Choosing the Right Glasses for Children with Hyperopia and Amblyopia

Q: Choosing the Right Glasses for Children with Hyperopia and Amblyopia

Hello： First of all, the differences in measurements for children at different institutions are primarily due to the strength of the cycloplegic agents used. <br>Children have very strong ciliary muscle capabilities, and the refractive error can vary significantly between a tense

Pediatric hyperopia and amblyopia?

Hello, the child is currently 5 years and 7 months old.
A month ago, it was diagnosed that the right eye has hyperopia while the left eye is normal, leading to anisometropia and subsequently amblyopia.
Four hospitals provided the following reports: 1.
National Cheng Kung University Hospital ==> Right eye hyperopia +3.25, recommended prescription +2.25.
2.
Tainan City Hospital ==> Right eye hyperopia +2.25, recommended prescription +1.25.
3.
Kaohsiung Chang Gung Memorial Hospital ==> Right eye hyperopia +3.00, recommended prescription +2.00.
4.
An ophthalmology clinic ==> Right eye hyperopia +2.75, recommended prescription +1.75.
Each facility reported different measurements, and the doctors explained that the variations are due to the different strengths of the cycloplegic agents used during the examinations.
Consequently, a prescription of +2.00 was chosen, and the child has been wearing these glasses for a month while undergoing occlusion therapy.
Upon returning to Tainan City Hospital for follow-up, the child could see 0.4 with the +2.00 glasses and 0.6 with the +1.25 glasses.
The doctor advised selecting the +1.25 prescription, stating that if the glasses are too strong, it may cause the child to strain their eyes, which would be counterproductive to the correction.
After returning home, we visited two more optical shops and confirmed that the child sees more clearly with the +1.25 prescription.
I would like to ask: how should we choose the child's glasses prescription? After all, Tainan City Hospital provided the lightest measurement, and would wearing a stronger prescription be more beneficial for the child, or is it better to choose the prescription that allows the child to see more clearly?

Kunhuo de Xiao Lin, 30~39 year old female. Ask Date: 2014/10/28

Dr. Zhuang Yamin reply Ophthalmology

Hello: First of all, the differences in measurements for children at different institutions are primarily due to the strength of the cycloplegic agents used.
Children have very strong ciliary muscle capabilities, and the refractive error can vary significantly between a tense and a fully relaxed state, potentially by hundreds or even thousands of diopters.
Theoretically, the stronger the cycloplegic agent, the more relaxed the muscle becomes, resulting in a higher measured hyperopia that is closer to the child's true refractive error.

As you mentioned, the child currently exhibits signs of amblyopia and is already over five years old.
It is crucial to expedite the treatment for amblyopia.
The principle of amblyopia treatment requires first determining the accurate relaxed refractive error and providing appropriately powered corrective lenses.
Subsequently, it is important to monitor the child's refractive changes to understand the state of muscle tension and relaxation.
If necessary, additional medications can be used to assist the muscles in learning to relax and adapt to the glasses.

The focus of treatment should not be solely on reducing the lens prescription but rather on improving the best-corrected visual acuity.
Correctly powered glasses have the most significant effect on enhancing vision.
In children who are accustomed to straining their muscles or even experiencing spasms, initially providing fully powered glasses may lead to poorer visual performance.
However, with appropriate guidance to promote muscle relaxation, there is a greater chance for visual improvement.

Wishing you well,
Ophthalmology Department, Changhua Hospital.

Reply Date: 2014/10/28

More Info

When it comes to selecting the right glasses for children with hyperopia (farsightedness) and amblyopia (lazy eye), it is essential to consider several factors, including the degree of hyperopia, the child's comfort with the glasses, and the potential impact on their vision development.
In your case, your child has been diagnosed with varying degrees of hyperopia across different examinations, which is not uncommon. Variations in measurements can occur due to differences in the strength of the cycloplegic agents used during the eye exams, the technique of the examiner, and even the child's cooperation during the testing. This is why you received different recommendations from various hospitals and clinics.

Choosing the Right Prescription
1. Understanding the Measurements: The measurements you received ranged from 225 to 325 degrees of hyperopia, with recommendations for corrective lenses varying accordingly. The key is to find a balance between providing enough correction to improve vision without overwhelming the child with a prescription that is too strong.
2. Trial and Comfort: It seems you have already tried different prescriptions, and your child found the 125-degree lenses to be clearer. This is a crucial factor. Children are more likely to wear glasses that they find comfortable and that allow them to see well. If the 125-degree lenses provide better clarity and comfort, they may be the best choice, especially if they are also effective in improving visual acuity.

3. Impact on Amblyopia: Since your child has amblyopia, it is vital to ensure that the glasses help stimulate the weaker eye. The goal of treatment for amblyopia often includes using the appropriate prescription to encourage the use of the affected eye. If the glasses are too strong, they may cause discomfort and lead to avoidance of wearing them, which can hinder treatment.

4. Follow-Up and Adjustments: Regular follow-up appointments are essential to monitor your child's vision and the effectiveness of the glasses. If your child is not responding as expected, adjustments may be necessary. The eye care provider may also recommend patching the stronger eye to encourage the use of the weaker eye, which is a common treatment for amblyopia.

5. Professional Guidance: Ultimately, the decision on which prescription to use should involve a discussion with your child's eye care provider. They can provide insights based on their clinical experience and your child's specific needs. If the provider suggests a lower prescription based on the child's comfort and visual acuity, it is likely a reasonable approach.

Conclusion
In summary, when selecting glasses for a child with hyperopia and amblyopia, it is essential to consider the clarity of vision, comfort, and the potential impact on visual development. The prescription that allows your child to see clearly and comfortably while also supporting the treatment of amblyopia is likely the best choice. Regular follow-ups with an eye care professional will help ensure that your child's vision continues to develop appropriately. If you have concerns about the varying prescriptions, discussing these with a pediatric ophthalmologist or optometrist who specializes in children's vision can provide further clarity and guidance.

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