Glasses for 5 year-old twins?

Discussion in 'Glasses' started by Pat Coghlan, Aug 23, 2006.

  1. Pat Coghlan

    Pat Coghlan Guest

    We have 5 year-old identical twins who will turn 6 next month.

    The optometrist checked them 3 years ago and said they needed glasses,
    but a second opinion from 2 child opthamologists said they could do
    without glasses.

    They were just checked again by the same optometrist who said they are
    both far-sighted with a weaker right eye and wrote a prescription for
    something in the range of -1.75.

    I noticed that they could both read the tiniest paragraph on the
    cardboard sheet as well as identify the smallest pictures, so they can
    obviously compensate (one of the benefits of being so young) and that
    the glasses would mostly be to relieve the strain. Not having glasses
    would not harm their eyes.

    I'm a bit reluctant to have them start wearing glasses and will probably
    get a second opinion again.

    What's the general consensus re: fitting them with corrective eyewear at
    this age when they can obviously compensate and don't seem to complain
    of headaches, sore eyes etc? They will be starting grade 1 soon, but I
    don't imagine that they'll have too much difficulty seeing the board
    since they are far-sighted.

    Do optometrists look at this situation differently than opthomologists?

    Thanks in advance.
    Pat Coghlan, Aug 23, 2006
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  2. Pat Coghlan

    otisbrown Guest

    Dear Pat,

    It is always wise to obtain the second-opinion. Then you can decide

    This statement is not consistent:

    Pat> They were just checked again by the same optometrist who said
    they are
    both far-sighted with a weaker right eye and wrote a prescription for
    something in the range of -1.75.

    Otis> In general a "farsighed" person will require a POSITIVE value,
    say +1.75 diopters. A "nearsighed" child will have some blur
    at distance, and will required a -1.75 diopter lens. Perhaps
    you could obtain a clarification.


    otisbrown, Aug 23, 2006
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  3. Pat Coghlan

    Salmon Egg Guest

    I agree with Otis on the disparity between the prescription numeric value
    (-1.75) and the diagnosis of "farsighted." You do not need to be a rocket
    scientist or health care professional to know that. The fact that they do
    see the smallest pictures would be an indication to me that they are
    near-sighted. With further testing there should be no doubt.

    Your more profound question is more difficult to answer. Should the twins be
    fitted with prescription glasses? If you read this newsgroup over the years,
    you would know that any answer to that question is controversial. It seems
    to me, that the almost party line response from the professionals is yes but
    a small proportion is wavering toward no. Otis and I, who are not vision
    professionals, probably would lean toward no.

    With twins, you might be in a position to do an experiment. Give one
    corrective glasses as proposed by your optometrist. The other would not get
    glasses or get bifocals to be used for reading but with no power for distant
    vision. As a parent, you obviously want the best for your kids. The trouble
    is, as you already point out, you do not know what that is.

    With hindsight, I would consult a vision specialist to find out if not
    getting glasses will do actual harm to your twins. My guess is that they
    will say no, but that it would make it tough to do well in school because
    they cannot see the blackboard well. Then I would give one twin the glasses
    and not the other. In a year or two you can fit both with glasses if

    Good Luck!

    -- Ferme le Bush
    Salmon Egg, Aug 23, 2006
  4. Pat Coghlan

    otisbrown Guest

    Dear Pat,

    As an engineer -- I prefer to do my own measurements and testing,
    just to double check.

    A competent person (medical, engineering, or science) should have
    no problem with YOU doing the checking.

    Just to make certain of your twin's Snellen reading, I would suggest
    that the read a "easy" Snellen on my site:

    This is the IVAC Snellen, and had "pictures" that the twins
    can easily see. If you inform your professional, I think
    he will be positive with you doing these "at home" measurements.

    There are ophthamologists who are very reluctant to put a
    5 year-old into a minus. That is the second-opinion on the

    Further, as stated here, a percentage of 5 year-olds do not
    have 20/20, but rather 20/30.

    The DMV in most states is between 20/50 and 20/40 -- and
    there is no reason to "rush" a child into a minus lens.

    So these are issues you should consider.



    otisbrown, Aug 23, 2006
  5. Pat Coghlan

    drfrank21 Guest

    I think both of you are misguided; the original poster likely got the
    sign incorrect and meant +175 and not -175. Both of you guys
    should be jumping up and down that the provider of these
    twins are suggesting the holy grail of PLUS lenses and not
    the evil twin of the MINUS lens (only a fiend would prescribe
    a minus lens).

    Without knowing what the dry and possibly wet refraction
    results, it would be pure speculation on whether the kids should
    be wearing a correction or not but I guess you and Otis know more
    about this than a lowly optometrist.

    drfrank21, Aug 23, 2006
  6. Pat Coghlan

    Salmon Egg Guest

    You are are attributing more to me than I wrote. I noted the the OP said
    that his twins could accommodate to close work. If that truly is the case,
    why would a main line optometrist suggest a +1.75D lens?

    I once was a "rocket scientist," but it does not take one, or an MD or OD,
    to ask such a question.

    -- Ferme le Bush
    Salmon Egg, Aug 24, 2006
  7. Pat Coghlan

    Pat Coghlan Guest

    It could have been a +1.75 instead of -1.75. She did mention that the
    eyeball was shorter, while someone who is short-sighted (myopia) has an
    eyeball that is longer.
    Pat Coghlan, Aug 24, 2006
  8. Pat Coghlan

    Pat Coghlan Guest

    I guess the /do no harm/ rule is the one we want to follow.

    She explained that the opthamologists probably did not recommend
    corrective lenses two years ago is that the visual demands of 3
    year-olds are not that great (distance reading, detail work etc.). Now
    that they are headed into grade 1, these demands will increase.

    I know that when I can't see or read something (I have a mild Rx for
    astigmatism, something like 0.5), I can get either of the twins to read
    it for me or tell me what it is, so they certainly can see fairly well.

    It's frustrating to have to keep 2nd-guessing the OD though. If we get
    another opposing opinion, I think we're going to have to change
    optometrists :-(

    Pat Coghlan, Aug 24, 2006
  9. It sounds like they are hyperopic and +1.75 is fortunately not a huge
    amount of that, so the Rx probably is pretty optional at this point. As
    a result, you will get a wide spectrum of answers, none of which will
    probably harm or help the kids all that much, but nobody knows for sure.
    Having said that, if they were my kids, I'd probably go with the Rx,
    at least part time (reading, tv, etc).

    If they were +3.00 or more, I'd say it was probably not optional and
    witholding the Rx could be damaging. If it were over +4.00 I'd call the
    cops if you didn't give them the Rx.

    w.stacy, o.d.
    William Stacy, Aug 24, 2006
  10. Pat Coghlan

    Salmon Egg Guest

    If the twins could do close work as indicated by their dad, that means that
    they could get accommodation of 1.75 + 3 = 4.75D presuming they viewed
    pictures at 33cm. Is that a reasonable amount even for young eyes? I am not
    the vision pro.

    What harm occurs when a strong positive lens is used for young eyes? That is
    other than just bumping into things.

    -- Ferme le Bush
    Salmon Egg, Aug 24, 2006
  11. Pat Coghlan

    Ace Guest

    5 year olds have great accomodation. Even if they were +3 or +4 they
    wouldnt need glasses *unless* it was for amblyopia controll if one eye
    was significently weaker and started getting lazy. I doubt they would
    wear glasses when it would make *no* difference in their vision! I for
    one would never wear glasses if I could see perfect without! Just give
    them eye exams annually and make_sure_that their refractive state does
    not fall into the negetive. When they fall down to +.5 it may be time
    to take action with a plus lens(with prisms if neccessary) for near
    work to prevent a negetive refractive state.
    Ace, Aug 24, 2006
  12. Pat Coghlan

    Neil Brooks Guest

    Do you see any potential harm in placing all of that effort on a young
    accommodative mechanism?

    Do you understand the near vision triad?

    Can you explain accommodative esotropia or esophoria?

    Could you please explain how it comes in to play here ... if it does at

    In light of your answers to the above, can you please explain your
    rationale for giving the above advice, and ... on what basis you
    provide it?

    Thanks, Ace. You're always annoying ... and quite often dangerous.
    Good to see =that= hasn't changed.
    Neil Brooks, Aug 24, 2006
  13. Pat Coghlan

    Simon Dean Guest


    it has been quoted to me, "once you go to prisms you cant go back". are
    you sure you mean prisms?
    Simon Dean, Aug 24, 2006
  14. Sure they *can* accommodate that much, but it causes esophoria and often
    esotropia, the former of which is usually uncomfortable for the child
    and the latter of which is always harmful to the child. Ace, Otis, et
    alia always view the human vision system one dimensionally, as if
    binocularity was of no importance. Ignorance is bliss.

    w.stacy, o.d.
    William Stacy, Aug 24, 2006
  15. Pat Coghlan

    otisbrown Guest

    Dear Pat,

    If the optometrist said "too short", then the refractive STATE is

    The refractive state of the young, normal eye runs between
    zero to +2 diotpers -- in the young.

    It is difficult to call refractive STATES in this range a "problem".

    Their Snellen is most probably normal for age 5 -- about
    20/30. (Worth your own checking).

    Perhaps you could get this majority-opinion optometrist
    to explain EXACTLY why he thinks these children
    should be wearing a "plus" lens at this point
    in their life.

    I would suggest the second-opinion, which was
    previously suggested to you -- to keep a
    lens off their face until they have more time
    to develop.

    It is good that you understand these two
    contradictory, or second-opinions. It allows you
    to make a choice in this matter.


    otisbrown, Aug 24, 2006
  16. Pat Coghlan

    Pat Coghlan Guest

    I asked her if the primary purpose for getting them corrective lenses
    was to relieve strain and her reply was yes.

    She also said one of the twins' right eye was a 'bit lazy', but she was
    so all over the map that I'm definitely going to get an opinion from the
    opthamologist they saw two years ago. If he again recommends against
    any correction at this stage, it's time to find a new OD.
    Pat Coghlan, Aug 25, 2006
  17. Pat Coghlan

    otisbrown Guest

    Dear Pat,

    If the ophthamologist recommends that a child with a refractive STATE
    of +1.75 diopters NOT wear a plus lens -- I would consider this
    a vaid second-opinion and NOT put the child into a strong
    plus at age 5.

    There is indeed a "secondary" effect to a +1.75 diopter lens worn
    all the time, and that is that the refractive STATE of the child
    will move in a strong positive direction. And that
    is what the ophthamologist would wish to avoid
    for your twins.

    There are STRONG OPINIONS about this issue -- and
    you will have to sort them out to the best of your ability.


    otisbrown, Aug 25, 2006
  18. Pat Coghlan

    Ace Guest

    Otis is right, plus at this point will be overkill, not only will it
    prevent myopia, it will leave them with too much hyperopia which will
    cause big problems in the future as they lose their accomodation and
    end up in bifocals. Let them undergo emmetropization, they shouldnt be
    +1.75 as they get older due to emmetropization. Otis has said its
    normal for young people to have this much positive refractive state
    which will go down to about +.5 several years from now and to plano
    somewhere in high school. Thats where they may want to use plus glasses
    for reading to avoid inducing a negetive refractive state.
    Ace, Aug 25, 2006
  19. Pat Coghlan

    CatmanX Guest


    you opted not to listan to this optom 2 years ago, you choose not to
    listen to them now. Why do we need to answer you? You will not listen
    to us either. You want to hear what you want to hear, not what is
    happening with your children.

    Yes, optoms look at eyes differently to ophthals. We actually know more
    when it comes to functional issues.

    With their script, it may be advisable to get glasses for near work,
    but I would like to see how their eyes function. The script should
    reduce by 1/2 over the next 4-5 years, and glasses will make no
    difference to the final Rx. They make a huge difference to how they go
    with learning to read however.

    dr grant
    CatmanX, Aug 25, 2006
  20. In all my years of practice, I've never ever heard an optometrist, an
    ophthalmologist, or any scientist in the field agree with that
    statement, and I've never seen it happen to any of the hundreds kids
    I've prescribed plus for. You and ace are misleading inoccent people in
    a harmful way. Your incessant b.s. on myopia development is at least
    not as potentially harmful as the above advice.

    w.stacy, o.d.
    William Stacy, Aug 25, 2006
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