Astigmatism in Children: Eye Exam vs. Glasses Prescription

Astigmatism in children

Hello, my child (5 years old) had an eye examination and it was found that the right eye has astigmatism of 100 and hyperopia of 125, while the left eye has astigmatism of 225 and hyperopia of 175.
These measurements were taken after dilation.
The doctor recommended that my child wear glasses.
I then took my child to an optical store to get glasses, but after the optical store used the prescription provided by the ophthalmologist, my child's vision was only 0.5.
The optical store then re-measured and found the results to be right eye (astigmatism 100, myopia 25) and left eye (astigmatism 225, myopia 50).
The astigmatism remained the same, but the hyperopia changed to myopia, and the difference is significant.
I observed that with this prescription, my child can see about 0.8.
I would like to ask the doctor if the discrepancy between the ophthalmologist's measurements and the optical store's measurements is normal (due to dilation?), and whether I should continue using the prescription given by the optical store or stick with the ophthalmologist's prescription.

Tony, 30~39 year old female. Ask Date: 2010/05/13

Dr. Wang Zhishun reply Ophthalmology

Hello, when you take your child to the optical store, how long has it been since the visit to the ophthalmologist? If it has been more than a day, the effects of dilation may have worn off, which could lead to a change in the prescription.
Children often have strong accommodative abilities, so it is usually necessary to perform the refraction after dilation to obtain an accurate prescription.
I hope you find this information helpful.
If you have any questions, please feel free to discuss further.
Thank you!

Reply Date: 2010/05/13

More Info

Understanding astigmatism and the discrepancies between eye exams and glasses prescriptions in children can be quite challenging for parents. Your situation highlights some common concerns regarding the accuracy of measurements and the implications for your child's vision.

First, it's essential to understand that astigmatism is a refractive error caused by an irregular shape of the cornea or lens, which leads to blurred or distorted vision. In children, astigmatism can often be detected during routine eye exams, and it can change as they grow. The measurements you provided indicate that your child has varying degrees of astigmatism and hyperopia (farsightedness) in the right and left eyes.

When it comes to the differences in measurements between the eye doctor and the optical shop, several factors can contribute to this discrepancy:
1. Measurement Techniques: Different equipment and techniques can yield varying results. Eye doctors typically use more sophisticated instruments and may perform additional tests, including cycloplegic refraction (using dilating drops) to get a more accurate measurement of refractive errors. In contrast, optical shops may rely on automated machines that can be influenced by the child's cooperation and the presence of any residual accommodation (the eye's ability to focus on near objects).

2. Cycloplegia Effects: If your child was dilated during the eye exam, this could temporarily affect the measurements. Cycloplegic agents like atropine or tropicamide temporarily paralyze the ciliary muscle, allowing for a more accurate assessment of refractive error without the influence of accommodation. If the optical shop did not use such agents, the results could reflect the child's ability to accommodate, leading to a different prescription.

3. Prescription Validity: Given that the optical shop's measurements resulted in a significant shift from hyperopia to myopia (farsightedness to nearsightedness), it's crucial to consider the context. If the optical shop's prescription allows your child to see better (0.8 vision) compared to the eye doctor's prescription (0.5 vision), it may be more practical to use the optical shop's prescription temporarily. However, it is advisable to consult with the eye doctor to confirm the accuracy of the new prescription and ensure it is appropriate for your child's needs.

4. Follow-Up: Since your child is only five years old, regular follow-up eye exams are essential. Children's eyes can change rapidly, and ongoing assessments will help monitor their vision and any changes in refractive error. If there are concerns about the accuracy of the prescription or the child's vision, a follow-up visit to the eye doctor for a re-evaluation is recommended.

5. Importance of Corrective Lenses: If your child has been prescribed glasses, it is essential to ensure they wear them consistently, as this can help improve their visual acuity and reduce the risk of further vision problems. Properly fitted glasses can significantly enhance a child's ability to see clearly, especially in educational settings.

In summary, while discrepancies between eye exam results and optical shop prescriptions can occur, it is crucial to prioritize your child's vision needs. Consulting with the eye doctor to clarify the best course of action is advisable. Regular eye exams and appropriate corrective lenses will support your child's visual development and overall eye health.

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