Ophthalmology & Optometry/astigmatism


QUESTION: My son is 5 years & 8 months old. Although he doesn't complain of any eye problem, for an over all check-up we got his eye testing done for the first time. The doctor checked through various different ways including dilating, and found that he has power. After 2 days again he was checked for his correct power and the power prescribed by the doctor is:
For right eye:
Nil(SPH), +1.0(CYL), 80deg(AXIS), 6/9(VA)
For left eye:
-0.5(SPH), +1.75(CYL), 90deg(AXIS), 6/9(VA).
He has been told to wear the respective glasses throughout the day, specifically when in school, reading, doing home-work, watching TV. But not necessary if he's moving around or playing.
On asking the doctor, whether the power can be corrected fully if he wears regularly, the doctor says that with age, the + power can be corrected, but - power generally keeps increasing with age, so possibility is he may have to use glasses forever.
Can you please throw light on this observation for a second opinion? Also i want to know, isn't it too early to wear glasses. What i have been knowing is that the cornea muscles get stronger day by day for a child as he grows, so their eye-sight keep improving as they become toddler.
Please suggest.

ANSWER: Papiya,
Once the astigmatism (cyl) is over 1.50 it is very standard to prescribe, as uncorrected astigmatism is highly associated with developing amblyopia, or a 'lazy eye.'  
I would agree with the doctor's recommendations, and prescribe your son to wear the glasses, and would likely recommend full time.  The prescription may get a little better, or may get worse, over time.  Wearing glasses will not change how the eye develops.
When in doubt, get a second opinion, but it sounds very reasonable to me.
Good Luck,

[an error occurred while processing this directive]---------- FOLLOW-UP ----------

QUESTION: How is astigmatism detected? How is the exact power of astigmatism detected? For a 5 year old child, can the power of astigmatism be detected accurately? Because when we went on the second day, and he was asked by the doctor to read the alphabets on screen to estimate the actual power, the doctor said that with & without glasses he sees with same clarity. So how did they finalise on the power?
Should we get the power checked by another doctor before starting with wearing glasses? Or should we start with the glasses immediately, and sometime later go for another check-up?
Will his eyes get affected if he's not wearing the accurate power glasses now?

There are many ways a doctor can determine the correct prescription. It wouldn't hurt if you got a 2nd opinion before wearing the glasses, waiting a week or two would harm nothing. I normally scheduled my young children 48 follow up in 30 days. At that point I will recheck the prescription and make adjustments if necessary. Good luck

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John M. Dovie, OD, FAAO


As a residency-trained Fellow of the American Academy of Optometry I am able to answer most questions regarding eye and vision health. Anything is welcome, ranging from dry or allergy eyes, bifocal contact lenses, or thoughts on LASIK surgery. As I am not a surgeon, detail-oriented surgical-related questions may be better answered by an ophthalmologist.


Selected to participate in the PCO residency program in Philadelphia at The Eye Institute, where I worked OD and MD specialists gaining invaluable experience in various clinics including glaucoma, cornea and cataract, oculo-plastics, retinal disease, neuro-ophthalmic disease, primary care, emergency medicine, and special populations. Have practiced and trained in numerous settings including hospital, academic, retail and private practice. I earned my Fellowship in the American Academy of Optometry (FAAO). There are currently only about 3000 active fellows worldwide, and there are only about 70 Fellows in the state of Virginia. I currently own and operate my own optometric practice/clinic.

American Academy of Optometry, American Optometric Association (Contact Lens/Cornea Section member since 2001), Southwest Virginia Optometric Association, Virginia Tech Alumni Association

“Nyctalopia as the Presenting Sign of Vitamin A Deficiency: A Late Complication of Gastric Bypass Surgery.” Clinical Case Study Poster presented at The American Academy of Optometry Denver, Colorado, December 2006, co-authored with Bradley Lane, OD.
“The Importance of Considering Paranasal Sinus Mucocele as a Differential Diagnosis in Diplopia.” Clinical Case Study Poster presented at The American Academy of Optometry San Diego, California, December 2005, co-authored with Kelly Malloy, OD, FAAO and Cherie Farkash, OD.
“Acute Onset of Halos and Glare: Bilateral Keratitis—An Atypical Presentation of Amiodarone Keratopathy.” Clinical Case Study Poster presented at The American Academy of Optometry Tampa, Florida December 2004. Also Presented to New Jersey Academy of Optometry, Neptune, New Jersey March 2005.
“The Opportunity for an Optometrist to Save a Life.” Clinical Case Study and Grand Rounds Presentation presented at The Pennsylvania College of Optometry, Philadelphia, Pennsylvania, September 2004.
“Corneal whorls cause wonder.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 10/15/2006.
“Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.” Co-authored with Andrew Gurwood, OD, FAAO. Published February, 2006, Optometry.
“Pondering the posterior polka-dots.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 5/15/2005.
Professional Involvement:
“AION: Amiodarone-Induced or Anterior Ischemic Optic Neuropathy?” Participated as a peer-review referee for Expert Review of Ophthalmology (London, UK); refereed 10/2006.

Bachelor of Science, Cum Laude, Virginia Tech. Bachelor of Science, Pennsylvania College of Optometry. Doctorate (OD), Pennsylvania College of Optometry Residency, Pennsylvania College of Optometry Fellow of the American Academy of Optometry

Awards and Honors
Winner, First Place, "Best Beside Manner" by Our Health Magazine: 2012, 2013, 2014 Winner, First Place, "Best Eye Doctor" by The Roanoke Times: 2013, 2014 Recognized as a Fellow of the American Academy of Optometry, December, 2006 Recipient of the Onofrey G. Rybachok Memorial Scholarship, 2000-2001 Member: The Golden Key International Honor Society Member: The National Biological Honor Society Member: The National Honor Society Eagle Scout awarded 1994

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