Question:
My paediatrician referred me to an eye specialist when my
daughter was 1
month and 2 weeks old because he thought her squint was quite pronounced.
The
doctor said it was normal, come back when she is 6 months. She is now 3
months and
the squint is very pronounced. I recently took her to a paediatric
opthomologist who
told me that she has strabismus and amblyopia. He has started us on
occlusion therapy,
with a review in 10 days time. He said she is also long sighted (about 400
degrees and
that she would require surgery when she turns one as strabismus is not a
condition she
will outgrow. My questions are:
1) Was it too early at one month for the first eye specialist to detect
strabimus? 2) Is
surgery required in all strabismus cases ? In view of my daughter's age,
is there any
likelihood that with occlusion therapy she will be cured? 3) Should I seek
a second
opinion?
Thank you.
C Chua
(C Chua)
Answer:
Dear Chua,
First, I wonder what you mean by "long sighted". Do you mean farsighted ?
And did
the pediatric ophthalmologist found +4.00 farsightedness ? Then your
daughter would
be a candidate for early glasses, because one of the reasons for the
convergent
strabismus is that, as she lacks the glasses, she has to focus already 4
dioptres when
looking in the distance, and focusing (accommodation) always goes together
with
convergence (eyes moving towards nose). Certainly before surgery the
glasses would
have to be worn because, otherwise, only the angle of squint would be
measured (and
operated !) that your daughter has during focusing. The focus fluctuates
without the
glasses, however, and so will the angle of squint.
The occlusion therapy (patching the good eye several hours each day) is the
most
important part of the treatment: This cures the amblyopia and, accordingly,
she will
later be able to see with either eye. It is not likely that your daughter
has developed
depth perception, as she squint at the time that binocular depth perception
develops.
Note that the occlusion only cures the amblyopia.
The surgery is primarily cosmetic. It can be done at an early age (USA) or
at age 2 or 3
(more common in Europe). The slight differences that result from operating
early or
late are not all that important to you. Suffice it to say that in Europe we
have a multi-
centre study going on comparing the two: the proponents of early surgery
say that
binocular vision and depth perception is better when operating early,
whereas opponents
say that later surgery is more precise. When operating late you need, on
average, less
operations and the treatment of the amblyopia is easier. In 2002 we will
know the
answer.
Seeking a second opinion is not necessary, your daughter seems to be in
good hands
with the pediatric ophthalmologist.
Yours truly,
(Herb Simonsz, MD, PhD)
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