too arrogant to deliver, it will speak volumes as to not just his character, but also his work ethic. Either way, be proactive.
He is how he is. Change doctors. You may do better in a University setting. Are you near any Universities? If this is not his speciality, (even though he may say it is) he may be avoiding his incompetence. If it were to come to surgery, you probably do not want him to do it.
Ask your doctor or nurse, how much does Dr. Eye do Strab work? Like others said, it must be a Ped Ophthal. It needs to be a busy one that has done alot of these. Its a crazy science reading and understanding these eyes. If he is good, he probably wont mind the questions. Look for a Dr. that does 1-3 or more surgeries a week for Strabismus.
Good luck on finding a new Doc.
Don't touch the doctor, they have gotten to be as standoffish about being touched as police.
He should know, he is a cop ;) Your daughter is in our thoughts and prayers.
Had 2nd appointment. Shorter than the first. Figured I would give the guy another shot since I didn't have my wits about me last visit. Same attitude:
The visit in full:
How is she doing? We still notice it but it's difficult for us to discern if the frequency has changed. If it has declined it certainly wasn't noticeable and I'm not convinced it hasn't increased either
Dr. attempts to look into her eye with his tool from 5ft away while my child is holding still for less than a nano second at a time. Spends exactly 8 seconds doing this and states: "I'm happy with the progress and see a change so lets keep her in the glasses and come back in 6 months."
I ask: What things have you seen changed? A muscle development? Size of something? A different property than last time? etc
His response: "things"
And he walks out of the room. Total time elapsed. Under 4 minutes. No bullshit.
**** this asshole. I'm finished with him. How dare he treat my family with such disregard. How dare he, in my opinion, provide sub level treatment and care for a potentially serious issue.
Taking her to my eye doc this week. I'm pissed.
Lastly, just tonight I was snapping some pictures of her and noticed it happening in the other eye now. Great. :(
Ok first things first. Take a step back, and calm down.
The thing that causes me the most concern is this doctors lack of bedside manner. While his skills may or may not be good, that is no excuse for the poor communication.
I can tell you that some of my son's check-ups were shorter than others, although I don't remember my doc using any kind of instrument from 5ft away.
Go see a few other doctors. Since they are all seeing the same patient, their diagnosis should be similar, and providing they all have a good rep, go with the one that you are the most happy with. The process for the diagnosis and treatment is a bit lengthy. In my original post I stated that my son's surgery was at 4. If I remember correctly 4 is when we first noticed it and began treatment. I think he was 5 or 6 by the time he needed surgery.
If she goes under the knife, while bedside manner is certainly important, remember it's the skill you are after here.
...... Because my post wasn't clear I can't blame you for missing the point. All I care about is a clear diagnosis and treatment plan for my daughter. I don't feel this guy has provided that. He certainly has given us words but when pressed for an explanation behind his diagnosis he refuses to answer. Not real hard to put it together. I'm finished with utilizing his so-called services. I'll be taking my daughter elsewhere.
It sounds like you had some bad luck with that guy. Unfortunately there are some docs that just don't like to talk. Take your daughter to a Pediatric Optometrist. In my experience, they are usually really patient and nice. It sounds like she has a Accommodative Esotropia based on what you are telling me, but it is impossible to know from here. The glasses must stay on in order for her to make up any ground, don't let her stop wearing them. Any correction in the right direction is better than none.
The device he is using is a retinoscope. From about 3-4 feet away he can evaluate the way the light is reflecting off the back of her eye to see if the correction is within ballpark of what he is looking for....I don't know how well if it was only for a few seconds. In all honesty, you will see no consistent improvement in 8 weeks...it will take some time. Reread my earlier posts and the links I provided and you should have A LOT of information.
CarlosDJackal
01-20-10, 11:31
I think my niece had this (I often wondered how she kept from running into a things). When she was around 10-years old my sister and her husband decided to have it corrected surgically.
I believe all they did something to one of her optic muscles. She is now in her upper 20s and is doing fine. In her case the operation did what it was supposed to.
Good luck.
He is a pediatric. I do appreciate the information. Thoughts on the other eye now doing it? What time frame should I be looking at for noticeable improvement? I ask so I know that after _____ period of time I can assign a grade to her progress. Thanks again. Means a lot that you are taking the time to help.
The other eye shouldn't be doing it, but I don't know as I am not seeing what is going on. I'm also not a pediatric specialist, just a doc with experience in 4+ year olds.
The time frame for improvement depends....assuming the spec correction is 90-100% correct, she shouldn't have any remaining eye-turn, but the glasses are going to be a permanent thing in her life, until she is old enough for contacts. If this is her first exam, it is highly unlikely that the spec Rx is 100% correct because she isn't given enough of an exam (1 or 2, 3 or 4) to get her subjective answers. The time frame also depends if she developed amblyopia, or decreased best corrected visual acuity. If she did have amblyopia, that would require patching the "good" eye to strengthen the bad eye. Don't try to judge her progress too "technically". Her recovery will be a very fluid process and may not follow any guidelines/predetermined checklist.
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