DS's eyes don't "move together"?

[DrSally]

We had our 4 yo well child visit today. The ped mentioned something about DS's eyes "don't move together", were his exact words. His vision is 20/30. He asked if there's a family hx of lazy eye, which I am not aware of. This has never been mentioned before and it all happened so quickly, I didn't get a chance to ask more questions. He thinks it's fine and wants to recheck at 5 yo, but after reading about it, I want to get it checked out by a pediatric opthomologist? sooner. My understanding is that Amblyopia can't be detected in the peds office. Neither of DS's eyes seems to turn in or out.
Any BTDT advice? Should I be seeing an opthomologist?

While I'm at it, I should make an appt. for DD. She has not had an eye screening yet (DS had one at 1 yo--he looked at a tv screen with electrodes hooked up).

[sunshine873]

My DD is only a year old, but she has ROP and we have spent a lot of time with the pediatric ophthalmologist. My understanding is that a lot of these things can be treated easily when caught early. The longer they are left, the more "retraining" that needs to be done. I would insist on seeing not just an ophthalmologist, but one that specifies in pediatrics. If nothing else, it will give you peace of mind.

[DrSally]

What's the difference between an optometrist and an opthamologist? There's an optometrist in town that works with children that I've met at some kid's events.

[vludmilla]

What's the difference between an optometrist and an opthamolotist? There's an optometrist in town that works with children that I've met at some kid's events.

You need a pediatric opthalmologist, not an optomotrist. The opthalmologist is an MD, whereas an optomotrist is a doctor, but not a physician who just specialized in eyes. Opthalmologists often have more intensive training to deal with serious eye problems and may be surgeons.

[mommy111]

You definitely need a pediatric ophthalmologist, an optometrist is not an MD and can probably follow up DC but for the first time, you need a peds ophthalmologist

[Gena]

I agree with the other posters that you should go to a Pediatric Ophthalmologist (PO). Amblyopia, and some other eye problems, can be more easily corrected the early it is caught and treated. Also, the brain needs to receive a clear image from the eyes for the visual processing centers to develop properly.

My DS has complex vision problems and sees the PO several times a year. Ours has a lot of tricks for working with DS (who can still be rather uncooperative at times, but is getting better) and is great at explaining everything to me.

And just FYI: many Pediatric Opthalmologists do not participate in vision insurance plans. However, they usually can bill your medical insurance as a specialist for diagnosis and treatment of medical diseases of the eye. So depending on your insurance plan(s), don't be surprised if the PO's office wants your medical card instead of your vision plan card.

[ThreeofUs]

You've gotten great advice. I'll just chime in: get to a PO as soon as you can. And you really want an ophthalmologist - they are the folks to have the training and experience to treat such disorders.

[cchavez]

check out covd.org

[lilycat88]

l'll be the voice of dissent. I'd go with a pediaric optometrist for something like this. In our experience an optometrist will spend more and less stressful time with your child. Optometrists who work with kids primarily are also very used to doing visual training with children to strenghten muscles and "train" the eyes to work together. We've had DD to both and MUCH prefer the optometrist experience when you are dealing with something that is probably not a "medical" problem that can be fixed with medication and/or surgery. I have a cousin who lives in a rural area and drives 90 minutes every week to take her son to a pediatric optometrist because she doesn't like the ped opthalmologist who comes to the area weekly.

[mominmarch]

My father was an optometrist, and my father in law an opthamologist. The former is technically a doctor, but is an O.D., not an M.D. and goes to either 2 or 4 years of optometry school after college. They can do a lot, but they cannot do surgery. Opthamologists go to medical school after college (4 years plus) and generally can do surgery.
My father always did eye exams and referred kids on to an opthamologist when the situation warranted. Like the PP said, I like to think that he actually spent more time and had more of a rapour than sometimes the 15 minute surgeon visit, but it is just a matter of the personality of who you see in particular.

[AnnieW625]

I think you should get your son's eyes checked ASAP. My DH's family doesn't have a history of lazy eye so they didn't catch DH's lazy eye until he had issues in kindergarten and by the time they finally caught it wasn't fixable except with glasses, and he thinks that his bad eyesight is worse because of it. Granted this was 1979 so things have changed a lot since then, but the sooner a lazy eye is caught the easier it is to fix. I would get him into a pediatric opthamologist as soon as possible. We had DD checked out at 2 just to be safe and so far so good, but we plan on taking her to the optometrist again as soon as she turns 4.

This website might also be helpful:
http://www.strabismus.org/

[DrSally]

I called the peds office asking for a recommendation for an "eye doctor" for DS, and they recommended a ped opthamologist who happens to specialize in strabismus and amblyopia. We have an appt. for Today! It may be overkill, esp. since the ped wasn't too worried about it, but I have also heard that peds cannot detect these things in a normal office visit, and it was enough for him to mention. If, in fact, his "eyes don't move together" it's not something that will correct itself with time, from what I understand. I will take DD to the optometrist I mentioned for a routine exam. Unfortunately, the appt. can take up to 2 hours and I have to take DD with me. I also have to get ready for DS's bday party tomorrow. But, I really wanted to nab this appt.

The nurse at the peds office said to make sure to check with my insurance. I talked with the opthamologists office and they said they bill it as a medical eye exam, so it's not billed to our vision plan, which I think is pretty abysmal anyway.

ETA: Interestingly, the optometrist said the appt. should be about 15 min, but the opthamologist said the appt. can take up to 2 hours.

[DrSally]

Thank you for the site, Annie. I did take a look at that one last night when I was "googling". My (adopted) brother happened to mention that he has decreased vision in one eye b/c he was always "squinting" that eye as a child. I think he prob couldn't see well out of that eye to begin with and it was never corrected.

[BelleoftheBallFlagstaff]

Good luck today, let us know what happens!

[infocrazy]

The up to 2 hrs thing...I'm guessing that some of that time at least will be to dilate the eyes. DS1 did his infantsee check and they dilated his eyes with something that took an hr. We went to a different dr (closer) for DS2 and he used one that only took 15 min. This is all 2 and 4 yrs ago, but I know there were 2 different lengths so you might be able to ask. Not sure if the longer one is better, but thought I'd mention it.

Good luck!

[AnnieW625]

Thank you for the site, Annie. I did take a look at that one last night when I was "googling". My (adopted) brother happened to mention that he has decreased vision in one eye b/c he was always "squinting" that eye as a child. I think he prob couldn't see well out of that eye to begin with and it was never corrected.

Also if it helps your DS any or even you if you google Matt Leinert Strasbismus you'll find some good articles. Matt had to have strabismus surgery as a young child and is now an NFL quarterback. It might be pretty inspiring to DS if it turns out he has to wear glasses or have surgery.

[ThreeofUs]

Glad to hear you're going today. Please update us.

[michellerw]

I would recommend an ophthalmologist just because they can zero in on the issues more quickly. DH has/had strabismus and still sees an ophthalmologist specializing in it, after something like three surgeries to correct it. He wore a patch as a small child... he's an extreme example. Obviously, the earlier this sort of thing is identified, the better.

[DrSally]

Just got back from the Opthamologist (along with the dollar tree for party ballons!). The doctor was very good and they had special things for kids to "look at" to keep their attention during the exam. First the nurse did a regular vision exam. Instead of looking at a chart, they flashed the letter (in various sizes) on a computer screen, and had DS point out the corresponding letter on a card. DS got them all right, whereas, in both his Kindergardern screening and his 4 yr well child visit, he was 20/30. It was always my suspicion that he got shy and stopped answering at a certain point. With this method, his vision was perfect (and symmetrical). The nurse said that that happens a lot--getting better results in their office. In any case, it is a very good sign in ruling out "lazy eye" (to have good vision in both eyes).

Then they dialated his eyes (he didn't like the drops going in), and called us in for the exam about 15 min later (luckily not 2 hrs!). The doctor spent about 15 min, looking at his eyes watching them while he looked at various things he was holding. He said he was looking, but couldn't find anything wrong!! There was not a hint of anything wrong. He said that sometimes in ped's offices, there's a lot going on and the child can become distracted and basically try to look at the doctor and mom at the same time. He said he wasn't sure what the ped did see, but he couldn't find anything.

I feel the exam was very thorough and feel confident about the results. We both thought that the ped may have observed DS trying to look in 2 different directions, coupled with the discrepency in his vision exam (one eye appeared to be stronger than the other in the peds office), prompted the ped to ask me if lazy eye ran in the family.

I'm going to keep the appt. with the optometrist to get an eye exam for DD as a screening (she's never had one). This doctor said, I could also wait to bring her in at 3 yo for an exam with him (when she could cooperate).

ETA: Thanks guys, for all the support and info!

[AnnieW625]

Great soo glad things went well!

[ThreeofUs]

Whoo-HOO! What a fantastic outcome!

That's just great, Sally - so glad to hear your DS has good eyesight and no probs. :)

[Gena]

That's great news!

I'm glad you were able to get in to see the PO so quickly - ours books months in advance. It sounds like the exam was very thorough and that your DS handled everything well. You must be very relieved.

[DrSally]

Very relieved, indeed. I tend to freak out about health things to begin with, so I was really glad to be able to get a same day appt. with a highly recommended PO. Now, I can just enjoy his bday party (if I can get this house clean!). A good PSA, though, about getting childhood eye exams. From what I've been reading, the ones at the peds office are just vision screenings, not really "eye exams", KWIM?

[squimp]

Glad it all went well. My experience with a few local pediatricians is that they are poorly trained to diagnose or even recognize eye problems. You got good advice, and if the ped opth didn't notice anything, sounds like you're good. Smart to jump on it right away - my DD has a pretty substantial strabismus and it came on suddenly so you just never know.

[KpbS]

Great news! What a relief! Enjoy your weekend :)

[DrSally]

Glad it all went well. My experience with a few local pediatricians is that they are poorly trained to diagnose or even recognize eye problems. You got good advice, and if the ped opth didn't notice anything, sounds like you're good. Smart to jump on it right away - my DD has a pretty substantial strabismus and it came on suddenly so you just never know.

Yeah, our ped is good, but I just think of them as "screeners" for eye problems. Just curious, how does a strabismus come on suddenly? Was there an injury/infection, or did it just totally come out of the blue?

[squimp]

Yeah, our ped is good, but I just think of them as "screeners" for eye problems. Just curious, how does a strabismus come on suddenly? Was there an injury/infection, or did it just totally come out of the blue?

It happened in the fall when she started a new school, which meant more close-up work that caused her to use her eyes in a different way. She's farsighted and to see up close she had to cross her eyes.

[DrSally]

It happened in the fall when she started a new school, which meant more close-up work that caused her to use her eyes in a different way. She's farsighted and to see up close she had to cross her eyes.

I see. I hope things have improved for her with treatment.

[Gena]

A good PSA, though, about getting childhood eye exams. From what I've been reading, the ones at the peds office are just vision screenings, not really "eye exams", KWIM?

Very true. I'm grateful that our ped referred us to the PO at DS's 2 year well child check when he was concerned about DS's photophobia and noticed a possible strabismus. DS has been wearing glasses since he was 2 we are still woking towards a full understanding of his complex vision problems. DS is now 5 and I hate to think what could have happened if we had waited until Kindy to get an eye exam.

I've been encouraging my SILs to get eye exams fo their own young kids. Unfortunately neither one seems to feel that it's needed.

[spanannie]

l'll be the voice of dissent. I'd go with a pediaric optometrist for something like this. In our experience an optometrist will spend more and less stressful time with your child. Optometrists who work with kids primarily are also very used to doing visual training with children to strenghten muscles and "train" the eyes to work together. We've had DD to both and MUCH prefer the optometrist experience when you are dealing with something that is probably not a "medical" problem that can be fixed with medication and/or surgery. I have a cousin who lives in a rural area and drives 90 minutes every week to take her son to a pediatric optometrist because she doesn't like the ped opthalmologist who comes to the area weekly.

Yeah that. My daughter saw a ped opthalmologist for amblyopia for almost a year and we made no progress. Her fantastic teacher referred us to a developmental optometrist (I didn't even know they existed) who was light years more thorough, versed in new and old techniques for DD's condition, getting her Rx just perfect, etc. She also does vision therapy, but we have to wait until DD's sight improves before starting that.

[spanannie]

Yeah, our ped is good, but I just think of them as "screeners" for eye problems. Just curious, how does a strabismus come on suddenly? Was there an injury/infection, or did it just totally come out of the blue?

I know this wasn't a question directed at me, but our pedi didn't even notice DD's problem (when screening), neither did we or the teachers (PreK). The screener at the school she goes to did and repeated the test 3x.

She wore glasses for a year after that with sporadic patching (due to cooperation issues) and started Kinder, where the teacher noticed something was still wrong with her sight (could see it in her head movements and how she wrote on the page). We got the new eye doctor (developmental optometrist) and she's patching much more regularly now. She has amblyopia, astigmatism and, I think, something else (can't recall right now).

[melrose7]

Glad it all worked out. I know it can come out of nowhere as DD2 all of a sudden had one eye start to wander in October. I took her to the PO I had taken DD1 to last year and thankfully was able to get in right away. She ended up being far sighted in both eyes and we got glasses right away. A month later we needed to start patching the weak eye. Now another month later and she said it's gotten worse, not better, so DD2 is going to have surgery at the beginning of Feb. I can't believe how fast this is happening. I hate thinking of her having surgery so soon. For us it runs in the family as DH had lazy eye as a child and what they did back then didn't help him. So he is having surgery at the end of this month to correct it. It won't help his vision so for him it's more cosmetic but it is something that has always bothered him. Now as long as everything turns out and are all better before the baby comes.

[DrSally]

Thank you for sharing your stories. It's all very interesting. Seems that far-sightedness and the onset of reading is one cause of strabismus. I could see where subtle cases wouldn't be detected in reg ped's visits. Seems there are a lot of stories of adults that weren't treated in childhood. I think about my brother who was always squinting one eye and tilting his head, and ended up having very poor vision in that eye. No one ever caught it.