High Astigmatism in Children: Vision Correction Challenges

Q: High Astigmatism in Children: Vision Correction Challenges

Hello Kelvin： 1. <br>The visual acuity is measured with correction; the uncorrected vision is less important. <br>As long as you have clear vision while wearing glasses, that is considered normal, and you don't need to worry about uncorrected vision. <br>2. <br>If the corrected v

High astigmatism in children and vision correction issues?

Hello, doctor.
My son is almost eight years old.
Last June, during a visit to the clinic, we discovered he has high astigmatism in both eyes at 200 degrees.
Previously, his vision tests showed normal results (1.0), so we were quite surprised.
He started wearing glasses in September of last year, and now, after ten months, his right eye maintains a vision of 1.0, but his left eye is weaker, around 0.8-0.9 (which varies with each measurement).
He also feels that his left eye's vision is poorer.
Today, his uncorrected vision measurements were surprisingly low: right eye 0.5 and left eye 0.3.
Why has his uncorrected vision dropped so much? He currently has no myopia, just astigmatism.
Is this condition amblyopia? What methods can help improve his left eye's vision? Should he wear an eye patch? What could have caused such a significant drop in his uncorrected vision? Since last June, his left eye's prescription has fluctuated between 0 to -25 degrees of myopia.
The doctor advised using a cycloplegic agent daily for the left eye to prevent myopia, while the right eye had 50 degrees of hyperopia at that time, so it didn't require treatment.
During a follow-up in May of this year, the left eye's prescription remained similar, but the right eye was already at 0 degrees, so we started using the cycloplegic agent for the right eye as well.
Could the daily use of the cycloplegic agent for the left eye be the reason his left eye's vision is not keeping up with the right eye? (Could the lack of clarity in the left eye hinder its visual development?) To summarize my questions: 1.
Why has his uncorrected vision decreased so much despite wearing glasses? Is there an issue? Can it be improved? 2.
Is he experiencing amblyopia? I’ve heard that by age eight, it’s difficult to make changes, is that true? 3.
Should we consider stopping the cycloplegic agent? Thank you for your help!

Kelvin, 40~49 year old female. Ask Date: 2021/06/20

Dr. Gao Pilin reply Ophthalmology

Hello Kelvin: 1.
The visual acuity is measured with correction; the uncorrected vision is less important.
As long as you have clear vision while wearing glasses, that is considered normal, and you don't need to worry about uncorrected vision.
2.
If the corrected visual acuity exceeds 0.8, then amblyopia is no longer present.
3.
Cycloplegic agents are used to inhibit myopia; currently, using cycloplegic agents should help in preventing myopia.
If the medication is stopped, it is important to monitor whether myopia increases.
Online responses can only serve as a reference; if necessary, it is still important to seek medical attention at a healthcare facility.
I hope to have the opportunity to serve you.
Gao Pilin

Reply Date: 2021/06/20

More Info

Understanding high astigmatism in children can be quite complex, especially when it comes to vision correction challenges. Your concerns about your son's vision are valid, and it's essential to address them thoroughly.

1. Why has his naked vision decreased significantly despite wearing glasses?
The decrease in naked vision (the ability to see without corrective lenses) can be attributed to several factors. First, it's important to understand that astigmatism can lead to blurred vision, and if the corrective lenses are not adequately compensating for the astigmatism, the child may still experience visual difficulties. Additionally, if there has been a change in the shape of the cornea or lens, or if there are other underlying issues such as amblyopia (lazy eye), this could also contribute to the decline in naked vision. Regular follow-ups with an eye care professional are crucial to monitor these changes and adjust prescriptions as necessary.

2. Is this condition indicative of amblyopia?
Given that your son has a significant difference in vision between his two eyes, it is possible that he may be experiencing amblyopia, especially if the left eye is not developing visual acuity as expected. Amblyopia occurs when one eye does not achieve normal visual acuity, often due to a lack of proper visual stimulation during critical developmental periods. While it is true that the window for effective treatment of amblyopia narrows as children age, interventions can still be beneficial even after the age of eight. Treatment options may include patching the stronger eye to encourage the weaker eye to work harder, vision therapy, or further corrective measures.

3. Should the cycloplegic drops be discontinued?
The use of cycloplegic drops is typically intended to temporarily paralyze the ciliary muscle of the eye, allowing for a more accurate measurement of refractive error without the influence of accommodation (the eye's ability to focus). If your son has been using these drops and is experiencing a decline in vision, it may be worth discussing with his eye care provider whether to continue their use. The goal is to ensure that the treatment does not hinder the visual development of the weaker eye.
In terms of helping your son improve his left eye vision, several strategies can be employed:
- Patching Therapy: This involves covering the stronger eye to force the weaker eye to work harder. This method can help improve visual acuity in the amblyopic eye.

- Vision Therapy: This is a structured program of visual activities designed to improve visual skills and processing. It can be particularly effective for children with amblyopia or other visual processing issues.

- Regular Eye Exams: Frequent check-ups with an eye care professional are essential to monitor progress and make necessary adjustments to treatment plans.

In conclusion, your son's situation requires careful monitoring and possibly a multi-faceted approach to treatment. It is crucial to maintain open communication with your eye care provider to ensure that the best strategies are employed for his visual development. Early intervention can make a significant difference in outcomes, so do not hesitate to seek further evaluations or second opinions if necessary.

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