Follow up to Questions about partially hyperopic 12 year old

Discussion in 'Optometry Archives' started by max, Jan 27, 2004.

  1. max

    max Guest

    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
    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, Jan 27, 2004
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  2. 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
    and you can buy a replica of the Original Dr. Bates book
    "Perfect Sight Without Glasses"
    and if you are interested, join the group
    Rishi Giovanni Gatti, Jan 27, 2004
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  3. max

    Otis Brown Guest

    (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?



    Otis Brown, Jan 29, 2004
  4. 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'.


    Ian Hodgson - Isle of Man
    Ian Hodgson Opticians Ltd, Jan 29, 2004
  5. max

    max Guest

    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 ????

    max, Jan 29, 2004
  6. 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

    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)
    David Robins, MD, Jan 31, 2004
  7. max

    max Guest

    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
    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
    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
    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

    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
    (simply transcribed the numbers incorrectly ???)

    thanks for hearing me out
    max, Jan 31, 2004
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