A year ago, my then 5 year old child had his eyes tested (by a clinical ophthalmologist who I feel did a thorough exam) and I was told he was borderline for needing glasses, but if he wasn't manifesting any problems then we should just recheck in a year because he might outgrow and be fine. No particular problems were noticed, although he has never really been interested in the "school work" portion of his Kindergarten program and is a part of the Title I program to help him with the needed pre-reading/reading skills.
He was rechecked this week (same doc), now age 6, and the problem was explained in a bit more depth as latent hyperopia. His pre-"eye drops" sight had a correction of +.25/+.37, so he is correcting well. With the drops, he would need a +3.25 in both eyes - the same as last year. The eye doctor is basically telling me it is our choice at this point with glasses and whether or not we think he needs them. Again, apparently this is right on the fence. (?) He will get rechecked again in a year - or sooner if we request it.
The doc gave me the script, but said we could 'wait and see' how he does. It was our call. He said if we get them, he wouldn't need to wear them all the time so he could still work on adjusting himself if he is going to outgrow it. I don't want him to use them if he will then never be able to out grown it, but if it would help him with school work, I'm all for it. He doesn't seem to care one way or another about getting them.
I am have no idea what to do. He doesn't complain of problems, but at his age (and personality) he probably wouldn't anyway. I'm concerned it may be difficult to tell with him if he is having a problem. I don't know if his pre-reading/reading skills are related to eye sight at all, or just a lag in learning/personality (his temperament is strong willed to say the least). Getting him to do any kind of seat work to observe his behavior is challenging anyway.
So - what is common practice for this? What will happen if he does use glasses (even part time) - will he ever have the chance to outgrow the latent hyperopia? Is it even likely he will outgrow it with the +3.25? Any information on how to handle this or what to "watch for" will be appreciated.. .I just have no idea what the best course of action is with my little guy.
There is NO long-term benefit in avoiding the glasses. No harm will be done by wearing them.
A conscientious doctor would recommend glasses if there were symptoms (headaches, avoiding close work) or objective findings like esotropia or reduced stereo vision. Since they did not recommend glasses outright, we assume there were no such findings.
Some doctors would be appalled at NOT recommending glasses in this case. But in the absence of symptoms or objective findings, there's no compelling reason to make him wear glasses. Hyperopia is the normal condition for young people and they have enormous reserves for coping with it.
As age and the quantity of near work increases, he might tolerate the hyperopia without symptoms until his third decade. Or he may need glasses for symptoms that crop up. Or he may be one of the 25% of (caucasians?) who start turning nearsighted about age 10, and that would reverse the condition.
What you do now is not likely to influence any of these outcomes.
Suggestion - get him a "cool" pair of drugstore +2.00 glasses and see if he likes to wear them when he reads. (The +3.25 was measured in artificial conditions and "full" correction is not always used.)
> A year ago, my then 5 year old child had his eyes tested (by a clinical > ophthalmologist who I feel did a thorough exam) and I was told he was > borderline for needing glasses, but if he wasn't manifesting any problems > then we should just recheck in a year because he might outgrow and be fine. > No particular problems were noticed, although he has never really been > interested in the "school work" portion of his Kindergarten program and is a > part of the Title I program to help him with the needed pre-reading/reading > skills.
> He was rechecked this week (same doc), now age 6, and the problem was > explained in a bit more depth as latent hyperopia. His pre-"eye drops" sight > had a correction of +.25/+.37, so he is correcting well. With the drops, he > would need a +3.25 in both eyes - the same as last year. The eye doctor is > basically telling me it is our choice at this point with glasses and whether > or not we think he needs them. Again, apparently this is right on the fence. > (?) He will get rechecked again in a year - or sooner if we request it.
> The doc gave me the script, but said we could 'wait and see' how he does. It > was our call. He said if we get them, he wouldn't need to wear them all the > time so he could still work on adjusting himself if he is going to outgrow it. > I don't want him to use them if he will then never be able to out grown it, > but if it would help him with school work, I'm all for it. He doesn't seem > to care one way or another about getting them.
> I am have no idea what to do. He doesn't complain of problems, but at his > age (and personality) he probably wouldn't anyway. I'm concerned it may be > difficult to tell with him if he is having a problem. I don't know if his > pre-reading/reading skills are related to eye sight at all, or just a lag in > learning/personality (his temperament is strong willed to say the least). > Getting him to do any kind of seat work to observe his behavior is > challenging anyway.
> So - what is common practice for this? What will happen if he does use > glasses (even part time) - will he ever have the chance to outgrow the latent > hyperopia? Is it even likely he will outgrow it with the +3.25? Any > information on how to handle this or what to "watch for" will be appreciated.. > .I just have no idea what the best course of action is with my little guy.
> Thank you in advance.
> Confused Mommy Janice :)
Janice,
I strongly recommend that you do a literature search on hyperopia. Jerome Rosner of the University of Houston College of Optometry has published many studies showing the strong correlation between uncorrected moderate hyperopia and poor academic achievement. Even the official Clinical Practice Guidelines of the American Optometric Association includes "aversion to reading" as a symptom of hyperopia. If it were me, I would weigh the risk (?) of wearing a spectacle correction with the possibility of a lifetime of academic difficulties. If it were me, I would also get a second opinion from a pediatric optometrist. Please bear in mind that there is huge disagreement among professionals concerning when and how much plus to prescribe a young hyperope, especially when neither amblyopia or strabismus are present.
>Please bear in mind that there is huge >disagreement among professionals concerning when and how much plus to >prescribe a young hyperope, especially when neither amblyopia or >strabismus are present.
I'm very grateful for the responses thus far. I have been doing searching and have encountered some of the literature in this category. One question that I have as a layperson is when the literature discusses the implications, etc. for hyperopia, do those findings apply to a child like my son who was diagnosed with latent hyperopia, and is - apparently - self-correcting at this point? I've read several items, but I am uncertain if the findings also apply in the case of latent hyperopia.
At this point, we have informed his teachers (he starts 1st grade next week) and if they sense any sign at all, we will immediately proceed with the glasses. In the meantime, I am continuing to try and figure this out and see if I can feel more certain of what decision to make.
What part of the world are you in, Janice -- if you don't mind saying??
I'm a layperson, but a high hyperope who's learned a thing or two along his 4+ decades of being in the patient's side of the chair.
I think you should get your son evaluated by the best pediatric strabismus opthalmologist that you can -- much as Dr. Leukoma recommends.
I know a name or two, in a couple of parts of the country. Others on this forum may know additional eye docs.
In a painfully obvious fashion, I think this could go one of two ways: he could be fine for years and years -- even decades -- and then need glasses ... or....
The "or" is that his eyes (and the neurologic components of vision) could be overtaxed by all of the accommodation that he'll surely need to use, to get through school and life. This could cause eye-turn (strabismus), double vision, accommodative difficulties, etc., etc.
Trust me when I say ... you don't want the "or."
A thorough exam by a truly excellent pediatric ophthalmologist will help to understand if there are ANY deficits or problems with his accommodative or binocular function that COULD make all of that accommodation problematic.
Along with you and his teachers watching for any and all the usual symptoms of vision trouble, I'd probably have him checked by a good OD or ophthalmologist more frequently than the standard annual visit. As with so many things, early intervention offers the best possible outcome.
"Latent" means real hyperopia. It's latent because it's hidden. It's hidden because he compensates for it by accommodating, exerting constant effort to focus. Compensating is very easy in the young, very hard by age 40-50.
Kids do not usually grow out of hyperopia, except as I mentioned, some percentage will experience genetic nearsightedness starting around age 9-12. Generally, the rest get gradually worse.
In kids, the hyperopia measured after cycloplegic drops ("wet" refraction) stays pretty stable or increases gradually. Between ages 30-60 it's more likely to increase than decrease.
From an early age, the hyperopia we measure _without_ drops always increases gradually to match the refraction _with_ cycloplegic drops. That's consistent with the decrease in accommodation that causes most people to have near problems at 40.
Most farsighted people have been that way all their lives. Often they didn't "need" glasses til they started school, or college, etc.
If your son has symptoms, there's no question. A cycloplegic refraction of +3.25 justifies glasses unless a kid is behaviorally and academically "normal."
If there's any question of reading difficulty, avoiding near work, headaches with close work then those are symptoms deserving treatment.
Does he color, read, write, use a computer, gameboy or psp? Does he resist or avoid any of these?
Again, glasses will not do any harm. The cycloplegic refraction is not likely to increase just because you get him glasses. If the "dry" refraction seems to increase, it's just because they get used to exerting less effort.
> >Please bear in mind that there is huge >>disagreement among professionals concerning when and how much plus to >>prescribe a young hyperope, especially when neither amblyopia or >>strabismus are present.
> I'm very grateful for the responses thus far. I have been doing searching > and have encountered some of the literature in this category. One > question > that I have as a layperson is when the literature discusses the > implications, > etc. for hyperopia, do those findings apply to a child like my son who was > diagnosed with latent hyperopia, and is - apparently - self-correcting at > this point? I've read several items, but I am uncertain if the findings > also > apply in the case of latent hyperopia.
> At this point, we have informed his teachers (he starts 1st grade next > week) > and if they sense any sign at all, we will immediately proceed with the > glasses. In the meantime, I am continuing to try and figure this out and > see > if I can feel more certain of what decision to make.
> Additional advice and opinions is still welcome!
> >Please bear in mind that there is huge > >disagreement among professionals concerning when and how much plus to > >prescribe a young hyperope, especially when neither amblyopia or > >strabismus are present.
> I'm very grateful for the responses thus far. I have been doing searching > and have encountered some of the literature in this category. One question > that I have as a layperson is when the literature discusses the implications, > etc. for hyperopia, do those findings apply to a child like my son who was > diagnosed with latent hyperopia, and is - apparently - self-correcting at > this point? I've read several items, but I am uncertain if the findings also > apply in the case of latent hyperopia.
> At this point, we have informed his teachers (he starts 1st grade next week) > and if they sense any sign at all, we will immediately proceed with the > glasses. In the meantime, I am continuing to try and figure this out and see > if I can feel more certain of what decision to make.
> Additional advice and opinions is still welcome!
can I ask why you wouldn't simply try to introduce the idea of using readers to your child and just observe for yourself their effect on his attention span and willingness to engage in prolonged near work?
kids who are straining to see at near do not always clearly behave in a predictable manner. some may complain of headaches or eyestrain but many just simple avoid near tasks and never complain about anything. being a +3.25 hyperope (latent or not) is almost certainly a strain on your son and using part-time reading glasses isn't that difficult or scary. if he were my child I wouldn't take the chance that farsightedness might be slowing his academic development-- I would just get him a cheap pair of readers and encourage him to use them and see what happens. why not?
and your question about the long-tern ramifications of being hyperopic-- its pretty simple really. when you are young you will use reading glasses occasionally but when get older you will likely be wearing glasses all the time.
> What part of the world are you in, Janice -- if you don't mind > saying??
> I'm a layperson, but a high hyperope who's learned a thing or two > along his 4+ decades of being in the patient's side of the chair.
> I think you should get your son evaluated by the best pediatric > strabismus opthalmologist that you can -- much as Dr. Leukoma > recommends.
> I know a name or two, in a couple of parts of the country. Others on > this forum may know additional eye docs.
> In a painfully obvious fashion, I think this could go one of two ways: > he could be fine for years and years -- even decades -- and then need > glasses ... or....
> The "or" is that his eyes (and the neurologic components of vision) > could be overtaxed by all of the accommodation that he'll surely need > to use, to get through school and life. This could cause eye-turn > (strabismus), double vision, accommodative difficulties, etc., etc.
> Trust me when I say ... you don't want the "or."
> A thorough exam by a truly excellent pediatric ophthalmologist will > help to understand if there are ANY deficits or problems with his > accommodative or binocular function that COULD make all of that > accommodation problematic.
> Along with you and his teachers watching for any and all the usual > symptoms of vision trouble, I'd probably have him checked by a good OD > or ophthalmologist more frequently than the standard annual visit. > As with so many things, early intervention offers the best possible > outcome.
> Neil
Neil,
I specifically said "pediatric optometrist," not pediatric ophthalmologist. Of course, I would not object to a third opinion by a pediatric ophthalmologist if strabismus was involved.
Suppose it is true that corrective negative lenses to compensate for myopia myopia does indeed lead to progressive myopia. (Don't jump on me yet.) How could such putative knowledge be used to cure hyperopia?
Suppose enough positive power is used to correct a young child's hyperopia so that reading distance is moved in to be closer than typical reading distance. That is, the far point is brought into where the normal near point would be. Then I would expect that all the visual behavior with such positive lenses would be pretty much the same as that of a myope. Would that cause the eyeball to lengthen? I sure do not know.
Such technique is probably testable on animal models. Other strategies might hold even more promise.
> Suppose it is true that corrective negative lenses to compensate for > myopia myopia does indeed lead to progressive myopia. (Don't jump on me > yet.) How could such putative knowledge be used to cure hyperopia?
> Suppose enough positive power is used to correct a young child's > hyperopia so that reading distance is moved in to be closer than typical > reading distance. That is, the far point is brought into where the > normal near point would be. Then I would expect that all the visual > behavior with such positive lenses would be pretty much the same as that > of a myope. Would that cause the eyeball to lengthen? I sure do not know.
> Such technique is probably testable on animal models. Other strategies > might hold even more promise.
