See what you missed

When Ann Robertson discovered her four-year-old son had a squint, she immediately felt guilty. Could she have acted sooner?

We only noticed that four-year-old Adam had a squint when he became obsessed with the computer. A two-hour stint staring at the screen, topped up by his daily diet of a full-length video or two, seemed to result in our son's right eye turning inwards. I made valiant but unsuccessful attempts to wean Adam away from the screen, in the hope that his eyes were tired, rather than skew-whiff. But as the squint became more obvious over the next few weeks, my husband persuaded me to take Adam to our GP.

The GP said that Adam had a latent squint. When a torch was shone in his eyes, I could see that the light was reflected in the same part of both eyes - demonstrating that they were in the same position. But then the GP told Adam to keep looking at a picture of a little monkey that he had pasted to the top of a wooden stick. He put his hand in front of Adam's left eye and then moved it away: the eye that had been covered remained in the same position as both eyes stared at the little monkey. But when he put his hand in front of Adam's right eye, and then removed it, even I could see that the right eye had drifted off and had to move back to fixate on the monkey. The GP explained that this was a latent squint - the squinting eye was wandering off course when covered and had to make an extra movement to keep up with the stronger eye.

I had no idea what to expect next, and my GP, although very nice and prompt with a referral to the local hospital eye clinic, didn't have much of an idea either. When our appointment card arrived, I was flummoxed by the fact that we had been booked to see three different people, all at different times. We were to see an ophthalmologist, optometrist and optician. I am a GP myself, and I had absolutely no idea what all these professionals did exactly, or why we had to see them.

The first appointment was with the optometrist, a child-friendly lady who flashed prisms, screens, lenses and moving images in front of Adam's eyes, while jotting down indecipherable notes as Adam did or didn't see the images projected in front of him. Adam thought it was marvellous - nearly as good as his Lion King CD-Rom. I had no idea what she was doing, or why. The one thing I did understand was that with his left eye, Adam had no difficulty seeing a small picture of a cat held some distance away, but when his left eye was covered so that he had to use his right eye, he could barely see anything. As the optometrist held up a large image of a boat, Adam said tentatively, "Is it a cat again?" and then, "I can't really see it," as if he'd failed at something he was expected to know. I very nearly cried.

The person who did manage to make me cry was the ophthalmologist. The optometrist had explained to me that her job was to perform vision measurements. She would pass on her findings to the ophthalmologist who is a medically qualified eye surgeon. He would examine Adam's eyes to ensure there was no disease there, and would discuss the results and a plan of action with us.

The ophthalmologist put drops into Adam's eyes to open up the pupil to allow a clear view of the back of the eye. He told me that Adam's vision would be blurred for the rest of the day as a result of the drops. He said that there was no tumour or disease in Adam's eyes: a frightening thought that hadn't even occurred to me before he mentioned it. He also told me that Adam had a tendency to squint when he focused on near objects because there was a very large discrepancy between the vision in his two eyes. "The right one is very long-sighted indeed. In fact, if his left eye were as bad as his right eye, he'd be registered as partially sighted," he said.

He explained that Adam needed to wear glasses for close work, like using the computer. We would need a third appointment, this time with an optician, to supply the glasses. And Adam should wear a patch over his stronger, left eye for a few hours every day to encourage the long-sighted eye to work harder. "If we had picked this up when Adam was very young, he would only have had to wear a patch for a short time and would have been expected to gain much better vision in the right eye," he said. "But because his brain has received so little stimulation from that eye for the past four years, it may be impossible to help him much as the nervous pathways in the brain are mostly established in the first two years of life. You really should have come sooner."

That was when I burst into tears. I was feeling guilty, of course, that Adam had a problem. But I had taken him for his routine check-ups when I was supposed to, and I had sought help when the squint became obvious. How was I supposed to have picked up the problem sooner, and what good was there in telling me that the delay in picking up Adam's problem would impede his progress?

The optometrist later told me that the standard screening tests that comprise the check-ups at six weeks, seven months, 18 months and three years are woefully inadequate. "You can expect the health visitor or GP who usually does the checks to pick up a very obvious squint or severe visual loss in both eyes. But they don't have the training or equipment to allow them to pick up the kind of problem Adam has," she said.

Children in the state primary sector have an eye-test in their first year, so Adam's problem may well have been detected when he started school. But by then the chances of achieving any improvement in his vision by means of patching would have been minimal. In private schools, eye-testing is apparently the exception rather than the norm.

Once your own child starts wearing glasses, you notice how many other kids are sporting them too. Asking parents of children who wear glasses how they discovered that their child needed them, confirmed my belief that it is a totally hit-and-miss affair. Not one said that it had been picked up during a routine check-up: most had taken their child to the optician because there was a family history of shortsightedness or some other visual problem. Adam suffered from the fact that neither his father nor myself wear glasses. I have vowed that if I ever have another child, I'll take him or her to an optician by the age of two to see if there's a problem, and then to an optometrist if there is.

Adam didn't mind wearing his glasses at all, but the patching, worn directly over the good eye with the glasses on top, has cost us a small fortune in Power Ranger bribes as Adam could see so little out of his right eye that he was loathe to have his good eye covered. But we persevered through the summer holidays, and six weeks later, the optometrist reported that Adam's right eye was showing a small but definite improvement. Now he's at school and wears ordinary glasses during the day, and the patch at home, so as not to be stigmatised. He still hates the patch: it itches, and hurts when it has to come off.

We're hoping for further improvement, although we've been told he'll never be able to be a pilot or ophthalmologist. After my recent experience with the latter, I wasn't too devastated by the newsn

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