accommodative spasm

Discussion in 'Optometry Archives' started by cdavis, Apr 21, 2007.

  1. cdavis

    cdavis Guest

    Are ophthalmologists and optometrists trained to recognize
    accommodative spasm, lengthening of the eyeball, and pseudomyopia?
    What do they do about it and how do they inform the patient about it?
    Are they supposed to tell the patient what is going on? If they need
    to adjust the distance prescription so the doctor can sell them
    progressive lenses, do they tell the patient?
     
    cdavis, Apr 21, 2007
    #1
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  2. cdavis

    Ms.Brainy Guest

    I don't know anything about the 3 items you mentioned, nor do I know
    whether ophthalmologists or optometrists are trained to recognize
    them. However, I do know how hard it is to convince them that you
    deserve being informed. Most simply consider it a waste of time since
    they presume the patient is incapable of understanding their
    specialized diagnosis and the complexity of all the issues involved.
    For them the patient is not smart or educated enough to provide a
    second opinion, and usually they don't like a second opinion.

    Also, since medicine nowadays is so specialized, they don't seem to
    realize that there is person attached to the eye. Most relate to the
    portion of the eye that they are specilaized in, forget the person.

    IMO this stems from the status of healthcare in the U.S. as business,
    and consequently money is the main factor in running the business.
    MDs' time is worth gold, insurance pays by the visit and less time
    spent with the patient means more profit. One doc sent me to the
    Internet when I asked some basic questions. This is a shame.
     
    Ms.Brainy, Apr 22, 2007
    #2
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  3. cdavis

    otisbrown Guest

    Dear Brainy,

    You are correct. And if you complain they will
    look down there nose at you and tell you that, "...you
    will get used to it".

    And where is your medical degree that you have the
    right to ask any questions.

    It would be of value if you were offered a choice (second-opinion)
    and sent to the internet to research that choice.

    Best,

    Otis
     
    otisbrown, Apr 22, 2007
    #3
  4. cdavis

    cdavis Guest

    I'm sorry, that sure didn't come out right. What I meant was: If the
    doctor feels the need to adjust the distance prescription to less than
    optimal strength, would he have the obligation to discuss this with
    the patient? For instance, my eyes need a different correction (in
    each eye) for reading but the optometrists I have seen seem intent on
    keeping the add power the same for each eye and then giving me less
    than optimal distance correction. Maybe they don't want to use prism
    or slab-off?
     
    cdavis, Apr 22, 2007
    #4
  5. cdavis

    Jan Guest

    schreef:
    Again you are asking here whit out providing the necessary data about
    your own situation.

    In earlier postings here you give the impression in one eye your inner
    lens (lens crystallina) was removed.

    If you want a useful answer on your question than give the necessary data.

    Then it is possible for the real specialists here to give a good answer.

    Again and again you are suggesting eyecare professionals as a group are
    only interested in how to get money out of your pocket and meanwhile you
    want answers from the same people who earn there money as an eyecare
    specialist here on Internet.

    What is your real goal mister flatscreen?

    Jan (normally Dutch spoken)
     
    Jan, Apr 22, 2007
    #5
  6. cdavis

    cdavis Guest

    My real goal here is to find out why it is difficult to acquire a good
    prescription from an optometrist and also find some answers as to
    whether there is something I can do to retain whatever health I have
    in my eyes. I went to another optometrist in the Portland area (not
    where I live) and some of the results were as I suspected. For
    distance I need:
    Plano
    +1.25
    which leaves me wondering about the doctors saying I needed
    -.50
    +.50.
    I do indeed have IOL's in both eyes but he did not know this until
    after the refraction, when he did the dilated exam. He also said
    another YAG would not do any good and the haze was from the IOL
    itself. I guess that nobody here can tell me whether I really had
    cataracts before the surgery. These were supposedly cortical cataracts
    of grade 2 in the right and grade 1 in the left. I would go in every
    year or two complaining of not being able to see well in the distance
    (I could see myself in the mirror and read just fine) and they would
    give me a new prescription and when I said I still couldn't see and
    couldn't even read well with the glasses on, they said that was the
    best they could do and that my eyes were healthy. Making it seem as if
    it were somehow my fault. They sent me for thyroid workups and MRI.
    They sent me for diabetic workups also. All tests were normal. So now
    I wonder if it was just too complicated for them to grind the lenses
    so they told me I needed cataract surgery. This might have been fine
    but during my latest refraction I realized that, contrary to what I
    had been told, I do have accommodation. This is less strong in my left
    eye but now I will exercise that eye more. My right eye only needs
    +1.50 to read and a stronger prescription leaves me feeling like the
    lens is too close to my eye. This type of accommodation might make an
    exam less than accurate because it takes me a little bit longer than
    before to focus up close. I began reading about accommodative spasm.
    For me, I don't know if spasm is the correct word. I have been doing
    the same things with my eye muscles since before I started school.
    What is the difference between progressive myopia and accommodative
    spasm? They both seem to lengthen the eye and compromise the vitreous.
    Over this many years shouldn't doctors be able to tell and inform the
    patient of this condition? Now that I have an IOL and still over-
    accommodate will my eye continue to lengthen and compromise the
    vitreous? Maybe I will become nearsighted in that eye again but I will
    be given a reading add based on my age and what I "should" need. What
    does the chart say for a person 55 years old? These are the questions
    brushed aside by OD's and OMD's alike. I still have many productive
    years left but I have not driven on the freeway since 1995 because I
    could not see far enough into the distance. Now, trying to get a good
    pair of reading glasses or bifocals seems impossible. Yet nobody has
    mentioned any diagnosis or prognosis. How do I find a skilled doctor
    who will take the time to listen and help me work with my eyes for the
    long term, not just until next week. I am private pay and have paid.
     
    cdavis, Apr 22, 2007
    #6
  7. cdavis

    Jan Guest

    schreef:
    More details please about which one is for the left or for the right eye
    and please give the best corrected vision acuity numbers

    And what best corrected vision acuity did you get with this prescription?
    Strange, it is quite common to ask you several things (the anamnese).
    Maybe you forgot to tell these important issues when the optometrist
    asked you about your eyehealth history?

    Reminds of the man who came to the general doctor.

    man: I'm ill
    doctor: what's the problem?
    man: don't know, you'r the doctor.


    He also said
    You give the answer yourself.

    I would go in every
    If you can read without spectacles I suppose you are myopic in one or
    both eyes, so your prescription S-0.5 S+0,5 might be more correct as
    your latest is.

    and they would
    Again your information is too less, what are the numbers of this
    prescription and where they meant for distance or reading or both?
    More details please.

    They sent me for thyroid workups and MRI.
    Here you go again, you change from history to nowadays and backwards and
    that is quit confusing.
    It is hard to follow where to place the different subjects in (time)place.

    This might have been fine
    If your inner lenses are removed and replaced by stiff IOL's you have NO
    accommodation possibilities.


    This is less strong in my left
    That's corresponding with the prescription you got before the last one.
    You also should noticed your vision acuity (uncorrected) for distance is
    less with the same eye.
    Your reading distance could be calculated to refraction error 0.5 dpt
    plus the 1.50 = 2.00 dpts what results in a 50 cm work distance.


    and a stronger prescription leaves me feeling like the
    Again, you have NO possibilities to accommodate.

    I began reading about accommodative spasm.

    For you, no need to.
    Here we go again, one or two IOL's?

    and still over-
    If you still have your own inner lenses it's possible to have a bit of
    accommodation left, not much however.


    These are the questions
    I refuse to accept that none of these eyecare professionals informed you
    about your problem and told you more than you are telling us now.


    I still have many productive
    For a start, try to write down your history with your eyes in a logical way.
    Be precise about the date and the findings on that particular date.
    Most of all, do not keep your mouth shut when a professional is asking.

    Jan (normally Dutch spoken)
     
    Jan, Apr 22, 2007
    #7
  8. cdavis

    cdavis Guest

    Thank you. I will get my long history together along with all
    prescriptions and measurements that I have. I don't have records from
    before 1995, only what I had been told were the needed corrections.
    Where I said that I could not see, I meant nothing well with the
    glasses on but I could see in the mirror and read with them off. I did
    go back, several times, but he would not remake them unless I paid
    more money because a new slab-off was time consuming and expensive. He
    did not do any remakes.
     
    cdavis, Apr 22, 2007
    #8
  9. cdavis

    Ms.Brainy Guest

    And you maintain that the patient should not even know what you have
    diagnosed?
    No, but he would explain that he has soldered the pipe so it won't
    leak.
    Sure. Is this what you would tell a 75 yr old with a retinal
    detachment? "Go to the library, grandma, and find out what it is. Or
    better ask your grandson to do some research for you on the Internet.
    It will take you a couple of weeks, but by then your macula will
    detach and you you may be blind beyond repair. What? You don't know
    what is macula?"
    Or look at our own "cda", with a computer and a determination to
    figure out what's going on with him (even suggesting that they might
    have removed his cloudy lens but didn't replace it with an IOL), who
    is totally lost in his desparate "homework".
    I believe that both can get the necessary basic "education" in a few
    minutes by a physician who is willing to give them those few minutes
    before he cut their eyes.
    Ask the Brits if it's better or not.
     
    Ms.Brainy, Apr 23, 2007
    #9
  10. cdavis

    Ms.Brainy Guest

    $300/hour????? You must be kidding! But this explains everything.
    So why do they say in those TV commercials -- "Talk to your doctor"?
     
    Ms.Brainy, Apr 23, 2007
    #10

  11. Let's say you go to a doctor with a headache, and the doctor thoroughly
    examines you, finds no health issues that pose a danger. The doc
    recommends you try an aspirin. You do, and the headache goes away.
    Further, every headache of this type responds the same way to aspirin, and
    the headaches no longer bother you.

    How much imaging should you go through to try to find a cause of this
    headache?

    Indeed, in the case brought up here, many patients would end up with
    corrective lenses, with or without the most accurate of "diagnoses"
     
    Scott Seidman, Apr 23, 2007
    #11
  12. cdavis

    otisbrown Guest

    Dear M. Brainy,

    Subject: The second-opinion, and how it develops.

    It is clear (from the conversations by M.O. ODs on sci.med.vision)
    that they believe that a strong minus (prescribed for "Best
    Visual Acuity) is the ONLY answer to Snellens on the order
    of 20/40 (if you would ever check).

    That is fine, they believe so totally that they put their
    own children into a strong minus -- the best and
    final ethical verification for doing so.

    But there is a second-opinion. And that is of course
    prevention (by various methods). If you are unhappy
    with your prescription, and want better suggestions, perhaps
    to clear your Snellen, they I would suggest that you
    MIGHT have accommodation "spasm", where your
    Snellen is 20/50, but with some work you could clear
    the muscle spasm, and pass the 20/20 line -- as
    some pilots have done it.

    But of course if you don't value your distant
    vision, then just wear your minus and don't worry
    about it.

    Otis
     
    otisbrown, Apr 23, 2007
    #12
  13. cdavis

    A.G.McDowell Guest

    I'm not in a position to compare the NHS with anything else, but I will
    comment that the NHS doesn't cover everything these days. As I have what
    they define as a complex prescription (in my case 18D myopia or so with
    about 2D of astigmatism on top) I get one free eye test a year and an
    allowance of about £30 for my glasses. The provision of glasses is
    private and my glasses cost about £400 with the allowance taken off. I'm
    not very happy with their quality either (I suspect my prescription has
    got to the point where it is too different from them to run through the
    same routine as with all their other pairs) but I guess that's a
    separate point. Similarly, there is supposedly an NHS dental service but
    the government fell out with the dentists over rates some years ago and
    never made up, which means that it is almost impossible to register as
    an NHS patient with a dentist.

    I have found UK opticians uniformly pleasant and helpful, but then again
    I don't detain them by asking them questions, apart from "is it safe for
    me to drive a car?"
     
    A.G.McDowell, Apr 23, 2007
    #13
  14. cdavis

    Ms.Brainy Guest

    Dear Otis,

    This is not the kind of second opinion I mentioned. This is rather a
    suggestion of an alternative method of treating the symptom.

    About 15 years ago a friend of mine died from breast cancer, 2 days
    before her 30th birthday. When she first noticed a lump in her breast
    she went to one of those "wholistic" healers, who diagnosed it as a
    cyst. He sold her some tea herbs, ordered her to quit coffee and some
    other stuff, and to come back for a followup within 2 months.
    Needless to say, the lump continued to grow, and when it became a size
    of a tennis ball I forced her to go to a real physician for a second
    opinion. Unfortunately, it was too late.

    A few years ago I went to see an ENT doc for a sinus problem. As he
    entered the room, and before even checking me, he already told me that
    I would need a special surgery. I didn't like his attitude and went
    for a second opinion. The other ENT doc laughed at the findings of
    the first doc and told me that I did not need any surgery, and gave me
    something to clear my sinus inflamation. It worked fine.

    Ever since, I became suspicious of those who rush to propose surgery.
    THERE IS MONEY IN SURGERIES, much more than in office visits. With
    this in mind, I went for second opinion when I was first diagnosed
    with a macular hole and was advised that I needed an eye surgery,
    although I had an OCT that showed the hole very clearly. How could I
    know that the OCT was really of MY eye? I was convinced only when I
    received an identical OCT from the second-opinion ophthalmologist, but
    before subjecting my eye to the knives I did an extensive reasearch on
    possible alternatives to surgery, risks involved, chances of success,
    etc.. Statistical data played a central role in my considerations,
    but they were not satisfactory to me. But I found out that high
    myopes were more prone to suffer macular holes. I concentrated in my
    research on macular holes, and still knew nothing about retinal
    detachment, which happened to my same eye 2 months after the mac hole
    was repaired, and started to collect info about it only AFTER my
    emergency RD surgery.

    Dear Otis, I was not a "high" myope according to the "official"
    definition, however, even my moderate myopia increased my risk of the
    affliction. Could any of your methods have spared me? Did it spare
    YOU from having a retinal detachment?

    Being curious, I checked your website with the hope to find out what
    you are advocating. I read your autobiography, but found nothing
    about your experience, only about your mental development. I checked
    a few of your links but couldn't find any explanation of the "plus
    method" and how it works. Maybe it's somewhere there, but I gave up.
    By repeating your "plus" and "second opinion" mantra you are not
    making any point. I think I have some idea of your suggested method
    of curing myopia, but it does not make much sense to me. For one, I
    don't think there is any evidence that any activity of the eye changes
    the SHAPE of the eye, that seems to be hereditory. You are playing
    ("accommodating") with the lens, but the lens is not the cause of
    myopia.

    Your "second opinion" is of no help to me and I don't believe it could
    have been when I was 13 and got my first pair of glasses that enabled
    me to see what the teacher wrote on the blackboard. If you take me as
    a potential convert or supporter, you are mistaken.
     
    Ms.Brainy, Apr 23, 2007
    #14
  15. cdavis

    Ms.Brainy Guest

    I agree with you. Whatever I wrote was not specifically directed to
    you or any particular eyecare professional who writes here. My
    comments were general. I don't even know what your specialty is,
    although I gather that most of the professionals here are optometrists
    who specialize in writing prescriptions and detecting problems that
    require referral to a specialist care. In fact I appreciate
    tremendously you and your colleagues willingness to give advice here
    to people who need it and can't find it elsewhere -- all this for
    free, no $300/hr charge :)
    much information. My next door neighbor, who has had 2 retinal
    detachments (which I detected by her droopy eyelid) has no idea
    whether she has had a vitrectomy or a scleral buckle, nor the location
    of her detachments. Furthermore, she has no clue of her eyeglasses Rx
    -- and she was a nurse! Apparently most people come to the doctor,
    tell what bother them and say: Fix me!

    When I faced a decision of whether to operate on my mac hole, I needed
    information to enable me to make a rational and educated decision.
    Unfortunately, I had no idea of the risk of retinal detachment, nor
    did I know (and still don't know) how often it happens. What I do
    know is that my condition today is worse than it could have been
    without the original surgery, but maybe nobody could have predicted
    it.

    After my retina surgeon left town I requested and received my medical
    record, and found many interesting things there. Among them I found a
    note (dated 3 months after my retinal detachment) about a macular
    pucker. Macular pucker? Nobody told me anything about it. Do I have
    a macular pucker? I still don't know. I asked the next retinologist
    who checked me thoroughly, and he said that I have some wrinkling of
    the retina. What does it mean? I don't know. I only know that my
    vision in the bad eye is distorted, besides being blurry from
    increased myopia and a thick cataract. Will a cat surgery correct
    it? I don't know. How correctable my vision is? I don't know. And
    if my vision is improved, how would my brain process it? I don't
    know, and I am worried about it. Maybe I am better off leaving the
    cataract in place, thereby causing my brain to ignore the bad eye,
    instead of ending up with a smaller disparity and confusing my brain?
    I don't know, and have no idea how I can educate myself and find out.
    If there are answers to these questions, only my ophthalmologists can
    tell me. And if there are no answers, they should also tell me. I
    need to make decisions and I don't have the information on which I can
    base these decisions, and nobody gives me this information.

    As a side note, I have found much false information on the Internet
    (on professional websites) about issues that I do know, together with
    lots of accurate and very helpful information.
     
    Ms.Brainy, Apr 24, 2007
    #15
  16. cdavis

    cdavis Guest

    Thank you again. As soon as I get back from Portland I will look them
    all up and post them. If they were written in +cylinder form should I
    post them that way or convert them to minus cylinder?
     
    cdavis, Apr 26, 2007
    #16
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