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Help - 11 year old son with amblyopia
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Thu Jul 13, 2006 9:39 pm    Post subject: Help - 11 year old son with amblyopia Reply with quote

My son, aged 11, has only recently (in the last 2 weeks) been diagnosed
with Amblyopia. He has excellent (6/4.5) vision in his left eye but is
very long-sighted in the right eye and can only read about 20% (6/30
just) in that eye without glasses. This is brought up to only about 50%
(6/12) vision in the poor eye with glasses. The eyesight problem has
only recently been diagnosed by chance, as he has never had any
problems reading or headaches - his left eye has been doing all the
work. I feel terribly guilty we did not spot this earlier, and am
anxious to do what I can for him before it is too late. Sadly, we were
told by the optician he is now too old for patching. However, after
doing some research on the internet, I have read that studies are being
carried out in the US patching older children with some positive
results. Then I came across some work by a team at Nottingham
University, developing a Virtual Reality system which sounds like it
might be even more suitable for my son. Furthermore I have come across
UK optomotrists on the internet who mention on their sites they are
happy to treat amblyopia in older children by patching and vision
therapy. I have also read about a treatment called IPS which might
help.

I am now totally confused as to who to approach. I emailed the
Nottingham team to see if they are carrying out further trials; they
are not right now, but they suggested I ring around a few consultants
before getting referred. However, getting consultants contact details
is proving hard without a referral and I don't really know what to ask.
What treatment should I be looking for? I went back to the optician and
she has agreed to write me a letter of referral if I can find someone
who will see my son, but because of his age, she suggested probably
only the Institute of Opthalmologists in London would be receptive to
seeing him. I emailed the Institute but have yet received no reply.

Can anybody out there please advise me what to do next. I live between
halfway between Oxford and Stoke Mandeville hospitals but according to
my optician, children over 8 are considered too old for treatment by
the hospital specialists and are referred straight back to the local
opticians. I know I can go to a private optomotrist - there is a good
childrens one in Cheltenham - but would an optomotrist be specialised
enough, or do I need to see an opthalmologist or orthoptist? How would
I find the right one and contact him/her?

I would be grateful for any advice anyone can offer. Having seen the
research going on, I cannot accept that my son is too old for treatment
at 11. Also would it be best to wait until he has had his glasses a
while to see what improvement they can offer to his VA before treatment
such as patching/ vision therapy is attempted - or bearing in mind his
age should he be starting treatment ASAP? (For information: currently
he has been prescribed a +4.25 lens for longsightedness in the poor eye
with -2.5 astigmatism correction. His actual longsightedness I am told
is actually +5.00. His good eye prescription is plano.) Many thanks.
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William Stacy
medicine forum Guru


Joined: 01 May 2005
Posts: 1177

PostPosted: Thu Jul 13, 2006 10:33 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

Start with full time glasses and see how he does. I think part time
patching of the good eye might be helpful, even at his age, but just
when doing things where he doesn't need sharp vision (like tv watching),
but only when wearing his Rx!

Consider a contact lens as soon as he seriously wants them.

w.stacy, o.d.

LG wrote:
Quote:
My son, aged 11, has only recently (in the last 2 weeks) been diagnosed
with Amblyopia. He has excellent (6/4.5) vision in his left eye but is
very long-sighted in the right eye and can only read about 20% (6/30
just) in that eye without glasses. This is brought up to only about 50%
(6/12) vision in the poor eye with glasses. The eyesight problem has
only recently been diagnosed by chance, as he has never had any
problems reading or headaches - his left eye has been doing all the
work. I feel terribly guilty we did not spot this earlier, and am
anxious to do what I can for him before it is too late. Sadly, we were
told by the optician he is now too old for patching. However, after
doing some research on the internet, I have read that studies are being
carried out in the US patching older children with some positive
results. Then I came across some work by a team at Nottingham
University, developing a Virtual Reality system which sounds like it
might be even more suitable for my son. Furthermore I have come across
UK optomotrists on the internet who mention on their sites they are
happy to treat amblyopia in older children by patching and vision
therapy. I have also read about a treatment called IPS which might
help.

I am now totally confused as to who to approach. I emailed the
Nottingham team to see if they are carrying out further trials; they
are not right now, but they suggested I ring around a few consultants
before getting referred. However, getting consultants contact details
is proving hard without a referral and I don't really know what to ask.
What treatment should I be looking for? I went back to the optician and
she has agreed to write me a letter of referral if I can find someone
who will see my son, but because of his age, she suggested probably
only the Institute of Opthalmologists in London would be receptive to
seeing him. I emailed the Institute but have yet received no reply.

Can anybody out there please advise me what to do next. I live between
halfway between Oxford and Stoke Mandeville hospitals but according to
my optician, children over 8 are considered too old for treatment by
the hospital specialists and are referred straight back to the local
opticians. I know I can go to a private optomotrist - there is a good
childrens one in Cheltenham - but would an optomotrist be specialised
enough, or do I need to see an opthalmologist or orthoptist? How would
I find the right one and contact him/her?

I would be grateful for any advice anyone can offer. Having seen the
research going on, I cannot accept that my son is too old for treatment
at 11. Also would it be best to wait until he has had his glasses a
while to see what improvement they can offer to his VA before treatment
such as patching/ vision therapy is attempted - or bearing in mind his
age should he be starting treatment ASAP? (For information: currently
he has been prescribed a +4.25 lens for longsightedness in the poor eye
with -2.5 astigmatism correction. His actual longsightedness I am told
is actually +5.00. His good eye prescription is plano.) Many thanks.
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Mike Tyner
medicine forum Guru


Joined: 24 Mar 2005
Posts: 1299

PostPosted: Thu Jul 13, 2006 11:29 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

Quote:
My son, aged 11, has only recently (in the last 2 weeks) been diagnosed
with Amblyopia.

I agree with Dr. Stacy. Full time correction and part-time patching,
contacts (likely just the right eye) as soon as he's able.

I think it's important to know how well your son sees in stereo. It's very
likely, since he has no squint, that he can appreciate a 3-D movie or a
stereogram. Stereo vision (stereopsis) is pretty tolerant of the blur of
amblyopia. Most of these kids (20/40 best corrected) have better than 100
arc-seconds of stereo.

Most practitioners would agree it's going to be hard to improve the
corrected acuity. But you owe it to yourself to google "Stereo Sue." Stereo
vision is more "recoverable" than amblyopic blur, so I think it's important
that he wear correction for the right eye, whether or not the best corrected
acuity improves over time.

As such, it may be less important to patch him (treating amblyopia while
hindering stereo vision) and more important to give him good binocular
vision and let him use it in real space. Sports like tennis or even
billiards will exercise and train stereo vision. Video games would not.
Video monitors can be made to simulate stereo, and "used under a doctor's
supervision" for a considerable fee, but I'm not convinced the "therapy"
environment is any better than real-world, real-stereo life.

Stereo Sue said she cried, standing in the middle of the first snowstorm
after "learning" to see in stereo. Her optometrist, Dr. Theresa Ruggiero,
reportedly began with a "brock string", a simple yard-long string with three
colored beads. I'm not yet convinced it takes a lot of special training or
apparatus.

-MT, OD


Quote:
My son, aged 11, has only recently (in the last 2 weeks) been diagnosed
with Amblyopia. He has excellent (6/4.5) vision in his left eye but is
very long-sighted in the right eye and can only read about 20% (6/30
just) in that eye without glasses. This is brought up to only about 50%
(6/12) vision in the poor eye with glasses. The eyesight problem has
only recently been diagnosed by chance, as he has never had any
problems reading or headaches - his left eye has been doing all the
work. I feel terribly guilty we did not spot this earlier, and am
anxious to do what I can for him before it is too late. Sadly, we were
told by the optician he is now too old for patching. However, after
doing some research on the internet, I have read that studies are being
carried out in the US patching older children with some positive
results. Then I came across some work by a team at Nottingham
University, developing a Virtual Reality system which sounds like it
might be even more suitable for my son. Furthermore I have come across
UK optomotrists on the internet who mention on their sites they are
happy to treat amblyopia in older children by patching and vision
therapy. I have also read about a treatment called IPS which might
help.

I am now totally confused as to who to approach. I emailed the
Nottingham team to see if they are carrying out further trials; they
are not right now, but they suggested I ring around a few consultants
before getting referred. However, getting consultants contact details
is proving hard without a referral and I don't really know what to ask.
What treatment should I be looking for? I went back to the optician and
she has agreed to write me a letter of referral if I can find someone
who will see my son, but because of his age, she suggested probably
only the Institute of Opthalmologists in London would be receptive to
seeing him. I emailed the Institute but have yet received no reply.

Can anybody out there please advise me what to do next. I live between
halfway between Oxford and Stoke Mandeville hospitals but according to
my optician, children over 8 are considered too old for treatment by
the hospital specialists and are referred straight back to the local
opticians. I know I can go to a private optomotrist - there is a good
childrens one in Cheltenham - but would an optomotrist be specialised
enough, or do I need to see an opthalmologist or orthoptist? How would
I find the right one and contact him/her?

I would be grateful for any advice anyone can offer. Having seen the
research going on, I cannot accept that my son is too old for treatment
at 11. Also would it be best to wait until he has had his glasses a
while to see what improvement they can offer to his VA before treatment
such as patching/ vision therapy is attempted - or bearing in mind his
age should he be starting treatment ASAP? (For information: currently
he has been prescribed a +4.25 lens for longsightedness in the poor eye
with -2.5 astigmatism correction. His actual longsightedness I am told
is actually +5.00. His good eye prescription is plano.) Many thanks.
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Fri Jul 14, 2006 6:55 am    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

Mike Tyner wrote:


Quote:
I think it's important to know how well your son sees in stereo.

I have tested my son with magic eye 3D pictures and he can see them
both with and without his glasses. I presume this must be an indication
of stereo vision since you can't see them with only one eye. I am
amazed he can see them with only 20% vision in the poor eye. Do you
think practicisng with them regularly will help his vision?
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Mark A
medicine forum Guru Wannabe


Joined: 30 Apr 2005
Posts: 226

PostPosted: Fri Jul 14, 2006 7:19 am    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

Quote:
I have tested my son with magic eye 3D pictures and he can see them
both with and without his glasses. I presume this must be an indication
of stereo vision since you can't see them with only one eye. I am
amazed he can see them with only 20% vision in the poor eye. Do you
think practicisng with them regularly will help his vision?


As someone who has amblyopia, I can tell you that even with a fairly severe
case (20/200+ in bad eye), some stereo vision is present.

When performing certain eye exercises past a certain age, there may be a
risk of causing your child to be cross-eyed or other similar condition . I
am not saying that 11 years is past that age (since I am not qualified to
say), but I would only do what a licensed professional (OD or MD) told me
was OK for my child. I also would not take advise from someone who has not
personally examined my child and is able to monitor his progress.
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Mike Tyner
medicine forum Guru


Joined: 24 Mar 2005
Posts: 1299

PostPosted: Fri Jul 14, 2006 12:49 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

"LG" <lesley@goetz.eclipse.co.uk> wrote

Quote:
I have tested my son with magic eye 3D pictures and he can see them
both with and without his glasses. I presume this must be an indication
of stereo vision since you can't see them with only one eye.

It sure is, and it's a very good sign.

Quote:
I am
amazed he can see them with only 20% vision in the poor eye.

I think you've misinterpreted the numbers. The "percent" scale can be
confusing. You're hearing "20% vision" where I'm pretty sure they mean "20%
reduction." Big difference.

Quote:
Do you
think practicisng with them regularly will help his vision?

Welllll... yes but so would any other real-life task involving stereo
vision.

-MT
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Fri Jul 14, 2006 1:13 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

Mike Tyner wrote:

Quote:

I am
amazed he can see them with only 20% vision in the poor eye.

I think you've misinterpreted the numbers. The "percent" scale can be
confusing. You're hearing "20% vision" where I'm pretty sure they mean "20%
reduction." Big difference.

Oh, Ok...I was told his vision without glasses was 6/30 (or 20%) and

6/12 (or 50%) without. Now I am more confused!
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Mike Tyner
medicine forum Guru


Joined: 24 Mar 2005
Posts: 1299

PostPosted: Fri Jul 14, 2006 1:53 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

"LG" <lesley@goetz.eclipse.co.uk> wrote

Quote:
Oh, Ok...I was told his vision without glasses was 6/30 (or 20%) and
6/12 (or 50%) without. Now I am more confused!

The Snellen fraction (6/12) doesn't translate to a percentage of visual
ability.

A person without glasses could easily be 6/1200 and still be perfectly
healthy, so the "6/30" is only an indication that he's farsighted.

The 6/12 is significant because it indicates the state of his physiology,
when the farsightedness is corrected.

In the US, "percent" measures of vision are only used by lawyers and
beurocrats. Pull up this link:
http://www.socialsecurity.gov/disability/professionals/bluebook/2.00-SpecialSensesandSpeech-Adult.htm
for a description of visual _disability_ based on snellen acuity. Scroll way
down to a table under section 2.09 and you'll see that 6/12 corrected vision
is considered "85% visual efficiency" by our Social Security administration.

-MT
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Fri Jul 14, 2006 3:22 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

Mike Tyner wrote:

Quote:
The Snellen fraction (6/12) doesn't translate to a percentage of visual
ability.

I think my optician was trying to simplify the results for me by
quoting them as percentages. I went back to her to get the actual VA
results after doing the research on the internet. I'll just stick to
the VA results from now on!

Quote:
Pull up this link:
http://www.socialsecurity.gov/disability/professionals/bluebook/2.00-SpecialSensesandSpeech-Adult.htm
for a description of visual _disability_ based on snellen acuity. Scroll way
down to a table under section 2.09 and you'll see that 6/12 corrected vision
is considered "85% visual efficiency" by our Social Security administration.

Does the 85% mean he has 85% vision (after correction) in the poor eye
working alone or in both eyes working together?
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