Accomodative Esotropia

[Kristi0621]

My son was dx with Accomodative Esotropia when he was 2.5 yrs old.  He has worn glasses since then & also had muscle surgery at age 4.  The surgery helped the turning a lot, but not completely.  His eyes still turn when looking at something close-up.  He began school last year & there were some concerns with his academics - he was behind in everything.  I suspected his eyes may be the problem, as they still cross when reading, writing, etc.  We attempted bi-focals - but he adamently refused to wear them after he put them on.  He made quite a scene at the eye Dr!  I figured this whole event was traumatic enough for him & did not want to make things worse, so I let it slide & we went back to a single - but stronger - lens.  He made it through kindergarten, but now his 1st grade teacher has her own concerns & is asking me if there is anything she could do to help him in the classroom.  

I guess my question is this: Will this disorder cause a child to have difficulty with school work & ultimately learning?  Is there anything we should be doing that we are not?  I think we will attempt bi-focals again over Christmas vacation - that way he has some time to get use to them before heading back to the classroom.  But until then, is there anything we can do?  Is it normal for a child with this problem to be experiencing this?

Thanks in advance - Kristi

[John C Hagan III, MD, FACS, FAAO]

First of all Kristi if you child needs bifocals as determined by an ophthalmologist you should not be negotiating it with him. He's the child, you're the parent. If he needs bifocals to keep his eyes straight, improve his studies then he needs to go into them now (not at Christmas).  Would you let him stay out all night if he wanted,  drink and drive, take drugs, not take important immunizations. Of course not. Letting him do somethng that may be harmful to his vision and education is no different.

If you are seeing an ophthalmologist with a lot of experience in strabismus (eye muscle problems) or a pediatric ophthalmologist then he/she will have much experience in how to make this happen. You have not stated your child's age but sometimes drops called atropine are used to relax the focusing muscle while the child gets use to the bifocals. It also prevents focusing up close so that the child can only read with the bifocals making them initially indispensible.

If you take care of the near eye muscle problem the learning problem may improve. If not then it shoud be considered a educational problem and he may need some extra attention from the teacher, placement in special reading needs class or have a private tutor.

JCH III MD

[Kristi0621]

Thank you for answering so quickly.  I just wasn't sure if I should "blame" his eyes for his academic difficulties or not.  At least now I know that it definitely is a possiblity.  Do you have any recommendations as to the best way to teach him in the reading & writing department at this time, until we get the bi-focals (assuming he agrees to wear them this time!)  - Kristi

[John C Hagan III, MD, FACS, FAAO]

Hello Kristi, In my opinion your son should be under the care of an Eye MD, ideally a Pediatric Ophthalmologist.  The problem you describe is best treated with bifocals (where the eyes are straight with glasses at distance but cross at near). No line bifocals that look like single vision glasses work well especially for children concerned about their appearance.

If he does need bifocals then yes it will interfear with his schooling as he has two choices when he reads, uses a computer or does near tasks: 1. have single but fuzzy vision  2. Have clear vision but see double.

An experienced strabismus/pediatric Eye MD can help you with the transition to no line bifocals.

JCH III MD   Eye Physician & Surgeon