Amblyopia Part six

You know I like family web sites and blogs. In this mom's blog she sometimes writes about her child's adventures in   dealing with amblyopia. Here's part six in their adventures.

http://kadydiddesigns.blogspot.com/2012/05/adventures-in-amblyopia-part-six.html

I'm Seeing More Strabismus These Days!

As I travel from school to school to check on my students with visual impairments, I have noticed a rise in the number of students who are not on my caseload who have misaligned eyes or strabismus. I've had to send notes home via the school counselors to get the parents to take those children to their ophthalmologist.

Three children had significant vision loss in the inward or outward turned eye. I had  write one mom a couple of times. The counselor said it had been an issue before and she was hoping that my being a vision specialist teacher would light a fire under her. The school had even gone as far as procuring transportation to the doctor for her and the child. Finally, near Christmas break he came to school with the cutest pair of flimsy wire framed glasses. I don't think they helped much. I checked on him later in his next teacher's class and we talked about making some accommodations for him even without an IEP. Gosh, I wonder about that kid. He should be in second grade by now. Even though that school is no longer on my caseload, I should contact the school counselor and see how he's doing.

The second child was in pre-k in the class of another student who was on my caseload. He had so much involvement from being born preemie that his eye was easy for his folks to overlook. He had a shunt and had orthopedic issues, using a wheelchair for most of the school day. He'd had so many surgeries that, of course mom and dad were happy he was sitting up and talking. In fact, in that class he was the only one who could string together a complete sentence! I was taking pictures of the class during a birthday party as they tackled chocolate cupcakes. He was the only child in the class to understand that he should be able to see a preview of the photo from the back of the camera, asked if he could see the photo of himself. While letting him see it I suggested we play a game where I cover one eye at a time and see what his picture looked like. When I covered the good eye, his picture disappeared! "Um..Where did I go?" he said. Then when I removed my hand he said, "There I go!" Fortunately, the school nurse was across the hall and I sent a note home through her as suggested by the teacher. The parents were on it right away and had him seen by an ophthalmologist.  

The next time I saw him, the para was pushing his chair down the hall and he was laughing with his friends. "Look! Show Ms. Kathy your new glasses!" she said. "His folks took him right to the doctor and they discovered he needed surgery. He had one on the same eye as an infant and was supposed to have it checked again but with all the other things they had to have checked--like his shunt, his wheelchair, they didn't think of it after a year."

Those were the cutest little glasses--and the eyes behind them were straight on!

If it's my child or yours and their little eyes are not lined up, get it checked out. It could mean that the vision is slightly different in one eye from the other. It could mean that as an infant, the eye muscles need to mature a bit more and they'll align as they approach five or six months old. But it could be something a bit more serious if by pre-k or kindergarten one eye seems to wander for near and far vision. Wouldn't you rather err on the side of caution when it comes to your child's vision?

I met a parent at a festival whose cute-as-a-button four-year-old had a pronounced inwardly turned eye. [Yes, I'm one of those people who talk to strangers concerning the health of their children.]  She said his pre-K teacher and his doctor mentioned it but she was content that his eyes were just a part of him that was different--even though other children teased him about his cartoon eyes. The doctor had suggested surgery, which I would have suspected from the severity of the inward turning of that eye--called esotopia. An outward turned eye is called exotropia. From what I've read, esotropia is more difficult to repair--especially  if it is not corrected a soon as possible. This mother said that she didn't want her child to suffer through a surgery. I reasoned with her: Would you rather he have a temporary discomfort from a surgery or a preventable blinded eye? Because what is happening is that in order to avoid the confusion of double vision, the brain will gradually ignore the visual input from the misaligned eye and that eye will be unable to send sight messages from non-use.

There are different causes for strabismus and different approaches to ameliorating the condition or not, depending on it's cause. But, please, get your child's eyes checked to uncover the cause. 

Here's a link to an easy-to-understand-even-for-me explanation of strabismus:

http://www.nlm.nih.gov/medlineplus/ency/article/001004.htm

PubMed Results

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1.	J AAPOS. 2012 Feb;16(1):75-9. Competency checklists for strabismus surgery and retinopathy of prematurity examination. McClatchey SK, Lane RG, Kubis KC, Boisvert C. Source Ophthalmology Department, Naval Medical Center San Diego, San Diego, California; Uniformed Services University of Health Sciences, Bethesda, Maryland; Loma Linda University Medical Center, Loma Linda, California. Abstract PURPOSE: To evaluate two checklist tools that are designed to guide, document, and assess resident training in strabismus surgery and examination of infants at risk for retinopathy of prematurity (ROP). METHODS: A panel of staff surgeons from several teaching institutions evaluated the checklists and provided constructive feedback. All former residents who had been trained via the use of these checklist tools were asked to take self-assessment surveys on competency in strabismus surgery and ROP examination. A Likert 5-point scale was used for all evaluations, with 1 being the lowest rating and 5 the highest rating. RESULTS: Six experts in strabismus and seven in ROP rated the checklists. Their comments were used to revise the checklists, which were sent to the same group for reevaluation. The mean Likert score for the final checklists was 4.9 of 5.0 for both checklists. Of 16 former residents, 9 responded to the self-assessments with a mean overall score of 4.1 (of 5.0) for strabismus surgery and 3.9 for ROP examination. CONCLUSIONS: These checklist tools can be used to assess the quality of a resident's training and experience in these specific ophthalmology skills. They are complementary to other curriculum and assessment tools and can serve to organize the educational experience while ensuring a uniformity of training. Published by Mosby, Inc.
	PMID: 22370670 [PubMed - in process]

Amblyopia and Strabusmus

My two month-old baby’s eyes don’t seem to work together. Since I had a “lazy eye,” do you think my son will too?

There are several different medical conditions that may be referred to by the lay population as lazy eye. The two major types are Amblyopia and Strabismus.

For the nine months that the child was developing inside the uterus there was no need for the eyes to focus on a single point with both eyes. Once the child is delivered he/she needs to learn how to focus on a subject in front of him/her. Initially the eyes see independently. This of course could be very confusing to the brain to process these separate images and understand it’s environment. Thus over the first four months of life, the child develops this ability to focus with both eyes thereby developing binocular vision (3-D vision with depth perception). If there is any obstruction to clear vision (such as a cataract), if the eye can’t focus, or if there is another condition not correctable by eyeglasses, Amblyopia will develop. Since it is too difficult to make sense of the unfocused and focused views, the brain “shuts down” the blurred vision. Thus, if there is no intervention made, the child’s vision will worsen in the eye that started with the problem. This condition is estimated to occur in approximately 3 percent of children. Most of these types of problems are random conditions, and do not seem to “run in families.”

Chidren with a Strabismus are unable to align their eyes for proper vision due to a weakness or descepancy in the length of one of the muscles of the eye; therefore, when the eyes try to focus, they cannot do so for more than a short time, and the eye will stray. This causes two separate images, and the child may see “double” because of it. Once again, since this is difficult for the brain to proces, it will frequently “shut down” one of the eye’s images thereby reducing the acuity of that eye. This then leads to Amblyopia or a true “lazy eye.” The incidence of this condition is approximately 5 percent of children. There is a tendency to see this trait in families without a true genetic inheritance. If one parent had a “lazy eye” in their past, then there is a somewhat greater degree of one their offspring to have one; however, it is not that much greater than the general population.

Children prior to four months will have eyes that seem to “wander.” After this time they should remain straight and focused. If there are any concerns, it is necessary to make sure that your child is evaluated.

Good Luck
DRTOM

[Source Link: http://www.healtheagle.com/amblyopia-and-strabismus/]