What Parents Should Not Do: An Eye Doctor's Perspective

I was initially going to break this topic into multiple segments. Each would described my experience with a different young patient (and his or her parents). Instead, to my surprise, I recently encountered a 6 year old boy whose mother unfortunately embodied all of the poor tendencies that doctors try their hardest to discourage.

To maintain the annonymity of this dynamic duo, let's call the boy John and his mother Jane.

Jane brought John in for his eye exam and mentioned that he had (not so recently) lost his glasses and may need another pair.

As I entered the exam room, I immediately noticed that, while he fiddled with all of my instruments as his mother sat idle, little John's left eye had an outward turn (aka Exotropia). I took my seat and asked Jane about the eye turn. She responded very casually with "Oh yes, his dad and his older brother both have the same thing. Its no big deal." No big deal?? I controlled my initial urge to scold this mother of two and I politely suggested to Jane that this is something we will need to discuss at the end of the exam.

Next came the refraction. Trying to determine John's glasses prescription was about as easy as teaching my dad how to use the bluetooth function on his phone (not easy). Both tasks required a lot of patience and reiteration of instructions. At the end of it all, I was able to improve John's vision with a prescription that involved a lot of astigmatism, but he still was not seeing as well as I would have liked. Especially with the left eye.

While we normally aim to have our patients seeing 20/20 with both eyes, John was only seeing 20/40 with the right eye and 20/60 with the left.

What we are seeing here is the development of  amblyopia, or a lazy eye. Basically, if the brain is receiving a blurry image or double vision, it will start to shut the blurry (or turned eye) off in an effort to make vision more comfortable.

This process occurs at a young age. In fact, after the age of 8 it is very difficult to recover the quality of vision that is lost. And the older the patient gets, the harder it is. Eventually, no amount of glasses, contacts, or lasers will help. From this point on, it is a problem with the brain and not the eyes.

In John's case, because of the high prescription in both eyes, he is at risk of both eyes becoming lazy.

Luckily he is still young and with aggressive therapy, I am confident that most, if not all, of his vision can be recovered.

But what is required? The first step is a pair of glasses with the full prescription worn every waking moment of the day. The second, is the use of a patch. It is worn over the right eye (the one that is not turned) for a certain number of hours a day to force the left eye back into action. If the eye turn is not resolving, surgery to help straighten the eye is a possibilty.

After discussing all of this with Jane, she conceded that she was provided most of this information by another optometrist a couple of years earlier. In fact, that eye doctor had also scheduled a follow up visit a couple of months after the initial exam. But, since her older son and husband have similar problems and are "doing fine", she figured that it was "no big deal" and didn't follow up. I was really beginning to lose my patience with Jane's nonchalant attitude towards her young son's vision.

After all of the things I had just finished explaining to her, Jane asked if it was ok not to get the glasses yet. She was hoping to let John decide when he was older if he wanted to wear glasses or get laser surgery. That way she didn't feel like she was forcing it on him. What??

NO THAT IS NOT OK. AND IT IS A BIG DEAL!

When your child's vision is at stake, its a big deal. When his aptitude to read and learn is affected, its a big deal. When his ability to see and experience the world is degraded, its a big deal! How could anything be more important???

While Jane is an extreme example, there are a lot of people who exhibit this type of behaviour to a lesser degree. For as long as I can remember, as a student and now as a doctor, I have watched far too many people carry a complacent disposition regarding their health. Too often, I've heard people say "its no big deal" or "it'll get better". I'm guilty of it myself. But, if there is one situation in which I can't ever imagine having that kind of attitude, it is when a child's health is in question.

In British Columbia, annual eye exams are free for all children under the age of 19. If there's one thing our government is doing right, this is it.

So bring your kids in. We'll be happy to see them :)