I know that we all want the best for our kids.  We are lucky to have such a great Opthamologist and a kid that has some vision (just not the greatest) AND the potential to make her eyes stronger.  

BUT, it is hard to watch a toddler in the examination room each month struggling to see the large letters on the eye chart. 

It is hard to place a patch every morning on her “good eye” and take away her vision.

It is hard to look at her alligator tears when she is trying to convince us to keep the patch off for just 5 minutes so she can see.

It is hard to watch her run into walls and fall off playground equipment. 

It is even harder to hear that her vision is decreasing.

For the past 3 months, our daughter has not had the greatest visits.  For the first 2 of the 3 visits, the staff thought maybe we were just catching her on bad days or on her silly moods… but I knew better.  Last week we were given the news that she needed another prescription change and is now up to -8.5 in her right eye and -1.5 in her left.  Was the 10-12 hours of day of patching not helping???  No, it is helping because both eyes are getting worse together. Her nearsightedness is getting worse because she is growing and will unfortunately continue to get worse.

I am getting better at holding it together until I get home from appointments and can remove myself from her view.  I really need to be positive for her.  But behind the closed doors, I cry.  I cry because I want the best for my child.  I cry because I want her to have every opportunity in the world.  And I cry because I feel helpless.

Then it’s time to open the door and face reality; I get to work.  I called the vision specialist.  Because Elly’s vision is doing the opposite than we had hoped and we are patching full time, they are going to qualify her for temporary vision services. Additionally, the OP said that she is sending a referral to occupational therapy as it may help strengthen the eye – so I called to schedule an initial appointment.  And last, but not least, I put a smile on my face, thankful of all the joy my daughter brings to my life and for all the opportunities she will have because we have caught her vision issues at such a young age.

When people ask what Zoe’s vision is, they’re normally expecting to hear her visual acuity – usually given as 20/20 or the metric equivalent 6/6 – and then they want to know how she compares with other children.  I don’t actually know what her uncorrected acuity is, but I was curious about what you might expect a preschooler’s acuity to be.

Visual acuity is the measurement of how clearly we see at a specific distance, usually 20 feet or 6 meters, though that can vary.  It is generally tested in adults with the well-known Snellen eye chart (the one with the big E on top) and with a variety of charts for children.  The acuity is usually presented as two numbers that indicate how close a person will need to be to an eye chart to see the letters or symbols clearly, compared to what a person with “normal” vision would see.    Let’s say my uncorrected visual acuity is 20/200 – that’s 6/60 in metric – (which it is, more or less, in my right eye).  That means that I have to stand 20 feet – or 6 meters – away from the eye chart to read the big E.  A person with good vision, on the other hand, could see the E at the top of an eye chart from 200 feet – or 60 meters – away.

It’s worth keeping in mind that visual acuity is not the whole picture (so to speak) when it comes to measuring vision.  Visual acuity does not indicate how well the eyes work together, or peripheral vision, or even what the prescription needs to be to correct vision.

For adults, it’s pretty easy to look at the acuity numbers to see how good your vision is: if the first and second numbers are the same, 20/20 or 6/6, that means normal visual acuity.  If the second number is smaller than the first, you have better than normal acuity, and if it’s larger than the first your vision is poorer.  But for young children, it’s not quite as straight forward.  Because children’s vision hasn’t completely developed, a child can have “normal” vision that is worse than 20/20.

In 2003, the American Academy of Pediatrics adopted a policy on Eye Examination in Infants, Children, and Young Adults by Pediatricians.  According to those standards, pediatricians should refer any child under the age of 5 with a visual acuity of worse than 20/40 – that’s 6/12 in metric – to an eye doctor.  At age 6 and older, they should refer any child with acuity of 20/30 – 6/9 metric – or worse.

More recently, though, a study called the Multiethnic Pediatric Eye Disease Study looked at visual acuity norms in preschool children with the goal of gaining more accurate visual acuity norms for children.  The results were published in Optometry and Vision Science in June 2009 (abstract and full citation).  They measured the visual acuity of 1,722 children ages 30 to 72 months with no significant refractive errors – so kids that should have good vision.  From those measurements they determined the threshholds for visual acuity that would include 95% of the children tested.  That means that if the test were done by pediatricians and these guidelines were followed, you’d expect that 5% of children with no refractive error would be referred on to an eye doctor for a follow up.  You’d hope that all of the kids with visual problems would also be caught with the testing and also be referred on to an eye doctor.  That’s not necessarily the case, the researchers note that children who have “normal” visual acuity may still have visual problems, but that’s a topic for a different post.  The nice thing about this study is that it breaks out the age range in to more detail, understanding that vision is still developing significantly in children between the ages of 2 1/2 and 6.

So, according to this most recent study, normal visual acuity for preschoolers may be better defined as:

30 – 35 months:  20/63  (6/20) or better

36 – 47 months:  20/50  (6/15) or better

48 – 59 months:  20/40  (6/12) or better

60 – 72 months:   20/32 (6/10) or better

Annie brought up this topic on the Little Four Eyes facebook group.  -Ann Z

How many of us Little Four Eyes parents have had to attempt to fix glasses until new ones come in? We just ordered Aubrie’s new prescription & her backup pair broke. She’s rocking some serious duct-tape on her temple until the new ones, and the backup replacements come in. Usually we ALWAYS have backups, but her 3rd pair are just way too small and she said they hurt. Anyway, I figure I can’t be alone. I felt absolutely terrible sending her to a library program around all her peers in duct-tape, but hey what can you do until they have your new ones ready? I’m just glad she’s 3 and doesn’t realize she’s rocking the duct-tape…if it happens again in Jr. High I’ll be doomed!

I know for a fact that Annie isn’t alone in trying home repairs.  So, what kind of glasses repairs have you had to do?  Duct tape? Rubber bands?  Anything work particularly well – or not well at all?  We’ve only tried to repair Zoe’s glasses once, and that was pretty close to a failure (she refused to wear them with the electric-taped ear piece).  Thankfully her new glasses arrived the next day!

Alright, so reading the comments recently, it sounds like we’ve got a number of people with different experiences with the different sunglasses options.  I’d like to write a round-up post that talks about the pros and cons of the different options: transition lenses, prescription sunglasses, clip-ons, (am I missing any other options?  I suppose you could do non-prescription sunglasses.).  So this is where you come in.  If you’re child is using one or more of these options for sunglasses, would you either leave a comment with a brief comments on what you liked and didn’t like?  Or email me – ann@shinypebble.com – especially if you wouldn’t mind submitting a picture.  Also, if you’re willing to share what you paid for them, and where you got them, I’d love to include that as well.

Thanks!

Here is a picture of Elliana’s clip-on sunglasses.