Vision Issues in Twins: Expert Insights on Eye Health

Could you please provide more details or specify your question regarding vision?

Hello Dr.
Wang, I have a pair of twins (currently 16 years old, in the second year of high school).
Yesterday, I took my older son to an ophthalmologist.
His left eye has a vision of 0.3 with 100 degrees of hyperopia and 150 degrees of astigmatism, while his right eye has a vision of 1.0 with 50 degrees of myopia.
Is his left eye vision stable? Will this difference in vision between the two eyes cause him to rely more on the right eye, potentially leading to significant deterioration of the left eye's vision over time?
Additionally, my younger son had an eye exam yesterday as well.
His left eye has a vision of 0.3 with 25 degrees of hyperopia and 150 degrees of astigmatism, while his right eye has a vision of 0.5 with 50 degrees of myopia and 75 degrees of astigmatism.
However, he mentioned that the clarity of vision between the two eyes is different, with the left eye appearing significantly darker.
After prolonged use (about an hour), both eyes struggle to focus together, requiring considerable effort to achieve focus.
When he was younger, he was advised to undergo patching therapy on the right eye to force the use of the left eye, but he was not very cooperative, and the treatment was discontinued shortly after.
I wonder if his left eye vision is stable now and if it will worsen in the future.
If he covers his right eye for one to two hours while doing homework at night, will that still be beneficial for his left eye? The ophthalmologist mentioned that his right eye has mild pseudomyopia (the same for both brothers) and prescribed a short-acting cycloplegic agent for the right eye.
Should he use it? Could treating the right eye's myopia lead to even less use of the left eye, resulting in further deterioration of its vision?
I have heard that if there is a disparity in vision between the two eyes during childhood, such as significant hyperopia in the left eye and normal vision in the right eye, the left eye may become amblyopic due to insufficient stimulation.
However, as the child grows, the refractive error may decrease, leading to a situation where, by adolescence, the left eye's refractive error appears close to normal but is already amblyopic.
Since I did not inquire about the degree of hyperopia in my younger son's left eye when he was younger, I would like to know if his poor vision now, despite not having high hyperopia, can be considered amblyopia.
Could it have been caused by significant hyperopia in childhood?
Additionally, I am particularly concerned about their eye conditions because there is a family history of severe amblyopia; my brother, their uncle, has one eye with significant amblyopia (he was exempt from military service due to this).
Thank you for your response.

Zhong Mama, 40~49 year old female. Ask Date: 2015/10/06

Dr. Wang Zhishun reply Ophthalmology

Hello, the refractive error of the eyes generally stabilizes around the ages of 18 to 20, while visual development typically completes around 10 to 12 years of age.
The older son's condition is still within an acceptable range and does not pose issues of dependency or deterioration.
The younger son's situation is more complex and requires consideration of historical data on vision correction and changes in refractive error for a comprehensive assessment.
Amblyopia responds well to treatment before the age of nine, but the effectiveness decreases significantly after the age of twelve.

Reply Date: 2015/10/06

More Info

Understanding vision issues in twins, especially in the context of differing refractive errors, is crucial for their long-term eye health. It’s important to address the concerns regarding both twins’ visual acuity and the potential implications of their respective eye conditions.

1. Visual Acuity and Dependence on One Eye
For your older son, with a left eye vision of 0.3 (which indicates significant refractive error) and a right eye vision of 1.0, it is likely that he may develop a reliance on his right eye for clear vision. This phenomenon, known as "monocular dependence," can occur when one eye is significantly stronger than the other. Over time, if the left eye is not used effectively, it may lead to further deterioration of vision in that eye, a condition known as amblyopia or "lazy eye."
For your younger son, with similar issues, the situation is compounded by his reported difficulty in focusing with both eyes after prolonged use. This suggests that his visual system may struggle to integrate the input from both eyes, which can be exacerbated by the differences in refractive errors.

2. Treatment and Management Strategies
Regarding the treatment options, it is essential to follow the recommendations of the eye care professional. If the doctor suggested patching the right eye to encourage the use of the left eye, this can be beneficial, especially if done consistently. Patching can help stimulate the weaker eye, potentially improving its function. However, compliance is key; without consistent use, the benefits may not be realized.

The use of short-acting cycloplegic agents, as prescribed for your younger son, is typically aimed at temporarily relaxing the eye muscles to allow for a more accurate assessment of refractive error. This can help determine the true prescription needed for optimal vision. It is crucial to monitor how the eyes respond post-treatment, as the goal is to ensure that both eyes are functioning well together.

3. Concerns About Amblyopia and Long-Term Outcomes
Your concerns about the potential for amblyopia due to the differing refractive errors are valid. If one eye is significantly weaker, it may not receive adequate visual stimulation, leading to a decline in its visual acuity. The fact that both boys have a family history of amblyopia adds an additional layer of concern.
While the current refractive errors may not seem severe, the history of high hyperopia (farsightedness) in childhood could have contributed to the development of amblyopia if left untreated. It is essential to have regular follow-ups with an eye care specialist to monitor their vision and make necessary adjustments to their treatment plans.

4. Recommendations for Eye Health
- Regular Eye Exams: Ensure both twins have regular comprehensive eye exams to monitor their vision and refractive status. This is crucial for early detection of any changes.

- Patching Therapy: If recommended, consistent use of patching therapy can help improve the weaker eye's function.

- Visual Exercises: Engage in activities that promote binocular vision, such as games that require both eyes to work together.

- Limit Screen Time: Encourage breaks from screens to reduce eye strain, especially during homework or prolonged reading sessions.

- Healthy Habits: Promote a healthy diet rich in vitamins A, C, and E, and omega-3 fatty acids, which are beneficial for eye health.

Conclusion
In summary, the visual discrepancies between your twins warrant close monitoring and proactive management. While the current refractive errors may not seem alarming, the potential for amblyopia and the impact of monocular dependence are significant concerns. By adhering to the recommendations of eye care professionals and fostering an environment that encourages healthy visual habits, you can help ensure that both twins maintain optimal eye health as they grow.

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