Glasses for 5 year-old twins?

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.

 

Dear Pat,

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

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.

Best,

Otis

 

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
necessary.

Good Luck!

Bill
-- Ferme le Bush

 

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:

www.myopiafree.com

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
subject.

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.

Best,

Otis

+++++++++

 

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.

frank

 

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.

Bill
-- Ferme le Bush

 

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.

 

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

 

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.

 

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.

Bill
-- Ferme le Bush

 

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.

 

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
all.

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.

 

prisms????

it has been quoted to me, "once you go to prisms you cant go back". are
you sure you mean prisms?

 

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.

 

Dear Pat,

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

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.

Best,

Otis

 

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.

 

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.


Best,

Otis

 

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.

 

Pat,

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

 

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.