Hi, Our son is 4 years old and is being treated for amblyopia and esotropia. He was diagnosed about a year ago, when his pediatrician noted his right eye turning in during a routine exam. The ophthalmologist we were referred to (who is board certified by the ABO) asked us to patch the eye for two hours each day (more on the weekends ) to first resolve the amblyopia. After 3 months, his vision had improved from 20/90 to 20/40 but the esotropia did not resolve itself and his right eye was still turning in. At this time, he indicated that glasses would not help since his hyperopia was only +2 diopters and suggested surgery. We were informed that the success rate was about 75%, and decided to move forward. The procedure took place the following month (he operated on both eyes) and was unfortunately not successful in resolving the esotropia. His right eye still turned in, and now there was also now a very slight inward turn of the left eye, probably not noticeable to someone who is not looking that closely but noticeable to us. At the follow-up a few days after the surgery, we were told that the goal was to improve binocular vision without over-correcting. He advised us to continue patching for an hour a day and scheduled a follow-up in 3 months. In the interim, we sought out a second opinion. Our son was not that cooperative during the acuity test, unfortunately, so his visual acuity could not be determined at that visit, but the second ophthalmologist told us that the outcome of the surgery was an under-correction. Without being able to determine the level of hyperopia as a disclaimer, his initial suggestion was for a second surgery. 3 months after the surgery, we had the follow-up with the doctor that performed the surgery. At that visit, he informed us that our son’s hyperopia has increased from +2 to +4 diopters. The diagnosis was changed to accommodative esotropia and glasses we prescribed (bi-focals); he stated that there was a 50/50 chance of success. The glasses appeared to work, and the next follow up with the doctor who performed the surgery confirmed that the deviation had been significantly reduced, and the glasses should continue to worn during all waking hours. He also told us to continue patching the left eye for an hour a day, since he felt that the left eye was still being favored. He also mentioned that chances for a postive outcome have improved with the success of the glasses, though future surgeries could not be ruled out. Although I am relieved that the glasses are working, I’m beginning to wonder if we may have rushed into the surgery. We realize that we can’t “put the genie back in the bottle” so to speak, but I have some questions I would like answered (that I would feel uncomfortable discussing with him directly) to help us decide whether to continue with this doctor or seek out another. My primary interest is whether some of my concerns below are warranted, since there are relatively few pediatric ophthalmologists where we live and our son is now comfortable with ophthalmologist (no small task). So, my questions are: 1. Is it possible for hyperopia to go from 2 diopters to 4 diopters in 6 month time period in the normal course of events for a 3 year old? 2. If not, could the surgery have caused the change in far-sightedness? 3. As a general rule (understanding that every individual case is different), can glasses be prescribed when the hyperopia is measured at 2 diopters for a 3 year old child? 4. Are there any potential negative ramifications to having had strabismus surgery first, followed by glasses? (My understanding is that the usual treatment plan is reversed – glasses followed by surgery if necessary.) Do the potential odds for future surgeries increase, even though the glasses are working, after having had a surgery? Thanks so much.
yes, thanks for the quick response
yes, i suspected that number one was more likely, but wanted to be sure. thanks
that is very helpful, I'm just a little curious why, since it's not surprising for the diopters to change from 2 to 4
why is wasn't suggested to wait a little while
I understand in the end, the parent are responsible for the decision
but your answers have been very helpful and reassuring
yes, it does, thanks
but can one still have binocular improvement after a surgery and not have the esotropia resolved?
i assumed that one outcome is related to the other..
but the surgery by itself probably did not improve binocularity if the esotropia was still present
after the under-correction, and before the glasses
and they are now, so I guess that is what I should be focusing on.
so to speak..
thanks so much
no, no more questions
you have been very helpful