Glasses for 5 year-old twins

Our twins finally got a 2nd opinion from the opthamologist after being
told by an optometrist that they needed glasses.

To recap, one of our twins was (under drop, the term used by the
opthamologist) -1.50 in each eye, while the other was -2.00 and -2.75.

The opthamologist said the following:

1) Children under-9 should NOT normally be given corrective lenses if
they are hyperopes and within 2-3 diopters, provided they seem to be
able to function well visually. He mentioned something about young
children having lots of "reserve".
2) Although optometrists in Ontario fought for years for the right to
administer cytoplegic (?) drops, few actually use them and it's
virtually impossible to accurately measure a child's refraction without
them (e.g. with an auto-refractor).
3) He is currently doing about 20 second opinions each week (he had done
4 by noon today when he called me back) and reversing virtually all the
recommendations received from optometrists for prescriptions given to
young children. As a result, there must be thousands of young children
out there wearing glasses unnecessarily.

For us, that makes twice in 3 years that the OD has overruled the
optometrist. We're going to follow his recommendation.

-Pat

On 10/17/06 7:08 PM, in article 45358c42$0$5567$(E-Mail Removed),
"Patrick Coghlan" <(E-Mail Removed)> wrote:

> For us, that makes twice in 3 years that the OD has overruled the
> optometrist. We're going to follow his recommendation.

I thought OD meant optometrist. Did you mean ophthalmologist?

Bill
-- Fermez le Bush

If they are hyperopes, the numbers must be (+) not (-). Minus is myopic.


On 10/17/06 7:08 PM, in article 45358c42$0$5567$(E-Mail Removed),
"Patrick Coghlan" <(E-Mail Removed)> wrote:

> Our twins finally got a 2nd opinion from the opthamologist after being
> told by an optometrist that they needed glasses.
>
> To recap, one of our twins was (under drop, the term used by the
> opthamologist) -1.50 in each eye, while the other was -2.00 and -2.75.
>
> The opthamologist said the following:
>
> 1) Children under-9 should NOT normally be given corrective lenses if
> they are hyperopes and within 2-3 diopters, provided they seem to be
> able to function well visually. He mentioned something about young
> children having lots of "reserve".
> 2) Although optometrists in Ontario fought for years for the right to
> administer cytoplegic (?) drops, few actually use them and it's
> virtually impossible to accurately measure a child's refraction without
> them (e.g. with an auto-refractor).
> 3) He is currently doing about 20 second opinions each week (he had done
> 4 by noon today when he called me back) and reversing virtually all the
> recommendations received from optometrists for prescriptions given to
> young children. As a result, there must be thousands of young children
> out there wearing glasses unnecessarily.
>
> For us, that makes twice in 3 years that the OD has overruled the
> optometrist. We're going to follow his recommendation.
>
> -Pat

> 2) Although optometrists in Ontario fought for years for the right to
> administer cytoplegic (?) drops, few actually use them and it's virtually
> impossible to accurately measure a child's refraction without

Cycloplegic drops should be administered by medical doctors and optometrists
are NOT medical doctors.

> For us, that makes twice in 3 years that the OD has overruled the
> optometrist. We're going to follow his recommendation.

The OD stands for the optometrist. An ophthalmologist is an MD who
specializes in the eye. Your twins need to see a pediatric ophthalmologist,
not a general optometrist.

Fidelis K wrote:
> > 2) Although optometrists in Ontario fought for years for the right to
> > administer cytoplegic (?) drops, few actually use them and it's virtually
> > impossible to accurately measure a child's refraction without
>
> Cycloplegic drops should be administered by medical doctors and optometrists
> are NOT medical doctors.
>
> > For us, that makes twice in 3 years that the OD has overruled the
> > optometrist. We're going to follow his recommendation.
>
> The OD stands for the optometrist. An ophthalmologist is an MD who
> specializes in the eye. Your twins need to see a pediatric ophthalmologist,
> not a general optometrist.


Actually, optometrists *are* allowed to use "drops" to dilate the pupil
and administer a cycloplegic refraction. I believe they can also
prescribe some types of medicine and eyedrops, such as used for dry
eyes. What they *cant* do is surgury, although I heard theres a waiver
for PRK(not lasik!)


anyway if your children are hyperopic, they dont need glasses if theres
no symptoms. If they are myopic, Otis can offer advice to help them
clear their vision to 20/40 or better.

Just an opinion from an optometrist.


>
> The opthamologist said the following:
>
> 1) Children under-9 should NOT normally be given corrective lenses if
> they are hyperopes and within 2-3 diopters, provided they seem to be
> able to function well visually. He mentioned something about young
> children having lots of "reserve".


Why under 9? Why not 10? There is no logic here. 2-3 dioptres is not a
good level to read with even with "plenty of reserve".


> 2) Although optometrists in Ontario fought for years for the right to
> administer cytoplegic (?) drops, few actually use them and it's
> virtually impossible to accurately measure a child's refraction without
> them (e.g. with an auto-refractor).


This is a total load of crap!!! I will pit my retinoscope up againt
your ophthal any day. Cycloplegics don't give you much difference in
result and you are assessing an unnaturally altered system. I always
base my scripts off my ret, even having done a cyclo refraction. Also
autorefractors are for clowns that can't use a ret, and for what it is
worth, the good autorefractors these days will get the result without
using cyclo.

> 3) He is currently doing about 20 second opinions each week (he had done
> 4 by noon today when he called me back) and reversing virtually all the
> recommendations received from optometrists for prescriptions given to
> young children. As a result, there must be thousands of young children
> out there wearing glasses unnecessarily.


Yes, but I see 20 second opinions from ophthals a week, most have been
given wrong prescriptions or no prescription. That your ophthal says
not to get glasses does not make him right. The major difference
between optoms and ophthals is that we deal with systems that function
in the real world, not the hypothetical of "plenty of reserve". The
requirements of children at school these days is very different than
when you were at school. The worst case scenario of your children
getting glasses is that they would be of no benefit. They would not
cause problems, worsening or anything else.


>
> For us, that makes twice in 3 years that the OD has overruled the
> optometrist. We're going to follow his recommendation.
>


That may be a wise decision or it may be not. Having not tested your
children, I can't say one way or another, but for what it is worth, an
ophthal does not know more about eyes than an optom, he may know more
about surgery, but your children don't need that. Optoms are much
better than an ophthal at what they do, which is prescriptions and
glasses and contacts. I will happily put my refraction skills against
an ophthal. What I look for in cases such as your children is how they
are functioning, which your ophthal can't assess as he has stuck
cycloplegic in their eyes. How has he assessed their focussing and
convergence skills? What is their AC/A ratio? How much lag is there
when they read? Can they clear minus lens with ease? What are their
accommodative and vergence reserves? I bet these were not tested, but I
wouldn't be making any recommendation to you without these results as
they tell me how your kids eyes work. Once I have this, I have a
baseline to compare against at a later date.

dr grant

Fidelis K wrote:
> > 2) Although optometrists in Ontario fought for years for the right to
> > administer cytoplegic (?) drops, few actually use them and it's virtually
> > impossible to accurately measure a child's refraction without
>
> Cycloplegic drops should be administered by medical doctors and optometrists
> are NOT medical doctors.

Your reasoning here is? Using that argument, dentists should not be
allowed to administer anesthetics or give injections, nor should
podiatrists, because neither are "medical doctors." I have a thriving
pediatric section to my practice, and have been using cycloplegic drops
routinely on children from 2 years and up for the past 20+ years.
>
> > For us, that makes twice in 3 years that the OD has overruled the
> > optometrist. We're going to follow his recommendation.

Studies show that uncorrected hyperopia is the vision condition most
responsible for reading-related learning disorders in children.
Uncorrected hyperopia is also more likely to be associated with lazy
than any other refractive condition.
>
> The OD stands for the optometrist. An ophthalmologist is an MD who
> specializes in the eye. Your twins need to see a pediatric ophthalmologist,
> not a general optometrist.

An OD specializes in vision and the diagnosis and correction of vision
problems in adults and children.

DrG

"Dr. Leukoma" <(E-Mail Removed)> wrote in news:1161175798.987539.309500
@b28g2000cwb.googlegroups.com:

> dentists should not be
> allowed to administer anesthetics

Actually, a friend of mine is an anesthesiologist with a dental anesthesia
practice. Dentists and oral surgeons hand him money like he's doing them
the biggest favor in the world--and in fact, it is close. Dollars to
donuts, if I ever require a general during a dental procedure, this would
be the arrangement I'd use. It's safer.

That's not to say that this has anything to do with cycloplegic agents, of
course, but the risks of using these agents are not the same as those of
general anesthesia during a dental procedure.

--
Scott
Reverse name to reply

Dr. Leukoma wrote:

> Studies show that uncorrected hyperopia is the vision condition most
> responsible for reading-related learning disorders in children.
> Uncorrected hyperopia is also more likely to be associated with lazy
> than any other refractive condition.

That should read "lazy eye."

But, look, certainly if a child is symptomatic the prescription is
given. The key is in determining whether the child is symptomatic, or
rather if there are signs of a problem. Signs of a problem would
include reading ability or performance on nearpoint tasks. Beyond
that, there is a threshold beyond which glasses should be prescribed
simply because the burden on the accommodative/convergence system is
too much even in the absence of any "demonstrable" signs or symptoms,
and this "threshold" is not something all doctors are going to agree
upon. There is also the question of whether the hyperopia --
regardless of magnitude -- is bilateral and relatively equal between
the two eyes. Also, and perhaps more importantly, what are the visual
acuities?

With respect to pediatric OMD's vs. optometrists: Can you say "turf
war"?

DrG

Scott Seidman wrote:

> That's not to say that this has anything to do with cycloplegic agents, of
> course, but the risks of using these agents are not the same as those of
> general anesthesia during a dental procedure.
>

I wasn't even thinking of general anesthetics. I was thinking of
locals. I don't have a problem with my dentist administering light
sedation with nitrous, but I have never used it.

DrG