severe increase in uncorrectable astigmatism

[ToriLori]

My 14 year old daughter went from a minor prescription (-1.25/plano) to +5.37 -4.00 x 93, and the other eye was slightly less.  The problem is the opthalmologist was not able to correct her 20/50 vision.  Blood tests show she does not have diabetes.  They have ordered a field of vision test for next week.  What else can I do?

[CSBDR]

Astigmatism comes either from the cornea or lens within the eye, or both.  If indeed your daughter's prescription had no astigmatism in the past, this is not a normal change.  Does she rub her eyes alot??  

A couple of suggestions:
-Request color copies of the corneal topographies that were performed and post them on this forum for others to review
-Ask your eyeMD to either take photos or a different type of topography image (Pentacam) of the lens to see if there are abnormal protrustions on the front or back surface
-If your daughter is already getting a physical, make sure her kidney function is checked as this can rarely be associated with changes in the lens of the eye.

Keep us posted

[Sandra M Brown, MD]

She needs a test called a corneal topography.  To go from simple, mild nearsightedness to this prescription suggests that she may have a condition called keratoconus, where the cornea (the clear front part of the eye) starts to sag.  Corneal topography is a simple office test.  I cannot see any value in a visual field test which does not detect the cause of major changes in prescription, unless there are details you have not provided which make it an indicated test.  Diabetes can cause an increase in overall nearsightedness (usually the patient is pretty sick with diabetes before this happens) but rarely causes a major increase in astigmatism.

[ToriLori]

They did do both of the tests they do to check corneal thickness and topography- (that they normally do for ilasik patients) and I was told they were normal.  I had the numbers backwards- one eye was -5.37 +4.00 X 93, the other was -3.75 + 2.50 X 63 average readings on the first test they did when she went into the office.  The strange thing was that no matter what lenses they put in front of her eyes she could not read better than the 20/50 line - the same as she could read without any correction with both eyes open. I plan to take her to her pediatrician for a physical.  Is there anythink I should ask him to check for? Thanks!