Follow up to Questions about partially hyperopic 12 year old

This is a follow up to a post from last month.

Back in December I took my son to the doc, the Rx:
OD +3.50 + .75 * 90 (this is a corrected lazy eye)
OS +.50 sph

He has never worn glasses before.

We got the glasses a couple weeks ago, and he can not see from the
right eye.
I just got back from a follow-up appointment.
She did not use eye drops.
Doc has given me a new Rx:
OD +1.25 sph
OS +.25 sph

She keeps saying that he really is +3.5, but that "he's choosing not
to use the eye"
so we should try this weaker prescription. But I do not understand
because using the eye chart and covering his left eye, he can not even
read 20/60 with the +3.5 spectacles. I understand that with spectacles
his brain may decide it prefers to only use the left eye.
But after several days of wearing the spectacles wouldn't he adjust to
the correction? I don't see how she can claim that +3.5 is really
correct.
I'm wondering if the +1.25 is just a guess.


I don't know whether to get the Rx filled or go to a new eye doc.

Any comments here would be appreciated.

Thanks in Advance
Max

 

Idiot doctors think that putting a TRIAL lenses before the eyes of
children has some value!!!

It has, but a negative one.

The children just refuses them.

They should be taught how to use the eyes correctly, by means of central
fixation, and how to rest them.

That will be scientific and intelligent.

If the lenses do not work, the blame is put on the poor child!!!

And these people call themselves "doctor"...

--
Please visit
http://www.stores.ebay.it/juppiterconsultingrishi
and you can buy a replica of the Original Dr. Bates book
"Perfect Sight Without Glasses"
and if you are interested, join the group
http://health.groups.yahoo.com/group/PerfectSight/

 

(max) wrote in message
Dear Max,

In my opinion, your son should be described
as amblyopic in the right eye.

You might ask the OD if ANY lens will create
at least 20/40 in the right eye.

Amblyopia is a condition where NO lens will
clear the distant vision. It is considered
nerurological, and can not really be "fixed"
with an applied external lens.

Dr. Dave Robins can probably clarify that
point. I am surprised the OD used the
term "hyperopia" to describe amblyopia -- although
it is her call.

A person with "hyperopia" is considered to
be a person whose distant vision can be
cleared to 20/20 with an applied positive lens.

How old is your son?

Best,

Otis
Engineer


*********

 

Amblyopia ex anopsia ( trans: blunted vision due to disuse) which is usually
discussed on this newsgroup,
usually has a refractive cause and without use of a corrective lens will not
resolve as the image is out of focus.
The neurological element occurs because the 'brain' is recieving a different
image to the other eye. The amblyopic eye may be
considered to have been 'switched out of circuit' and orthoptics and
spectacles are an attempt to bring it back in.
Treatment involves the use of corrective lenses and vision training.
Where there is no refractive cause then treatment is very difficult.

NO. Hyperopia is where the correcting distance lens is plus.The level of
corrected vision is immaterial. Just because someone has a V.A. of 6/24 and
the correcting lens
is +4.00DS does not mean that they are not hyperopic, they are, but they
have partial amblyopia.

In the case in question the young man would appear to have refractive
amblyopia, but there is no mention
as to whether he has a right stabismus (squint) as this will effect any
treatment. My feelings are that he
should have the full correction with patching and if heading upto aet 7 then
maybe pleoptic treatment should be
consideredin addition. For interest if he has a squint in the Right Eye the
it may be he has a true 'Donders Squint'.


Regards


Ian Hodgson - Isle of Man

 

otis,
thanks for your reply.
i should have been clear.
he was treated by this doctor for amblyopia in the right eye a few years ago.
he wore a patch for many months. many checkups.
she declared him cured, but never prescribed glasses.
i had no idea that he could not see out of the eye without glasses.
when we went for a routine exam in decemeber, she used
drops, and, with correction, he did see 20/20 from the right eye.
i mention the drops because at the followup appointment where
i was concerned because he could obviously not see out of his glasses,
the doctor insisted the Rx was correct because that's the Rx
with the drops.

it's all very frustrating.

anybody know a good eye doctor in northern NJ ????

thanks
max

 

I would base the prescription only on a cyclopleged refraction (eyedrops
used). If the correct Rx is the first one, then in an amblyope where you
want to try to treat, I would give almost the full Rx (cut maybe 0.25 or
0.50 off the full numbers. You must maintain the right-left difference in
order to make the eyes come into focus at the same time. So, I'd likely use
a +3.00 +0.75 x90 (R ), and plano (L).

She is claiming the +3.50 is correct because it is - the cuting of that lens
more than the other is to give up on hoping to get the eyes into focus
corectly.

HOWEVER: even with the best focus, the amblyopic eye will only see as well
ast he brain allows it to. I believe in a later post you said in December he
did see 20/20 with correction. In which case, you want to leave both eyes
with the correct focus, as in the first paragraph. Normal eyes will
accommodate well and see maybe 20/20 even with a 4D hyperopia, but amblyopic
eyes sometimes are unable to accommodate well. In any case, during amblyopia
treatment, as well as after, the refractive difference in the eyes has to be
accounted for with the glasses in order to maintain the best vision.



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

 

Dr Robins,

I appreciate your reply to my post.
The problem is that after about a week or so of wearing these glasses
(evenings only, i must say, since he couldnt even walk without
bumping into walls), it was clear to me that he could not
see from the right eye.
Even when i took him back to the dr, using her eyechart, he couldn't
even quite read the 20/60 line through that eye with his glasses.
at that same visit he DID read the eyechart better through the right
eye without his glasses.

i don't know why she didn't do the cyclopleged refraction on this 2nd
visit
since we were having such problems.
my assumption was human error in her writing of the Rx.
I figured a 2nd cyclopleged refraction
would be the way to confirm or refute that.

as for your comment that he should have had glasses during the lazy
eye treatment. as a layperson, that's what i would have thought.
as i mentioned in another post on this thread, i had no idea
what his vision was. i assumed the correction of the lazy eye brought
him to 20/20 in that eye. since it seems like it brought it to more
like 20/40 - 20/50ish (uncorrected), as a parent, and as somebody
wearing glasses all my life (and with an UNCORRECTED lazy eye), i
would
have expected a recommendation that he wear glasses.

one comment on this most recent visit from the dr was that
since my son "is not willing" to use the right eye, we dont have to
make him.
he's perfectly fine using just one eye.
i expressed my concern that he wouldnt have binocular vision,
and she said that this was only important in close-up work.
as a layperson with poor binocular vision, and poor depth perception,
that sounds nuts to me.
i'd give my right arm to turn back the clock and force my parents to
have
forced me to wear that patch when i was a young child.
i'm a 20/30 minus, corrected, in my lazy eye, and it makes a world of
difference.

i'm just very confused as to what to do, and what's really going on.

bottom line, i feel in my gut like she must have screwed the first
exam
(simply transcribed the numbers incorrectly ???)

thanks for hearing me out
max