Glasses for 5 year-old twins

Our twins finally got a 2nd opinion from the opthamologist after being
told by an optometrist that they needed glasses.

To recap, one of our twins was (under drop, the term used by the
opthamologist) -1.50 in each eye, while the other was -2.00 and -2.75.

The opthamologist said the following:

1) Children under-9 should NOT normally be given corrective lenses if
they are hyperopes and within 2-3 diopters, provided they seem to be
able to function well visually. He mentioned something about young
children having lots of "reserve".
2) Although optometrists in Ontario fought for years for the right to
administer cytoplegic (?) drops, few actually use them and it's
virtually impossible to accurately measure a child's refraction without
them (e.g. with an auto-refractor).
3) He is currently doing about 20 second opinions each week (he had done
4 by noon today when he called me back) and reversing virtually all the
recommendations received from optometrists for prescriptions given to
young children. As a result, there must be thousands of young children
out there wearing glasses unnecessarily.

For us, that makes twice in 3 years that the OD has overruled the
optometrist. We're going to follow his recommendation.

-Pat

 

I thought OD meant optometrist. Did you mean ophthalmologist?

Bill
-- Fermez le Bush

 

If they are hyperopes, the numbers must be (+) not (-). Minus is myopic.

 

Cycloplegic drops should be administered by medical doctors and optometrists
are NOT medical doctors.

The OD stands for the optometrist. An ophthalmologist is an MD who
specializes in the eye. Your twins need to see a pediatric ophthalmologist,
not a general optometrist.

 

Actually, optometrists *are* allowed to use "drops" to dilate the pupil
and administer a cycloplegic refraction. I believe they can also
prescribe some types of medicine and eyedrops, such as used for dry
eyes. What they *cant* do is surgury, although I heard theres a waiver
for PRK(not lasik!)


anyway if your children are hyperopic, they dont need glasses if theres
no symptoms. If they are myopic, Otis can offer advice to help them
clear their vision to 20/40 or better.

 

Just an opinion from an optometrist.

Why under 9? Why not 10? There is no logic here. 2-3 dioptres is not a
good level to read with even with "plenty of reserve".

This is a total load of crap!!! I will pit my retinoscope up againt
your ophthal any day. Cycloplegics don't give you much difference in
result and you are assessing an unnaturally altered system. I always
base my scripts off my ret, even having done a cyclo refraction. Also
autorefractors are for clowns that can't use a ret, and for what it is
worth, the good autorefractors these days will get the result without
using cyclo.

Yes, but I see 20 second opinions from ophthals a week, most have been
given wrong prescriptions or no prescription. That your ophthal says
not to get glasses does not make him right. The major difference
between optoms and ophthals is that we deal with systems that function
in the real world, not the hypothetical of "plenty of reserve". The
requirements of children at school these days is very different than
when you were at school. The worst case scenario of your children
getting glasses is that they would be of no benefit. They would not
cause problems, worsening or anything else.

That may be a wise decision or it may be not. Having not tested your
children, I can't say one way or another, but for what it is worth, an
ophthal does not know more about eyes than an optom, he may know more
about surgery, but your children don't need that. Optoms are much
better than an ophthal at what they do, which is prescriptions and
glasses and contacts. I will happily put my refraction skills against
an ophthal. What I look for in cases such as your children is how they
are functioning, which your ophthal can't assess as he has stuck
cycloplegic in their eyes. How has he assessed their focussing and
convergence skills? What is their AC/A ratio? How much lag is there
when they read? Can they clear minus lens with ease? What are their
accommodative and vergence reserves? I bet these were not tested, but I
wouldn't be making any recommendation to you without these results as
they tell me how your kids eyes work. Once I have this, I have a
baseline to compare against at a later date.

dr grant

 

Your reasoning here is? Using that argument, dentists should not be
allowed to administer anesthetics or give injections, nor should
podiatrists, because neither are "medical doctors." I have a thriving
pediatric section to my practice, and have been using cycloplegic drops
routinely on children from 2 years and up for the past 20+ years.
Studies show that uncorrected hyperopia is the vision condition most
responsible for reading-related learning disorders in children.
Uncorrected hyperopia is also more likely to be associated with lazy
than any other refractive condition.

An OD specializes in vision and the diagnosis and correction of vision
problems in adults and children.

DrG

 

Actually, a friend of mine is an anesthesiologist with a dental anesthesia
practice. Dentists and oral surgeons hand him money like he's doing them
the biggest favor in the world--and in fact, it is close. Dollars to
donuts, if I ever require a general during a dental procedure, this would
be the arrangement I'd use. It's safer.

That's not to say that this has anything to do with cycloplegic agents, of
course, but the risks of using these agents are not the same as those of
general anesthesia during a dental procedure.

 

That should read "lazy eye."

But, look, certainly if a child is symptomatic the prescription is
given. The key is in determining whether the child is symptomatic, or
rather if there are signs of a problem. Signs of a problem would
include reading ability or performance on nearpoint tasks. Beyond
that, there is a threshold beyond which glasses should be prescribed
simply because the burden on the accommodative/convergence system is
too much even in the absence of any "demonstrable" signs or symptoms,
and this "threshold" is not something all doctors are going to agree
upon. There is also the question of whether the hyperopia --
regardless of magnitude -- is bilateral and relatively equal between
the two eyes. Also, and perhaps more importantly, what are the visual
acuities?

With respect to pediatric OMD's vs. optometrists: Can you say "turf
war"?

DrG

 

I wasn't even thinking of general anesthetics. I was thinking of
locals. I don't have a problem with my dentist administering light
sedation with nitrous, but I have never used it.

DrG

 

But it does make you wonder. Every day, people receive general from oral
surgeons-- and its fine, until something goes wrong, in which case, you
really wish an anesthesiologist were around. FWIW, its my understanding
that its the malpractice discount that pushes dentists towards services
like that my friend offers.

 

I have no problem with an anesthesiologist administering general
anesthesia, because I am somewhat frightened of it. I have had several
extractions by oral surgeons in my lifetime that involved the injection
of sodium pentothal. The problem is that I am not in any position to
debate the training of oral surgeons in that area, and I have always
just assumed that it was quite extensive.

I know of quite a few eye surgeons who utilize nurse anesthetists
instead of anesthesiologists, and have seen a few of them administer
pentothal induction before giving the peribulbar injection.

DrG

 

What a hero. My take is that there are thousands of young children out
there who are potentially being deprived of proper treatment and good
vision in the critical learning years.

DrG

 

Subject: Ophthamologist versus optometrist

With respect to pediatric OMD's vs. optometrists: Can you say "turf
war"?

Otis> I think the correct term would be majority-opinion versus
second-opinion.

Otis> Thus the medical doctor would not put a child (who has
good visual acuity) into a strong plus for a refractive STATE of +1.74
diopters,
versus the second-opinion optometrist would do that.

Otis> Patrick has the right to understand that:

1. His children have visual acuity comparable for a child of their age
and:

2. The second-opinion is that a child with a refractive STATE
of +1.5 diopters -- should not be wearing a +1.5 diopter lens
at that age.

That is the reason for an informed, competent second-opinion
on putting a child into a plus lens.

It is a parents right to be informed of this issue -- as
we are doing on sci.med.vision.

Best,

Otis



DrG

 

Dear Pat,

I think that the ophthamologist is correct.

A positive refractive STATE is called "hyperopia", and
the un-necessary prescription would be +1.5 diopters
and +2 diopters. Refractive STATES are normal.
It would be of value to establish the child's approximate
Snellen reading.

If the child were at -2.0 diopters, his Snellen would be
about 20/70 to 20/100. I do not think this is the
case.

Best,

Otis


To recap, one of our twins was (under drop, the term used by the
opthamologist) -1.50 in each eye, while the other was -2.00 and -2.75.

 

[sarcasm]That sure added clarity.[/sarcasm]

 

....you can always believe [DR]Brown.

Oh, and by the way, a refractive error of +2.00 on a five year/old is
not normal...statistically speaking.

 

I find it difficult to believe that Otis Brown was a myopic child.
Myopic children are typically much more intelligent. Hyperopic
children, on the other hand, have a much higher rate of reading-related
learning disabilities. Possibly Otis was a hyperope who underwent a
radical myopic shift.

DrG

 

Dear Pat,

Please disregard Otis's postings. He is not in the medical profession nor
in any position to give medical advice.

Thank you.

Allen

 

Leuk> What a hero. My take is that there are thousands of young
children out

Otis> Good Vision? There was no statement about
visua acuity, and a refractive STATE of +1.75 diopters
is normal for a five year-old child.
The optical medical doctor was correct. There is
no good reason why the child should be put into
a +1.75 diotper lens. But that is the second-opinion,
and you fail to understand the concept, not to
mention the right of the parent to informed choice
in this matter.

Best,

Otis