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Eye and Vision Care

13-month-old son extremely long sighted

10/21/2008

Question:

Yesterday we took our 13 mon old son to the optician after we have observed him squinting his right eye. He was diagnosed as extremely long sighted +5D. We were astonished with the news since we do not have any precedent cases of anyone in both our families with this condition and we always thought these were normally genetic situations. He was told that he would have to wear glasses probably throughout all his school age and maybe even beyond that. My son seems to have good vision for very small objects placed very near since his pincer grasp is very effective. So I am finding it weird that he is really +5 and seeing a very small object without any apparent problem. We would like to ask whether it is too early to diagnose with certainty the degree of the problem with him being so young. For example he was asked to point from an eye sight chart to an elephant without him not yet knowing what an elephant is! Also is there any surgery that can be undertaken to correct long sightedness.

Thanks a lot for your help as I am very worried right now.

Answer:

Thank you for your VERY important question! You are correct in understanding that high amounts (usually considered to be over + 6.00 D) of farsightedness and nearsightedness have a genetic transmission profile.

At 13 months, +5D is at the very high "normal" range. If the condition is just in one eye, this puts your child at very high risk for amblyopia (lazy eye) and/or strabismus (tropia, eye misalignment). The observation of squinting is associated with children who develop an eye that turns out later in life (exotropia) and the development of other associated sensory disorders.

At this time your child has a high amount of focusing ability due to the flexibility of the lens inside the eye to compensate for the farsightedness. This could enable him to see small objects at near. However, your child has to use 5 units of this focusing ability just to clear things up for distant objects and then another 2-3 units for near objects (total = 7-8 D). When your child gets a little older and begins to look at books (2-5 years), he will likely become very fatigued trying to keep near objects/pictures clear. Such children tend to avoid near play.

Research suggests that some of the farsightedness may decrease over the next year or so but you need to consult a pediatric eye doctor who has the appropriate instruments and tests for evaluating your child's vision now. I therefore urge you to seek a second opinion.

Amblyopia is responsible for more lost vision in the United States than all other disease and trauma combined among those 45 years of age and younger. Vision loss due to amblyopia is entirely preventable with early detection and treatment of the underlying cause. The amount of farsightedness that you indicateĀ at present does put your child at risk for amblyopia.

Should you wish to contact our Pediatric Vision Clinic here at Ohio State, the contact number is (614) 292-1113. Once again, thank you for asking about your child's very important vision disorder.

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Response by:

Paulette P Schmidt, OD, MS Paulette P Schmidt, OD, MS
Professor Emeritus of Optometry
College of Optometry
The Ohio State University