Saturday, April 9, 2011

Who You Callin' Lazy?

This picture may come in handy one day...

We had Nolan's vision appointment yesterday. His left eye read the eye chart with no problem. His right eye, however, couldn't see a thing. They tried several different lenses, and he couldn't get down to the "normal" line, even with correction. The verdict?

A lazy eye due to a difference in refractive power between the two eyes. Or, as the ophthalmologist put it: "he has anisometropic amblyopia." Anisometropia (literally, "unequal seeing") is more common among children than adults, and the result can be devastating for the affected eye if amblyopia develops and remains untreated. The brain doesn't like the poor vision it gets from the one eye, so it simply turns it off and relies on the better eye.

For Nolan, his right eye is myopic with a good deal of astigmatism. His left eye is very slightly farsighted, and also has a decent amount of astigmatism. His vision screen suggested 4 diopters of difference between the two eyes, but the real exam shows that he has 2 diopters of refractive difference between the eyes. This is a bit of a relief (the greater the difference, the greater the amblyopia). There is also a difference of about 1 diopter with regard to astigmatism.

The worst thing about amblyopia is that it is completely invisible. There is absolutely no way to tell if a child has amblyopia without an eye exam - there are no outward signs.* Your child could literally be going blind in one eye, and you would never know it.

My PSA: get a comprehensive vision exam before kindergarten. Especially if your child has a hearing loss - amblyopia can be treated very successfully if kids are caught in the preschool years.

I have his prescription in hand, and Nolan will get glasses very soon. Probably wire rims with cable arms, and they'll probably be blue. Nolan wasn't thrilled with the idea of glasses at first. I tried telling him that he would have glasses like Mommy and Daddy, but it didn't really sell him on the idea.

When we used one of his little friends from the John Tracy Clinic as a role model, however, he was right on board. Nolan loves Noah, and loves Noah's glasses. When we explained that he was going to get to wear glasses like Noah does, he was suddenly OK with the whole idea. In fact, he was more than "OK" with it - he wanted them badly. When we left the pediatric ophthalmologist's (PO's) office without a pair of glasses, he burst into tears! I promised him that we'll get his glasses very soon, and he was temporarily placated. I suspect we'll have to make our trip to Walmart over the weekend, or we're going to have a very disappointed little boy on our hands!

Of course, when I got home, Nolan went up to Matthew and declared, "I get to get GWASSES!" Then Matt burst into tears. "Now I'm the only plain one!" Oh, the plight of the older sibling who has no "accessories." We'll probably get Matt a pair of kid's sunglasses, since he feels a bit left out.

We are hoping that Nolan won't have to do any patching. We return to the PO in about six weeks for a follow-up check. If the vision in his right eye hasn't reached the normal level with his glasses, we'll have to start patching his good eye. Here's to a successful reawakening of his right eye before our June appointment - he relies on his vision for distinguishing some sounds (he speech reads the m and n sounds, for example), so the thought of taking away his good eye isn't very attractive.

*Many people confuse crossed eyes or wandering eyes with "lazy eye." Crossed or drifting eyes are strabismus, not amblyopia. While strabismus can lead to amblyopia, it is not the same thing. Most children who have amblyopia have straight eyes, with absolutely no outward sign of the condition. Children will not complain of poor vision in one eye, so the only way to catch amblyopia is to get a comprehensive eye examination.


Herding Grasshoppers said...

Oh poor Matt, the only plain one! I remember Gunnar making his own "hearing aids" out of blue pipe cleaners at one point.

Praying that Nolan's eye "wakes up" with the glasses, and cheers to you for being such a with-it detail-oriented mom :D


tammy said...

So glad he's excited about his glasses! Poor Matt thinking he's the only "plain" one! One of my favorite books is "The Crayon Box That Talked". I used to read it to my students every year to talk about uniqueness. It's always been one of Kailyn's favorite books too.

Joey @ Big Teeth and Clouds said...

Our ENT recommended an eye test right away when the hearing loss was first discovered. This is a good PSA. Of course, Tim and I were both very near sighted prior to having LASIK. I figure Julia's eyesight is doomed. Poor kids!

Hope Nolan adjusts to the new specs!

Terena said...

that is an absolutely adorable picture

Charlie said...

I just happened upon your blog as I was searching about my daughter's lazy eye. You did such an amazing job explaining it. Thanks. She just turned three and doesn't know many of her letters so the PO decided to wait 4 months until she can to fit her for glasses. He felt like it would be more accurate. I hadn't thought about my older daughter feeling left out when little sister gets glasses. The sunglasses idea is great!

leah said...

Thanks, Charlie! Nolan is wearing glasses now and is doing great with them. We go back in September to see if we have to start patching. I really hope we don't have to patch, but it will be worth it to save the vision in one eye if we do have to do it.

Good luck with your daughter when you go back in a few months! They used the "HOTV" test with my son (just four letters - he had to point to the matching ones). They also did a dilated eye exam - they don't need the child's cooperation for that portion of the exam, and they can get a very accurate prescription by bouncing light off the back of the eye. There is a great facebook page called "little four eyes" that has a lot of experience and advice on lazy eye!