the Accuracy of Computerized Eye Exams for Children - Ophthalmology

The accuracy issues of computer-based vision testing?

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Hello Doctor, thank you for your response! I took my child to the ophthalmology clinic for an examination, where they performed a fundus examination, OCT, and slit lamp examination.
I informed the clinic doctor about my child's eye condition, and after the examination, the doctor concluded that the eyes were stable and normal.
However, there was still no conclusion regarding the appearance of shadows, and it was suggested that it might be caused by the dilating drops.

1.
I would like to ask if such a condition could be caused by the cornea, such as keratoconus.
It seems that astigmatism is not easily increased, but this time it increased by 25 degrees, and myopia increased by 75 degrees in just two months.
Could this be an early symptom of keratoconus? What tests should be done to rule out keratoconus?
2.
Later, due to the increase in prescription, I went to an optical shop to get new glasses.
I found that during the previous examination at the clinic (using the E chart), the corrected vision for both eyes was between 0.9-1.0 (I have been monitoring for a year and a half).
However, this time at the optical shop, the owner used a numerical vision chart, and the corrected vision for my child was less than 0.8, at most 0.7.
The owner mentioned a possibility of amblyopia.
My child is now 8 years old; is there still a chance for correction?
3.
Could the underlying cause of the shadow in the eye be responsible for the decrease in vision? Thank you, Doctor, for your patience in answering many questions! I have been monitoring my child's eye condition for a year and a half and have noticed many issues! I really appreciate your thorough responses, thank you!
Response from Dr.
Gao Pi-Lin, Ophthalmology:
Hello,
1.
You can perform a corneal topography, but mild astigmatism is less likely to be the cause.

2.
Since the previous vision was 0.9-1.0, there is still a possibility of recovery, but it is essential to wear the correct glasses.
Sometimes, dilation can also affect vision.

3.
This is unclear.
If you do not want to use dilation drops, you may consider wearing orthokeratology lenses, which can help control myopia and astigmatism.
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Doctor, I apologize for the trouble.
My child is 8 years old and has been using a low-dose 0.125% dilating agent in both eyes.
Previously, due to the issue of shadows in my child's eyes, we visited a new clinic where the computer refraction (without additional dilation drops) showed right eye -2.50 with astigmatism 2.25, and left eye -1.00 with astigmatism 2.25.
The next day, when I went to the optical shop for new glasses, the computer refraction results were right eye -2.50 with astigmatism 2.00, and left eye -0.75 with astigmatism 2.50.
Both places conducted the refraction at 3 PM.
However, today, when I visited the original clinic for follow-up, the computer refraction (without additional dilation drops) showed right eye +0.50 with astigmatism 2.50, and left eye -1.00 with astigmatism 2.25, which was done at 12 PM.
1.
May I ask, since my child is using a long-acting 0.125% dilating agent every night, does this mean that additional dilation drops are needed during the refraction?
2.
Among these three refraction results, which one is more accurate? Since my child is considering orthokeratology lenses, the left eye results are similar, but the right eye varies significantly from +0.50 to -2.50.
Could this lead to over-correction or under-correction issues?
3.
Is this discrepancy due to the different measurement times affecting the efficacy of the dilating drops? I understand that there will be some variability in computer refraction results, but since my child needs orthokeratology lenses and the right eye has a significant difference in myopia, I am concerned about potential adverse outcomes.
Thank you for your assistance!

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Xiao Wu, 0~9 year old female. Ask Date: 2021/10/07