Glasses for 5 year-old twins

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

  1. Patrick Coghlan

    otisbrown Guest

    No, Allen, I do not give "medical advice".

    I just suggested to Pat that he become knowledgeable
    of the second-opinion, that refractive STATES of
    the fundamental eye run between zero to +2 diopters
    for a child of that age, and that a MEDICAL DOCTOR
    recommended that the child NOT be put into
    a plus.

    Pat has a right to understand that issue and
    make a choice between forcing his child to
    wear a +1.75 diopter 16/7, or wear
    no plus at all.


    otisbrown, Oct 18, 2006
  2. Pretty active thread, of course. Any time you get o.d.s against o.m.d.s
    or vice versa it gets interesting.

    Are you sure they were - not +? -=myopia, +=hyperopia.
    That's possible, but not necessarily true. It is also possible that
    he's undoing a lot of good.
    Fine. There is room for differences of opinion about what is
    "necessary" and what isn't. You pays your money and takes your
    chances. Hopefully the kids won't suffer. An 8 y.o. with 3 D. would
    be prescribed by every o.m.d. I know, and most of them will go lower
    than that in both age and diopters. So I think your o.m.d. may be
    showboating and loves to hammer on o.d.s.

    w.stacy, o.d.
    William Stacy, Oct 18, 2006
  3. Patrick Coghlan

    Pat Coghlan Guest


    Pat Coghlan, Oct 18, 2006
  4. Patrick Coghlan

    Pat Coghlan Guest

    Well, in the opinion of the opthamologist, you can't get a proper
    reading from young children without them. In fact, I think I said that
    they can't even bill unless the drops have been administered.
    Pat Coghlan, Oct 18, 2006
  5. Patrick Coghlan

    CatmanX Guest

    Who said your ophthal is right? He is restricted by his ability. If he
    does not know how to use a retinoscope, of course he will say this. It
    does not go to prove that he is correct in any way, maybe that he is
    ignorant or incompetent.

    The most effective way to treat your children is to evaluate the way
    the visual system operates, and you may want to think about the word
    system here. It means all the bits operating together. How can your
    ophthal assess anything about your children's eyes when he has
    deliberately taken one part out of the system? He is looking at a
    prescription, not how your children's eyes are working.

    You do not need to use a cyclo on all children. You especially don't
    need it at your kids levels of +1.5 to +3.00 and you need to consider
    what effects there may be in the long term.

    dr grant
    CatmanX, Oct 18, 2006
  6. Patrick Coghlan

    A Lieberma Guest

    As usual Otis WRONG AGAIN.

    The above are YOUR WORDS which sure appears to be medical advice.

    A Lieberma, Oct 18, 2006
  7. Patrick Coghlan

    Dr. Leukoma Guest

    Don't lecture me on vision. There is more to it than a Snellen chart
    at 20 feet.

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

    Dr. Leukoma Guest

    Pat has right to a second "qualified" opinion. This, of course,
    excludes yours.

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

    Dr. Leukoma Guest

    Gee, you think? I only encounter this with pediatric OMD's, by the
    way. Otherwise, I get along just fine with other MD subspecialists who
    actually go out of their way to make me look like a hero in front of my
    patient. Can somebody shed some light on this syndrome?

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

    otisbrown Guest

    Otis> And, it is obvoius, you would also "omit" telling
    Pat about the highly qualified judgment of an
    Ophthamologist, who recommends that
    a child with good visual acuity NOT wear
    a plus lens for a refractive STATE of +1.75 diopters.

    Otis> That is WHY there is a second-opinion -- and
    why it must exist and be understood by Pat.
    If I had a choce between a highly qualified MEDICAL
    opinion, and your OD opinion -- I would suggest
    that hte ophthamologist is more qualified than
    your are.

    otisbrown, Oct 19, 2006
  11. Patrick Coghlan

    Ace Guest

    You do know young hyperopes are still undergoing emmetropization. That
    +2 hyperope could very well become +.5 in a few years. Why interrupt it
    with a plus lens if he sees well and has no symptoms of eyestrain?
    Ace, Oct 19, 2006
  12. IF the refraction WERE 1.50 - 3.00 - but I have seen enough cases where the
    lack of a cycloplegic hid the fact that they were much more hyperopic, or
    anisometropic. I think testing BOTH ways is important, once, at least, when
    starting out, so you have all the information.

    BTW, what "effects there may be in the long term" are you talking about? I
    can't think of any in particular resulting from a cycloplegic exam that I
    have seen. And none that I know about other than a temporary allergic
    reaction or such (rare).
    David Robins, MD, Oct 19, 2006
  13. wrote:

    I would suggest
    The fact is that optometrists have more theoretical and didactic
    training in refraction and binocular vision and the treatment
    consequences of related problems. By far. I would say that the only
    o.m.d.s that could pass the refraction, optics and binocular vision
    parts of the National Board of Optometry Exams are those few who were
    first optometrists, then decided to be ophthalmologists. There are a
    handful of those in the U.S.

    Having said that, some of my best freinds are ophthalmologists, and they
    are certainly the best in surgery and treating difficult pathology
    cases. This thread is not about those cases.

    w.stacy, o.d.
    William Stacy, Oct 19, 2006
  14. Patrick Coghlan

    Dr. Leukoma Guest

    Prescribing for hyperopia in children without amblyopia or
    accommodative esotropia is highly variable. Since +1.75 diopters of
    hyperopia in a 5 year old is far outside of the norm, there should
    definitely be a "discussion" about prescribing. Hyperopia of less than
    one diopter is another matter.

    Since the only thing that matters to you is performance on a static
    Snellen chart, the rest of this discussion is totally moot. However,
    the reality is that in this highly competitive world, a child who lacks
    good reading skills is at a distinct disadvantage. Myopes typically do
    not have this problem nearly as often as hyperopes.
    And I would suggest that your opinions are absolutely worthless, and
    most here would agree.

    Just stick to what you know best: over the counter reading glasses to
    prevent myopia in pilots.

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

    CatmanX Guest

    I certainly don't disagree there David. My disagreement was that there
    is no assessment from the ophthal regarding accommodative status and
    can be none until the cyclo has worn off. Also a well performed ret
    will garner much the same result as a cyclo. I do both regularly.

    By long term, I am talking about reading performance, comprehension and
    the likes. My mnajor dealings with kids pertain to reading issues and
    is always the first thing that crosses my mind. +3.00 with reading
    issues is a poor combination. Glases can be very helpful here. What I
    am concerned about here is optoms pushing glasses, as well as ophthals
    pushing no glasses. It would appear neither camp in this case is
    looking at the kids, merely their personal bias. I try to make each
    judgement based upon the test results, the childs performance in class
    and how all this impacts upon the child and family. The ophthal here
    appears to be against glasses period. The optoms either are pushing
    glasses or not doing a good job explaining to the parents that the
    glasses are worthwhile.

    CatmanX, Oct 19, 2006
  16. Patrick Coghlan

    Dr. Leukoma Guest

    I also routinely perform retinoscopy, and in most cases it does an
    adequate job. However, it is not unusual to underestimate the amount
    of total hyperopia without using a cycloplegic agent. In fact, I can
    recall more an instance or two where both methods failed to reveal
    hyperopia. I think there are other important reasons to use a
    cycloplegic, if for no other reason than facilitating a better fundus
    examination and for medico-legal reasons.

    Dr. Leukoma, Oct 19, 2006

  17. From an earlier post from the OP
    "I'm a bit reluctant to have them start wearing glasses and will probably
    get a second opinion again."

    It almost seems to me that there's been some doctor shopping here, and the
    no-glasses approach might have been actively sought out.

    Perhaps this isn't the best case study over which to discuss the OD vs OMD
    approach. It's hard for me to believe that both types of practices would
    usually arrive at nearly the same treatment path nearly all of the time.
    Scott Seidman, Oct 19, 2006
  18. Patrick Coghlan

    Dr. Leukoma Guest

    I don't call recommending glasses for a +1.75 hyperope age 5 years as
    "pushing" glasses. Anything less than 1.00 diopter? Probably. Most
    parents have a strong antipathy towards eyeglasses for their children,
    and such a recommendation is never made lightly. It helps if there is
    a behavioral basis for the decision, such as poor concentration, poor
    attention span for close work, headaches, squinting, rubbing the eyes,
    etc., etc. But, I think that +1.75 or +2.00 in a 5 year/old is a
    prescribable amount, and I wouldn't be acting the apologist.

    What I do find fault with is the manner in which the second opinion
    doctor disparaged a perfectly legitimate recommendation. Even the
    great authority on these matters, GK Van Noorden, states that
    prescribing for hyperopes is highly variable across practitioners.

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

    otisbrown Guest

    WS> ...and didactic training

    Otis> didactic -- fitted or intended to tach; prescriptive, Pedagogy;
    of teaching; systematic instruction.

    Otis> and yes, you do receive training -- but fail to discuss
    the seecond opinion when a child has a refractive STATE of
    +1.5 diopters, and the second-opinion is that the
    child should not be wearing the "plus" at that time.
    What you need to do is to be "didactic" with Pat,
    and explain EXACTLY why you think a child at +1.5 diopters
    should be wearing that plus -- when other highly qualified
    experts think (for didactic reasons) that the child should
    NOT be wearing a +1.5 diopter as the age of five.

    Otis> You need to "clean up" you "reasons why" at this point.
    (I do accept that there CAN BE reasons-why, but you
    have not been very articulate about them.)

    Otis> Maybe you can make the case FOR the +1.5 diopters
    to Pat so we can truly understand the "reasons why".
    That is what is all about.



    The fact is that optometrists have more theoretical and didactic
    training in refraction and binocular vision and the treatment
    consequences of related problems. By far. I would say that the only
    o.m.d.s that could pass the refraction, optics and binocular vision
    parts of the National Board of Optometry Exams are those few who were
    first optometrists, then decided to be ophthalmologists. There are a
    handful of those in the U.S.
    otisbrown, Oct 19, 2006
  20. Patrick Coghlan

    Dr. Leukoma Guest

    The reasons for doing something (as opposed to doing nothing) have been
    explained. Can't you read?
    I have made the case, which is that moderately hyperopic children tend
    to have a higher incidence of reading-related learning problems....even
    if they can pass the DMV exam.

    As was mentioned, it would appear that the OP was shopping for the
    advice they wanted to hear.

    Dr. Leukoma, Oct 19, 2006
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