Child needs glasses?

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.)

 

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
anything.

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.)

 

The answers are, Yes, Yes and Yes. There are those rare times.

 

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... )

 

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.

 

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

 

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.)

 

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 parents FULLY UNDERSTAND THE PURPOSE
AND INTENTION OF THE PLUS. See:

www.chinamyopia.org

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.


Best,

Otis

 

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?

???

 

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.

 

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.

grant

 

You've just met Otis Brown.

 

LOL

grant

 

LOL

grant

 

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.

Best,

Otis

 

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
vision?

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.]

Best,

Otis

Dicky

 

And the award for Greatest Irony of the Year goes to ... Otis Brown,
King of Distortions, Misrepresentations, and Outright Lies.

 

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

What happened?

 

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
don't.
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
minus.

Best,

Otis


-MT

 

Anecdotal, n=1, useless information, but ... considering the
source....

Your nephew has a fool for an uncle.

ibid.