eye exam

Daniel had his long-awaited ophthalmologist exam today.  He had a good attitude throughout the long drive there and back (we had to go to another city), testing, and waiting.  He did tell me, when he was asked to read progressively smaller lines of print, that he was tired and it was making his head hurt.  And right now he is taking a nap, so apparently he wasn't kidding!  They dilated his eyes, so although we had been planning on sending him in to school when we got back, we decided it wasn't worth it.

So, his vision: 20/250 uncorrected, slight refractive error in the right eye, significant astigmatism.  (Most of his vision issues are due to his retina being underdeveloped because of his lack of pigment; the refractive error and astigmatism only contribute modestly.)  We got a surprise, though: he has a cataract in his left eye!  Once the doctor pointed it out to me, I could see it clearly.  (Of course, his eyes were dilated at the time.)  If I remember her explanation correctly, she said it is a type of cataract that tends to form around a small, congenital defect in the very back of the lens.  Since his eye has not turned to one side, as it might from long compensation for a blind spot, she is hopeful that the cataract has not been there very long (she says this kind can grow quite suddenly) and that once it is removed, his eyes can go back to functioning as they did pre-cataract.  Of course we have very little medical history for him; the only thing we have is his pre-adoption exam, done when he was age ten, which lists the vision in his left and right eyes as "normal."  His vision has never been normal, but I hope that at least means they looked in his eyes and didn't see anything amiss at the time.  (Then again, another older child from his orphanage came with medical records that were almost certainly falsified to make her medical condition look less serious than it was.)

At the evaluation, we got to talk to several different professionals, and Daniel got to try out some nifty vision aides.  He came home with a monocular (kind of like a short telescope) and a dome magnifier.  He is also on a list to try out some more high-tech (and expensive) equipment in his school; that equipment will be owned by his school district, but will be very useful to him for things like seeing the board (which he currently can't do, even from the front row).  Once the official report is given to his school district, they will start the process of getting him an IEP for vision.  Meanwhile, we have been given the name and phone number of a doctor an hour away who can deal with his cataract.  I'm not sure what all cataract surgery on a teenager entails, but once that is all taken care of, then we can start to think about correcting those parts of his vision that are correctable.  One of my big concerns going into this evaluation was eye protection.  He does not, not, not like wearing glasses.  I have not pushed daily sunglasses yet, partly because I wanted to prioritize my energy into pushing sunscreen and toothbrushing, and partly because I wasn't sure whether the tinted lenses made it harder for him to see details even as they protected his eyes from UV damage.  (Since his irises are less pigmented than those of a person without albinism, his retinas are particularly vulnerable to damage.)  So, this evaluation became my "due date" for figuring out eye protection.  I talked the issue over with several of the professionals there, several people experimented with putting sunglasses on him, and the consensus is that he is a good candidate for tinted contact lenses.  His facial shape is such that most glasses are uncomfortable for him, not just because they are an unfamiliar sensation, but because they are truly an awkward fit.  Add to that the fact that sunglasses are forbidden at his middle school (except for medical reasons, but what teenager wants to stand out?), and that he doesn't really get why he should wear them (after all, he hasn't been wearing them for fourteen years, and he hasn't seen any negative consequences), and it would just be too easy for him to take them off and neglect to put them back on again.  He will likely think contact lenses are uncomfortable too, at first, but at least once they're in, you don't have to do anything more about them until bedtime.  And that way we can improve his visual acuity a little bit while at the same time keeping out those dangerous UV rays.  However, that is several months down the road.  First up, IEP and cataracts, goody for us!  Not.  But we're thankful to be in a position to get him the medical care and practical help that will give him the very best use of the eyesight he has.