When can I stop working on midline eye convergence in supine?
When the infant presents in supine with a totally neutral head position (no tip or rotation) and the resting eye position is symmetrical.
how do i know if i should send my patient to see a pediatric optometrist?
If a patient has one eye that turns in/out or is higher/lower than the other. If a child frequently tips or turns their head to see things close or far. If a child covers an eye or frequently closes an eye.
When is it ok to work a baby in flat prone?
When the baby is able to hold his head up without tipping or rotating in elevated prone. Typically not before 4 months.
How do i explain the difference between an opthalmologist and optometrist?
They both look at acuity (near sighted/far sighted) and they both look at the structure of the eye, but optometrists look at how the eyes function on their own and together. They are looking at the effect that vision is having on head position and function.
how do i decide when to do a patch test?
When a little one presents with his head turned to one side more than 80% of the time, throw a patch on and see what happens.
how do prism glasses work?
Prisms move the image to a spot where the patient can better see one object while using both eyes without tipping his head. They allow the eyes to work together so one eye isnt doing all or most of the work.
As a general rule, if you have a patient that is tipping their head, a prism assessment is indicated.
does insurance cover visits to the optometrist?
It depends on the policy but since optometrists are not MD typically medical insurance does not cover that total visit. If the patient has vision coverage that will cover at least some of the visit as well.
how do you get babies to keep their glasses on?
If the prescription is correct, kids don't take the glasses off because they instantly see better.
do you ever do manual work with infants with torticollis?
If an infant has PROM limitations then yes, but I always also do midline eye convergence exercises with every infant with torticollis.
can i get in trouble for patching an infant?
Yes, patching is a touchy thing to play around with therefore I recommend using it only with those patients who you trust that the parents with follow through with the specifics of patching. Never fully patch an eye! Never send home HEP for patching on an infant younger than 8 weeks of age. When in doubt use patching in your sessions if it proves to be helpful and dont worry about doing patching at home.
when should i progress to prone midline eye convergence?
Only once the child presents in supine with a neutral head and symmetrical resting eye position.
What are the rules for prone midline eye convergence?
You should always hold the head in a neutral position when doing prone eye work and be in front of the baby to make sure their eyes are working together. It is tough to know from behind if a little one is using both eyes...other option is put a mirror in front of infant so you can see their eyes when behind them.
will kids wear prisms forever?
No, the intention when I put kids in prism glasses is to wean them off of the prism component of the correction. Typically I prefer for prisms to begin being weaned after 3-6 months.
What is your opinion on eye surgery for eyes that turn in?
I would be hard pressed to ever be ok with a patient of mine having it, especially without having first seen an optometrist to evaluate them for prisms to attempt to improve their eye position. The surgery would also have to be followed up with extensive vision therapy since much like muscle releases or botox, if they aren't followed up by aggressive strengthening of the opposing weak muscles, the eyes will likely begin to turn in again eventually.
what is the youngest infant you put prism glasses on?
how long should kids wear their glasses?
As much as they will tolerate. The vision is always getting stronger when the glasses are on.
How do you know when the prescription needs to be changed?
In a child that is verbal, they will likely tell you that the glasses "don't work anymore". In non verbal kids you may start to see the head tipping again, they will start closing or squinting an eye or taking the glasses off.
How do i explain my recommendation for a prism assessment to a parent
Easiest first to take some pictures and videos of the kiddo and go over the eye position with the parents. Kids tip their heads to not see double so that is plain and simple to explain. A mis-aligned eye with a straight head also means they are seeing double which leads to weakening or turning off of one eye to prevent double vision so this is just as detrimental if not more as head tipping. If a child sees double at any point in their day, their awareness of where they are in space, their coordination and their ability to learn shapes and letters are just a few things that are negatively impacted.