Child needs glasses?

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

  1. Well, I beg to differ also. (And yes, we can agree to differ - that is what
    this group is all about.)

    I still think +0.50 cannot be the cause of headache. It is too insignificant
    (NORMALLY). I say normally, because a child's accommodation is many times
    that of the +0.50 hyperopia, and as such should not cause headache. It just
    doesn't make sense.

    Yes, if they have a real lack of all accommodation, thenit is possible, but
    those are very rare indeed.

    I'll bet some of those kids would have stopped having headaches with a plano
    Rx, as a lot is in their head, not their eyes.

    (This is based on my 25 years of experience of doing kids.)
    David Robins, MD, Nov 1, 2005
    1. Advertisements

  2. Ahah! The HYPEROPIC child. How hyperopic? Yes, if they are strainging near
    the limits of accommodation, then 0.50 might tak e the edge off it. I'm
    talking about the "normal" child, who is not very hyperopic. Certainly, if
    their cycloplegic is +0.50, then +0.50 Rx is not going to do much of

    IF they are going through a growth spurt, I do somethimes see a child,
    usually in the 7-11 y/o range where they complain of reading problems. I get
    some over the counter readers, perhaps +1.00 or +1.25, which sometimes seems
    to help. They use them a couple of months, and the symptoms go away. (My own
    daughter did have that problem.)
    David Robins, MD, Nov 1, 2005
    1. Advertisements

  3. The answers are, Yes, Yes and Yes. There are those rare times.
    David Robins, MD, Nov 1, 2005
  4. I have never ordered less than +1.00 readers in children. I have tried trail
    lenses with less, and never found it to make any more improvement than I got
    with plano.

    (PS. I wonder if Dr.G was referring to my remark, not yours, where I
    blanket-statement said +0.50 is homeopathic., which may have overstated it
    just a slight bit... )
    David Robins, MD, Nov 1, 2005
  5. EmmettPower

    p.clarkii Guest

    if a child truly has just +0.50 refractive error then what you say is
    true. however commonly they cycloplege much higher than that. so say
    they are truly +1.50-- then giving them +0.50 readers leaves them just
    enough hyperopia that they can handle comfortably themselves via
    accommodation without blurring their distance.

    so i usually try to give a child with near complaints a spectacle
    correction using the maximum plus that they can accept and still retain
    their maximum distance BVA (20/20, 20/25 or whatever i find it to be).
    in my experience patient acceptance is better by reducing distance blur
    complaints and they still get benefits from the Rx. frequently i
    cannot get a child's "maximum plus to maximum acuity" more than +0.50.
    p.clarkii, Nov 1, 2005
  6. EmmettPower

    CatmanX Guest

    I would expect that response from a paediatric ophthalmologist.
    However, you have not ascertained whether there were symptoms or what
    the child's reading performance is like. What are their phoria,
    accommodative skills, ocular motility and vergences like? What is the
    child's reading level? Are they complaining of headaches,
    distractability, fatigue, etc?

    As a huge generalization, mothers do not take their children for eye
    tests unless there is some problem initially. Was there in this case?
    Before we start flaming optometrists for lining their pockets, why
    don't we get a few details first?

    Grant Mason BScOptom MOptom FACBO FCOVD PGCOT
    Board Certified Optometrist
    Paediatric Specialty
    Senior Optometrist Sydney Olympics 2000
    Senior Optometrist Special Olympics 2002, 2003, 2004
    CatmanX, Nov 19, 2005
  7. EmmettPower

    CatmanX Guest

    Interestingly enough, +0.50 is easily capable of causing symptoms.
    Ciliary muscle is smooth muscle, and not designed for continued
    constriction. Smooth muscle tends to fatigue over time, and this is
    where low plus helps. The ciliary muscle does not get stronger with
    continued use, that is striated muscle that does this. The reason kids
    grow out of low plus is development of better control of the A/C system
    over time. Low plus helps continued concentration on near work until
    this happens.

    Why do we see more low plus being prescribed? Mainly due to increased
    reading at younger ages. What happens in your scenario is the child
    stops reading, reduces reading or changes technique to skimming to
    reduce the stress. My approach is to keep reading performance at
    optimal levels.

    (This is based on my 22 years of experience doing kids.)
    CatmanX, Nov 19, 2005
  8. EmmettPower

    otisbrown Guest

    Dear Catman-X,

    Subject: Explaining the "reasons" for providing a plus.

    I am going to agree with the use of the plus -- but not
    for the reasons you suggest.

    As per Dr. T. Grosvenor, I believe that a strong plus should
    be STARTED when the child is a +1/2 diopter -- provided

    The failure develops when the parents are not
    completely informed of the need for the plus.

    If they are not -- the "plus" can not be used.

    I believe that this is the major point being
    made on this thread.


    otisbrown, Nov 19, 2005
  9. EmmettPower

    Dick Adams Guest

    Plus what, fercrisakes?

    A convex lens with a certain value, in diopters focal length?
    Possibly compounded with cylinder and prism?
    Maybe more than one?
    In a frame supported by the nose and ears?
    Used how?

    Dick Adams, Nov 19, 2005
  10. EmmettPower

    Dick Adams Guest

    Does he want convex lenses to blur distance vision or to lessen some of
    the work (strain?) to of accomodating for reading and other close vision?

    "Plus" I think is adjective. Certainly not a noun. You are using it as a noun,
    as well as Otis. You guys are letting Otis make you silly.
    Dick Adams, Nov 19, 2005
  11. EmmettPower

    CatmanX Guest

    Your logic is flawed. Myopia is predominantly due to peripheral retinal
    blur. THis can happen with genetic inheritance or environmentally or
    both. Wearing plus for myopia retardation only resolves one of these
    issues, not the other.

    Secondly, MOST kids of +0.50 are not going to go myopic, so why put
    high plus on them for no reason. Secondly, one study found
    over-plussing was worse than no script in on group of kids (B1 type).

    The issue in this thread is what was the reason for the script in the
    first place? Sounds like either:
    1) Child needs glasses and optometrist not explaining reason to mum,
    2) Mum not listening/understanding optometrist,
    3) Need more sales for the day.

    I do not know which is correct. I do know that plus can be beneficial
    in some children, but you need to do the tests to estabkish this and
    you need a reason to prescribe, such as symptoms or academic problems.

    CatmanX, Nov 19, 2005
  12. EmmettPower

    Neil Brooks Guest

    You've just met Otis Brown.
    Neil Brooks, Nov 19, 2005
  13. EmmettPower

    CatmanX Guest


    CatmanX, Nov 19, 2005
  14. EmmettPower

    CatmanX Guest


    CatmanX, Nov 20, 2005
  15. EmmettPower

    otisbrown Guest

    Dear Mike,

    Again you totally mis-quote me.

    1. If a plus is to be used, I suggest
    that the parents be informed of
    the basic concept -- before their
    eye chart goes below 20/40.
    This information is "free" and you
    can find it on Steve Leung's
    web site.

    2. It is essential that the person
    (kid) understand this issue clearly.
    If he has no interest -- then that
    ends the discussion and the possiblity
    of prevention for that kid. (He can
    always wear a -1.5 diopter lens
    all the time -- and develop
    stair-case myopia.)

    3. But equally, if the "kid" figures
    it out, uses the plus and passes
    the 20/20 line, then the issue
    is not a medical issue. In fact
    you suggested that the people
    who did this had "pseudo-myopia"
    and if so, could always clear on
    their own -- with out your involvement.


    otisbrown, Nov 20, 2005
  16. EmmettPower

    otisbrown Guest

    Dear Dicky,

    Thanks for your response.

    As ususal, Mike will distort
    what I have said about the
    natural eye's proven behavior -- for
    his own purposes.

    I personally agree that "prevention" is difficult but possible -- if
    the person is
    prepared to agressively use the
    plus -- before he starts wearing that minus.

    Otis> If the kid does not want to develop stair-case myopia (ref:
    Oakly-Young study) maybe he will take prevention seriously. In which
    case "compliance" will be up to this kid, won't it?

    Dicky> Does he want convex lenses to blur distance vision

    Otis> The "situation" is that the parents and kid verify eye-chart as
    20/40 or better. That passes the DMV test in most states. Thus his
    eyes are on the threshold of nearsighedness. The issue is clearing to
    better-than 20/40 under the person's control. It is indeed a difficult
    thing to do, because most people only want instant sharpness of vision
    -- with a minus lens. Certainly the "minus" is far easier than the
    preventive-plus, but
    that issue must be discussed.

    Dicky> ... or to lessen some of
    the work (strain?) to of accomodating for reading and other close

    Otis> With the conditions I stated, the proper-strength plus would be
    used for all reading. The eye-chart would be monitored by the kid --
    to make certain he always passes all legal visual-acuity requirements
    that apply to him.

    Dicky> "Plus" I think is adjective. Certainly not a noun. You are
    using it as a noun,
    as well as Otis. You guys are letting Otis make you silly.

    Otis> Yes, they seem to go "off" when I state basic objective facts
    that prove that the natural primate eye is a dynamic device -- when
    correctly tested.
    That is because they can not allow scientific truth to be, well,
    scientific truth.

    [The usual "explosions" will follow.]



    otisbrown, Nov 20, 2005
  17. EmmettPower

    Neil Brooks Guest

    And the award for Greatest Irony of the Year goes to ... Otis Brown,
    King of Distortions, Misrepresentations, and Outright Lies.
    Neil Brooks, Nov 20, 2005
  18. EmmettPower

    Neil Brooks Guest

    Weren't you going away?? Didn't you vow to leave this place and have
    no further part of it?

    What happened?
    Neil Brooks, Nov 20, 2005
  19. EmmettPower

    otisbrown Guest

    Dear Mike,

    Subject: Prevention -- not "cure"

    Mike> Yes, you suggest that, but you don't have a license to maintain.

    Otis> That is correct. That is why the person himself MUST make
    up his mind about the use of the plus, i.e., take complete
    control as Dr. Stirling Colgate did. Further, my nephew
    did for the same reason. And specifically, Keith
    was presented with the Oakley-Young study
    (over 4 years) that proved that the plus group
    went down at approximately zero diopters,
    and the single-minus went down at
    -1/2 diopter per year AVERAGE.

    Otis> The result (potentially) is that a person
    using a stronger plus -- UNDER HIS OWN CONTROL --
    can clear his visoin, while his fellows are
    developing -2 diopters during four
    years in school.

    Otis> But you are in NO POSITION to
    help anyone with true-prevention are you.
    This fact FORCES the person (Keith)
    to do it himself. His last report
    is 20/20 (actually better).

    Yes, but you believe kids who wear glasses get worse than kids who
    Despite all evidence to the contrary.

    Otis> Cut the self-serving bull s___. "All evidence to the contrary".
    No that is just your "majority opinion" talking. You don't
    speak for all ODs, and many, including Professor
    T. Grosvenor has suggested prevention with the
    plus as you well know -- but TOTALLY IGNORE.

    Otis> But eqully, I do agree that implementation is tough,
    which again means that the person must decide
    for himself how much he values his distant
    vision -- before he loses it to an over-prescribed



    otisbrown, Nov 20, 2005
  20. EmmettPower

    Neil Brooks Guest

    Anecdotal, n=1, useless information, but ... considering the
    Your nephew has a fool for an uncle.
    Neil Brooks, Nov 20, 2005
    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.