Pupil Dilation and Vision Discrepancies in Children

Q: Pupil Dilation and Vision Discrepancies in Children

Hello： The difference in prescription between the two eyes has already occurred and cannot be corrected. <br>However, it is possible that the prescription of the less myopic eye may increase more significantly, which would reduce the disparity between the two eyes, but it is not

Could you please clarify the issue regarding the use of dilating drops in children and the problem of binocular disparity?

Hello, Doctor! My child is currently in the fifth grade.
He started using atropine eye drops since first grade, beginning with a low-concentration long-acting formula, and his prescription has been maintained under 200 degrees.
However, a year and a half ago, he developed a 100-degree disparity, which increased to 125 degrees six months ago.
The clinic doctor said that his disparity is due to poor eye habits and cannot be corrected.
Is it true that my child's disparity cannot be corrected? Later, the clinic doctor prescribed a higher concentration long-acting atropine (0.3) for him, and we continued using it until the end of last year.
I feel that every two months, the check-ups only involve measuring his prescription and providing education, followed by receiving the medication.
Although his prescription has not exceeded 200 degrees, I switched to another clinic for an examination at the beginning of this year to hear other doctors' opinions.
However, the new doctor also prescribed the same atropine eye drops and advised us to continue using them.
The only difference is that instead of applying one drop in each eye before bedtime, we are now instructed to apply three drops (with a five-minute interval).
Doctor, will applying three drops have any other effects on my child's eyes? Is the dosage too high? Why do different doctors prescribe different dosages of the same atropine eye drops? Thank you for your response! (I apologize for the lengthy message.)

Mao Mao, 30~39 year old female. Ask Date: 2020/02/04

Dr. Gao Pilin reply Ophthalmology

Hello: The difference in prescription between the two eyes has already occurred and cannot be corrected.
However, it is possible that the prescription of the less myopic eye may increase more significantly, which would reduce the disparity between the two eyes, but it is not possible for the more myopic eye to become less myopic.
Each physician has different methods for treating myopia, along with varying experiences and outcomes, so it is advisable to inquire directly for more accurate information.
If it were my prescription, I would recommend using the eye drops once before bedtime, as that should be sufficient.
Taiwan E-Hospital Puzi Hospital Ophthalmology: Monday, Tuesday, Thursday, and Friday mornings from 8:00 AM to 12:00 PM, and Wednesday afternoons from 2:00 PM to 4:30 PM.
Online responses can only serve as a reference; it is still necessary to seek medical attention at a healthcare facility.
I hope to have the opportunity to serve you.
Gao Pilin

Reply Date: 2020/02/04

More Info

When it comes to children experiencing vision discrepancies, particularly in the context of pupil dilation and the use of cycloplegic agents (like atropine), it's essential to understand both the physiological and psychological aspects that may contribute to these issues. Your child's situation, where they have been using a cycloplegic agent for an extended period, raises several important points for consideration.

Firstly, pupil dilation is often used in pediatric ophthalmology to temporarily paralyze the ciliary muscle, allowing for a more accurate assessment of refractive errors without the influence of accommodation (the eye's ability to focus on near objects). This is particularly important in children, as their accommodation can mask underlying refractive errors. The use of cycloplegic agents can help in diagnosing conditions such as myopia (nearsightedness) and astigmatism more accurately.

In your child's case, the increase in refractive error (from 200 degrees to 300 degrees) and the reported vision discrepancies (an increase in astigmatism) could be attributed to several factors, including genetics, environmental influences, and visual habits. The notion that poor visual habits contribute to these discrepancies is a common belief among practitioners, but it is also essential to recognize that some children may have a predisposition to refractive errors that are not solely influenced by their habits.

Regarding the use of higher doses of the cycloplegic agent, such as the increase from one drop to three drops, it is crucial to understand the pharmacodynamics of these medications. While the intention behind increasing the dosage may be to achieve a more profound and longer-lasting effect, it is essential to monitor for potential side effects. Common side effects of cycloplegic agents can include blurred vision, sensitivity to light, and increased intraocular pressure. In children, these effects can sometimes lead to discomfort or behavioral changes, as they may not fully understand why their vision is altered.

The variation in treatment protocols among different practitioners can stem from their clinical experiences, the specific needs of the patient, and the desired outcomes. Some may prefer a more conservative approach, while others may advocate for a more aggressive treatment plan. It is essential to maintain open communication with your child's ophthalmologist and express any concerns you may have regarding the treatment plan. If you feel uncertain about the prescribed dosage or the rationale behind it, seeking a second opinion from another pediatric ophthalmologist can provide additional clarity and reassurance.

In conclusion, while it may seem that your child's vision discrepancies are not easily correctable, it is vital to continue regular follow-ups with an eye care professional. They can monitor the progression of your child's refractive errors and adjust the treatment plan as necessary. Additionally, encouraging good visual habits, such as taking breaks during prolonged near work and ensuring adequate lighting, can help mitigate further issues. Ultimately, the goal is to optimize your child's visual health and ensure they have the best possible outcomes as they grow.

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