Re: Latent Hyperopia - Child age 6 - glasses? (+3.25 script)

What part of the world are you in, Janice -- if you don't mind
saying??

I'm a layperson, but a high hyperope who's learned a thing or two
along his 4+ decades of being in the patient's side of the chair.

I think you should get your son evaluated by the best pediatric
strabismus opthalmologist that you can -- much as Dr. Leukoma
recommends.

I know a name or two, in a couple of parts of the country. Others on
this forum may know additional eye docs.

In a painfully obvious fashion, I think this could go one of two ways:
he could be fine for years and years -- even decades -- and then need
glasses ... or....

The "or" is that his eyes (and the neurologic components of vision)
could be overtaxed by all of the accommodation that he'll surely need
to use, to get through school and life. This could cause eye-turn
(strabismus), double vision, accommodative difficulties, etc., etc.

Trust me when I say ... you don't want the "or."

A thorough exam by a truly excellent pediatric ophthalmologist will
help to understand if there are ANY deficits or problems with his
accommodative or binocular function that COULD make all of that
accommodation problematic.

Along with you and his teachers watching for any and all the usual
symptoms of vision trouble, I'd probably have him checked by a good OD
or ophthalmologist more frequently than the standard annual visit.
As with so many things, early intervention offers the best possible
outcome.

Neil

Neil, the child has about +3 diopters (measured).

There are two opinions:

1. Don't wear a plus.

2. Get a plus lens that "matches" the child's refractive status --
for
full time wear.

Which of these two choices would you recommend.

You have experience with an identical situation, were
your eyes were protected by that plus lens that
you were prescribed.

What you you recommend? You have been very
vocal on the subject.

Majority/Second Opinion best,




On Aug 28, 7:54*pm, Neil Brooks <neil0...@yahoo.com> wrote:
> What part of the world are you in, Janice -- if you don't mind
> saying??
>
> I'm a layperson, but a high hyperope who's learned a thing or two
> along his 4+ decades of being in the patient's side of the chair.
>
> I think you should get your son evaluated by the best pediatric
> strabismus opthalmologist that you can -- much as Dr. Leukoma
> recommends.
>
> I know a name or two, in a couple of parts of the country. *Others on
> this forum may know additional eye docs.
>
> In a painfully obvious fashion, I think this could go one of two ways:
> he could be fine for years and years -- even decades -- and then need
> glasses ... or....
>
> The "or" is that his eyes (and the neurologic components of vision)
> could be overtaxed by all of the accommodation that he'll surely need
> to use, to get through school and life. *This could cause eye-turn
> (strabismus), double vision, accommodative difficulties, etc., etc.
>
> Trust me when I say ... you don't want the "or."
>
> A thorough exam by a truly excellent pediatric ophthalmologist will
> help to understand if there are ANY deficits or problems with his
> accommodative or binocular function that COULD make all of that
> accommodation problematic.
>
> Along with you and his teachers watching for any and all the usual
> symptoms of vision trouble, I'd probably have him checked by a good OD
> or ophthalmologist more frequently than the standard annual visit.
> As with so many things, early intervention offers the best possible
> outcome.
>
> Neil

On Aug 28, 6:54*pm, Neil Brooks <neil0...@yahoo.com> wrote:
> What part of the world are you in, Janice -- if you don't mind
> saying??
>
> I'm a layperson, but a high hyperope who's learned a thing or two
> along his 4+ decades of being in the patient's side of the chair.
>
> I think you should get your son evaluated by the best pediatric
> strabismus opthalmologist that you can -- much as Dr. Leukoma
> recommends.
>
> I know a name or two, in a couple of parts of the country. *Others on
> this forum may know additional eye docs.
>
> In a painfully obvious fashion, I think this could go one of two ways:
> he could be fine for years and years -- even decades -- and then need
> glasses ... or....
>
> The "or" is that his eyes (and the neurologic components of vision)
> could be overtaxed by all of the accommodation that he'll surely need
> to use, to get through school and life. *This could cause eye-turn
> (strabismus), double vision, accommodative difficulties, etc., etc.
>
> Trust me when I say ... you don't want the "or."
>
> A thorough exam by a truly excellent pediatric ophthalmologist will
> help to understand if there are ANY deficits or problems with his
> accommodative or binocular function that COULD make all of that
> accommodation problematic.
>
> Along with you and his teachers watching for any and all the usual
> symptoms of vision trouble, I'd probably have him checked by a good OD
> or ophthalmologist more frequently than the standard annual visit.
> As with so many things, early intervention offers the best possible
> outcome.
>
> Neil

Neil,

I specifically said "pediatric optometrist," not pediatric
ophthalmologist. Of course, I would not object to a third opinion by
a pediatric ophthalmologist if strabismus was involved.

On Aug 28, 9:13 pm, "Dr. Leukoma" <d...@leukoma.com> wrote:
> Neil,
>
> I specifically said "pediatric optometrist," not pediatric
> ophthalmologist. Of course, I would not object to a third opinion by
> a pediatric ophthalmologist if strabismus was involved.

Sorry, Doc.

Didn't mean to mis-quote.

From my perspective, I'd advocate either -- provided he/she are
experienced in thoroughly evaluating binocular and accommodative
status.

On Aug 29, 12:35*pm, "JWard6971 via MedKB.com" <u45776@uwe> wrote:
> Neil Brooks wrote:
> >What part of the world are you in, Janice -- if you don't mind
> >saying??
>
> I'm in West Central Wisconsin.
>
> This is interesting conversation! *And I should correct a mistake in myfirst
> message. *We saw an optometrist not an ophthalmologist. *However, nota
> pediatric one. *Within our regional medical system, I cannot seem to locate
> any optometrist with a "pediatric optometrist" specialty, although a few list
> it as an interest in their medical profiles. *(Not the same - I know.)
>
> Couple of extra pieces of information in response to comments here. *Weare
> Caucasian, there is no family history on either side of hereditary myopia..
> Typical hyperopia in later years (mid-40s for my side, I believe similar for
> my husband). *However, I do have some of my own eye "fun". *I do not require
> reading glasses yet (I'm 37), but my whole life (I will explain in layman's
> terms as I'm afraid to mess up the medical terminology I'm learning!) I have
> had a slight intermittent turning inward of my left eye - only when fatigued,
> but it has not resulted in a lazy eye. *I was seen by a specialist for many
> years to track this, and have never developed a lazy eye. Both eyes are
> similar in strength (at worst a +1.00 currently (when using the eye drops)).
> I, however, do not have good stereo/binocular (?) vision. *Since I do not
> know the terminology, I always describe it as the fact that I do not see one
> picture when I look in a ViewMaster - I see two - unless I manipulate my eyes
> to compensate. *If I take an eye exam in one of those devices like at a
> driver license station, I look one way first and then the other as I do not
> see one picture. *However, it seems to have no noticeable affect on my depth
> perception or day to day life. *(Those cute little eye puzzle pictures where
> something is supposed to appear when you stare long enough don't work forme
> either.) *I only mention this in case it matters to my son - so far he shows
> no eye turning at all.
>
> As far as my son is concerned, he has a GameBoy, but it is not something he
> uses a lot. *He has never been a "coloring book" kid and his seat work
> requirements have been limited in Kindergarten. *More will come this year.
> His academic skills are behind, but I don't have any clear picture if vision
> is a related cause. *I think I could talk myself into lots of things that
> seem to avoid close up work if I tried!
>
> Seems like the case has boiled down to a few items. *Glasses or wait and see?
> While I won't say I've seen a hard, clear recommendation there seems to be a
> leaning towards the glasses. *The second issue seems to be a lot of
> recommendation for a lower prescription than the full 3.25 we were given.
> Not sure there what to do there? *I'm also wondering about the OTC readers -
> how will I know if they make a difference with a child this age (and
> temperament - he is a stubborn one and not likely to tell me it's better)..
> (Side question - do they make child sized OTC readers?)
>
> I think a second opinion is a good idea, but I'm not sure how to pick a good
> doctor to do that. *(And honestly, there is some dread about putting myson
> through the eye drops again - they are a battle!)
>
> If you aren't sick of me yet, your continued feedback is welcome.
>
> Janice
>
> --
> Message posted via MedKB.comhttp://www.medkb.com/Uwe/Forums.aspx/vision/200808/1

Janice,

You say your son's academic development is delayed but haven't a clear
picture of the cause. As a layperson, what evidence will suffice in
that regard? With respect to making a decision about whether or not
to give him correction at this stage, I would ask myself this: Is the
risk on the side of doing something or doing nothing? If you do
nothing and the development continues to lag further, would you feel
better than if you had "wasted" money on eyeglasses that didn't work
now? I think that's a decision only you can make (a pound of
prevention and all that).

With respect to the power of the glasses, anything between the
manifest and the cycloplegic is fair game, with ease of adaptation
favoring the lower prescription. I know what I would probably do, but
it's not my place to tell you. Perhaps you should get a second
opinion from a pediatric ophthalmologist if you cannot find a
pediatric optometrist.

On Aug 29, 1:35*pm, "JWard6971 via MedKB.com" <u45776@uwe> wrote:
>
> His academic skills are behind, but I don't have any clear picture if vision
> is a related cause. *
>

what kind of clear picture do you expect to see?

whats clear to me from what you've written is: 1) that your child's
academic skills are behind, 2) his refraction is +3.25D indicating
that he is significantly farsighted, and 3) farsightedness is clearly
associated with inhibition of academic development and performance.
The path forward is pretty clear from what my experience is, and I
think that you know it. But for some reason you seem to be averse to
the idea of your son wearing glasses.

> Glasses or wait and see?

do you want "wait and see" for your child's development? whats the
downside of using readers part-time?

>
> Janice

your child's young age allows you to be a little "sloppy" in your
decision-making now because he hasn't started into any prolonged
reading and writing exercises yet. regardless, a reasonable course of
action for you would be to simply get a weak pair of readers, say
+1.50, and have him use those to read along with you or color or
whatever. he's not going to tell you that he sees better, or that he
feels better-- the only proof that you would get that they are
benefiting him is if he improves his academic development. kids
notoriously give poor clinical feedback. its not the clear evidence
that you seem to be looking for but visualize the alternative-- do
nothing and ignor the likely cause of my son's slow academic
development.

i guess i'm not sure why you don't just jump at this as a real
possibility to improve your sons situation?

On Aug 31, 12:02 am, p.clar...@gmail.com wrote:
> On Aug 29, 1:35 pm, "JWard6971 via MedKB.com" <u45776@uwe> wrote:
>
>

Is this true:

The child's manifest (Snellen and trial lens) refractive STATE is +1/2
diopter.

(That means that more plus will blur the Snellen -- significantly, say
by about 20/100 through an additional +3 diopters.)

Thus, while the +3 diotpers might be "good" for near, the child's
distant vision will be seriously bad -- as I described it.

Have you explained this to the mother?

Enjoy,

Otis




>
> > His academic skills are behind, but I don't have any clear picture if vision
> > is a related cause.
>
> what kind of clear picture do you expect to see?
>
> whats clear to me from what you've written is: 1) that your child's
> academic skills are behind, 2) his refraction is +3.25D indicating
> that he is significantly farsighted, and 3) farsightedness is clearly
> associated with inhibition of academic development and performance.
> The path forward is pretty clear from what my experience is, and I
> think that you know it. But for some reason you seem to be averse to
> the idea of your son wearing glasses.
>
> > Glasses or wait and see?
>
> do you want "wait and see" for your child's development? whats the
> downside of using readers part-time?
>
>
>
> > Janice
>
> your child's young age allows you to be a little "sloppy" in your
> decision-making now because he hasn't started into any prolonged
> reading and writing

ses yet. regardless, a reasonable course of
> action for you would be to simply get a weak pair of readers, say
> +1.50, and have him use those to read along with you or color or
> whatever. he's not going to tell you that he sees better, or that he
> feels better-- the only proof that you would get that they are
> benefiting him is if he improves his academic development. kids
> notoriously give poor clinical feedback. its not the clear evidence
> that you seem to be looking for but visualize the alternative-- do
> nothing and ignor the likely cause of my son's slow academic
> development.
>
> i guess i'm not sure why you don't just jump at this as a real
> possibility to improve your sons situation?