Her vision is bad enough for glasses, but if she doesn't wear them no big deal???

[Dobela]

kind of long... I guess mostly, has anyone else BTDT?

 

DD turned 4 10 days ago. She was a micropreemie born at 26 weeks. She has a diagnosis of Retinopathy of prematurity. Her blood vessels did develop without issue fortunately although she was closely followed for months. Other than being told she has slight nearsighted tendancies, we have always been told that her vision is fine and her eyes are fine. Last year we were told that she had the smallest astigmatism possible.

 

Yesterday was her annual follow-up with an opthamologist. According to him, dd has an astigmatism, her vision is about 20/30 (I question that), but with her age and history he thought she was doing wonderful. The astigmatism is enough that he wanted to put her in glasses for the first time. But then he says, "The glasses are not going to make much difference in her vision. She will probably not want to wear them because she won't notice the tiny change. If she doesn't like the glasses, and doesn't want to wear them, no big deal. It is not going to make her vision worse. I will want to follow up in 3 months."

 

So why the glasses? I am ordering them today, it will be 3-6 weeks before they arrive. Her insurance will pay for them if I do it this way. I guess I will let her try them, and keep them handy but not force the issue.

 

I do question the accuracy of the initial exam. It was done using the Allen pictures instead of letters. They were very simply silhouette-ish in black and white of a hand, a birthday cake, a jeep, a duck/bird, and a telephone. The telephone was a desk phone complete with rotary dial. The woman administering the exam seemed very focused on having dd identify the phone. I finally had to say, 'You know, that is really a very dated picture. I doubt that dd has ever seen a phone like that." So then she switched to the jeep (that looked like one from MASH) - and didn't accept the answer 'truck'. :001_huh: DD calls everything either a car or truck... When I pointed that out, the lady then opens a whole row of smaller pictures and asks dd to identify them. Quickly dd identifies the hand, the cake, and the 'duck'. She doesn't name the jeep and phone, even with prompting so the lady says she doesn't think dd is seeing that row well.

 

sigh.

 

Since the opthamologist is 60 miles away, I stopped to order glasses from my optometrist at home. She sees the Rx, is also very familiar with dd, and says that her instinct and 20 years previous experience tell her that dd's curvature will most likely self correct due to her age if left alone. She feels that the glasses are a mistake, but since the other dr is not wanting us to force them not much harm will be done. It is also her opinion that if we did force the glasses then the curvature will never self correct.

 

So, when I go back in July to the opthamologist, is there anything I need to be saying or asking? Has anyone else BTDT?

[TheCoffeeChick]

Would your insurance pay for a second opinion? I agree that the phone and jeep were not appropriate pictures. :glare: My kids probably have not seen a rotary phone ever either. (in fact, they're not even familiar with a home phone, as we've not had one for 8 years!)

[Ravin]

I'd probably skip the glasses until she starts wanting to read, then get re-evaluated in case she needs them for that. 20/30 is not much difference really; I'm 20/50 in my right eye, much worse, and uncorrected I could get along fine except for driving, watching TV, and reading.

[Dobela]

Would your insurance pay for a second opinion? I agree that the phone and jeep were not appropriate pictures. :glare: My kids probably have not seen a rotary phone ever either. (in fact, they're not even familiar with a home phone, as we've not had one for 8 years!)

Possibly insurance would. The problem is that the next nearest opthamologist that will see her is 150 miles away. We do have a children's hospital but they discharged her at 1 year old because they were so overrun with patients that they only kept the most severe. None of the other opthamologists will see children under the age of 6. It is something to consider though.

[Starr]

Our opthamologist told us that children won't wear glasses until they really notice a difference. I wonder why he had you get them if he didn't think she would wear them?

[abacus2]

Possibly insurance would. The problem is that the next nearest opthamologist that will see her is 150 miles away. We do have a children's hospital but they discharged her at 1 year old because they were so overrun with patients that they only kept the most severe. None of the other opthamologists will see children under the age of 6. It is something to consider though.

 

I would try get as second opinion from an optometrist instead then, especially since you are questioning the basic accuracy of the vision exam.

 

 

ETA: If you can, cancel your glasses order until you decide for sure what you're doing.

[KristinaBreece]

Eek. My DS had his first ophthalmologist appointment just after his 3rd birthday. We had taken him to our optometrist, and she wrote him a prescription, but told us it was definitely not strong enough and that he would need to see a pediatric ophthalmologist. The PO has been fantastic with him, although his vision problems are much more pronounced than your DD's, it sounds like. He's 4 and a half now, and he's testing at 20/50 with the glasses. I would let her try the glasses, and I would also try to find a pediatric ophthalmologist for her to see. Try calling the Children's Hospital again-- that's who our PO is contracted through.

[Dobela]

Our opthamologist told us that children won't wear glasses until they really notice a difference. I wonder why he had you get them if he didn't think she would wear them?

That is part of what has me so confused honestly. At first I thought maybe it was a way for me to buy glasses from his office, but when I asked if I could order them locally he told me that was a great idea considering gas prices, time involved in fittings, and all that.

 

I would try get as second opinion from an optometrist instead then, especially since you are questioning the basic accuracy of the vision exam.

 

 

ETA: If you can, cancel your glasses order until you decide for sure what you're doing.

Glasses aren't ordered completely yet. DD was at another therapy appt when I went to order them. I didn't realize I would have so many choices thru her insurance and just ended up narrowing them down to a couple of pairs. I am supposed to take her back today to see which look best.

 

Our optometrist said she would like to follow up as well but thought it best to wait a couple of months to see if there is any change from the opthamologist findings. I really, really trust and know this optometrist well. I will ask her more questions today.

 

Dh suggested we just order the glasses and then leave them on a shelf so we can say we followed the doctors orders in ordering them, and then just say she didn't want to wear them. If by chance she needs glasses in the next year, her insurance will pay for another pair if the prescription changes.

 

Eek. My DS had his first ophthalmologist appointment just after his 3rd birthday. We had taken him to our optometrist, and she wrote him a prescription, but told us it was definitely not strong enough and that he would need to see a pediatric ophthalmologist. The PO has been fantastic with him, although his vision problems are much more pronounced than your DD's, it sounds like. He's 4 and a half now, and he's testing at 20/50 with the glasses. I would let her try the glasses, and I would also try to find a pediatric ophthalmologist for her to see. Try calling the Children's Hospital again-- that's who our PO is contracted through.

That was a good idea. I called them based on your advice and they will not see her again without a referral from her opthamologist. Apparently he is already considered an affiliate with them, which is why I was referred to his office when the children's hospital discharged her.

[KristinaBreece]

That was a good idea. I called them based on your advice and they will not see her again without a referral from her opthamologist. Apparently he is already considered an affiliate with them, which is why I was referred to his office when the children's hospital discharged her.

 

In that case, I would call the ophthalmologist's office, explain to them that you need to see someone closer to home, and ask if they would be able to refer you to the CH. I've never had a doctor deny a request like that. I would try to present it as being a proximity issue, rather than making their standard of care the major point. People tend to get defensive if they think you're unhappy with them. Maybe it's a little devious, but it's at least a good part of the truth, KWIM?

[Dobela]

In that case, I would call the ophthalmologist's office, explain to them that you need to see someone closer to home, and ask if they would be able to refer you to the CH. I've never had a doctor deny a request like that. I would try to present it as being a proximity issue, rather than making their standard of care the major point. People tend to get defensive if they think you're unhappy with them. Maybe it's a little devious, but it's at least a good part of the truth, KWIM?

LOL the children's hospital is actually another 15 miles past this guy.:D I don't think that will work. :D

 

I think I am just going to play the game for right now. Come July if I am still unhappy, I will look for some other options seriously.

[Unicorn.]

Honestly, I wouldn't bother getting the glasses, and I wouldn't go back in July either. I would wait a yr, then take her back for a reg. annual eye exam. I would also show her pics of jeeps and old fashioned phones before going in. Just so she knows what they are. :)

[Sun]

Honestly, I wouldn't bother getting the glasses, and I wouldn't go back in July either. I would wait a yr, then take her back for a reg. annual eye exam. I would also show her pics of jeeps and old fashioned phones before going in. Just so she knows what they are. :)

 

:iagree: I know it's not a financial issue because your insurance will cover them, but it seems wasteful to order glasses that the doctor doesn't think she'll wear and that you don't plan to have her wear. Our experience with kids' glasses is what Starr said: the kids will only start wearing them when it makes a significant difference in their sight. I wish we'd skipped the first pair and just waited a little longer until they were more needed.

[Occasionally]

Both of my oldest wear glasses; it's what we expected based on family history. Both have slight astigmatism and slight nearsightedness. My daughter was having headaches, and that's why we took her to have her eyes checked. I was told at the time that astigmatism can definitely cause headaches--since she's worn the glasses, no headaches!

 

If it were me, I'd get the glasses and ask her to try them out. If she doesn't wear them, no biggie. She might even be getting headaches and doesn't realize it enough to say something at that age.

 

Oh, and I agree about the pictures on the initial exam. The lady giving the exam sounds like she wasn't using her noggin, but the opthamologist should have looked at your daughter's eyes through lenses to finally determine the prescription (if not, I'd think about that second opinion.)

[prairiewindmomma]

---

Edited November 10, 2021 by prairiewindmomma

[EKS]

My son got glasses at age 4. He has perfect vision in one eye and a mild to moderate astigmatism in the other. We had him pick out the frames (and had him try them on to make sure they fit properly). Then we were just very matter of fact about his wearing them. Not wearing them is simply not an option. He's been wearing glasses now for five years and we have had no compliance issues.

[jplain]

I do question the accuracy of the initial exam.

My older daughter took the Allen pics exam when she was too young to identify letters.

 

What you described was an improperly conducted exam. The child is supposed to be shown the pictures up close at first, and the child is prompted to identify the pictures. The examiner is supposed to accept whatever answer the child gives, regardless of how ridiculous it is, as long as the child consistently identifies the picture using the same word (or a synonym).

 

Was that a tech who gave the exam? Or the ophthalmologist? Honestly, if it was a tech I'd complain to the office manager. It was developmentally inappropriate for the examiner to insist on certain words or do anything that left your daughter reluctant to give her own answers.

 

Follow your gut. At her age and given your description of her vision, I'd be willing to wait a year before seriously considering glasses, unless the ophthalmologist said anything about amblyopia.

[Dobela]

I really appreciate all the input. Having someone else to discuss this with is very helpful.

If it were me, I'd get the glasses and ask her to try them out. If she doesn't wear them, no biggie. She might even be getting headaches and doesn't realize it enough to say something at that age.

 

Oh, and I agree about the pictures on the initial exam. The lady giving the exam sounds like she wasn't using her noggin, but the opthamologist should have looked at your daughter's eyes through lenses to finally determine the prescription (if not, I'd think about that second opinion.)

After the lady did the Allen pictures, dd's eyes were dilated. The optho used a bunch of lens (like monocles) and a light shining thru them to determine astigmatism.

 

We've had two ped optho's tell us the same thing. Children generally don't want to wear glasses until they can tell a huge difference in doing so. Since no harm is occuring to the eye by not wearing the glasses, it's a discretion thing.

 

I would wait to order....our ds's prescription changed dramatically in 6 months time...from 20/40ish to 20/100ish. I would just go back in a year unless your child shares that they are having problems or you notice a difference. Some 4 yo's aren't very vocal about change, though, so I *would* go back in a year. My dd went to "counting fingers" (ie beyond the chart)--we realized she suddenly had an issue, but we didn't realize how bad it was until we got her in. A good check of distance vision is to play "I spy" in the car.

 

ETA: If you do end up ordering glasses for kids, zenni optical is a great way to get inexpensive glasses. I advise ordering 3 pairs at once. We went through six pairs of glasses during ds's first year of wearing glasses.

Thanks for zenni. I had forgottenthem. My son did fine his first year (at age 8) but then last year went thru 4 pairs. I had 3 pair on hand fortunately.

 

My son got glasses at age 4. He has perfect vision in one eye and a mild to moderate astigmatism in the other. We had him pick out the frames (and had him try them on to make sure they fit properly). Then we were just very matter of fact about his wearing them. Not wearing them is simply not an option. He's been wearing glasses now for five years and we have had no compliance issues.

If she needed them all the time, I would have no problem with requiring compliance. But the optho prescribing them and then saying it was no big deal if she didn't wear them just seemed odd to me.

 

My older daughter took the Allen pics exam when she was too young to identify letters.

 

What you described was an improperly conducted exam. The child is supposed to be shown the pictures up close at first, and the child is prompted to identify the pictures. The examiner is supposed to accept whatever answer the child gives, regardless of how ridiculous it is, as long as the child consistently identifies the picture using the same word (or a synonym).

 

Was that a tech who gave the exam? Or the ophthalmologist? Honestly, if it was a tech I'd complain to the office manager. It was developmentally inappropriate for the examiner to insist on certain words or do anything that left your daughter reluctant to give her own answers.

 

Follow your gut. At her age and given your description of her vision, I'd be willing to wait a year before seriously considering glasses, unless the ophthalmologist said anything about amblyopia.

It was a tech. She was younger (20s, younger than me ;)) but had great rapport with dd right off. She never used cards. She wasn't asked to identify the pictures before we began either. The Allen pictures were projected onto a mirror that then projected them onto a small screen in front of dd, about 5 ft away. At one point dd wanted to see the pictures behind her instead of in front of her (she noticed the light beam from the projector apparently) so it was pretty frustrating trying to get her to look the correct direction and comply at one point.

 

I was told in the past that she is at risk for amblyopia but I don't know if the optho looked for signs of that or not. Honestly, I am much more concerned about this than the astigmatism and nearsightedness.

 

I'm glad I just let it go because a year later they claimed he didn't need them at all.

We all wear glasses here as well, but she isn't my biological child. We don't have a vision history of her bio family either. My dh is agreeing more with you. Order the glasses, give her a time to 2 to try them, and if no interest, just put them away until she has more serious vision problems and is willing to wear them herself. At least by ordering them and trying them we can say we tried it and still followed dr orders.

[MeganW]

I have two kids in glasses right now. For one, it is like your DD - barely any prescription. BUT, it makes a huge difference for him. His problem isn't the prescription part, it's that the eyes don't want to work together and focus. I won't pretend I understand why, but for whatever reason, the glasses do help. He would prefer not to wear them, because they fog / get in the way / get dirty / insert other excuses. But his ability to pay attention and follow along is significantly better with the glasses on.

 

Our rule is that my kids WILL wear them for 4 hours every morning, which more than covers the amount of time we are sitting at the table doing schoolwork. After that, they are optional. We are on the waiting list to begin vision therapy as soon as a spot is available.

 

I should mention that my kiddos were 31w1d preemies, but did NOT have any ROP diagnoses.

[courtney.byrum]

We were told when my daughter was 3 that she had a slight astigmatism. By the time she was 4 it had gone away and again at 5 was not visible. Her vision was 20/40 I think at 4 and he told us that since eyes do not finish developing until about 6 that that was great vision for a 4 year old and not to worry. I believe at 5 it was 20/30 and he says that she is fine for now. Oh and she was a 29 week preemie as well. She does seem to have some far-sightedness starting but we'll see in about 9 months at her next apt unless she complains earlier.

 

My son got glasses at 5 because he was complaining about his eyes. He does have an astigmatism and slight near sightedness but the dr. said specifically that it wasn't bad enough to require glasses unless he was complaining. We got the glasses and he wore them consistently for about 6 months and then not much since then as they said not to force them on him at this stage. Most likely in the next year (he's 6.5) we will need to enforce them as his vision was slightly worse this last visit, but they still say they wouldn't prescribe them unless he complained as it isn't bad enough to require them yet.

[jplain]

I was told in the past that she is at risk for amblyopia but I don't know if the optho looked for signs of that or not. Honestly, I am much more concerned about this than the astigmatism and nearsightedness.

Any head tilting? Do you ever get the feeling that her eyes wander? Go back and look at candid photos too. Are there many photos where one or both eyes aren't tracking straight? I suspected my daughter had a vision problem because I thought her eyes were wandering when she was tired. (Everyone else thought I was nuts.) In retrospect I should have realized earlier, because in candid photos one or both eyes were often misaligned.

 

A basic test for amblyopia is the cover-uncover test, and it takes only a few seconds per eye. The doctor holds a paddle over one eye, swings it away, swings it back, repeat, repeat, repeat. While this is going on, the child is supposed to focus on the ophthalmologists's finger or nose or some other specified object. If the uncovered eye shifts back and forth as the other eye is uncovered, that's a sign of amblyopia.

 

If you have good rapport with the local optometrist, maybe she'd be willing to do a quick check to help you decide whether there's a compelling reason to use glasses now. :)

[Dobela]

I have two kids in glasses right now. For one, it is like your DD - barely any prescription. BUT, it makes a huge difference for him. His problem isn't the prescription part, it's that the eyes don't want to work together and focus. I won't pretend I understand why, but for whatever reason, the glasses do help.

That was my son completely. He still wears glasses for schoolwork and such. He also had 18 months of VT and we call it our miracle for him.

 

We were told when my daughter was 3 that she had a slight astigmatism. By the time she was 4 it had gone away and again at 5 was not visible. Her vision was 20/40 I think at 4 and he told us that since eyes do not finish developing until about 6 that that was great vision for a 4 year old and not to worry. I believe at 5 it was 20/30 and he says that she is fine for now. Oh and she was a 29 week preemie as well. She does seem to have some far-sightedness starting but we'll see in about 9 months at her next apt unless she complains earlier.

 

My son got glasses at 5 because he was complaining about his eyes. He does have an astigmatism and slight near sightedness but the dr. said specifically that it wasn't bad enough to require glasses unless he was complaining. We got the glasses and he wore them consistently for about 6 months and then not much since then as they said not to force them on him at this stage. Most likely in the next year (he's 6.5) we will need to enforce them as his vision was slightly worse this last visit, but they still say they wouldn't prescribe them unless he complained as it isn't bad enough to require them yet.

Thanks for sharing your experience. Some one else has described a similar experience, and I think my optometrist was alluding to cases like your dds.

 

Any head tilting? Do you ever get the feeling that her eyes wander? Go back and look at candid photos too. Are there many photos where one or both eyes aren't tracking straight? I suspected my daughter had a vision problem because I thought her eyes were wandering when she was tired. (Everyone else thought I was nuts.) In retrospect I should have realized earlier, because in candid photos one or both eyes were often misaligned.

 

A basic test for amblyopia is the cover-uncover test, and it takes only a few seconds per eye. The doctor holds a paddle over one eye, swings it away, swings it back, repeat, repeat, repeat. While this is going on, the child is supposed to focus on the ophthalmologists's finger or nose or some other specified object. If the uncovered eye shifts back and forth as the other eye is uncovered, that's a sign of amblyopia.

 

If you have good rapport with the local optometrist, maybe she'd be willing to do a quick check to help you decide whether there's a compelling reason to use glasses now. :)

I have had concerns before but her eyes seemed to stop the wandering around age 2. At one time I was also told to watch for stabisimus. If the eyes are wandering now, it is so slight I have not noticed. She is very light sensitive though and it is very difficult to take pictures because she won't look at a camera. The optho didn't do any kind of exam like you described though. He came in and went straight to the lens drawers for astigmatism.

 

Our local optometrist is also our son's vision therapist. She has done brief tests with dd before so I will ask her again. I had a migraine today so did follow thru with the glasses, but will tomorrow. While I am there I will ask her to do a fast check if she doesn't have any other patients.

 

Thanks again!

[Dobela]

Any head tilting? Do you ever get the feeling that her eyes wander? Go back and look at candid photos too. Are there many photos where one or both eyes aren't tracking straight? I suspected my daughter had a vision problem because I thought her eyes were wandering when she was tired. (Everyone else thought I was nuts.) In retrospect I should have realized earlier, because in candid photos one or both eyes were often misaligned.

 

A basic test for amblyopia is the cover-uncover test, and it takes only a few seconds per eye. The doctor holds a paddle over one eye, swings it away, swings it back, repeat, repeat, repeat. While this is going on, the child is supposed to focus on the ophthalmologists's finger or nose or some other specified object. If the uncovered eye shifts back and forth as the other eye is uncovered, that's a sign of amblyopia.

 

If you have good rapport with the local optometrist, maybe she'd be willing to do a quick check to help you decide whether there's a compelling reason to use glasses now. :)

Back to the head tilting...anything else I can be watching for? I don't remember any head tilting, but I will be watching. Sometimes she can't seem to find her own hand in front of her but then can describe in great detail something she is seeing 15 ft away. The next day the opposite will be true. I know some of it is her age, is all of it her age?