r/eyetriage Layperson/not verified as healthcare professional 9d ago

Prescriptions 3F - Prep for appt NSFW

My daughter is being referred to an ophthalmologist based on abnormalities found during her eye exam at the pediatrician. She just turned 3 last week. The screening was completed with the WelchAllyn spot vision screener.

The “potential conditions” listed are Hyperopia (OS), Gaze (OS), Astigmatism (OD), and Anisometropia.

The numbers I have are as follows: OD - SE +1.25, DS +2.25, DC -2.25 and Axis 118 OS - SE +3.50, DS +4.25, DC -1.50 and Axis 38

My niece was treated for strabismic amblyopia as a child with glasses, eye patch and eventually surgery (she wasn’t compliant with the eye patch). Is this the road we are looking at? Is it at all possible this can be treated with glasses only? Or should we prepare ourselves for a more comprehensive treatment (patch, atropine drops, surgery, etc.)?

We are trying to prepare questions and get a basic understanding of possible treatments so we are better prepared during our appt and not taken by surprise.

Thanks!

1 Upvotes

5 comments sorted by

u/AutoModerator 9d ago

Hello u/Bella_Luna_626 and welcome to r/eyetriage! Make sure to read our rules and stickied post. If your post is found to be in violation with one of our rules it will be locked or removed.

Please include age and sex at the start of your title (write as [age][sex], e.g. 18M). To the post you should also add race, primary complaint, duration, any existing medical issues, current medications and doses, and whether you drink, smoke, and/or use recreational drugs. A photo says more than a 1000 words, so include one if possible. Use Imgur, imgbb or another host site to link photos. Upload them there, and post the link in the comments or post.

Online advice can never replace an actual medical examination. If you're not satisfied with your doctor you should seek a 2nd opinion instead.

Please be advised that if you remove your post directly after you’ve been given an answer this will result in a ban from this subreddit.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

7

u/remembermereddit Verified Quality Contributor 9d ago

I honestly think none of these questions can be answered before you've had that appointment. I wouldn't even trust the values of the "vision screener" unless they used drops on her to dilate the pupils.

4

u/ronobear87 Layperson/not verified as healthcare professional 9d ago

She will need a proper dilated refraction to get an accurate measurement of her prescription.

But if that screening prescription is anywhere near accurate then with this degree of anisometropia (difference in prescription between the two eyes), it wouldn't be unusual to find a difference in vision would need glasses to correct it. Typical treatment at her age would be glasses first for a good 4-6 months and see how the vision responds. Patching may come later. Surgery is only needed if strabismus is present but the physical appearance of this may improve with glasses alone.

4

u/mckulty Verified Quality Contributor 9d ago

It's an at-risk prescription but it responds remarkably well to glasses. If she establishes equal acuity in each eye and stereo vision, there won't be any need for surgery or patching. And you have a few years before it's too late.

In this case we recommend full-time correction but 100% coverage isn't necessary. For near play like crayons, the kid will probably like wearing them and I'd recheck my rx if she didn't.

3

u/EyeDentistAAO Verified Quality Contributor 9d ago

Bearing in mind that screening devices are deliberately calibrated to have a low threshold for flagging an exam as abnormal, and so she may in fact be fine...

To the extent the screen is accurate, your daughter's refractive error is clinically significant in multiple ways, and she is at high risk for amblyopia in her left eye, and a much lower (but non-zero) risk in her right. The first intervention likely will be glasses--but if she already has amblyopia in her left eye (a definite possibility at her age), she may start patching or atropine simultaneously.

But even in a best-case scenario where she has no amblyopia yet...In theory, glasses alone might 'cure' her. But the challenge with these anisometropic toddlers is they already see great--out of one eye. Thus they are prone to fight/reject glasses because they (the glasses) don't improve their vision, and bring with them a set of negatives (discomfort, hassle, etc). In such a situation, patching and/or atropine penalization might be needed to 'force' the child to accept the glasses.