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Ophthalmology & Optometry/unstable prescription in 5/6 year old


My daughter has been squinting since she was a toddler, but at well-child vision checks, they always said she was fine. On my own, I made an appointment with a ped. opthalmologist for her just before started kindergarten. At 5 years 2 months, the ophthalmologist dilated her eyes and diagnosed her with astigmatism and refractive amblyopia of both eyes.

OD -350 SPH. +350 CYL. 105 AXIS
OS  -350 SPH. +350 CYL. 075 AXIS

The first doctor had told us to follow up after three months, which we did but for logistical reasons, we had to see someone else. This time we saw an optician, who said her prescription was fine. He did not want to to dilate, and did various vision tests without dilation. However, a couple months later, the in-school vision screening referred her for further testing. We took her back to the clinic,  and again for logistical reasons, saw a third doctor, another pediatric ophthalmologist. This is only 8 months since getting glasses for the first time. He dialed her and revised her prescription:

OD -2.00 SPH, +5.50 CYL., 120 AXIS
OS  -2.00 SPH, +5.25 CYL, 65 AXIS

We got her new glasses. Just yesterday at her 6 year well child, they did the simple vision test and she could not read below the second line with her right eye.

My questions

Is it common for a child's prescription to change so frequently and so much? (Or is it not changing that much?)

Should I take her back to the pediatric ophthalmologist or go with a friend's recommendation and see her family optomotrist? We won't be able to get an appointment with the ped. opthm. for two months, but we could actually see the same person for a repeat visit. We could see the O.D. much sooner.

An optometrist, preferably one who does pediatrics, or the ophthalmologist, are both qualified however there is a large change in prescription from the first Rx to the second.  The latter one indicating a large amount of hyperopia and some 50% more astigmatism than the first one.  With this kind of prescription it it not unusual to have an amblyopic eye ( lazy eye) which explains why she doesn't read below a certain line on the Snellen acuity eye chart. She most certainly will need to wear her eyeglasses all her waking hours and need aggressive visual therapy like eye patching, therapeutic exercises, etc.  Good luck.   Dr Berger

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Any and all questions with regard to ocular ailments, eye diseases as cataracts, glaucoma, macular degeneration, diabetic retinopathy, etc , eye and visual sympomatology, eyeglasses, contact lenses, low or subnormal vision, pediatric vision conditions,and special and unique ailments will be discussed.


36 years of clinical experience in opticianry and therapeutic optometry. Still in private practice with special interests in vision conditions, diagnosing and treating ocular ailments, prescibing treatment plans which include medicine, eyeglasses, and contact lenses primarily. Although surgery is not within the realm of my area of expertise, I co-manage many pre and post -op surgical cases which include Lasik and PRK procedures.

New Jersey Society of Optometric Physicians American Optometric Association

B.A.,1968, Hunter College of the City University of New York B.S.,1970, Pennsylvania College of Optometry O.D.,1973, Pennsylvania College of Optometry Therapeutic Pharmaceutical Administration Certification, New Jersey 1992

Awards and Honors
Clinical Efficiency Award, 1973, Pennsylvaania College of Optometry

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