Children's Glasses: Managing Myopia and Astigmatism Concerns

Continuation: Issues of Glasses Prescription and Myopia with Astigmatism in Children

Dear Dr.
Gao,
Thank you for your response.
After measuring the axis at the optical shop, we found that the prescription with an axis of 5 is much clearer than the one with an axis of 10, so we decided to go with the 5.
I apologize for bothering you again, but I would like to ask you:
1.
Can my child use the old glasses with an axis of 10 for reading and doing homework? Will switching between the two prescriptions affect their vision?
2.
After dilation, the prescription was reduced by 0.25 diopters.
Is this reduction sufficient? The optician was very thorough and tested with various prescriptions, and the results matched the doctor's findings after dilation.
However, the optician suggested reducing by 0.25 diopters for easier adaptation.
My child may have been tested for too long, and their eyes were tired, which led them to say that the reduced prescription was clearer.
As a result, one eye was prescribed at 0.25 diopters less than the doctor's recommendation (doctor's prescriptions were 2.75 and 3.00, while we received 2.75 for both).
However, I later regretted this decision, as the post-dilation measurement should reflect the true prescription.
Would reducing by 0.25 diopters lead to an insufficient correction? We have a family history of high myopia, so I am quite concerned.
Thank you, Doctor.

Danxin de mama, 10~19 year old female. Ask Date: 2013/07/16

Dr. Gao Pilin reply Ophthalmology

Dear Concerned Parent,
1.
A difference of 5 degrees in astigmatism is not a concern if there are no symptoms, and it will not affect vision.
2.
While textbooks advise prescribing sufficient correction, some optometrists may choose to under-correct astigmatism slightly.
Clinically, if myopia and astigmatism are under-corrected by 25-50 degrees without affecting vision, it is generally acceptable and tends to cause less eye strain.
Currently, if the glasses are under-corrected by 25 degrees and the child can see clearly, there is no impact, so there is no need to worry.
Please let your child wear the glasses with confidence.
Thank you for your message.

Reply Date: 2013/07/16

More Info

Managing myopia and astigmatism in children is a crucial aspect of pediatric eye care, especially considering the increasing prevalence of these conditions. Your concerns regarding your child's glasses and the implications of their prescription adjustments are valid and deserve careful consideration.

1. Using Old Glasses with a Different Axis: If your child's old glasses have a cylinder axis of 10 degrees and the new prescription is 5 degrees, it is generally advisable to use the new glasses for activities like reading and homework. However, using glasses with a different axis can potentially lead to visual discomfort or strain, especially if the child is accustomed to the new prescription. Switching back and forth between glasses can cause confusion for the visual system, which may lead to headaches or fatigue. It is best to stick with the new prescription for consistent visual clarity and comfort.

2. Adjusting the Prescription After Dilation: Regarding the reduction of 25 degrees from the dilated prescription, this is a common practice in some cases, especially if the child appears to be more comfortable with a slightly lower prescription. However, it is essential to understand that the prescription obtained after dilation is typically considered the most accurate representation of the child's refractive error. Reducing the prescription may lead to insufficient correction, which could hinder optimal visual development, particularly in a child with a family history of high myopia.
In your case, if the child’s new prescription is 275 for one eye and 300 for the other, and the optician suggested reducing it to 275 for both, it is important to monitor how your child adapts to this change. If they experience any discomfort, difficulty focusing, or if their vision seems to worsen, it would be prudent to revisit the eye care professional for a reassessment.

Additional Considerations for Myopia Management:
- Regular Eye Exams: Given your family history of high myopia, regular eye examinations are crucial. These should ideally be conducted every six months to a year to monitor any changes in refractive error and overall eye health.

- Myopia Control Strategies: Discuss with your eye care provider about myopia control options, such as orthokeratology (corneal reshaping lenses), multifocal contact lenses, or atropine eye drops, which have shown promise in slowing the progression of myopia in children.

- Visual Hygiene: Encourage good visual habits, such as taking regular breaks during prolonged near work (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds), ensuring adequate lighting while reading, and limiting screen time.

- Outdoor Activities: Research suggests that spending more time outdoors may help reduce the risk of developing myopia or slow its progression. Encourage outdoor play and activities to promote overall eye health.

In conclusion, while it is understandable to feel anxious about your child's vision, maintaining open communication with your eye care provider and adhering to their recommendations will help ensure the best possible outcomes for your child's visual health. If you have any further concerns or if your child's vision seems to be fluctuating, do not hesitate to seek a follow-up appointment for a comprehensive evaluation.

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