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Ophthalmology & Optometry/5.5 year old's astigmatism - like mother, like daughter?

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When my daughter first went for an eye exam at 4.5 years, her prescription was OD: +0.50 -1.75 x 040 and OS: +0.25.  She was told to wear her new glasses 100% of her awake time, and to patch her left eye for 2 hours a day, or more if possible.

We did well keeping the glasses on her, but failed to get a patch on more than a few times and for only 10 minutes at a time.

Her prescription changed after about 8 months, and remains now that she is 5.5 years old as OD: +0.00 -1.50 x 040 and OS: +0.00.  Her doctor said that with this prescription, while wearing her glasses, her right eye is seeing about 20/30, and the left is 20/20.  The doctor would like us to continue patching, and has said our daughter can remove her glasses occasionally, such as for gym or recess.

My questions include:
1. Is patching essential?  Will the patching eventually lead to our daughter being able to see 20/20, with correction, out of her right eye?

2. Will our daughter ever be able to achieve 20/20 vision, with glasses, out of her right eye?  Am I somehow limiting this possibility by not patching?

3. My daughter complains that she sees perfectly without her glasses, and is now beginning to resist wearing them.  Essentially, she claims to perceive no vision change from life without glasses to life with glasses.  Is this because her left is compensating for her right eye?  Could I loosen up on requiring that she wear them? Or will this ensure that her left eye will do all the 'work' for the right, and therefor, that her right eye will worsen?

(I think she actually preferred her first pair of glasses / prescription over the current one. She often noted that everything appeared 'bigger'.  "Look Mommy!" she would say, "Baby Luke's head is so big!". With the new pair, no such difference is evident).

4. Will her right eye worsen if she doesn't wear her glasses?

5. Will she always need glasses?

I fear I bring too much of my own 'eye baggage' into the picture.  I began wearing glasses at 5 years old, but was given rigid gas permeable lenses at 12 years, and wore those successfully for 25 years.  Suddenly, at 37, severe dry eye, an allergic reaction to steroid drops, and blepharitis seemed to send me back to glasses.  My prescription is OD: -11.50 -2.00 x 032 and OS: -13.50.

I have struggled with the adjustment to wearing glasses, including everything from lost peripheral vision, awkwardness while exercising, headaches, clip on sunglasses, and vanity :)

I don't want my own issues to cloud the best care that I can provide for my daughter.  I know that I need my glasses on to make it through the day.  If I'm asking my daughter to wear a pair as well, I want to feel confident that she needs them.

Thank you!

Answer
Hi Jennifer, I apologize for the long delay in responding. you wrote a long letter with many questions.  It is  well written and well thought out, thank you for that. here are some of my thoughts, though it sounds like your daughter's doctor is making good suggestions. Patching is usually not well complied with, so we aren't surprised when that happens.  

after your questions are my answers?
1. Is patching essential?  A: No, and patching by it self won't do much.  She must do detailed visual work with the lazy eye to improve the vision, not just hang out or watch TV.  Will the patching eventually lead to our daughter being able to see 20/20, with correction, out of her right eye? A: doubtful, but her current right eye best vision isn't bad, and as she gets older she may be able to advise a more accurate Rx and see a little better.

2. Will our daughter ever be able to achieve 20/20 vision, with glasses, out of her right eye?  Am I somehow limiting this possibility by not patching? A: Well, as above, it may be not  happen even with patching, so you are certainly limiting the possibility without patching: but the astigmatism is mild and just barely bad enough to suspect that there could be a lazy eye (technically it would be 'meridional amblyopia' or at least 'refractive amblyopia' providing her binocular vision is normal and here is no cross eye, etc.

3. My daughter complains that she sees perfectly without her glasses, and is now beginning to resist wearing them.  Essentially, she claims to perceive no vision change from life without glasses to life with glasses.  Is this because her left is compensating for her right eye?  Could I loosen up on requiring that she wear them? Or will this ensure that her left eye will do all the 'work' for the right, and therefor, that her right eye will worsen? A: She does not see a difference b/c the good eye is perfect and the right eye doesn't add to the clarity.  But the right lazy eye does add very much peripherally and otherwise: if she were to patch the lazy eye she wouldn't like that either. so yes the good eye is the eye used for details, but both are used otherwise.  that's why working with details when patched is paramount, not just patching the good eye and hanging out.

#I think she actually preferred her first pair of glasses / prescription over the current one. She often noted that everything appeared 'bigger'.  "Look Mommy!" she would say, "Baby Luke's head is so big!". With the new pair, no such difference is evident#.A that doesn't matter.

4. Will her right eye worsen if she doesn't wear her glasses?  A: with your personal history she will likely get nearsighted as she grows up, but it won't be because she didn't wear glasses at age 5. The level of the right eye's best corrected vision, 20/30, likely won't worsen, though.

5. Will she always need glasses?  A: Not if he left stays as it is which is unlikely.  So probably somewhere in elementary school the left eye will need glasses to see well, and she'll use glasses until she gets old enough to correct with contact lenses or surgery.

Also blepharitis is skin related and therefore usually familial, so watch for that in your kids, though it often doesn't become a problem until they get older.  The doctor should emphasize safety to protect the eyes, especially the good eye, so for sports or dangerous hobbies or environments, she should use some kind of glasses .
Hope that helps, hopefully you can ask these questions to your doctor and get similar responses.
Regards,
Mitch Axelrod, OD

Ophthalmology & Optometry

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Mitchell Axelrod

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I'm happy to answer questions about eye exam findings and procedures, glasses and contact lens types/prescriptions/problems. I can also answer questions about general eye conditions/diseases. I do not answer questions concerning surgical techniques/procedures. Please state your age or within a small range when asking questions, as it is often important.

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Optometrist 19 yrs.

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Doctor of Optometry, cum laude; Residency in Ocular Disease

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