Operating as part of the Integrated Children’s Additional Needs (ICAN) Service, we provide eye care to children between the ages of 6 months and 8 years who live in Leeds. We provide diagnosis and treatment for vision defects, eye misalignment (squints) and eye movement disorders. We also lead the vision screening service in Leeds where all children aged 5 are offered a vision test in school.

Who's it for?

We assess, diagnose and treat children between the age of 6 months and 8 years with squints, visual development and eye movement disorders. We provide a service at Child Development Centres for young people under 19 and lead the school vision screening service in Leeds. We also provide care for older children who have special needs or learning difficulties. 

We offer treatment for reduced vision (Amblyopia) which may include glasses and wearing an eye patch. We also advise on treatment for squints, screen for eye diseases as required and refer on to the hospital Eye Service as appropriate.

Referrals

Referral form

Please download our referral criteria.

• QSquint and Lazy Eye (Amblyopia) in Children

  Lazy eyes and squints

  What is a ‘lazy eye’?

  People use this term to describe many different things. In the eye clinic, we use this term to mean one eye that doesn’t see as well as normal even when the correct glasses are worn. The medical term for a lazy eye is amblyopia. Amblyopia is commonly caused by a squint or a difference in the focusing of each eye.

  My child sees well when both eyes are open so why is treatment needed for a lazy eye?

  We can only help a lazy eye to ‘learn to see’ better up to the age of about eight years. Treatment at an early age can improve the sight. It is much better to have two good eyes than one poor one. If, for example, the good eye is damaged in an accident your child won’t be held back by the poor sight in the remaining lazy eye.

  What is a squint?

  A squint is when one eye drifts in a different direction to the other. A squinting eye may turn in (convergent), out (divergent) or more rarely it may turn up or down (vertical).

  I cannot see the squint. Does it really matter?

  Yes. When one eye turns, it is ‘switched off’. This can stop the eye sight from developing normally making it ‘lazy’.

  Do children grow out of squint?

  Almost never! Babies and children often look as if they are squinting when they are not and so some children appear to grow out of a squint when in fact they never squinted in the first place. It needs the specialist skills of an orthoptist to judge whether or not your child has a squint.

  My child only squints when tired or run down. Why?

  This is a warning sign that should not be ignored. It means your child is trying to control a tendency to squint but cannot manage to do so all of the time. If left, it may become permanent which may lead to amblyopia.

  Will my child need an operation?

  There are many different types of squint and only some require an operation. It is important to make sure both eyes are seeing well before an operation is advised. An operation on its own will not make a lazy eye see well.

  What about my other children?

  Squints and lazy eyes can run in families so we sometimes recommend that your other children are tested also. If you have any concerns about your other children, please tell your orthoptist.

  Glasses

  What is long-sight?

  A long-sighted person needs to focus more than average to see things clearly, even when looking into the distance. Many children can over focus to see fairly well despite being long-sighted. This is because the lens inside the eye that does the focusing is soft when they are young. This becomes more difficult as they get older. Sometimes this extra focusing can make one eye turn in leading to a squint.

  What is short-sight?

  A short-sighted person can usually see close things clearly but more distant things are blurred.

  What is astigmatism?

  This is where the front of the eye is curved unevenly. If a ball was made of these curves, it would be shaped more like a rugby ball than a football. This will result in blurred vision at all distances.

  My child appears to see well so why are glasses needed?

  One eye may see very well and the other very badly. Your child will not notice this when both eyes are open. Glasses will help a lazy eye see better and often help to straighten a squint. Once treatment for amblyopia is finished, it is important that your child continues to wear their glasses to stop the eye becoming lazy again.

  My child says the glasses make their sight worse

  This often happens in the first few days after getting new glasses especially in those who are long-sighted. This is because the eyes need to stop doing the extra focusing they have been used to doing and let the glasses do it for them. Once they have learned to do this, they will see clearly through the glasses. We usually test the vision six weeks after getting the glasses to check that all is well. It is important that your child wears the glasses all the time so they get used to them as quickly as possible.

  My child says the glasses make no difference to their sight

  This can happen if the two eyes are different from each other (e.g. if one eye is more long-sighted than the other). The sight can be the same in the good eye with and without the glasses but only when the glasses are worn does the lazy eye have a chance to see and develop properly.

  Can my child take their glasses off when playing?

  Glasses should be worn as much as possible. They may be removed for rough games such as contact rugby but could be worn for touch rugby. Glasses should be put on again as soon as possible. A sports band might be advisable. The lenses are plastic and will not splinter if broken. It is important they are not left off for long periods such as school holidays.

  Will I have to pay for glasses for my child?

  You will be given a prescription for glasses by the optometrist. This prescription contains a voucher towards the cost of the glasses. Many opticians have a range of glasses available within the value of the voucher so the glasses will cost you nothing. You may choose to pay towards a more expensive frame but if you do, you will have to pay towards any repairs or replacements if the glasses get broken or lost. It is worth shopping around to find a pair of glasses that your child likes, that fit well and don’t cost a lot or are free. No-one likes glasses that are always slipping down their nose or falling off! When you are choosing your optician remember that you have to take the glasses back to the same optician for repairs.

  Will my child always have to wear glasses?

  This will depend on the strength of the lenses. We treat amblyopia until about the age of ten and advise most young people to continue with their glasses at least until then. After that age the eyesight will not be permanently damaged if they leave them off. Your orthoptist will give you more details.

  Once I have got the glasses, can my optician take over my child’s care?

  When children have a squint, prescribing glasses of the right strength can be more complex than normal and is best done after discussion with an orthoptist. Most opticians do not have special training in squints so it is better to continue coming to our clinic (or a hospital eye department) where orthoptists also work. A squint is then not overlooked or treated inadequately. Some children will need treatment other than glasses for a lazy eye and very few opticians are experienced in this area. We discharge children to the care of their local optician as soon as we feel it is safe to do so.

• QAmblyopia Treatment

  What is amblyopia?

  Amblyopia is a condition where one eye doesn’t see as well as normal even when the correct glasses are worn. Amblyopia is most commonly caused by:

  • a squint - here the brain ignores the image coming from the squinting eye so the vision does not develop properly in that eye.
  • a difference in the focusing of each eye. If a stronger spectacle lens is needed for one eye than the other then until your child had glasses, they had constant blurred vision in one eye. This prevents the sight developing normally in that eye.

  There are other less common reasons too.

  My child sees well when both eyes are open so why is treatment needed for a lazy eye?

  We can only help a lazy eye to ‘learn to see’ better up to the age of about eight years. Treatment at an early age can improve the sight. It is much better to have two good eyes than one. If, for example, the good eye is damaged in an accident your child won’t be held back by the poor sight in the remaining lazy eye. There are also some jobs that require good sight in both eyes so we aim to try to give your child the widest choice of careers for the future.

  How do you treat amblyopia?

  An amblyopic eye does not see well because the part of the brain that responds to that eye has not developed at the same rate as the other eye. Covering the good eye forces the child to use the weaker eye and stimulates the development of the brain. This helps the amblyopic eye to ‘learn to see’ like the better one.

  Treatment involves temporarily reducing the vision of the ‘good eye’ in a variety of ways. If your child has been prescribed glasses, we do not usually start treatment for amblyopia until your child has been wearing their glasses for about four months. This is because the sight may improve with glasses wear alone. Not all children who appear to be amblyopic need any treatment other than the glasses, especially if they don’t squint.

  Once treatment is found to be necessary it is important that it is started straight away. More hours of patching are required in older children than younger ones so starting young makes the treatment easier. We don’t often patch after the age of about eight years as this is often too late to make a difference to the sight.

  What types of treatment can I try?

  This will depend on the age of your child and how good their sight is. We have some colourful sticky patches that are worn on the face and are suitable for all ages. Sometimes we use a fabric patch that slips onto the glasses and sometimes we ‘fog’ one lens of the glasses with some tape. Occasionally we might recommend using eye drops to blur the sight of the good eye but this needs to be prescribed at the hospital.

  Will the amblyopia treatment cure the squint?

  Not usually. Very occasionally, improving the poor sight in one eye helps a child control a squint that is only there intermittently. Usually amblyopia treatment is completed before other treatment for the squint is considered.

  My child cannot see well when wearing the patch so he won’t wear it.

  We understand how difficult this can be but it is often the only way to improve the sight. Please do all you can to keep the patch on as advised by your orthoptist. As the patch is worn and the sight improves your child should become less troubled by wearing the patch. Try to make the time wearing the patch fun.

  When is the best time to wear the patch?

  Patching is most successful when the child is concentrating on close activities such as colouring, reading, puzzles, hand-held computer (eg DS, PSP) or mobile phone games. Computer games can also be helpful. Watching TV and playing outside wearing the patch is much less effective.

  In younger children, patching is more successful if it is done when the child is not tired and you have time to play with him. If he is distracted and doing an activity he enjoys, he is more likely to tolerate wearing the patch and will enjoy the extra time spent with you. Star charts can be very helpful. School-age children often do best wearing the patch at school. Here they are constantly using their near vision and patching can become part of the daily routine. Wearing the patch at nursery can also help your child get into a good routine.

  How long will the treatment take?

  This can be very variable. The treatment may be completed in a number of months or may have to continue on and off during the period that sight develops (which is usually up to the age of approximately 7-9 years). Your orthoptist will be able to give you more detailed information.

  The treatment doesn’t appear to be making my child’s sight any better

  If there is no improvement after three months when your child has carried out the recommended treatment, further treatment options will be discussed with you and agreed before continuing.

  Are there any alternative patches for my child?

  Yes. We try to keep a variety of patches in stock for you to choose from but you may wish to explore other alternatives. We stock some fabric patches but if you would like a specific design that we don’t have in stock, you might want to look at the following websites.

  Kay Fun Patch - Medical Fabric Eye Patches for Children and Adults - UK
  Comfortable, Reusable Cloth Eye Patches for Amblyopia (Lazy Eye) (perfecteyepatch.com)Medical Eye Care Products | Fresnel Prism Lens (fresnel-prism.com)

  Please note, we are not able to refund any money you spend on patches bought elsewhere.

  Where can I get more information?

  If you have any questions, please ask your orthoptist. Some parents have found the following websites helpful:
  Squint Clinic - What is a Squint? Strabismus, Squint Treatment, Lazy Eye Information, Type of Squint, Squint Operation / Surgery, Divergent Squint, Convergent Squint, Botox treatment, Squint guide, Squint help, Squint Videos.

  Opticlude : Medical : 3M United Kingdom

• QChildren’s Glasses

  Information about wearing glasses

  How much should my child’s glasses be worn?

  It can take some time to get used to wearing glasses especially if it’s your first pair. To help your child get used to them, they should wear their glasses all day every day until you come back for your review appointment.

  Your child may say that their vision is blurred when they first put the glasses on. This is not unusual and is part of getting used to wearing them. The more the glasses are worn initially, the quicker your child will settle into them. Please encourage your child to persevere with the glasses as much as possible.

  How soon will my child’s eyesight improve?

  It can take 18 - 24 weeks for your child to get the full benefit of wearing glasses. This is because the part of the brain that is involved with eyesight needs to catch up with its development. The more the glasses are worn, the better the eyesight can develop. If your child’s eyesight is still reduced after this time, some other treatment may be required. Your orthoptist will discuss this with you.

  Do I need to bring my child back to clinic after they have got their glasses?

  Yes. It is very important to check how well your child’s eye sight is improving once they have their glasses. At the first follow up appointment (usually about 18 weeks after you are given the prescription) the orthoptist will check your child’s vision and how well the eyes are working together. They will then discuss with you whether any further treatment or follow up appointment is required.

  What do I do if the glasses get broken?

  The optician who made the glasses is responsible for repairing or replacing them whilst you have an up to date prescription. You must take the glasses back to where you got them. Please don’t wait until your next appointment before you get the glasses repaired, take them back to the optician as soon as you can.

  Glasses should continue to be repaired or replaced until you receive a new prescription and voucher - usually once a year. The clinic staff will decide when you require a new prescription, not the optician who provided the glasses.

  What do I do if my child won’t wear the glasses?

  Check that the glasses are fitting comfortably first of all. They shouldn’t leave red marks on the nose. Uncomfortable or poor fitting glasses are not pleasant to wear. You can seek advice from the optician if you have any concerns about how they fit. Depending on the age of your child, using strategies such as a star chart or reward system can help encourage your child to wear their glasses, getting relatives and teachers involved can also help. If you or other family members also wear glasses some of the time, wearing your glasses all of the time you are with your child can encourage them to wear theirs also.

  If you simply cannot persuade your child to wear their glasses, please telephone 0113 843 3620 and ask to speak to an orthoptist who will advise you. Please don’t wait until your next appointment as that may be many weeks away and this could delay your child’s treatment.

  Information about buying glasses

  What are the forms I have been given?

  You have been given two copies of your child’s prescription. One is for you to keep for your records, the other copy contains a voucher towards the cost of the glasses. You must give this to the optician where you get the glasses made up. You can only use this once.

  Where can I get my child’s glasses?

  You can get the glasses made up by any qualified optician. It is worth shopping around as prices and choice vary greatly from one optician to another. It is important that your child likes the frame and that it fits comfortably.

  Will I have to pay for my child’s glasses?

  You can buy glasses within the value of the voucher. Shop around to find glasses that fit well, that your child likes and that are free or don’t cost you a lot of money. Remember, if you choose to pay towards the cost of the glasses, you will have to pay towards repairs and replacements. If you choose free glasses, repairs and replacements will also be free. Some opticians offer children 2 for 1 glasses with an NHS voucher - ask around.

  What if I want a spare pair for my child?

  Under NHS regulations we cannot issue a voucher for a spare pair of glasses or sunglasses. You can buy these by taking your copy of the prescription to an optician but you will have to pay the full cost of these. You don’t have to buy these from the same place you got the first pair.

  How often can I get a new prescription and voucher?

  You are normally entitled to a new prescription and voucher for glasses every year unless your optometrist or orthoptist recommends a more frequent examination.

• QIntermittent Distance Exotropia

  What is intermittent distance exotropia?

  This is when one eye turns outwards (divergent squint) when looking at a distant object. This may be more noticeable when a child is tired, unwell or daydreaming. Most children are able to keep their eyes straight and working together when they view close objects or carry out near visual tasks such as reading.

  How does this affect my child?

  You may notice your child rubbing or closing one eye particularly in bright sunlight. It is rare for young children to notice any problems with this condition. As this type of a squint is intermittent, it is uncommon for amblyopia (reduced vision, also known as ‘lazy eye’) to develop in the eye that turns. However, this can occasionally occur in young children if the squint deteriorates and becomes constant. This may also disrupt your child’s ability to use both eyes together (binocular vision).

  At your eye clinic visit

  Your child will be seen in the Community Children’s Eye Clinic where initially an assessment of their vision, binocular vision and control of the squint will be undertaken by an Orthoptist.

  We will be interested in finding out from parents and carers:

  • how often the divergent squint is noticed (more or less than 50% of waking hours)
  • whether or not the squint is seen at near viewing distances as well as when the child looks further away.

  We may suggest that a glasses test is undertaken by our Optometrist (optician).
  Often children with an intermittent distance exotropia have normal vision in either eye; the need for glasses is similar to that of other children and appears incidental to the presence of the squint.

  Treatment / discharge

  Children with a mild intermittent distance exotropia do not usually require treatment and may be discharged either on their first visit or after a period of monitoring.

  If your child has been discharged this is because:

  • the squint is well controlled at near viewing and a sufficient level of binocular vision has been demonstrated which indicates that your child is able to use both eyes together
  • the eye drifts out for short periods of time when looking into the distance (less than 50% of waking hours), usually when tired / not concentrating.

  Treatment is indicated if:

  •  the squint is noticed more than 50% of waking hours
  • If the eye diverges for near as well as in the distance and looks like a ‘constant’ squint
  • the angle of the squint is large and/or becoming difficult to control for near viewing and disrupts binocular vision
  • there are problems such as double vision or regular headaches
  • there are concerns about the appearance of the squint.

  The aim of treatment would be to reduce the size of the squint and allow better eye alignment. This would restore or maintain straighter eyes for more of the time and improve binocular vision.

  Types of Treatment

  Glasses

  In some cases a pair of short sighted glasses may be prescribed as a temporary measure to help reduce the size of the squint and improve its control.

  Surgery

  If surgical correction of the squint is suggested your child will be referred to St James’ Hospital, Leeds.

  An operation will involve a general anaesthetic and, depending on the size of the squint, 1 or 2 muscles will be operated on. This could involve one or both eyes.

  Perfect alignment of the eyes cannot be guaranteed. We aim to reduce the amount of divergent squint so that hopefully it will be controlled more of the time. There is a risk of under or over correction of the squint and in some cases further surgery may be required.

  Children will need to be monitored for a while before surgery is considered so that accurate measurements of the squint can be obtained.

  Exercises

  Eye exercises do not generally help this type of squint. Eye exercises are usually carried out for problems with near viewing.

  Will it get better on its own?

  This type of squint is unlikely to get better on its own but not all children require treatment. Often this type of squint remains unchanged for years and never requires any treatment.

  After discharge

  If your child has been discharged you should continue to make observations at home. Please ask your GP (family doctor) to re-refer your child back to the orthoptist if you feel that:

  • the divergent squint is present for longer periods of time (greater than 50% of child’s waking hours)
  • the squint is present for near as well as distance
  • your child complains of double vision or regular headaches
  • there are concerns about the appearance that you feel warrants surgery

  Once discharged from the Eye Clinic, an optician can monitor your child’s vision and test for glasses. This is free whilst your child is in full time education until the age of 19. If your child lives in Leeds they will have a distance vision screening test in school at the age of 5 years.

• Contact