Your Child's Farsightedness and Astigmatism After Glasses

Q: Your Child's Farsightedness and Astigmatism After Glasses

Hello Dora： 1. To determine the appropriate prescription, complete dilation of the pupils is necessary; those with more hyperopia should have a more thorough dilation. 2. I recommend that you undergo another dilated eye exam and provide the previous data for t

Children with hyperopia and astigmatism may experience issues even after being prescribed corrective lenses. These problems can include difficulty focusing on near objects, eye strain, headaches, and discomfort during reading or other close-up tasks. It's important for parents to monitor

Recently, my child, who is over five years old, underwent an eye examination due to poor results in a vision screening.
At the first clinic, after complete dilation, a refraction was performed, but there were no pre-dilation refraction values (as we had already administered dilation drops at home).
The doctor stated that both eyes are hyperopic with a prescription of over +3.00 diopters, which has led to amblyopia.
Glasses were recommended, but no prescription was provided (we were instructed to go directly to the optical department at the clinic).
There was no need for patching therapy, but we were advised to attend vision training at their facility.
At the second visit to a medical center, both pre- and post-dilation refractions were conducted; however, it was uncertain if the dilation was sufficient (it took less than an hour).
The results indicated hyperopia in both eyes, with the left eye having amblyopia, and patching of the right eye was recommended.
The glasses prescribed were: Right Eye (OD) SPH +1.00, Cyl -1.50, Axis 180; Left Eye (OS) SPH +2.50, Cyl -2.50, Axis 180.
A follow-up appointment was scheduled for three months later (it has been difficult to make appointments due to full clinics).
After getting the glasses, my child reported that everything appeared very blurry without the patch, making it hard to see letters, and he experienced dizziness and felt the ground was uneven.
He often cried while trying to read books or look at the computer screen.
He is usually a cheerful child, so it must be quite uncomfortable for him to react this way.
My questions are:
1.
Is it normal for vision to be even blurrier after getting glasses, or could there be an issue with the prescription, especially since the two eye clinics provided differing opinions?
2.
Should my child be encouraged to adapt to these glasses? How long should we wait before seeking another refraction if he does not adjust?
3.
Can my child use spherical or multifocal lenses, and would they help with his current condition for both near and far vision?
4.
If amblyopia improves with the correct prescription, will he frequently need to change his lens prescription? (The doctor mentioned it wouldn’t be necessary, but the optical shop suggested changing lenses every three to six months and advised us to consult another doctor.)

Dora, 40~49 year old female. Ask Date: 2015/11/26

Dr. Gao Pilin reply Ophthalmology

Hello Dora:
1.
To determine the appropriate prescription, complete dilation of the pupils is necessary; those with more hyperopia should have a more thorough dilation.

2.
I recommend that you undergo another dilated eye exam and provide the previous data for the physician's reference.
A new prescription should be issued.

3.
Currently, the use of multifocal glasses is not advised.

4.
Improvement in amblyopia is indicated by better visual acuity, but typically the prescription does not change that quickly.
If there has been no change in prescription, there is no need to adjust it.
Initially, more frequent follow-ups are required, such as every one to two months, and then the follow-up interval can be gradually extended based on the situation.
If there is a significant change in prescription, it should be adjusted immediately according to clinical findings.
This is essential for the recovery of amblyopia.
Since the child is only five years old, if it is merely amblyopia, the chances of recovery should be quite good.
It is crucial to monitor closely to avoid missing the critical period for treatment.

Taiwan E-Hospital Puzi Hospital Ophthalmology: Monday to Friday, 8:00 AM to 12:00 PM, Wednesday afternoon 1:00 PM to 4:30 PM.
I hope to have the opportunity to serve you.

Gao Pi-Lin

Reply Date: 2015/11/26

More Info

Understanding your child's vision issues, particularly concerning farsightedness and astigmatism, can be quite challenging, especially when faced with conflicting information from different healthcare providers. Let's break down your concerns and provide clarity on each point.

1. Is it normal for vision to be unclear after getting glasses, or could there be an issue with the prescription?
It is not uncommon for children to experience some discomfort or difficulty adjusting to new glasses, especially if they have not previously worn corrective lenses. However, if your child is consistently reporting that their vision is blurry or that they are experiencing headaches and discomfort, this could indicate that the prescription is not accurate or that the lenses are not suitable for their needs.
The discrepancy between the two eye care providers could stem from differences in how they conducted the examinations, particularly regarding the effectiveness of the dilation (or "scattering") during the tests. If the first provider did not provide a prescription and the second provider's results indicated significant astigmatism and hyperopia (farsightedness), it would be prudent to seek a third opinion or a re-evaluation to ensure that the prescription is correct.

2. Should the child be encouraged to adapt to the glasses, and how long should this take before seeking further evaluation?
While it is important for children to adapt to their new glasses, if your child is experiencing significant discomfort or visual difficulties, it is essential to address these issues promptly. Generally, children may take a few days to a couple of weeks to adjust to new glasses. However, if after a week or two your child continues to struggle with clarity, headaches, or other symptoms, it would be wise to return to the eye care provider for a re-evaluation.

3. Can the child use spherical or multifocal lenses, and will this help with their current situation?
Spherical lenses are typically used to correct simple refractive errors like myopia (nearsightedness) or hyperopia (farsightedness). Multifocal lenses, which include bifocals or progressive lenses, can be beneficial for children who need correction for both distance and near vision. However, the suitability of these lenses depends on the specific visual needs of your child. Given the presence of astigmatism and the reported symptoms, it may be worth discussing the option of multifocal lenses with your eye care provider, especially if your child needs to focus on both near and far objects frequently.

4. Will the prescription need to be changed frequently if the amblyopia (lazy eye) improves?
In cases of amblyopia, regular monitoring and adjustments to the prescription may be necessary as the child’s vision improves. The frequency of changes can vary; some children may need adjustments every few months, while others may not need a change for a year or more. It is essential to follow up with your eye care provider as recommended (in your case, every three months) to assess the effectiveness of the treatment and make any necessary adjustments.

Additional Considerations
- Visual Comfort: If your child is experiencing discomfort, it is crucial to address this with the eye care provider. Discomfort can lead to avoidance of using glasses, which can worsen vision problems over time.

- Regular Eye Exams: Consistent follow-ups are vital in managing your child's vision issues. Ensure that you keep appointments and communicate any changes in your child's visual comfort or clarity.

- Encouragement and Support: Encourage your child to wear their glasses as prescribed, and provide support as they adjust. Explain the importance of clear vision for their activities, such as reading and playing.

In conclusion, it is essential to ensure that your child's glasses prescription is accurate and suitable for their needs. If discomfort persists, do not hesitate to seek further evaluations. Regular follow-ups and open communication with eye care professionals will be key in managing your child's vision health effectively.

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