Glasses for 5 year-old twins

Discussion in 'Glasses' started by Patrick Coghlan, Oct 18, 2006.

  1. 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.

    Patrick Coghlan, Oct 18, 2006
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  2. Patrick Coghlan

    Salmon Egg Guest

    I thought OD meant optometrist. Did you mean ophthalmologist?

    -- Fermez le Bush
    Salmon Egg, Oct 18, 2006
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  3. If they are hyperopes, the numbers must be (+) not (-). Minus is myopic.
    David Robins, MD, Oct 18, 2006
  4. Patrick Coghlan

    Fidelis K Guest

    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.
    Fidelis K, Oct 18, 2006
  5. Patrick Coghlan

    Ace Guest

    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.
    Ace, Oct 18, 2006
  6. Patrick Coghlan

    CatmanX Guest

    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
    CatmanX, Oct 18, 2006
  7. Patrick Coghlan

    Dr. Leukoma Guest

    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.

    Dr. Leukoma, Oct 18, 2006
  8. 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.
    Scott Seidman, Oct 18, 2006
  9. Patrick Coghlan

    Dr. Leukoma Guest

    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

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

    Dr. Leukoma, Oct 18, 2006
  10. Patrick Coghlan

    Dr. Leukoma Guest

    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.

    Dr. Leukoma, Oct 18, 2006
  11. 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.
    Scott Seidman, Oct 18, 2006
  12. Patrick Coghlan

    Dr. Leukoma Guest

    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.

    Dr. Leukoma, Oct 18, 2006
  13. Patrick Coghlan

    Dr. Leukoma Guest

    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.

    Dr. Leukoma, Oct 18, 2006
  14. Patrick Coghlan

    otisbrown Guest

    Subject: Ophthamologist versus optometrist

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

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

    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
    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

    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



    otisbrown, Oct 18, 2006
  15. Patrick Coghlan

    otisbrown Guest

    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



    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.
    otisbrown, Oct 18, 2006
  16. Patrick Coghlan

    Dr. Leukoma Guest

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

    Dr. Leukoma, Oct 18, 2006
  17. Patrick Coghlan

    Dr. Leukoma Guest 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.
    Dr. Leukoma, Oct 18, 2006
  18. Patrick Coghlan

    Dr. Leukoma Guest

    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.

    Dr. Leukoma, Oct 18, 2006
  19. Patrick Coghlan

    A Lieberma Guest

    Dear Pat,

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

    Thank you.

    A Lieberma, Oct 18, 2006
  20. Patrick Coghlan

    otisbrown Guest

    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.


    otisbrown, Oct 18, 2006
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