It’s A Go For Strabismus Surgery

Lyra will be having bilateral strabismus surgery next Tuesday, March 13th. Both of Lyra’s eyes cross inward. The purpose of this surgery is to straighten her eyes. By improving the appearance of her eyes it will hopefully improve her psychological and emotional development. The realignment of her eyes may also improve her depth perception and improve the likelihood of developing equal vision in both eyes. The following is from an information sheet given to us by Lyra’s pediatric ophthamologist, Dr. Trudi R. Grin called “Understanding Eye Muscle Surgery.” This explains the surgery:
” Eye muscle surgery involves re-positioning the muscles that attach to the eyeball. It is similar to releasing the tension upon reins to a horse’s head in order to control the horse. Muscles are attached to each eye to pull the eyes up, down, left, or right. Surgery to these muscles strengthens or weakens their functioning in order to straighten the eyes. This is done by putting a suture into the muscle, then cutting the muscle off of the eye and re-sewing the muscle at the appropriate position, which in turn strengthens or weakens that particular muscle.”This surgery was originally scheduled for February 27th. We chose to reschedule the surgery after we decided to have some blood testing completed first.
We did not take Lyra to have genetic testing after she was born to determine which type of albinism she had. At the time it wasn’t a priority. We knew we weren’t planning on having anymore children and it wouldn’t have affected how we cared for Lyra. During our planning and preparation for her surgery, we remembered there was one type of albinism, Hermansky-Pudlak Syndrome (HPS), that included bleeding tendencies. We hadn’t seen any symptoms such as easy bruising or prolonged bleeding that would give us reason to suspect HPS, but because we didn’t have the genetic testing, we couldn’t know for sure.
We still don’t know the answer to that question, but we do know that Lyra doesn’t have a bleeding disorder. Because of the time frame necessary to get an appointment and complete genetic testing, we decided to take her to a hematology clinic to test specifically for any bleeding tendencies. A genetic test alone would tell us if she had HPS, but we would still had to of had the blood testing to determine if the platelet dysfunction was present. Similarly, just because all of her blood tests came back normal, this does not tell us she doesn’t have HPS. Because of the risks involved with surgery, obviously testing for the bleeding tendencies was the priority. We plan to schedule the genetic testing after her surgery, hopefully within the next 6 months.

This surgery is an outpatient procedure. We have to be at the hospital by 6:45AM and the surgery will begin approximately an hour after we arrive. They said the surgery should last 45 to 60 minutes. After the surgery, she’ll need to stay in the recovery area anywhere between 30 and 60 minutes, hopefully no longer. After that she will be able to go into a “post-op” room where we can finally be with her again. They told us that assuming everything goes well, we could expect to leave the hospital before noon. Pain after this surgery is usually mild, but we may need to give her Tylenol or ibuprofen for the first day or so. Eye care following the surgery is fairly simple…basically just keeping them clean and free of crusty gunk. “Blood-tinged fluid will ooze from the eyes for a day or so following surgery.” Yipee! Doesn’t that sound like fun.
Yuck!!!
I’m not really even too worried about the actual surgery. I’m worried about her being put under general anesthetic. That’s what scares me. I know I’m going to be crying my eyes out when I have to hand her over to the nurse. It’s going to be an agonizing 1-2 hour wait. I can barely type this without crying. All I can do is pray and know that I’ll be leaving her in God’s hands.
She’ll be safe.


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Occupational Therapy Goals

Today at Lyra’s OT session, we began updating her IFSP goals/outcomes for the next 6 months. These are what we want Lyra to be doing somewhere between now and when she is 16 months old. We really just got started with updating these today. We may add some goals in these areas and we still need to set some for cognitive skills and self-help skills. These are not necessarily in any order and we will check them off as she reaches the goals.

Motor Skills
-lower self from furniture
-cruising
-stand independently momentarily
-walks forward, 2 hands held
-walks, 1 hand held
-stand alone well
-walking 2-3 steps independently
-creeps upstairs
-roll ball back and forth
-pick up small object with neat pincer grasp
-isolate/point with index finger
-put objects into container (voluntary release)
-builds 2 cube tower

Social Skills
-waves/responds to bye bye
-babbles with inflection
-imitates familiar gesture

Hair, Hair, and More Hair!

Hair1 Hair2Hair3

Lyra’s hair is getting sooooo long! She has a TON of hair. She’s got a second set of bangs growing under her bangs. That new hair is almost to her eyebrows.

The thought of cutting it makes me sad. She’s my last baby and I’m in no hurry for her to grow up. I’m not ready for her first haircut. :(( I love her hair.

I can’t put it in twisties anymore. The other day she pulled one out and was chewing on it like a piece of bubble gum. She’s not real fond of headbands or clips either.  As in the first photo above, without something putting her hair up, she looks like Stella from Over the Hedge.

Hair4 Hair5

Seeing the spoon.

How does a baby know to open her mouth for a spoonful of food? They see the spoon coming.
In Lyra’s case, at 4 months, she couldn’t see the spoon coming. This made feeding her more difficult. We tried different sound cues to get her to open up. One that was more successful was tapping the spoon on the bowl just before bringing it to her mouth. It didn’t consistently work though and eventually gave up on the sound cue. Maybe not the best decision on our part as parents. We decided to wait a bit longer for solid foods. Now Lyra can see the spoon coming and opens her mouth. She sometimes tries to grab the spoon. A lot of babies do this, but in Lyra’s case I think it also has to do with her visual ability, specifically her depth perception. She isn’t sure how far away the spoon is and wants to guide it to her mouth using her hand.

The strabismus surgery she is having in a couple of weeks could improve her depth perception. We’ll see if it helps with feeding.


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What Can Lyra See?

What Can Lyra See?
A lot…but just not as clearly as everyone else. Her vision now is about 20/200, which is legally blind, but this doesn’t mean she lives in a world of darkness. My vision without my glasses or contacts is 20/200. Very early on, we knew she could see something…we just weren’t sure what. She would look at toys, books, or objects that had very high contrast. We have a dark navy blue border along the top edge of the white walls in our bedroom. We would take Lyra in there, and she would look up at it and laugh hysterically. Of course so would we, it was so cute. This was as early as one or two months.
As her vision progressed, we could judge how well she could see based on how far away she could track or follow a lighted or unlighted object. Her field of vision is expanding more and more every day, but more slowly than a baby without a visual impairment.
Lyra’s vision is also affected by the nystagmus and strabismus. They affect her ability to focus on detail as well as her depth perception.
Because of the photophobia, it is also harder for Lyra to see things in rooms with very bright light or outside on a sunny day. Its like coming out of a movie theater into the bright sun. The glare can be almost painful. She see better in dim light. The bright light is very irritating on her eyes. Just the other day, we spent several hours at a mall. The mall had typical bright florescent lighting. Lyra would not leave her hat on no matter how many times I put it back on her head. By the time we left the mall, her eyes were red and watering.


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Early Intervention

Early Intervention Services-4 months-present
Vision Specialist and Occupational Therapist come once a week for an hour, one on Tuesday, the other on Thursday.
Work on vision skills- tracking, following, depth perception
Work on motor skills, reaching, grasping, holding head up, rolling over
Work on using vision and motor skills together- opening mouth when spoon is coming.
Prebraille (kids with albinism might use braille, might read print, or both for a while)

Tests/Assessments used
-HELP (Hawaii Early Learning Profile)
-OREGON Skills Inventory
-Parent/team report

IFSP Outcomes for Vision (9/19/06)
-Fixate on a variety of toys and faces
-Localize sounds and voices
-Follow in all directions
-Track in all directions
-Gaze shift between two toys and faces
-Monitor light sensitivity
-Scanning her environment
Time frame for goals-6 months

IFSP Outcomes for Motor skills (9/19/06)
– Lyra will use her vision to purposefully grasp a toy
-Lyra will play with a toy using both hands at midline, medium size toy, bottle, object to mouth
-Lyra will hold an item in each hand and bring them together at midline, i.e. banging 2 toys together
-maintain grasp on item in each hand
-Lyra will remove 3 hand size objects from a container
-Lyra will put 3 hand size objects into a container (voluntary release)
-Lyra will maintain position on all 4’s for 1 min.
-Lyra will crawl forward on all 4’s five feet
-Lyra will sit up with minimal support
Time frame for goals-6 months

Visits to Pediatric Ophthamologist

Visits to the Pediatric Ophthalmologist-Dr. Trudi Grin-

1 month old- low pigment in eyes, nystagmus, strabismus, and photophobia. I’m told her vision will likely be anywhere from 20/60 to 20/2200 corrected.

3 months old- doctor still seeing the nystagmus and strabismus in both eyes, now seeing a little bit of farsightedness, but not enough for glasses. We are told that eventually Lyra will need strabismus surgery.

6 months old- At home we were seeing Lyra’s right eye turning in more. Dr. prescribes patching the left eye, 1 hr a day, everyday.

7 months- We call the doctor to tell her we are now seeing both eyes turning in equally. Dr. prescribes patching each eye, alternating every other day, for an hour.

8 months old- Strabismus surgery is scheduled for February 27th. Lyra does not need glasses for farsightedness yet, but doctor says she will prescribe tinted glasses for the photophobia in the spring.


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