milestones, eye exams, and preparing your toddler for vision tests

Teller Acuity Cards, from www.stereooptical.com
Teller Acuity Cards, picture from http://www.stereooptical.com

Zoe is young enough that most of her eye exams didn’t use any of the eye charts that we normally think of to determine her prescription.  They used Teller Acuity Cards – where they showed Zoe a grey card with a box of black and white stripes, if she looks at the box, then she can see the stripes.  They show cards with progressively thinner stripes until she no longer noticed them (they get thin enough that I could hardly perceive the box of stripes).  You can read more about the test in this information sheet from Seattle Children’s Hospital (pdf).  They also dilate her eyes and then the ophthalmologist use a retinoscope to measure the refractive error of her eyes.

At her last appointment in December, she’d just turned 2, they tried having her use an eye chart.  Zoe was given a card with the 4 different shapes, and then the optician would point to a shape and ask Zoe to point to the matching shape on her card.  Zoe didn’t get it.  She was deep in the mimicry stage and did a very good impression of the optician, holding her card out for her to see and pointing at each shape one by one.  Cute, but ultimately unhelpful.

Lea chart. From the Visionary Eye
Lea chart. From the Visionary Eyecare Blog

We tried again at her appointment on Friday and she did awesome – both in terms of understanding what we were asking her to do, and in that she’s seeing well and equally well out of both eyes.  About a month ago, her daycare had focused on shapes, and just recently, we’d started playing matching games with her.  Though we weren’t intentionally trying to prepare her for the eye exam, I think those activities helped a lot in getting her to understand the task.

If you have a young toddler going in for their first eye exam, or if your child is getting old enough to start using eye charts, I’d recommend practicing ahead of time, especially with matching games.  We played a memory game – where you have cards with pictures on them laid out and you turn them over and try to find a match – but we had all the cards face up.  I’d pick up a card and ask Zoe to find a match.  You could draw a bunch of different shapes on paper and again ask your child to find matches.  Shape-sorters would probably also work as well.  At home, you can explain that these are matching games, and then at the eye exam, again explain that you’re going to play another matching game.  Zoe seemed to find the exam pretty fun.

The Visionary Eyecare’s Blog has a great post with pictures of some of the more common eye charts for children, if you want to look at some examples.  At Zoe’s appointment, they used the Lea chart.

To cover Zoe’s eyes, the optician hung a patch over her glasses on one eye, and then the other.  She told Zoe that Zoe would be a little pirate for a bit.  I don’t know if it’s related or not – but I can’t come up with another explanation – that evening, Zoe kept singing to herself, “hi-yo, hi-yo, I’m a pirate.  Pirate, pirate, I’m a pirate.”

ordering glasses online

There’s some good discussion and tips on the open thread on glasses about ordering glasses online.  I think I will add a section to the Collected Wisdom page about that.  So if you have any additional hints or tips, let me know.

The discussion was spurred by a question from Monica who is looking for any experiences with ordering Miraflex glasses online.  Her optical provider was particularly unhelpful with that.  Here’s part of her question:

So, my question is.. I have heard that these frames are durable and I think that is what we need at this point, but has any one ordered them from their website online without getting them fitted? Do they fit well? How do I know what size to get?

I’ve been thinking more about ordering online as well, after hearing some of the great experiences people have had with getting prescription sunglasses online (I’m still a little wary of ordering primary glasses online given how often we get Zoe’s glasses adjusted).  I want Zoe to have sunglasses, and the price is certainly right.  The problem for me is getting the Pupillary Distance (PD) measurement.  GeorgeB left a great comment about measurments for ordering online and said that you could use a small ruler with cm to get the distance.  But I have a pretty bad track record on this.  My husband has ordered his glasses online a couple of times, and the first time, he had me try to measure the pupillary distance.  I failed.  Wow, did I fail.  He ended up with glasses causing major eyestrain, and had an optician at Costco re-do the measurement.  Since we’re especially concerned with Zoe’s eyes staying aligned, I don’t want to mess this up.  I asked at her eye appointment yesterday, but her eye doctor’s office doesn’t sell glasses, so they didn’t have the equipment to do the measurements and told us to ask our optical shop.  But will our optical shop be willing to give us that measurement?  It’s certainly not in their best interest.  We’ll see tomorrow when I call.  So any hints for getting a good pupillary distance measurement?  I think at the optical shop, they put glasses on Zoe and marked with a grease pencil where her pupils were on the lenses of the glasses and then measured that.  I may give that a shot.

just for fun

Not sure what was going on, but I stumbled upon two articles about dogs and glasses today.  I know it’s a little outside the normal topic of the blog, but I had to share.  I hope you all enjoy as much as I did.

First meet Chanel, who at almost 21 is the world’s oldest dog.  She wears glasses for cataracts.  You can read more about Chanel, and check out more pictures at MSNBC.

Chanel, 21 years old - wears glasses for cataracts.
Chanel, 21 years old - wears glasses for cataracts.

~ ~ ~

And then from the April 1939 issue of Popular Science, an article about dogs and glasses.  The article talks about reasons for dogs to wear glasses (mostly nearsightedness) and even talks about the eye exam.  Check it out (article is online through Google magazines).

a dog gets measured for glasses
a dog gets measured for glasses

I love me some Target!

Ok, so I love Target in general and sometimes think I should just hand over our paycheck to them at times, but I’m even more lucky because our Target is a super Target and has an optical store in it and that’s where we got Sam’s glasses.

It’s been about 14 months since he got his first pair. We are now on to pair #3. Last week, he came up to me holding them in his hands and said “Momma, the glass fell out of my glasses!”
Sure enough, it had. I was hoping that the lens had just popped out, but discovered that the frame was broken. I don’t know what happened to it, and Sam says that he was wearing his glasses when the lens just fell out. But, he is prone to throwing them when mad, so I’m guessing that it finally caught up with us.

So, off to Target we go. Now, I’m totally expecting to have to buy new frames and we do. But I was so happy to find that they still had the same frames in stock, so we didn’t have to buy new lenses. And, they have a one year warranty on them, so we only had to pay half price for them.

So, I think that the Target Optical store totally rocks for keeping the same pair of frames in stock for 14 months and having a pretty decent warranty on kids frames.

Week 3 – Patch Pals

may 001Welcome to our patch challenge- WEEK 2.  My daughter is 2 ½ and has Amblyiopia.  We are currently trying to help her brain recognize her right eye.  She has perfect vision in her left eye and -7.75 in her rmay 002may 003ight.  The patching only and Atrophine only solution is not working, so our PO has recommended a combination of patching and drops. She has struggled with patching in the past and so….

We are on a quest for a PERFECT PATCH! 
This week we tried Patch Pals

http://www.patchpals.com/patch_pals_

PO Box 26
Hiawatha,  IA  52233
Phone and Fax: 319-393-2620
Email: PatchPals@aol.com

Cost: Patches range from $7-$10, Patch Club is $25 (T-shirt and more) Puppy and Patch $30

Ratings given 1-5 for the following criteria. 
1 Doesn’t meet my expectations, 5 Exceeds my expectations

Cuteness Factor     5+
Durability   5
Full Eye Occlusion 5*
Performs with sweat 3 
Patching Support 5

Reusable  Yes

* I cut a slit in the very end so that the temples could thread through the patch because the eye patch was slipping inside her glasses and rubbing her eyes and allowing her to see around the patch. After I did this, we had no problems at all. 

Total patching hours for the week (Goal 14), Actual = 14 hours

Elly’s response: “Oooohhh the doggie has a patch too!”
Mom’s response: 
I am very impressed with this company’s “total package.”  They really are about making the patching experience easier for kids.  Elly was in love with the patch pal doggie and carried her around all week.  He is the softest, cutest little doggie.  We only let her have him when it was patch time.  She really wanted the dog, so she kept the patch on.  One day she took the patch off and we put the patch and doggie away.  She cried by the door and begged to have the patch on again.  I really can’t argue with that!  She wasn’t as into the patch club t-shirt and other goodies.  I think she is really too young to get it, but I thought they were neat! 

As for the patch, I think we made our patching goals based on the cuteness of the patch and the puppy, because Elly didn’t really like the way the patch felt on her face.  It was made out of felt and had a thin liner, but was still a little scratchy for my texture oriented girl. She seemed to get used to it as time wore on.  On the flip side, I was impressed because for the first time she actually requested me to put the patch on when we went to a play date with friends.  She wanted to show them her puppy patch.  Thankfully all my mom friends played along and oogled over how cute it was.

Photos in the photo gallery

I know I’m way behind on this, but I finally got 2 new photos added to the photo gallery (Conall and Penny), and updated the photo of Paris.  I feel like I may have missed someone though.  If you’ve sent me a photo, either by comments or email, and it’s not on the page, I’m really sorry.  Could you send it again?  And I’ll throw out the call once again – send me a link or a photo via email and I’ll add it to our gallery (ann@shinypebble.com).

Update on Mia: glaucoma valve shifting and corneal scarring

Danielle posted this comment recently, and I wanted to post it on the blog for anyone else dealing with glaucoma or cataracts.  -Ann Z

I just wanted to give everyone an updated on Mia, she went in for an EUA (exam under anesthesia) on Thursday.  Her PO told us that her glaucoma valve shifted even further and is pressing against her cornea which has caused scarring.  The scarring is not obstructing her vision so we have a few options that we will be discussing with her glaucoma specialist from Mass Eye & Ear.  She might need to have corneal replacement surgery, at which point she will receive a donor cornea from a cadaver.  I have read that many babies reject the donor tissue and I do not want Mia on anti-rejection medication at such a young age.  I have read articles about a relatively new procedure were they use an artificial cornea called Keratoprosthesis, I also read that there is a very low rejection rate.  I will be speaking to her glaucoma specialist about this new procedure, I am hoping that this is an option, Boston Children’s and Mass Eye & Ear are very advanced in technology so I hope this will be a possibility.  Another option is we can remove the valve and hope her high intraocular pressure (glaucoma) does not return.  Or we could do nothing and see if the valve shifts further causing the scar tissue to obstruct her vision. Either way she will end up needing another surgery.   She was also sized for a regular contact lens that we will hopefully receive within the next 2 weeks.  Other than the shifted valve and news of another surgery, she is doing extremely well and her procedure under anesthesia went really great, she was starved when she woke up.

How can you tell what they are actually going through?

Being a toddler is tough enough.Everyone is bigger, stronger, smarter, and faster than they are. Then, add a few vision issues and limited ability to communicate and as a result we parents become their vision advocates. So how can we tell what is really going on?

Let me explain the situation. Sunday 2:00 A.M. Elly wakes us up with a curtling scream. I run to her bedroom and she is yelling, “My eye hurts, my eye hurts,” clutching her right eye (the one we put Atropine drops in) Then she says, “There is blood coming out, There is blood everywhere.” By this time, I am wide awake, have the lights on and have put a cold compress on her eye. No blood and she settles down easily and goes back to sleep, but I am wide awake and sleep on the floor beside her bed, just in case.

This event repeated again last night around the same time and same complaint. So is it really her eye hurting? And if so, wouldn’t it hurt more during the day or in the sunshine? And why now? There have been no daytime complaints.

Or, if you take into consideration that my husband had a MAJOR bloody nose complete with blood spewing all over the dinner table (TMI, I know) right before she went to bed Sunday night, then maybe she has found her inner voice and has begun dreaming or rather having nightmares. Or possibly, she is now in the stage where fears are real and very scary. Maybe the patching and drops and not being able to see is her fear (I can’t blame her) In which case, how do I address it, acknowledge it, and help her work through it? Either scenario is difficult and I find myself reaching out to people in my community who are more knowledgeable than I. I did put a call into my PO and we have a scheduled appointment this Friday. I’m also hoping to get a hold of the home visitation vision specialist and ask if there are specific things I can do to help Elly through her fears. And parents… any thoughts or suggestions?

Visitor map


Visitor Map
Create your own visitor map!

Just testing out this map of visitors that Amomofelly mentioned.

Open thread: Where are you all from?

Nicole asked on the little four eyes facebook group about where everyone is from, and I have to admit, now I’m curious, too. Leave a comment with where you’re from – at whatever level of detail you wish (yep, you can just say you’re from Earth, if that’s the case…).

Your stories – Anna’s story

This story was sent in by Christina.  -Ann Z

When I found out my daughter, Anna, needed glasses this past December I stumbled onto this blog.  Since then I’ve found it to be a great source of both information and support. And because of this I thought I would share her story.  Anna’s story is nothing shocking, but from reading this blog it seems like everyone’s story is interesting in some way and if nothing else you realize that you are not alone in this. We truly are the only ones who know what it’s like to have a very young child with an eye condition.

Anna was diagnosed with accommodative esotropia due to farsightedness at 18, almost 19 mos. old. I first noticed Anna’s left eye turning at around 15 mos., but it wasn’t very bad or very often – only really happening when she ate. At first I thought it was just me, but then I pointed it out to my husband and he could see it too.  A few days later my father-in-law said something about her eye without my husband or I saying anything to him. We had a regular check-up with her pediatrician a couple of weeks later so we figured it would be ok to wait and mention it to the doctor then. By the time of the appointment her eye was turning more often and occasionally the right eye would turn too. When I mentioned it to Anna’s doctor, I asked him if it this was normal and he told me it wasn’t. He recommended that we take her to see a Pediatric Ophthalmologist and even gave me a few names. I got home and made the appointment right away, but the earliest appointment I could get was 2 mos. away.

At first I wasn’t very concerned about the appointment being so far off because her doctor wasn’t overly concerned, but as the days and weeks went on Anna’s eye started turning so badly that you could only see a sliver of her iris at times. I kept calling and pestering the PO and finally was able to get an earlier appointment. Anna did remarkably well at the appointment despite being off her usual nap schedule. She looked at the stripes on the cards and watched for the light up dinosaur, etc. and didn’t really mind the exam until it was time to dilate her eyes – but who really likes that? When the doctor completed her full exam she told us that Anna was farsighted and that’s what was causing her left eye to turn. The specific diagnosis was accommodative esotropia due to hyperopia. At that time her prescription as +4.50 in both eyes, but she told us we needed to come back in 4 mos. and that Anna’s script may change.

During the exam I asked the PO if Anna had always been farsighted, etc. – you know, all the questions that start to flood after you find out your baby needs glasses – and she felt that she had, but it hadn’t presented itself until recently. Hearing her say that Anna has probably always been farsighted, made something click for me, so I asked the PO about a face Anna had made several times a day since she could hold her head up, but oddly stopped making around the time I noticed her eye turning. This face…

Anna at 10 months
Anna at 10 months

Now this is a cute face, right? Well after I described it to the PO, she believed this was actually a precursor to the eye turn – Anna’s way of focusing very early on. We never really thought much of her making this face because everyone that babysits her wears glasses and always peers over the tops of them, so we all just thought she was imitating – wrong! So of course as a parent I felt like I’d been a complete idiot. How could I not realize something was wrong with my baby? The fact that Anna needed glasses didn’t bother me as much as the fact that she probably needed them a lot earlier and I just didn’t notice. Another thing that should have tipped me off to something is that my Dad has poor vision, ambylopia, and as a child he had several surgeries to correct strabismus in both eyes. I didn’t know any of the terms yet, but the last thing I thought when I brought Anna to the PO was that she couldn’t see well. She has always been on par or ahead for her age – pointing out all sorts of things – butterflies, balls, flowers, etc. – in books, on wrapping paper, on t-shirts, you name it, so I honestly thought it was something more related to strabismus – a “weak muscle” as everyone would say to me – but definitely not trouble seeing.

We just went to Anna’s 2nd eye appointment and like her PO thought at the first visit, she needed a stronger script (+6.0 in the right eye and +7.0 in the left eye, but the new script is for +5.50 and +6.50). So now her PO has classified her as having extreme farsightedness, but doesn’t think she will need to be patched or have surgery because her eyes are so closely matched. We have to go back in 6 mos. and we’ll see what happens then. Fortunately Anna has been great about wearing her glasses from day one. A few weeks in she actually said, “I can see”, when I put her glasses on after her nap so I knew they were helping. She can be a bit rough with them at times – car rides are the worst; she gets bored and takes them off. And in the last couple of weeks she’s been taking them off a bit more and rubbing her left eye, but with the script change that now makes sense.

You wouldn’t think that finding glasses for a very young child would be difficult, but it really is. It took me a full day of searching, but we finally managed to find a great optical shop near home and in 4 mos. we’ve been there 4 times, but they have a decent replacement policy and they’ve been really helpful every time we’ve been in. Which is really all you can hope for when you’ve got a nearly 2 year old in glasses. Hopefully with Anna’s script being adjusted she’ll take her glasses off less and we won’t have to make as many trips.

I also wanted to share that the hospital where Anna’s PO is based is doing a genetic study of esotropia, strabismus, ambylopia, ptosis, and other related eye disorders. My husband and I spoke with the research coordinator and agreed to participate – it only required us to give saliva samples and fill out a questionnaire. I’m trying to get my Dad to participate because of his eye condition, but he’s not as eager as my husband and I. Hopefully though, our participation in this study will someday help kids like Anna get the care they need as soon as possible.

Our main goal in all of this – eye exams, trips to the optical shop, extra sets of glasses, participating in research studies – is to do everything we can to give Anna what she needs to continue being the happy, healthy little girl she is.

Anna at 20 months
Anna at 20 months

Week 2 – Anissa’s Fun Patches

Welcome to our patch challenge- WEEK 2.  My daughter is 2 ½ and has Amblyiopia.  We are currently trying to help her brain recognize her right eye.  She has perfect vision in her left eye and -7.75 in her right.  The patching only and Atrophine only solution is not working, so our PO has recommended a combination of patching and drops. She has struggled with patching in the past and so….  We are on a quest for a PERFECT PATCH! 

This week we tried Anissa’s Fun Patches

P.O. Box 455  Chuckey, TN  37641

Phone: (423)234-3404

http://www.anissasfunpatches.com/index.html

email:   anissasfunpatch@mounet.comapril-426

 Cost: 1 for $5.25, 3 for $18.00, or 4 for $20.00 with $2.00 shipping and handling

 Ratings given 1-5 for the following criteria. 

1 Doesn’t meet my expectations, 5 Exceeds my expectations

 Cuteness Factor           5

Durability                      3*

Full Eye Occlusion        4

Performs with sweat     5         

Patching Support          5

 Reusable                      Yes

 *We wore the patch the first day for 1 ½ hours with no complaints.  I turned my head for a second and she ripped the patch off the glasses.  We used a little electrical tape to fix it and after moms stern warning, she let me take the patch off for the rest of the week.

 Total patching hours for the week (Goal 14), Actual = 12 hours

 Elly’s response: “I want to see a picture of Anissa!”

Mom’s response:   This patch is SO cool. It is made out of foam that is stiff, but still flexible.  Some people come up with the most creative things!!!  Elly wore it very easily because it did not irritate her skin at all and I think she actually forgot it was on a couple times.  We would have made our patching goal for the week, but the patch was lost for a day (Whoops – found it in the laundry) I was worried that she would be able to peek around it, but when the patch is worn like the directions say, “Adjust position on ear piece so that the patch fits against the face eliminating the ability to see around the patch.”  There was only one time when I think she looked under it.  I also like the patching support they offer.  On the website, there is a Photo Gallery of kids wearing the patch and we showed the pictures to Elly during patch time and talked about how other kids patch to make their eyes stronger too.  They also have a cute little activity book with coloring pages of animals patching, some activities, and a reward chart with stickers.  We only let Elly color in the book when she was patching and found it helpful to have something new and rewarding to do.  If you are patching any amount of time, I strongly recommend having at least one of these patches around for the hot summer days.  They are comfortable, reusable, and very budget friendly.

Reader question: toddlers and glasses and tantrums

This question comes from Tobi, mom of Z – the cute little Ethiopian girl with Cortical Visual Impairment.  -Ann Z

I have a question that I’m wondering if others struggle with, and if so, what they do about it.  My daughter is now 3 1/2 and is finally tolerating her glasses very well.  In fact, she often asks for them first thing in the morning and becomes annoyed when we take them off for bed.  This is great.  What isn’t so great is that her glasses have become an emotional weapon of sorts.  Here’s what I mean:  when she gets frustrated or mad at something, she yanks her own glasses off and throws them down on the ground.  Sometimes she will even kick or stomp on them!

She has some developmental delays, and so this kind of behavior is fairly consistent with her developmental age, which is about 2 1/2.  When I give them back to her, after she appears a bit calmer, she freaks out again, only the second time around she will cry and say her glasses are off, she needs her glasses.  Again, I give them to her, and she whips them across the room.  I say “glasses all done, we don’t throw glasses” or something to that effect, and she goes bonkers — “I need my glasses!  I no see!”

So my question is, how do parents deal with glasses and temper tantrums.  Is it cruel to withhold the glasses until the kid calms down?  (I’m inclined to say that’s not cruel, that’s just drawing a line.)  What about saying:  “If you don’t treat them well, I will take away your glasses” – when she really doesn’t understand this consequences thing yet?  It’s so painful to watch her in one of these tantrums, and then without her glasses things really go from bad to worse.   I feel I’m being manipulated, but I have no idea how to stop this cycle.

are they real?

First, apologies for not updating the site or answering emails this week, my grandmother passed away unexpectedly and we were with family.  There should be a lot of updates and additions to the photo gallery coming in the next couple of days.

I’ve noticed that recently we’ve gotten a lot more questions about whether Zoe’s glasses are “real.”  I guess now that she’s old enough to choose her own outfits, it’s possible that she might want to wear glasses that do nothing for her.  Then on our train trip out to see my family I had two different people ask me if Zoe’s temporary tattoo of a dog driving a firetruck was real!  And I realize that silly comments are absolutely not limited to kids wearing glasses.

Week 1 – MYI Occlusion Eye Patches

 

Welcome to our patch challenge- WEEK 1.  My daughter is 2 ½ and has Amblyiopia.  We are currently trying to help her brain recognize her right eye.  She has perfect vision in her left eye and -7.75 in her right.  The patching only and Atrophine only solution is not working, so our PO has recommended a combination of patching and drops.

 

I recently e-mailed all the companies that made patches for little kids that I could find and asked them if they wanted to participate in my patch study.  Since Elly refuses to keep a patch on and has fought “patching time” for over a year, I am now on the quest for a PERFECT PATCH! 

 

Most of the company’s that sell kids patches are family stores created because someone special in their life has Amblyiopia.  Every company that I have written to or spoken with on the phone has been absolutely delightful to work with and genuinely care about kids with vision issues.  No matter which patch works best for us, I would highly recommend all of them for their level for their customer service!

 

This week we tried the MYI patches from

The Fresnel Prism and Lens Co. 
6824 Washington Ave S.
Eden Prairie, MN 55344 USA
 
800-544-4760 toll free
952-496-0432 phone
952-403-7900 fax

april-246www.myipatches.com

 

Cost: $15.00 per pack of 51 patches – you choose 3 designs per pack.Shipping in US by Priority Mail – 2-3 days for delivery – $6.75 for shipping 1-6 packs of patches

 

Ratings given 1-5 for the following criteria. 

1 Doesn’t meet my expectations, 5 Exceeds my expectations

 

Cuteness Factor           5

Durability                      4

Full Eye Occlusion        5

Performs with sweat     4 *      

Patching Support          3

 

Reusable                      NO

 

*Elly was running at the park and it was 80 degrees.  She was working up a sweat, but the patch stayed on for 90 minutes.

 

Total patching hours for the week (Goal 14), Actual = 13 hours

 

Elly’s response: “Ooooohhhhh, bright colors!”

Mom’s response:         

“They sent 10 patches of regular size and 10 of the smaller size. I laughed because Elly went through more than 100 patches in a week of a different brand of “peel and stick” patches. We made it through, but used all 20. =)   (Once undone, they don’t re-stick.)  I think it was because the designs were really bright and cute and she LOVED picking out which one she wanted to wear.  If you are using another brand of stick-on patches, I would highly recommend you try these to add some cute patching choices.  It may help motivate your child to keep the patch on longer.  I know it helped mine!  The inside of the patch is black and I know it did a really good job of occluding her vision, because there were many times during the week she would cry to take the patch off because she couldn’t see. There was only one time that her skin became irritated and red after removing the patch – maybe she pulled it off too quick?  I also really liked the smaller junior size with Elly because the glasses seemed to sit better on her face and bothered her less.  I just wish they were not so much $$$ or that our insurance would cover it.  The way we go through them, it would cost us around $30 per month at $360 per year for patches.