Ophthalmologist, Please Help! My nephew is only 5 years old and he has eyes problem ever since he was born.?

We took him to ophthalmologist for eye exam recently. We like to see more suggestions or options, whether eye surgery may be an option as he starts to have learning problem now. Here is what the report says

The patent has intermittent right divergent squint. Fundus abnormality is noted in physical exam and EUA was arranged for him. Right divergent squint of 30^ is noted.

EUA show high myopia BE with astigmatism. Anterior segment is unremarkable and Fundus exam show a falciform fold in the right retina which may be resulted from intrauterine infection and tractional retinal detachment and now settled. Possible causes include toxocariasis. The left eye is essentially normal except high myopia.

Refraction on RE is -8.25-2.25@180 and LE is -8.0-2.25@180
Glasses are order with RE -6.25-2.25@180 and LE -3.75-2.25@180
Part time occlusion therapy is advised but compliance is fair.
Cardiff acuity in latest follow up is 6/24 RE and 6/9.5 LE.
Answer:
Ok let me try to explain this for you a little bit,

This kid has strong myopia (short sightdeness, which result of wrong power of the eye lens system to form a clear image), plus astigamtism ( which means that his eye lens system is making a distorted image ).

When a child is born, he really doesn't see like we do. he then start to learn that each eye is giiving him the same image, and so he would learn to understand to use his eyes.

but when the eyes are not normal, the kid have trouble to coordinate the view between his eyes, and so he starts to squint, but the bigger problem is that he will learn to disable one eye and use only one ( which result in a lazy eye).

to prevent this, the doctor has to do two things, one is to correct the image in both eyes as much as possible, and the other thing is to alternate closing of both eyes (close on eye at a time). in order to force the child to use both eyes instead of using one a cancelling the other.

when someone has such high myopia, using glasses that will fully correct the defects can be stressful to the eye and so the doctor that would be the best fit between correction and avoiding eyey stress.

About your options, the treatment for refractive errors such as myopia can be done either by glasses, contact lenses, and surgery. but in child lenses can not be used because it will be trouble some with the child. also surgery of the cornea is not an option because the child is growing and his eye is changing.

So I guess that your best plan is use the glasses to correct his sight as much as possible now, until he grows up enough to be able to use contact lenses, and when he becomes old enough that his eye size becomes stable (usu about 25), he can have corretive surgery.

The report also indicate a retinal abnormality in one eye, which may result in a field defect ( a missing area in his field of vision, like wearing a glass that has a dirty spot that hides some of the image you can see), unfortunately this type of abnormality cannot be repaired.

The report also indicate that the cause of this abnormality may be toxocariasis, this is an intra uterine infection that affect the growing foetus during the pregnancy. I don't recall much information about toxocariasis but it may have other effects that may result in a low IQ.

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