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How is hypermetropia in children treated ?

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Practicing since : 1977
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My 4 year old son was diagnosed with strabismus and as extremely farsighted (+7.50/+6.25). I am confused as to how the diagnosis was made. When he did the vision test with the doctor's assistant he was able to see every letter from both far away (wall test) and close up (on a card in his hand). I have never noticed anything out of the ordinary with his eyes or vision. He reads books and plays with the iPhone at a normal distance with no squinting. Is it common to arrive at this diagnosis with no obvious symptoms?
Posted Thu, 3 May 2012 in Vision and Eye Disorders
Answered by Dr. N. K. Misra 3 hours later
Thanks for the query.

What your son has is hypermetropia.This is a common condetion in children.As they grow this condition gradually reduces as part of growing process.In your son's case it is more marked.

In such cases of high hypermetropia there is a inward shift of eye alignment due to over use of accommodation.This malalignment is mostly corrected by using glasses,which are to be used constantly.
In your child's case if you notice once he takes off his glasses there a slight inward shifting of the eyes.This is strabismus.This will be controlled by glasses and not corrected for the time being.

As his age advances his power may gradually reduce and ultimately he may be left with a very small power.

Since he has been diagnosed with stabismus the only thing for him to follow is to use glasses constantly.

There are situations where people have strabismus even with normal vision.In his case there is a reasonable amount of power involved.

In cases of hypermetropia visual loss occurs if glasses were not prescribed early ,then one lands up in a situation known as lazy eye or amblyopia,which will not happen in his case as glasses are being used.

I hope i have answered all your querries,in case of any problem please do get back to me .
Above answer was peer-reviewed by
Follow-up: How is hypermetropia in children treated ? 19 hours later
I understand the strabismus diagnosis, however, the doctor we saw implied that it was obvious and on the severe side yet no one in our family nor his pediatrician has ever noticed anything out of the ordinary (and I am extremely observant regarding my children). What did the ophthalmologist see that we can't? Also, he said he was severely farsighted and would need glasses for the rest of his life but on the eye test done both on the wall and a card with tiny writing he could see perfectly. I may not understand farsightedness as a nearsighted person, but I have a relatively weak prescription and I can't see anything without my glasses. How can he see without glasses if his prescription is so strong?
Answered by Dr. N. K. Misra 1 hour later
Hi ,
Thanks for getting back to me.

I will answer your query in two parts.

1)Why you do not see strabismus.
2)Why his vision is so good.

Strabismus(squint)is usually latent,as it is controlled by the binocular function of the eye,where two separate images from two eyes are fused as one.

This latent squint you do not see and it is seen after breaking down the binocular function.

How do you do it ? That is done by what is known as COVER TEST.

Let us see if you can follow my instructions.
Sit in front of the child so that your eyes are at the same level with each other.
Hold a pencil in front of him at about 10-12 inches(25 - 30 cm).
Cover his one eye with your palm.
Move the pencil in all directions to ensure that he is looking at the pencil tip.
Now move your hand from this eye and immediately cover the other eye.

Here is what you have to observe:
As you uncover say right eye and cover the left eye you will see that the right eye will move out to take up the fixation .
With the other eye will again move out to take up fixation.
This movement ,the amount of distance the eye travels out is the amount of squint known as latent squint.
This takes less than a minute
You will do it with your glasses on and his glasses off.

Now the part 2
Focusing in the eye is controlled by a lens which focuses the incoming light on the retina.This lens has a lot of elasticity so that it can change it's power by the strength of cilliary muscles in the eye.This elasticity iis gradually lost and you start needing support for reading in 40s.At 4 yrs of age your son has strong cilliary muscles to vary the power of his lens.

Since there is a lot of power of glasses ,a lot of action of cilliary muscle is needed(called as accommodation)this as a side effect turns the eye in.

That is the reason ,in spite of a reasonable power he is able to maintain a good vision and you with a much smaller power do not see well without glasses.

I hope i have answered your queries,but in case of any difficulty please do get back to us.
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