Glasses for 5 year-old twins

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.

Best,

Otis

 

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.

 

Yes.

 

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.

 

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

 

As usual Otis WRONG AGAIN.

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

Allen

 

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

DrG

 

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

DrG

 

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?

DrG

 

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.

Otis

 

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?

 

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).

 

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.

 

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.

DrG

 

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.

grant

 

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.

DrG

 

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.

 

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.

DrG

 

WS> ...and didactic training

Otis> didactic -- fitted or intended to tach; prescriptive, Pedagogy;
art
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 sci.med.vision is all about.

Best,

Otis


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.

 

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.

DrG