My grandson has bilateral amblyopia and strabismas and we're getting some conflicting

[CTyankee]

medical opinions. First we had one doctor who did absolutely nothing when we are now told she should have started therapy and now it's too late, by another doctor. We're seeking yet a third opinion in a few weeks in the hopes of getting this six year old some help.

I am absolutely enraged over this predicament. He is in the Los Angeles area where there are fine medical schools and he has good insurance coverage. Why does this sort of thing even happen? And if it happens to our family, what about the families lacking insurance and the means to find high quality care?

[hlthe2b]

1. this is not my area of expertise, but...

my understanding is that while it is best to start early as possible, that there can be benefit even in older chidlren. Best of luck. Truly.

Here's a media overview of the study (National Eye Institute at http://www.nei.nih.gov/ats3/):

Surprising results from a nationwide clinical trial show that many children age seven through 17 with amblyopia (lazy eye) may benefit from treatments that are more commonly used on younger children.

Treatment improved the vision of many of the 507 older children with amblyopia studied at 49 eye centers. Previously, eye care professionals often thought that treating amblyopia in older children would be of little benefit. The study results, funded by the National Eye Institute (NEI), part of the National Institutes of Health (NIH), appear in the April issue of Archives of Ophthalmology.

"Doctors can now feel confident that traditional treatments for amblyopia will work for many older children, said Paul A. Sieving, M.D., Ph.D., director of the NEI. "This is important because it is estimated that as many as three percent of children in the United States have some degree of vision impairment due to amblyopia. Many of these children do not receive treatment while they are young," he said.

Amblyopia is a leading cause of vision impairment in children and usually begins in infancy or childhood. It is a condition resulting in poor vision in an otherwise healthy eye due to unequal or abnormal visual input while the brain is developing in infancy and childhood. The most common causes of amblyopia are crossed or wandering eye (strabismus) or significant differences between the eyes in refractive error, such as, astigmatism, farsightedness, or nearsightedness.

Children in the study were divided randomly into two groups. One group was fitted with new prescription glasses only. The other group was fitted with glasses as well as an eye patch, or the eye patch along with special eye drops, to limit use of the unaffected eye. These children were also asked to perform near vision activities. The patching, near activities, and eye drops force a child to use the eye with amblyopia. Patching was prescribed for periods of two to six hours daily, while the eye drops were administered daily for the children seven though twelve years of age.

The study investigators defined successful vision improvement as the ability to read (with the eye with amblyopia) at least two more lines on a standard eye chart. The study investigators found that 53 percent of children age seven through twelve years who received both glasses and treatment with patches and near activity met this standard, while only 25 percent of those children in this age group who received glasses alone met the standard. For children age 13 through 17 years who were treated with both glasses and patches (these children did not get drops), 25 percent met the standard while 23 percent of children of these ages who received only glasses met the standard.

The study also revealed that among children age 13 through 17 years who had not been previously treated for amblyopia, 47 percent of those who were treated with glasses, patching and near activities improved two lines or more compared with only 20 percent of those treated with glasses alone. Despite the benefits of the treatment, most children, including those who responded to treatment, were left with some visual impairment. They did not obtain "20/20" vision.

"This study shows how important it is to screen children of all ages for amblyopia." said study co-chairman Richard W. Hertle, M.D., Children's Hospital of Pittsburgh.

Commented co-chairman Mitchell M. Scheiman, O.D., Pennsylvania College of Optometry, "This study shows that age alone should not be used as a factor to decide whether or not to treat a child for amblyopia. The opportunity to treat amblyopia does not end with the pre-school years."

It is not known, say the authors of the current study, whether vision improvement will be sustained in these children once treatment is discontinued. The NEI is supporting a one-year, follow-up study to determine the percentage of amblyopia that recurs among the children who responded well to treatment, as well as many other clinical studies of amblyopia at eye centers nationwide.

Dr. Sieving also commented that the current study results are "a wonderful example of the adaptability of the human visual system and brain. The NIH is exploring ways to take advantage of this adaptability in order to better understand and treat vision problems and other neurological conditions."

The study described in this release was conducted by the NEI-funded Pediatric Eye Disease Investigator Group. The Group focuses on studies of childhood eye disorders that can be implemented by both university-based and community-based practitioners as part of their routine practice. The study was coordinated by the Jaeb Center for Health Research in Tampa, Florida. A list of study centers is attached.

For more information on the study, visit the website of the National Eye Institute at http://www.nei.nih.gov/ats3/.

[emilyg]

2. Go to the Mayo Clinic website.

[hlthe2b]

4. Little confused... were you meaning to offer this to the OP?

or did you see something on Mayo's site that contradicts the study I cited from the National Eye Institute? I don't think there has been any dissent from the Opthalmology specialty groups since this study was released and didn't see anything suggesting so at quick glance at Mayo. :shrug:

[emilyg]

17. Sorry - didn't see your post.

[CTyankee]

11. Thanks I just copied your post in an email to my daughter.

You have been so helpful! What a relief that these findings show. I'm furious now with both doctors...

[hlthe2b]

15. Certainly... I feel confident you'll get the help you need...

Armed with the information to be able to ask the right questions. Best of luck.

[dana_b]

3. I don't know why this happens

and it sure as hell sounds like negligence on the first MD's part. I am hoping for the best for your grandson and you are very smart to go get that third and if need be fourth opinion! I can't believe it is too late.

I also had bilateral amblyopia but it was corrected with two surgeries. I remember doing intensive eye training when I was a very young child prior to the surgeries. Good luck to your family!

[CTyankee]

8. Thanks. As usual, DUers come thru with info!

My dtr kept asking the first MD about treatment and the doc kept blowing her off, practically showing her impatience.

He's very bright and does well in school. Interestingly, he is in an immersion program in Italian (it isn't spoken at home) in school and he is reading, writing and speaking in two languages now. I suspected that he was doing well in another language because his visual impairment has augmented his aural sense.

The second doctor heard him singing to himself in Italian and looked at his handwriting sample (taken from his homework) and asked my daughter if he often "babbled and wrote gibberish." OK, the doc is from Japan but still she couldn't understand the word "bambino" (which was on his homework)? My daughter informed her that he is bi-lingual....

[HuckleB]

5. This seems like the first MD dropped the ball.

Our pediatrician had a mild concern about amblyopia when our little guy was six months old or so. He was sent to a pediatric eye specialist, and followed the next few years. He never needed treatment, but they made sure that he did not need treatment.

I'm very sorry to hear about this. Our health care system is clearly fractured.

[Altoid_Cyclist]

6. I don't know if this will help, but I endured vision problems after a bicycle vs. car meeting.

That happened in 1998 and the double vision, blurred vision and loss of depth perception were getting worse as time went by. My problems were a little different. However, even after 12 years had elapsed, I finally found a Dr. who suggested that we at least try vision therapy.

She warned me (as did the therapist) that after 12 years there was probably not much that could be done. I finished therapy a few weeks ago. The therapy was able to greatly reduce the double vision and blurred vision to the point that it really made a difference in every day life. The depth perception will never come back due to the brain damage, but therapy (even though delayed) is always worth a shot.

It is a good idea to find a good Neuro-Ophthamologist to get their opinion also.

Good luck with your Grandson.

[CTyankee]

9. My grandson lacks depth perception and there is definitely brain involvement.

I'm not sure if the other docs are neuro-opthalmologists. I ask my daughter about that...

[NEOhiodemocrat]

7. My great niece had something like this

not sure if it was exactly the same diagnosis, but they didn't start her in treatment until she started kindergarten and she is now in third grade and doing fine. Treatments did help tremendously. They did hold her back in school one year while they did the treatments and she is now doing fine. Hope your grandson does well.

[CTyankee]

10. That's the thing. He does VERY well in school, except for his handwriting.

A low grade in that kept him off the Honor Roll this past semester. He does read and write (actually in two languages...he is in an immersion program where he spends 90% of his school day completely in Italian).

It would break my heart if he suffered any limitations because of this. I am hoping so intensely that he gets the help he obviously needs...

[HuckleB]

12. They have an honor roll for six-year-olds? 1st grade?

That's almost as bad as the mistake made by his doc.

Ugh.

[CTyankee]

13. His school is great and he's thriving.

I don't think the Honor Roll in itself is such a bad idea. But I do think that they takeinto consideration a child's visual problem. He tries very hard to write plainly, but all the trying in the world won't help unless he gets the right therapy. It's like grading down a kid who limps and can't do regular PE...

[HuckleB]

14. Unfortunately, that tends to happen for most such matters.

I see an Honor Roll at that age as just more of what's feeding the stress and anxiety levels of kids. It just seems to be lacking in perspective. We're pushing academics and homework on our kids earlier and earlier, while many of the countries that have better education systems don't get things rolling until age 7. It seems like we've decided to make dramatic changes in the lives of kids without good evidence to back it up the need, or even, non-harm of such changes.

[CTyankee]

16. Yes. I know what you are saying and I have looked into what other countries do.

It's impressive, the gains they have made, particularly Finland.

I can only judge by my own family experience. My grandson is not adversely affected by this at this point. Perhaps he is just a kid that thrives and my dtr doesn't push him to be in the Honor Roll. Maybe it's the school, because it doesn't make that huge a deal out of it. I don't know. I do know that the school does work on so many levels. There is an atmosphere of hope. There are some frictions, particularly with the Foreign Language Immersion class parents and the parents of the kids in the regular classes (this is a public school in Glendale,CA). It gets a little hinky sometimes such as when the Italian government gave a grant (thru an Italian fondazione in LA) that the school got for a nativespeaking Italian in the Italian class. But, for the most part the school has a great spirit and some progressive ideas that I applaud, (even if I have to speak Italian when I visit my grandson's class!).

[Odin2005]

18. I've had that in my right eye my whole life.

I often have to close my right eye when I am reading.