Thursday, September 20, 2012

Ophthalmology

Happy, even after a full eye exam
Allie had a busy day of physical therapy and an ophthalmology appointment.  We have noticed that sometimes Allie's eyes look a little turned inward.  We don't see it often but since it is common for the eye muscles on the affected side of hemi-kids to be weaker than the other side, we thought we would get it checked out.

Allie had a neuro-ophthalmology evaluation back in January when she was hospitalized for ACTH and the ophthalmologist said that her optic nerves are a little more fair in color than what he would expect, but this could be due to her fair skin color and is not necessarily a sign of something wrong.  He said that we would be able to assess Allie's eye health more accurately as she got older, but things looked fine for now.  Her epileptologist noted that Allie didn't seem to see things in her right peripheral vision but said that the hand waving test that she was doing was not terribly accurate and, again, we will have to wait until she is older to know more.

Given this previous input, we know that there is a chance that Allie's vision could be impaired in some way but know that until Allie can answer our questions, there is not a lot that can be determined.

The ophthalmologist today basically reaffirmed our two previous concerns: her optic nerves are more fair than normal and she doesn't seem to have great right peripheral vision.  Regarding the optic nerve, the ophthalmologist said that if she saw a kid without Allie's history with her nerve color, she would send the kid for an MRI.  She said that it is totally possible for optic nerves to be damaged looking but not notably impact vision quality.  Regarding the peripheral vision issues, she suspects that Allie has a right visual field cut impacting the right side of both of her eyes.  But, again... we have to wait and see.

The ophthalmologist also noted that Allie is farsighted, which is typical for kids her age, but because of her potential nerve issues we have to monitor her vision development more closely than we otherwise would.

Lastly, and the reason we went the doctor, her eye misalignment: everything looks fine.  She said that Allie may be straining to see close-up objects because of her farsightedness, which may make her look cross-eyed, but she did not see any inherent weakness.  Good news!

So that is her vision update, but let me tell you how great Allie was during this entire appointment.  When the nurse first came in to make sure all of Allie's background was accurate, she said that she was surprised to read such an extensive medical background for such a young girl.  After going through Allie's medications and while Allie was dragging me around the exam room so that she could explore everything, the nurse said "I'm so happy to see that the stroke did not impact her."  Excuse me?  I pointed out that her right side is a bit weak, and the nurse examined further and said "Yeah, OK.  I see that now but I never would have noticed it otherwise."  Pretty cool.  Then the doctor came in and did her pre-dilation exam and said "Well, I don't see any weakness."  I said "Great!  So, her eye looks good?"  The doctor clarified: "Well, yeah, but I meant all of her.  I don't see any weakness anywhere."  Seriously?  Maybe Allie was on a post-PT high.

The doctor then put the dilation drops in Allie's eyes and sent us out to the waiting room.  Here was her waiting room time in photos:

O...M...G... I love these things!
A friend!  Why is he looking at me like that?
He's stealing the toy!
And then yelling at me!
 
Luckily, Allie and her friend made up and bonded over some goldfish crackers.  He would dig them out of Allie's container and then gently feed them to her.  She liked it.  

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