An Ethical Problem

[Lelarep]

This is in Australia, right?

Seems that way, from the location of the OP as shown. American rules are likely not to apply, although I am sure they have a similar system.

[STURNER]

The Mom might just be embarrassed that she cant afford glasses for her child, feels guilt because of her own failings, (addiction , whatever) The shame results in anger, unfortunately directed at the person she perceives as judging her for her failings as a person & parent. That would be you unfortunately. Not your issue, not your problem.

I would help pay for glasses. Can send it thru PayPal, if your serious about helping the kid. I would rather feel good about getting the kid something really needed than pass the buck with a phone call.

[Uncle Fester]

We have a patient who was born in Russia where you could only get spherical corrections. She has about 3 diopters of cyl OU. She learned if she closed one eye and pushed the outer orbit of the open eye she could to make it clearer for near work.

She is Jewish and 35 or 40 years ago Israel would buy a lucky number each year their freedom to emigrate to the West.

When she got to Italy she was given a stipend and the first thing she did was buy her first pair of fully corrected glasses.

She wept when she put them on for the first time.

BTW- Shouldn't a pediatric Ophthalmologist look at this kid???

[drk]

Fester's right.

Not necessarily a pediatric ophthalmologist, but someone good in pediatrics. This is no "normal" case, by any means. The kid doesn't need just optical correction, there's undoubtedly merdional amblyopia (if indeed the astigmatism is that high, which I find hard to believe), not to mention the possibility of subluxated lenses, keratoconus, etc.

This isn't an "easy feel-good fix".

[fjpod]

I got the impression that she is now 35yo. Pediatrics? 3 diopter cyl.....mehhhhhhh, see them all the time. As long as it is bilateral, any amblyopia should fade quickly. This patient needs a comprehensive exam, which in my book includes a good refraction. Any optometrist should be able to take care of this. Some OMDs might be able to handle the refraction.

edit: I am referring to the patient in the post Fester mentioned, not that of the OP. But as far as the OPs patient, again, there should be a comprehensive exam....not just a refraction, and not just a medical exam. Both need to be done.

[rbaker]

Fester's right.

Not necessarily a pediatric ophthalmologist, but someone good in pediatrics. This is no "normal" case, by any means. The kid doesn't need just optical correction, there's undoubtedly merdional amblyopia (if indeed the astigmatism is that high, which I find hard to believe), not to mention the possibility of subluxated lenses, keratoconus, etc.

This isn't an "easy feel-good fix".

That's why I believe that there should be some professional intervention in this case. As stated the child's care giver may be a junkie and we commonly see physical abuse of children among this cohort. The apparent astigmatism could be caused by traumatic lenticular subluxation. The child needs to be evaluated by appropriate medical an social professionals.

[Lelarep]

We have a patient who was born in Russia where you could only get spherical corrections. She has about 3 diopters of cyl OU. She learned if she closed one eye and pushed the outer orbit of the open eye she could to make it clearer for near work...

I love it. That's the same cheat I use when I need to see something quickly in the distance and don't have my glasses on hand.

[Hayde]

I don't think it's an easy decision, and even when it is--it's never easy to do. But the fact is we only have a paragraph of 3rd hand information to go by.

The part of this story that doesn't make sense to me is Why did she bother getting her kid refracted at all if she was determined to ignore the obvious fact s/he can't see? With respect and humility, I have to wonder if the bedside manner delivering the diagnosis was all it could be?

Are we qualified to diagnose drug addiction? I personally have little doubt the OP nailed the call, but it's not in our professional realm of expertise to declare. If there's symptoms of drug use suggesting she's stoned during her kid's exam, or worse driving to and fro--then yeah, the decision got a lot easier. Absent that, the label drives a lot of emotion and imagination for us reading...and I think a little trigger happy from the righteous safety of our keyboards.

The parent's willingness to bring the kid to doctors at all could be at stake. A reactionary take by health care providers that ends up fizzling out in the end (or was based on bad assumptions) could end up making the kid's future worse instead of better.

The post suggesting to call the school nurse was the best advice yet.

Beyond that, punting this question to a doc would be my first piece of advice. Opticians don't get classes on medical ethics. Docs do. Let 'em do their thing. (I'm not sure if Australia is like the UK in the respect Opticians sign off on Rx's? If so, do they get more responsibility and training on general medical care along these lines?)

If I were an independent optician AND prepared to testify to all the points of fact in the OP (personally witness drugs or drug use or could somehow "deduce" heroine use with a capital "D,") then yeah I might make the call.

In my neck of the woods, as in much of the US, CPS is under a perpetual mountain of reports that they can never hope to dig out of. So unless the report is violence or 'dire' negligence, it just goes to a file. When a file gets thick enough with reports sharing some consistent patterns, then they may send someone to knock on their door and superficially check the situation out. I personally wouldn't expect vision correction to pique CPS's interest, but if it was one point of many reports indicating the kid wasn't getting appropriate health care, then it might have eventually done some good.

Good luck, azza. Praying on it never hurts.

[becc971]

I would also help VIA pay pal if something ends up happening.

[smallworld]

I work with a pediatric specialist , and we see plenty of non-compliance with parents and young children who need to wear glasses. As an optician, I try to give as much support and knowledge to the parents as I can. Getting a child to wear glasses is no easy task and can be compounded by developmental or intellectual disabilities. I've seen plenty of parents angry, sad, and frustrated. Other parents don't grasp the severity of their child's vision issue. As a mother of a child who wore glasses at age four(my daughter), and as an amblyopic child myself, I feel education and patience is very critical for success. I often refer parents to a website I found called : www.littlefoureyes.com They have great tips to help parents get through those early years. I also make sure if a parent expresses financial needs that I refer them to local programs.

I have been in two situations where I had to be very firm and direct with children's parents that were not taking appropriate care of their children's needs. In both circumstances I was able to get the parents to purchase new eyewear and afterwards they apologized for the neglect in their situations. Many parents are just very overwhelmed and need to get support and direction to get back on track(not an excuse, just a reality).

If I could not engage a parent in a positive way to get onboard , I would report them to CPS, but many times it takes more than a simple phone call to fix these kind of situations. If the parents let me help them, I can directly help that child and be a part of their care and success.

[Craig]

I work with a pediatric specialist , and we see plenty of non-compliance with parents and young children who need to wear glasses. As an optician, I try to give as much support and knowledge to the parents as I can. Getting a child to wear glasses is no easy task and can be compounded by developmental or intellectual disabilities. I've seen plenty of parents angry, sad, and frustrated. Other parents don't grasp the severity of their child's vision issue. As a mother of a child who wore glasses at age four(my daughter), and as an amblyopic child myself, I feel education and patience is very critical for success. I often refer parents to a website I found called : www.littlefoureyes.com They have great tips to help parents get through those early years. I also make sure if a parent expresses financial needs that I refer them to local programs.

I have been in two situations where I had to be very firm and direct with children's parents that were not taking appropriate care of their children's needs. In both circumstances I was able to get the parents to purchase new eyewear and afterwards they apologized for the neglect in their situations. Many parents are just very overwhelmed and need to get support and direction to get back on track(not an excuse, just a reality).

If I could not engage a parent in a positive way to get onboard , I would report them to CPS, but many times it takes more than a simple phone call to fix these kind of situations. If the parents let me help them, I can directly help that child and be a part of their care and success.

Thanks for doing the right thing as an instinct and not taking the easy way out.

[azzathejunglist]

Hi guys.

Sorry for the slow reply to my original post - I have been away from work for the past few days as i needed some serious time away from the office!


1st off i have to say thankyou for your input and advise on this subject. I will try and answer what questions i can without breaking any medical release laws as i can.

1st question I can answer definatly - I know the Mother is a Injecting Drug User - When she came in her arms were covered in track marks from previous injections. My store is located right near the seady side of the town - on this side of the railway tracks it is the biggest shopping / dining street. 400 metres up the road is shall we say, the "wrong" side of the tracks shall we say - Alot of high unemployment and drug use, "Ladies" that affections can be purchased for a hour on the streets etc. The Herion use is a guess, but based on her area of living it would be either Herion or Meth - and she was so slow in communicating to me I am betting it was Herion.

@pkbeans 6/7.5 would translate to 20/25 - I have been consulting with a pediatric ophthalmologist who works around the corner that I have worked with for many many years. I think i am going to do around a -7ish to a -8 cyl OD and a 6cyl OS as both her and my thinking is that we will be asking for alot of problems if we do the full Rx straight away.

drk : yes this in Australia - New South Wales actually. I was initially thinking a subluxated lens initially however everything looked good to me and another Optom that I had working on that particular day

[drk]

That's why I believe that there should be some professional intervention in this case. As stated the child's care giver may be a junkie and we commonly see physical abuse of children among this cohort. The apparent astigmatism could be caused by traumatic lenticular subluxation. The child needs to be evaluated by appropriate medical an social professionals.

I agree.

[Lelarep]

Well, if she is an obvious IDU, you really do need to get your equivalent of the CPS involved. You'd be professionally negligent not to. When one can objectively and easily demonstrate that the parent is an IDU, it makes it pretty much an open and shut case. The original post didn't make it so cut/dry. I haven't personally run into such an obvious case (yet, I'm sure its only a matter of time). My area is more meth-y, so its usually not so easy.

[Dustin.B]

I'm with Drk and Lelarep at this point, if the evidence of abuse is obvious and on hand then the proper folks need to be alerted sooner rather than later. I hope for the kids sake your authorities handle it better than many of the US ones and actually try to help the addict as well as the child. Too many broken homes out there already...

[Uncle Fester]

...and actually try to help the addict as well as the child.

Maybe the focus should be on just the kid.

Note Point #2...

http://www.thecleanslate.org/self-ch...nce-dependence

[azzathejunglist]

Hi Optiboarders.....


thought i will give an update on this case.


What i ended up doing was a week after my last post myself and the Paediatric Opthal went to the school to talk to the Principal of the school - I made 3 pairs of specs for the child with the reduced Rx close to what i stated before.

The Px went from a constant D-/F grade to a B- grade within a year!!! - Literacy is still behind but is catching up.

Every month the Px comes in for another refraction (free of charge) and i change her lenses (free of charge - myself and the Opthal split costs)

The mother HATES me but i can live with that. She is of the opinion that "glasses will make her eyes weak and used to wearing them" type - we have all seen this. The child wears the glasses still only in class time as enforced by her teachers and the equal to to CPS here - but now the child can read and see for some parts of the day.




That is why i do my job.


Thankyou for advice with this Difficult subject Optiboarders as you gave put my head on right for this.

Now we have had a well, constant failing 7 year old in school who was indifferent to learning, who is now is asking 1000 questions a day and wanting answers.



Azza

[Tallboy]

You just made my day. Thanks for taking the time to update.

[mervinek]

Wonderful! You helped to change this child's life for the better! The future this child may have! Great Job! Thanks for the update!

[Lelarep]

I needed to hear something like this today. Thanks for the update. It's nice to know that the positive forces in the universe still win sometimes.

[Uncle Fester]

Good on ya mate!

Now if we could get the authorities to call this the child abuse that it is so she can wear them full time...

Is the astigmatism internal?

[AngeHamm]

Magnificent! Cheers!

[IC-UC]

Brilliant news....one lucky young man!

[Diane]

This is in Australia, right?

Way to. Be the advocate for the small voice. It will make a difference in their life.

Diane