I’ve been hearing that many are concerned about Stella and wondering what’s up with her big blue eyes. To be honest, I keep sitting down to write about it, only to bail out and head directly to gossip blogs or pediatric eye health websites. The latter are now just as addictive as the former–but thankfully they don’t erode your soul. There are just too many details to convey! Too many questions! Too many nuances! Nuances can be real nuisances, you know.
Several weeks have passed since Stella’s ER visit during which doctors witnessed her eyes crossing and ruled out scary causes via a head CT scan. They stamped the nebulous “convergence spasms” n0n-diagnosis in our brains and promised they’d go above and beyond to help us to get in to see the head of ophthalmology at Children’s, Dr. Weiss, as soon as possible. As I fully expected, this never happened. They arranged for us to see another ophthalmologist, at a clinic that’s further away, after a two-and-a-half-week wait. All appointments are double- and triple-booked, so Stella is clearly not alone.
During our appointment, the ophthalmologist-who-is-not-Weiss and some other person, whose name and role I should certainly have noted, did a very thorough exam of Stella’s eyes. They dilated her eyes, with drops that nearly caused Stella’s eyeballs to unhelpfully shoot right out of her head due to sheer force of rage. They directed Stella’s gaze through lenses, at animatronic stuffed puppies and stickers, and on flicking, fast-moving fingers. They peered into her eyes through goggles that seemed to meld “space-age mind-reading device” with “old-timey miner helmet.”
Then, in very matter-of-fact fashion, the ophthalmologist told us that Stella is farsighted, and that they “think” she has accommodative esotropia, a type of strabismus (yep, I called it, and the ER can suck it). The doctor wrote a relatively strong prescription for glasses. This was big news in a way, but we took it well, considering the many worse scenarios we’d been ruminating.
Backing up. All toddlers are farsighted. They naturally outgrow it as their eyes get bigger and their vision develops. (By the way: Farsighted eyes are short eyes. Nearsighted eyes are long. Now you know.) Stella’s farsightedness is slightly above average for her age. Stella’s left eye is a bit more farsighted than her right, but the difference is not enough for concern. If her eyes never crossed, we were told, glasses wouldn’t be a consideration. The whole point of the glasses, we’re told, is to decrease strain in order to prevent her eyes from crossing. Because if Stella’s eyes start to cross more and more, her vision will suffer. Her brain, in an attempt to see clearly with two eyes that don’t cooperate with one another, would likely shut off one of her eyes (a condition called ambylopia). This would cause problems with depth perception and peripheral vision, among other potential worries. (Update: She totally wound up with amblyopia. Check it.)
Above all else, of course, we want to prevent problems with Stella’s vision–she gets frustrated enough already, trust me! Glasses are certainly nothing to cry about (though I have). But they will greatly impact her vision, for better or even possibly for worse. At this point, Stella rarely crosses her eyes. The last time I saw it, a couple weeks ago, it happened for about two seconds while she stared off into space–her right eye drifted in a bit, but snapped right back into place when I said, “Stella! Over here!” With accommodative esotropia, the crossing is expected to happen when looking at things up close. I think it’s possible or even likely that she has accommodative esotropia and needs glasses, but when I consult my gut, it doesn’t quite add up. I need a little more convincing before we move ahead with glasses. Yes, Stella’s doctors probably view me as a giant hemorrhoid. I am a second-guessing, question-asking pain in the ass that erupts at inconvenient times and makes it hard to sit down and relax. And proud of it. Pass the Preparation H.
I found a developmental optometrist via strabismus.org, and Stella and I ventured downtown for a second opinion. We only went to one wrong building and I only placed one out-of-breath phone call before we arrived seven minutes late at the correct destination–not bad! As suggested, Cody arranged for Children’s to send over the charts and notes from her previous exam. The optometrist reviewed them and conducted her own, less intensive exam with Stella, to see for herself how Stella’s eyes behaved.
Turns out that doctor number 2, after warning me that she has a “very different philosophy” from that of Children’s, strongly recommends holding off on glasses, and coming back to check Stella’s eyes in two months. A “wait and see” approach. (How’d that pun get in there?) Her opinion is that a strong glasses prescription is too aggressive at this point, because Stella’s eyes cross so rarely. She couldn’t get Stella’s eyes to cross during the exam–though she thought she may’ve seen one of them drift in very, very briefly at the end, while I got our stuff together and a tired Stella stared into space. During the previous exam, they put things right in front of Stella’s eye, moving to the center of her face and flicking quickly back out to the side. Again, far more aggressive. So, in the previous exam, Stella’s eyes did cross, but as I found out from doctor number two’s reading of the notes, only small number of times despite the intensive effort to get them to cross.
Here’s the thing that keeps me up at night. There is evidence that early intervention with strabismus reduces the risk of vision loss and other problems. Other studies inform me that glasses can inhibit the natural decrease in farsightedness that occurs at Stella’s age. We have a doctor on either side, for and against glasses. We also have solid research on either side, for and against glasses. I don’t know what Stella needs, and that isn’t a good feeling.
In a foll0w-up call with the ophthalmologist at Children’s, the one who prescribed glasses, I asked a lot of questions. During this chat, she tossed in, casually as an aside, “Stella has great vision in both eyes.” And that’s when confusion overload caused my own eyes to roll in and then drop out of my head. Turns out Stella’s visual acuity (acuteness or clearness of vision) is above average for her age. And she can track objects with her eyes very well. She, like most toddlers, has incredible focusing power. Stella can bring images into focus that adults with similar farsightedness just couldn’t sharpen. At the end of our talk, this doctor did reluctantly suggest that we could hold off on glasses but that she believes Stella’s eyes will start crossing more and more in the months ahead. (Update: This doctor was spot-on. I feel silly for delaying glasses at all. But you know what they say about hindsight: It’s a manipulative bitch!)
The consensus is that a short period of waiting is l0w-risk. Stella has great balance and her gross motor skills have always been ahead of schedule, she knows all the letters of the alphabet and numbers up to ten, and loves to read with us and page through books on her own. These are all reassuring signs that even if there is an issue requiring glasses, her vision is not hindering her at this point. On the other hand, Stella rubs her eyes a lot, and sometimes I wonder if the rubbing is really also “covering,” a behavior consistent with accommodative esotropia in which she is blocking one eye in order to help focus. She also stares into space quite often–but don’t most one-year-olds do that, especially when tired? It’s all so unclear (another pun?), so I find myself staring into her eyes all the time, looking for answers. Sometimes I think I see her eyes misaligned for a fraction of a second, but I’m never sure.
The optometrist told me that Stella is too young for vision therapy (eye exercises to correct vision problems), but that I should get Stella outside as much as possible, encourage her to crawl, and do “eye tracking” activities like rolling a ball back and forth. We’re going to get one of those collapsible fabric tunnels to get the crawling underway, and we’re spending even more time at the playground than before. I suspect it won’t make a huge difference, but you never know. And it’s something that, to some extent, I can control. Which is about as refreshing as a mimosa to my dehydrated, brunch-loving soul.
During that crazy ER trip when Stella was sick and her eyes were crossing severely–sometimes both at once, which is not really consistent with an early diagnosis of accommodative esotropia–I started blaming myself for this problem. Have I not made enough eye contact with her? Is it because she wasn’t fed in a “normal” fashion (bottle or breast) for some time as a baby, so her eyes didn’t get to “take turns” focusing during feedings? Is it because, despite our best intentions, we let her look at screens too much? Stella only crawled for two months–should I have encouraged her to crawl longer? Does she look at books too much at her young age?
During a session of my masochistic wondering, Cody made a remark that hit the spot. Among other possible sources for blame, and this is pretty ridiculous, I’d asked if we encouraged reading too much, if we rewarded that activity more than others without realizing it, because she sits in our lap to read. Cody pointed out that much of the time, she’s looking at books on her own. She’s always preferred books to other toys. She just loves books. He said, “That’s just who she is.”
He’s right. To the full extent possible, she calls her own shots. She has her own interests and preferences and personality that have little to do with me. I’m not, in fact, her. I’m her mom, and even at this early age, I only have so much influence over her. Stella is Stella. She’s an active little girl who walked at ten months. She loves to read, and cherishes her books above all other objects (except maybe Pup Pup). She couldn’t tolerate my milk but thrived on hypoallergenic formula while courageously overcoming a feeding aversion and moving on to develop a passion for cheese. She loves to do whatever we do, and that includes watching basketball when Daddy tunes in to a game and looking at pictures of herself on the computer and my iPhone at times. This eye issue, whatever it is and however it’s treated, is not so much a “problem” but just part of who Stella is. It’s not anyone’s fault. It just “is.” It’s something that needs to be addressed, yes. Something to lament or torment myself over? No.
After the initial diagnosis, I took Stella to several offices and shops to try on glasses. She hated it. I think the longest she tolerated wearing a pair was about four seconds, and that was with a very pained and confused expression on her face, and it required that I keep her fingers occupied–with a salted caramel cupcake. Yep, I really did resort to that. But since then, we’ve collected about six books featuring characters with glasses or getting glasses or finding amazing glasses. By the way, Stella and I absolutely love GOGGLES! by Ezra Jack Keats. As a result, her enthsiasm for glasses is growing, and it could come in handy. It would be great if Stella didn’t need glasses, to save us all extra hassle and to avoid inevitable battles over her having to wear them. But if after a third opinion (I’m working on that) and a few weeks of watching and waiting, Stella does need specs, we’ll figure it out. She’ll come around. She always does. My goal is to be ever positive, and as resilient as Stella.