Cincinnati Family Magazine

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December 6, 2022

The Eyes Have It

Do you know how to tell if your child needs glasses? Read on.

Full2286.jpgMy son Hayden’s first birthday party was a typical 1-year-old celebration. We had relatives and friends visiting, presents galore, too much food for anyone to eat and a cake that was purposely slathered with a ton of icing so that Hayden could dive face first into it for the typical first birthday party picture. In the end, Hayden was overwhelmed, we were tired, and the grandparents were shooting photos left and right of their beautiful grandchild for future scrapbooks.

I didn’t think too much of it at the time because a running joke in my family is that my mother lives and dies by the camera. Where she goes, the camera goes. However, when we got her pictures back from the developer, it was my mom that called our attention to the fact that Hayden’s right eye appeared to be turning inward slightly. She noticed it immediately because my sister had experienced the same thing as a youngster.

We took him to his pediatrician for an exam where we were promptly given a referral. Lesson one for me was learning that there are actually pediatric ophthalmologists that specialize in kids’ eye problems. So, we called around and made an appointment with Robert Estes, M.D., with Tennessee Lion’s Eye Center at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

I was put at ease right away when we walked into the office and realized that Hayden was not the only child on the planet that needed glasses. There were quite a few children waiting to be seen. Once we talked with the doctor, we realized that we had caught Hayden’s problem quite early. Many eye issues show up as children grow older and get into school that are not easily detected at a young age, especially when children are not yet able to express themselves verbally.

So, after we watched Estes whip through an exam with Hayden by having him focus on Barney videos and rubber dinosaurs held up to his nose, Hayden was diagnosed with esotropia, a form of amblyopia, or “lazy eye.” According to David Morrison, M.D., assistant professor of ophthalmology and pediatrics also with Tennessee Lion’s Eye Center, “Amblyopia is the most common eye problem in pediatrics.

It affects two to four percent of the population.” Amblyopia occurs when a child’s vision cannot be corrected to be perfect. Morrison adds, “It can be caused by an obstruction of the visual axis during childhood such as cataracts, strabismus (misalignment of the eyes) or a long-standing need for glasses.”

Our first concern was whether Hayden would need surgery. Franklin mother Ashlie Freeman knows about eye surgery all too well. “Tanner is currently 5 years old,” she says, “but we saw eye issues in him as early as 9 months old.

His eyes were not aligning correctly at around 2 months.” Morrison adds that any misalignment of a child’s eye after 4 months of age is considered abnormal and should be examined by a pediatric ophthalmologist, but doing it prior to 4 months of age may give you a false impression of the problem. Freeman says, “We talked to our doctor when Tanner was 2 months old, and he suggested we wait a few months as it is common at that age for the issue to correct itself.”

Lisa McBrey, mom to 10-year-old Charlie, realized he was having problems when he was much older. “At 8, his third grade teacher told us that he was having problems seeing the board in school,” she recalls. “Each year we had his eyes checked at his doctor’s office but his problem showed up later. Charlie was diagnosed as nearsighted or myopic.”

Morrison explains, “Most kids are slightly farsighted, or hyperopic. As children grow, their eyes grow, and the child grows out of the hyperopia. In some children that are excessively farsighted, glasses are required in childhood. In some cases of high hyperopia, the child’s eye actually crosses as the child strains to focus. This is called accomodative esotropia. In these children, glasses are worn to decrease the focusing effort and in turn, the crossing. Sometimes glasses may be discontinued if the child’s eye growth causes the hyperopia to lessen.”

Hayden has a focusing problem, not a vision problem. He appears to see fine without his glasses, but his right eye will slowly start to cross in over time. This baffles me because his glasses are quite thick and it amazes me that he can see without them. Morrison says, “Children’s eyes have an almost unlimited ability to focus through far sightedness. In fact, a small amount of hyperopia is normal for a child. However, everyone’s eyes converge, or draw slightly closer together when they focus. Thus, a child who has to focus through excessive hyperopia may see well, but have crossed eyes. Kids who are nearsighted will generally require glasses throughout life.”


A Perfect Fit

Daxx Dunn, an optometrist with Family Vision Care of Cool Springs says, “When fitting children with glasses, correct sizing is crucial. Up to about age 3 or 4, they are typically fit with cable temple frames (the kind that curl behind their ears) for a more snug fit. You want them to fit well but with children, we take into consideration the fact they they are still growing and a perfect fit now will be too small in a few months.” He explains that typically, it is necessary to leave a little bit of room to grow when fitting children. “I recently fit glasses on an 11-month-old, and we ended up going with two pair,” he says.

Christy Taylor, M.D., doctor of optometry with Taylor Made Eyecare and Optical in Franklin adds, “The frame should be durable and lightweight and the width of the frame and the temple length (the piece that goes behind your ear) should be adequate enough to allow for growth during the year.

Equally important are the lenses that are put into the frame. Most optometrists and opticians recommend polycarbonate lenses, which are highly impact-resistant. This is especially important with children since they are very active.” She continues, “A scratch-resistant coating on the lenses is also a good idea.”

Taylor adds, “Parents might also look into sun protection in their child’s glasses. Most damage from the sun occurs before age 18, and this includes damage to the eyes from ultraviolet light. This type of damage leads to premature cataracts and other eye diseases. Transition lenses (those that darken as you go outdoors) are an excellent option for kids of any age to provide protection when outdoors.”

For Freeman’s son Tanner, glasses did not work to correct his misalignment. “Originally, we patched Tanner’s eye along with wearing glasses,” Ashlie remembers. “It was explained to us that surgery would come later if the patching and glasses did not work, which they didn’t. In his case, surgery has resolved his amplyopia issue. Tanner stopped wearing glasses after his surgery at age 2-and-a-half and ended up having a second surgery at age 4-and-a-half.”

In Hayden’s case, he continues to do well with glasses for his esotropia. He is now 3-and-a-half years old and is careful with his glasses. Initially we assumed these problems were often fixed by surgery, but we were told surgery is not always the fix-all that some may believe. Morrison explains, “In the case of esotropia, glasses are a better fix than surgery.”

What About LASIK?

LASIK surgery, which eliminates the need for glasses altogether, is common today for adults, but not so for children. According to Morrison, “The eye continues to grow and change throughout childhood. If LASIK is done in a child, the refraction may change as the child grows. LASIK is not currently recommended until about 20 years of age.”


Don’t Wait

“If you suspect your child may need glasses, by all means, get them in to see an eye doctor as soon as possible,” says Dunn. “A lot of times kids show no noticeable symptoms that would indicate to parents that they are having problems. They might not even realize it either. Kids who haven’t had a comprehensive eye exam before have nothing to compare their vision to. If they’ve always had blurry vision, they may think it’s normal to see like that.”

The bottom line is that kids often need glasses for several reasons – some of which are different than for adults. Because a child’s eyes are growing and developing, glasses may play an important role in insuring the development of normal vision. And getting glasses can be fun since kids’ glasses are just as fashionable and trendy as adults in addition to being light weight and comfortable.

It’s usually best to express any concerns that you as a parent may have to your general pediatrician. They can often do a quick vision screen in their office and determine what cases need immediate referral to a specialist. This is the process that we followed with Hayden, and in his situation, life really has proven to be more fabulous with four eyes instead of two.

Shari Lacey is a mother and local freelance writer.


GO LOCAL

Davidson County

Politzer and Durocher, PLC
4525 Harding Pike, Ste. 100, Nashville
386-3036 • optometrists.org/politzer

Shanks Family Eye Care
412 Elysian Fields Road, Nashville
834-8495 • shankseyecare.com

Rutherford County

Coley & Coley
129 E. Clark St., Murfreesboro
893-8847 • coleyandcoleyeyecare.com

Williamson County

Brentwood Eye Clinic
5554 Franklin Road, Brentwood
373-4747 • brentwoodeyeclinic.com

Family Vision Care of Cool Springs
4085 Mallory Lane, Ste. 110, Franklin
771-2550 • drdaxxdunn.com

Taylor Made Eyecare and Optical
3046 Columbia Ave., Ste. 209, Franklin • 599-0037

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