Child needs glasses?

Discussion in 'Glasses' started by EmmettPower, Oct 28, 2005.

  1. EmmettPower

    Dom Guest

    I beg to differ. Dozens of patients have presented to me over the years
    c/o frontal HAs put down to "sinus", "stress" or idiopathic by their
    doctor but subsequently resolved very quickly and effectively with
    +0.50s once mild hyperopia was detected in the eye exam.

    Not every one with a refraction of +050 is symptomatic or requires
    correction, and the child at the start of this thread may well be in
    that group... however it would be irresponsible not to at least offer
    correction to those patients who do experience relevant symptoms (e.g.
    frontal headaches, eye strain, difficulty concentrating, a child falling
    behind in reading or comprehension, etc, etc).

    To suggest that +0.50s are prescribed as some sort of misguided
    amblyopia treatment is missing the point entirely.

    Dom
     
    Dom, Oct 30, 2005
    #21
    1. Advertisements

  2. EmmettPower

    Dom Guest

    When I see a patient like your son, I really want to know what his
    symptoms are: does he get sore eyes or headaches...hows his reading
    progress ... how's his comprehension...how's his concentration at school
    and for doing homework... (all relative to the norms for age)

    If I find +050 in the eye test, then the decision to get glasses or not
    is based almost entirely on whether he's coping well. If he's a straight
    A student with no problems (if you can be a straight A student at age
    6!) then there's no way I'd recommend glasses. However if I hear
    comments like "he avoids reading" or "he's a smart kid but just can't
    concentrate" or "he's always rubbing his eyes and blinking" then I do
    recommend the specs.

    Dom
     
    Dom, Oct 30, 2005
    #22
    1. Advertisements

  3. EmmettPower

    Dr. Leukoma Guest

    I agree with you in that the child must be symptomatic.

    But I also tell the parents that this is probably a temporary measure,
    that the child will outgrow the problem, and that the child will
    outgrow the need for the glasses as well.

    DrG
     
    Dr. Leukoma, Oct 30, 2005
    #23
  4. EmmettPower

    otisbrown Guest

    Dear Dom,

    Subject: Surprise -- I can agree with you.

    The real difficulty was that NO INFORMATION was given to Emmett.

    This clearly is a "second-opinion" situation, where you would
    "prescribe a +1/2 diopter lens, and other OD would not.

    Thus, any use of a lens (or not) should
    have been preceeded by a discussion with Emmett about this issue.

    In fact the OD did nothing of the kind, and INSISTED that the child
    wear the +1/2 diopter -- with full knowledge that he was doing
    something that many OTHER ODs would object to.

    That is the issue.

    Otis
     
    otisbrown, Oct 30, 2005
    #24
  5. EmmettPower

    p.clarkii Guest

    otis, does your term "the second opinion" refer to wearing plus lenses
    whether they are intended for myopia prevention or for ANY problem?

    Dom alludes to the issue of whether the patient might have latent
    hyperopia or an accommodative disorder that might produce problems when
    he is doing near work. he recommends, as almost all ODs would
    recommend, that such patients use +0.50 readers. these are almost
    alway beneficial to the patient. on the otherhand, if the patient is
    nonsymptomatic then their use is unnecessary.

    fyi, this is standard-of-care, or as you would say "the majority
    opinion".

    this topic has nothing to do with myopia prevention. you know even
    less than normal about this topic. just go away. go post in
    alt.med.vision.improve
     
    p.clarkii, Oct 30, 2005
    #25
  6. EmmettPower

    p.clarkii Guest

    i disagree. if a hyperopic child is symptomatic with eyestrain,
    headaches, blur, etc. when doing prolonged nearwork, or has difficulty
    concentrating on schoolwork then i have found +0.50 readers to be quite
    effective. what else would you recommend?
     
    p.clarkii, Oct 30, 2005
    #26
  7. EmmettPower

    LarryDoc Guest

    IMHO, it is a rarity that +.50 specs would be more than a placebo (but
    more on that coming!). But as Dom wrote, when there ARE symptoms for
    which you can not identify any pathology, that low plus rx might, for
    whatever reason, resolve those symptoms. Is it a spasm in
    accomodative-convergance? Is the cause an iris sphincter over reaction
    to that itsy bitsy accomodation? Does that +.50 just push the fusion
    system to finally lock? And so what if it is a placebo effect? As long
    as the parent and child understand that the specs are "therapy or
    treatment" that will be discontinued after a short time when the vision
    system is "healed", so be it.

    Sure, there might be unethical scam-and-rip-off eyeglass sellers willing
    to rx +.50s, but consider the ethical and responsible doctor actually
    listening to the patient's symptoms and trying something that actually
    be of benefit and doing so for that, and only that reason.

    I think it is far, far worse for MDs to rx antibiotics for a child with
    sniffles and runny nose caused by virus because the parent expects a
    pill to fix the symptoms. Or the doc who dispenses sodium sulfacetamide
    drops for the associated "pink eye." Eh, David?

    --LB, O.D.
     
    LarryDoc, Oct 30, 2005
    #27
  8. EmmettPower

    Dr. Leukoma Guest

    At the risk of seeming unpleasant, this is precisely the sort of
    knee-jerk, dogmatic, condescending type of response I find it difficult
    to understand.

    DrG
     
    Dr. Leukoma, Oct 30, 2005
    #28
  9. EmmettPower

    p.clarkii Guest

    i am not trying to be unpleasant. i apologize if my response seems
    strong. I guess i can't understand why anyone would make a sweeping
    statement that +0.50 readers are useless and only serve to make
    opticians money. do you use +0.50 readers? do you think they are
    useful for hyperopes who have eyestrain associated with reading? i use
    them for symptomatic patients; i think they are effective; and i can't
    think of an alternative solution.

    again, i'm not trying piss anyone off but i just don't understand and i
    think its reasonable to ask for clarification. it could be that i'll
    learn something.
     
    p.clarkii, Oct 31, 2005
    #29
  10. EmmettPower

    Dr. Leukoma Guest

    Ha! Sorry about that. I was referring to the post to which you were
    responding. My remarks were not meant for you. I was agreeing with
    you.

    I do believe that there is a place for +0.50 spectacles as I have
    stated in previous posts.

    DrG
     
    Dr. Leukoma, Oct 31, 2005
    #30
  11. EmmettPower

    otisbrown Guest

    Clar> otis, does your term "the second opinion" refer to wearing plus
    lenses
    whether they are intended for myopia prevention or for ANY problem?

    Otis> No, that was NOT the issue.
    The issue was that this OD (optician) totally FAILED to discuss the
    REASON why $400 reading glasses were prescribed -- with no discussion
    with Emmett about this issue. Had Emmett had the reason explained to
    him, and understood it, then I do not think he would have posted his
    objection. Consulting with the person RESPECTS that person's right to
    understand alternatives. In this case, NOT prescribing a +1/2 diopter
    was the second opinion at stated by Dr. David Robins.


    Clar> Dom alludes to the issue of whether the patient might have latent

    hyperopia or an accommodative disorder that might produce problems when

    he is doing near work.

    Otis> Fine. This SHOULD have been part of a discussion and review with
    Emmett BEFORE anything was done.
    The optician should have said that he believes that that +1/2 diopter
    was "right", but that the second-opinion, was that nothing should be
    prescribed. A true professional would have no problem making that
    statement to Emmett.

    Clar> he recommends, as almost all ODs would
    recommend, that such patients use +0.50 readers.

    Otis> It is obvious that this optician ORDERED the kid to get a +1/2
    diopter with NO intelligent discussion with Emmett as to WHY this was
    done.

    Clar> these are almost
    alway beneficial to the patient.

    Otis> And you know I agree with that statement! But even though I
    personally advocate this -- I still think that Emmet must be informed
    of the nature of his choice. Otherwise you wind up with Emmett deeply
    distructing the optician and the "reasons" for that "prescription".

    Clar> on the otherhand, if the patient is
    nonsymptomatic then their use is unnecessary.

    Otis> But again, the opticain totally failed to explain ANY OF THIS to
    Emmett. If he had, the there would be no problem. The failure was to
    explain Emmett's right-of-choice, the fact that the kid had (20/20 --
    best guess) and there was no overt reason for "prescribing" those 1/2
    diopter lenses.

    Best,

    Otis





    fyi, this is standard-of-care, or as you would say "the majority
    opinion".


    this topic has nothing to do with myopia prevention. you know even
    less than normal about this topic. just go away. go post in
    alt.med.vision.improve
     
    otisbrown, Oct 31, 2005
    #31
  12. EmmettPower

    Dr. Leukoma Guest

    At discussion is the principle of whether or not there is ever
    sufficient reason to prescribe +0.50D eyeglasses for a 6 year/old
    child. Nothing at all was mentioned about the price of them.

    Otis, of all people, should not be lecturing others on the ethics of
    prescribing lenses. Otis wouldn't hesitate to recommend plus lenses to
    Emmett, but only on the condition that he would not purchase them from
    an O.D.

    DrG
     
    Dr. Leukoma, Oct 31, 2005
    #32
  13. EmmettPower

    Ann Guest

    Which response is that then? You don't even give us a hint.

    Ann
     
    Ann, Oct 31, 2005
    #33
  14. EmmettPower

    EmmettPower Guest

    Coming back on the question as to why the optician was suggesting that
    glasses were needed.

    My son is doing well at school and socially and he is generally very
    happy in himself. He does well in ball games. He doesn't watch much
    television or spend a lot of time on a computer ~ maybe half an hour a
    day in total.

    He doesn't complain of 'constant' headaches or sore eyes.

    However, when he is tired he sometimes goes into eye-blink mode for a
    few seconds. The rate of blinking is maybe once a second. Occasionally
    he complains of having a mild headache. Both typically occur within an
    hour of his bedtime.

    The blinking occurs maybe once a week, the headaches maybe once a
    month. Both seem to be decreasing in frequency.

    We have seen the rapid eye blinking with his friends and cousins of the
    same age so we weren't particularily worried but we decided to take him
    to the optician just to check that everything was OK.

    The optician argued that he should have glasses because they 'might'
    help with the blinking. Her argument was that if we got the glasses and
    they didn't help then no harm was done.

    Of course, in the meantime she had sold us glasses without the ability
    to return them. I got the strong sense of end-of-month quotas.

    Regards

    Emmett
     
    EmmettPower, Oct 31, 2005
    #34
  15. EmmettPower

    Dom Guest


    Many who argue that +050s are unecessary claim it's because a young kid
    has many dioptres of accommodation in reserve, therefore to focus
    through the half dioptre of hyperopia should be well within their
    capabilities.

    But here's an analogy: - it's very easy to raise your straightened arms
    out away from your sides and hold them in a horizontal position, and in
    fact we could do it while holding an object in each hand, indicating
    that we have strength in reserve... but even empty handed, maintaining
    this position for more than a few minutes, or for six hours a day would
    be too much to ask. This is what we're asking a +050 hyperope to do when
    we send him to school for a day. It's not the acute demand, it's the
    continuous nature of the demand that causes the symptoms.

    There may well be a little bit of placebo in there too, and as Larry Doc
    says, who cares! But I think most of the effect is physical, real, and
    pretty simple to understand.

    Dom
     
    Dom, Oct 31, 2005
    #35
  16. EmmettPower

    Dr. Leukoma Guest

    The same post to which "" was responding, Ann.

    DrG
     
    Dr. Leukoma, Oct 31, 2005
    #36
  17. EmmettPower

    Ann Guest

    LOL.. long since deleted. But never mind, I've forgotten all about it
    now.

    Ann
     
    Ann, Oct 31, 2005
    #37
  18. EmmettPower

    otisbrown Guest

    Dear Dr. G.,

    No, I would NOT put a child with 20/20 into a +1/2 diopter lens
    (even IF I though it was wise) UNLESS the parent had
    full information as to the REASONS WHY.

    If Emmett does not understand those reasons, then
    (providing the child has eye-chart 20/20) you
    should not do it.

    Equally, if Emmett were given the resaons -- and evaluated
    them completely, then there would be a role for
    the use of the plus.

    Only AFTER Emmett agreed, and understood, should
    a "plus" be used. And in THAT case, I would suggest
    that a "plus one" should be used.
    (But that WHOULD require and "educated parent".

    The "price" I don't care about. I would rather pay
    $300 for the education about this issue (supported
    by prevention advocacy websites) and pay
    the going rate for over-the-counter plus lenses.

    The real "price" is in the educational process,
    and not in the lens.

    Best,

    Otis
     
    otisbrown, Oct 31, 2005
    #38
  19. EmmettPower

    p.clarkii Guest

    thanks for the reply.
    i try not to be a jerk but sometimes it just happens ;)
     
    p.clarkii, Oct 31, 2005
    #39
  20. At least, from Academy of Ophthalmology, regarding astigmatism specifically:
    at age 6, if >= 1.00 D of cylinder, should be ordered,. (But I also order if
    the vision is less than expected, and the cyl is less than 1.00 D )

    Myopia of -0.50 probably would not both a 6 year old at all, even in school.
    If they were older, and the teacher is writing small and far away, or they
    are driving age, then it starts to become significant.

    Hyperopia of +0.50 is not normally significant at all, except perhaps in an
    adult who is presbyopic age and is uncomfortable.


    David Robins, MD
    Board certified Ophthalmologist
    Pediatric and adult strabismus subspecialty
    Member of AAPOS
    (American Association of Pediatric Ophthalmology and Strabismus)




    )On 10/29/05 11:28 AM, in article
    X3Q8f.663$, "Dick Adams"
     
    David Robins, MD, Nov 1, 2005
    #40
    1. Advertisements

Ask a Question

Want to reply to this thread or ask your own question?

You'll need to choose a username for the site, which only take a couple of moments (here). After that, you can post your question and our members will help you out.