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Eye and Vision Care

Change in prescription for strabismus patient

07/21/2009

Question:

My son was diagnosed with accomodative estropia (strabismus) at age 2 and was give a +2 prescription in both eyes. He had surgery at age 3.5. His eyeglass prescription had not changed. He is now almost 7. Six months ago the doctor decided to change his prescription because I mentioned he was looking over the glasses. He changed the prescription to 1.75 in both eyes. At his most recent check up, they noticed his eyes beginning to turn once again and said he may need another surgery. Could the eye turn be caused by the change in prescription?

Answer:

Without examining your son, I could not say for certain in this case, but in general, the answer to your question is Yes, changing the prescription can cause an accommodative esotrope to develop an eye turn.

This diagnosis means that your son's eyes tend to turn in too much when he is focusing on near objects. The initial treatment is plus glasses that decrease how much he has to focus and thereby decrease how much his eyes turn in.

In conditions like this we typically prescribe the full amount of farsightedness (hyperopia) present and often also use bifocals to add more plus power at near as needed.

The doctor could have reduced the power in his lenses for two reasons. First, your son could be less farsighted than he was before. Therefore the lenses could have been too strong and blurring his vision, forcing him to look over the top to see clearly. Second, the doctor could have reduced the power of the lenses and allowed your son to focus through some of his farsightedness on his own thinking this would not add too much strain on his system and get him to view through his glasses instead of over them.

I would talk to your doctor and see which is the case. Certainly, prescribing the full amount of farsightedness based on a dilated cycloplegic exam and possible bifocals should be tried before another surgery.

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Response by:

Michael  Earley, OD, PhD, FAAO Michael Earley, OD, PhD, FAAO
Assistant Dean for Clinical Services
Professor of Clinical Optometry
College of Optometry
The Ohio State University