Glasses for 5 year-old twins

Dear "L",

Using non-standard methods on a child -- with no discussion
with the parent about the alternative. Effectively restraint
of information that is crucial to understand your "preferred"
alternative.

A 5 year-old child has a refracive STATE of +1.5 diopters and
visual acuity that is comparable to most 5 year olds.

There is no overt indication of any problem.

Pat did was not told of any problem AT ALL.

The +1.5 diopter was an OPINION of the OD who was
going to put the child into a +1.5 diopter lens.

While I would be willing to support that type of "approach",
I think Pat should have been given sufficient information
to understand that:

1. That is your second-opinion.

2. Standard practice is to NOT put a +1.5 diopter lens
on a child that has a natural and normal refractive STATE.

If you wish to do this, you need to explain this in detail
and get the written permission from Pat that you
recommend a non-standard method -- and the
reasons for it.

Pat might "buy into" your "reasons". But anything
less than that is not being completely fair to Pat -- and
he had to go to a "majority opinion" ophthamologist
to find this out.

I would in fact be WILLING to support the use of
the plus in the manner -- but ONLY if the parent is
fully informed as to the the reasons, and has
the ability to understand that putting a child
into a +1.5 diopter with good vision -- is at
best the "second-opinion".

Best,

Otis

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.

Otis> Funny, but Pat was not told of your second-opinion.
Further, he should have been told that this was YOUR OPINION,
and not standard practice.

Otis> Your failure was one of arrogance -- to ASSUME that
Pat "wanted" a +1.5 diopter -- and to prescribe it
with no informed concent.

Best,

Otis

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


DrG

 

Dear "L",

Using non-standard methods on a child -- with no discussion
with the parent about the alternative. Effectively restraint
of information that is crucial to understand your "preferred"
alternative.

A 5 year-old child has a refracive STATE of +1.5 diopters and
visual acuity that is comparable to most 5 year olds.

There is no overt indication of any problem.

Pat did was not told of any problem AT ALL.

The +1.5 diopter was an OPINION of the OD who was
going to put the child into a +1.5 diopter lens.

While I would be willing to support that type of "approach",
I think Pat should have been given sufficient information
to understand that:

1. That is your second-opinion.

2. Standard practice is to NOT put a +1.5 diopter lens
on a child that has a natural and normal refractive STATE.

If you wish to do this, you need to explain this in detail
and get the written permission from Pat that you
recommend a non-standard method -- and the
reasons for it.

Pat might "buy into" your "reasons". But anything
less than that is not being completely fair to Pat -- and
he had to go to a "majority opinion" ophthamologist
to find this out.

I would in fact be WILLING to support the use of
the plus in the manner -- but ONLY if the parent is
fully informed as to the the reasons, and has
the ability to understand that putting a child
into a +1.5 diopter with good vision -- is at
best the "second-opinion".

Best,

Otis

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.

Otis> Funny, but Pat was not told of your second-opinion.
Further, he should have been told that this was YOUR OPINION,
and not standard practice.

Otis> Your failure was one of arrogance -- to ASSUME that
Pat "wanted" a +1.5 diopter -- and to prescribe it
with no informed concent.

Best,

Otis

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


DrG

 

Excuse me????? Sure likes medical advice since you SUPPORT it.

Where is your medical practitionaire license?????

Hey Neil,

Maybe the PA state board would be intrigued by the above medical advice?

Allen

 

Are you privy to what was discussed? I am not.

A refractive error of +1.5 in a five year old is not normal. Can't you
get that through your thick cranium?

Again, I am not privy to that information. Are you?

I'm sorry. I don't recall where that was stated. Do you?

It was the recommendation of the optometrist, yes.

The OD was not consulted for a second opinion. The OMD was.

You have no idea what standard practice is. No idea whatsoever.

If this is a non-standard method, then Pat should inform the licensing
board.

On three separate occasions, no less.

No. The second opinion was from the OMD, who disagreed with the first
opinion. Is your reasoning impaired?

DrG

 

Read and enjoy:

Hyperopia and educational attainment in a primary school cohort
W R Williams1, A H A Latif2, L Hannington3 and D R Watkins4
1 School of Care Sciences, University of Glamorgan, UK
2 The Children's Centre, Royal Glamorgan Hospital, UK
3 Dewi Sant Hospital, Pontypridd, UK
4 Taff Street, Pontypridd, UK
Correspondence to:
Dr A Latif
The Children's Centre, Royal Glamorgan Hospital, Llantrisant, CF72
8XR;

Accepted for publication 7 July 2004

Background: Vision screening addresses the visual impairments that
impact on child development. Tests of long-sightedness are not found in
most school screening programmes. The evidence linking mild-moderate
hyperopia and lack of progress in school is insufficient, although
strengthened by recent findings of developmental problems in infants.

Aims: To report on the relation between hyperopia and education test
results in a cohort of primary school children.

Methods: A total of 1298 children, aged 8 years, were screened for
hyperopia on the basis of fogging test results. School test results
(NFER and SATs) were compared between groups categorised by referral
status and refractive error.

Results: A total of 166 (12.8%) fogging test failures were referred for
ophthalmic assessment. Ophthalmic tests on 105 children provided an
accurate diagnosis of vision defects, for reference to their education
scores. Fifty per cent of the children examined by optometrists
required an intervention (prescription change, glasses prescribed, or
referral). Mean (95% CI) NFER scores of children with refractive errors
(summed for both eyes) >+3D (98.4, 93.0-103.8, n = 32) or >+1.25D
(best eye) (99.3, 93.0-105.6, n = 26) were lower than the respective
scores of children with a less positive refractive state (104.8,
100.7-108.9, n = 43) (103.6, 99.7-107.4, n = 49), the non-referred
group, and total sample. The SATs results followed a similar trend. A
high proportion of the fogging test failures (16%) and confirmed
hyperopes (29%) had been referred to an educational psychologist, and
the latter group contributed substantially to the poor education
scores.

Conclusions: The results of this study provide further evidence for a
link between hyperopia and impaired literacy standards in children.
==================================================================

Optom Vis Sci. 2004 Apr;81(4):233-7.

A survey of clinical prescribing philosophies for hyperopia.

Lyons SA, Jones LA, Walline JJ, Bartolone AG, Carlson NB, Kattouf V,
Harris M, Moore B, Mutti DO, Twelker JD.

The New England College of Optometry, Boston, Massachusetts, USA.

BACKGROUND: Prescribing philosophies for hyperopic refractive error in
symptom-free children vary widely because relatively little information
is available regarding the natural history of hyperopic refractive
error in children and because accommodation and binocular function
closely related to hyperopic refractive error vary widely among
children. We surveyed pediatric optometrists and ophthalmologists to
evaluate typical prescribing philosophies for hyperopia. METHODS:
Practitioners were selected from the American Academy of Optometry
Binocular Vision, Perception, and Pediatric Optometry Section; the
College of Vision Development; the pediatric and binocular vision
faculty members of the colleges of optometry; and the American
Association for Pediatric Ophthalmology and Strabismus. Surveys were
mailed to 314 participants: 212 optometrists and 102 ophthalmologists.
RESULTS: A total of 161 (75%) of the optometrists and 59 (57%) of the
ophthalmologists responded. About one-third of optometrists surveyed
prescribe optical correction for symptom-free 6-month-old infants with
+3.00 D to +4.00 D hyperopia, but fewer than 5% of ophthalmologists
prescribe at this level. Most eye care practitioners prescribe optical
correction for symptom-free 2-year-old children with +5.00 D of
hyperopia, and this criterion for hyperopia decreases with age. Most
ophthalmologists (71.4%) prescribe the full amount of astigmatism and
less than the full amount of cycloplegic spherical component, and most
optometrists (71.6%) prescribe less than the full amount of both
components. When prescribing less than the full amount of astigmatism,
eye care practitioners do not tend to prescribe a specific proportion
of the cycloplegic refractive error. CONCLUSION: Pediatric eye care
providers show a lack of consensus on prescribing philosophies for
hyperopic children.

 

We've been down this road before. I ALWAYS DISCUSS the options of
wearing glasses with parents. Often, +1.50 is optional, often not at
all necessary. Sometimes it is crucial. Do you know anything about
AC/A ratios? Some kids that are +1.50 are esotropic because of it. Did
you know that? Did you know some of these kids can develop amblyopia if
they are NOT corrected early, and that sometimes a simple plus lens can
easily fix an esotropia?

If things were as simplistic as you think, I would have only needed a
few hours of physiological optics, binocular vision, and vision analysis
training, instead of years. For your level of knowledge and
understanding of this subject, you got just the right amount of training.

 

Dear "L",

All of that is very nice -- but Pat seems to not
be "impressed", and it seems his kids were
to be put into a strong plus with no
knowledge on his part of these issues.

So he had to get the real truth of this
situation from an ophthamologist -- who
and no problem SUGGESTING that
the plus was not necessary.

I do not recall Pat stating that he was
given a choice in this matter. If he had,
he would have made his mind up with no
need to post on sci.med.vision.

Best,

Otis

 

Dear "G",

I know that you believe that all refractive STATES are ERRORS.

That is what they teach you in OD school, facts
and concept to the contrary.

But let us be clear about natural refractive STATES
of primates in the wild. (Data taken from
Rhesus from the wild.

Average refractive STATE (+0.7 diopters)

Standard Deviation +0.7 diopters.

This means that 68 percent of the population
had refractive STATES running from zero
to +1.4 diopters.

At the 2 sigma level, the natural refractive STATE
ran between -0.7 diopters to +2.1 diopters.

I consider these to be natural refractive STATES
of the fundamental eye. Obviously you love
to call them "errors" from you antique
theory that calls a refractive STATE of
exactly zero -- the only "normal" state.

By your theory, about 1 percent of these
monkeys have "normal" eyes. All the
rest are "defective".

I can NOT agree with your wording, nor
description of the refractive STATES of
all natural eyes.



A refractive error of +1.5 in a five year old is not normal. Can't you

get that through your thick cranium?


Otis> Can't you get the idea that the natural eye can
have refractive STATES (not errors) and be normal?

Otis

 

I see that facts and the scientific method do not impress you. But,
we've know that for quite awhile now, haven't we?

Pat exercised choice on three occasions as far as I can tell.

DrG

 

Those of us in the "biz" call them refractive errors. You can call
them what you wish.

DrG

 

Not content to be the "expert" on myopia, Otis is engaging in "mission
creep" into hyperopia. Does his genius know no bounds?

DrG

 

Why are you discussing monkey data again? Is this not a HUMAN
discussion?

No one care what you consider. And what the hell is a "fundamental
eye"?

Obviously you love to make up terminology and quote statistics that have
no relation to the discussion.

Boring old man. You contribute nothing to the body of knowledge. I'd
guess you're only read for amusement. Doesn't that just eat you up
inside?

LB

 

I do recall the OMD mentioning that their refraction will continue to
change over the next few years.

Since they seem to see perfectly right now without straining, I'm
willing to wait and see.

 

No, not shopping for the advice I *wanted* to hear.

Rather, only putting 5 year-olds (now 6 year-olds) into glasses only if
really necessary.

Apparently, it's not.

 

True, she (OD) really didn't seem to lead me to believe that there was
any choice in the matter. She was happy to march us straight into the
lobby to look for frames, yet both boys can discern a "flea on a flea"
with their naked eyes.

 

Yes, kids are all individuals, and neither "side" should be pushing one of
the other - they should push inwhatever direction the individual child needs
(or doesn't need) help.

The accommodation needs to be measured, obviously, before the cycloplegic
retinoscopy. Can't start with that. It is true, I have been amazed to see
new patients come to the ophthalmologist's office already dilated at home
before they have ever been seen. This is in kids to rule out strabismus,
amblyopia, reading problems, etc., none of which can be done it they are
seen for the first time already dilated!!

 

Volumes have been written about the "necessity" of wearing corrective
lenses. Perhaps "advisable" is a better word in many cases. Moderate
uncorrected hyperopia is the only refractive condition that is highly
associated with reading/learning deficits in children, and would be
alert to early signs of fatigue and shortened attention span for close
work.

DrG

 

What makes you think that correcting a +2 hyperope for reading will
interrupt emmetropization?

How do you measure eyestrain? Do you ask the child if it matters to
them if they need to accommodate twice as much as an emmetrope? Or, do
you just muse about the marvels of accommodation and convergence and
the ability of young children to "compensate" and "cope," and the
virtues of necessity over prudence?

Or, would you give the child the opportunity to not have to work so
hard to accommodate and determine for themselves if the glasses are
beneficial? They'll tell you by how often they use them. Don't you
think the child has that right?

I think before I provided a "knee-jerk" second opinion condemning the
hyperopic correction, I would put the child's interests first and have
this discussion with the parent.

DrG

 

He's obviously up to his "monkey business" again.

Also, the new paradigm dictates plus for myopes to retard myopiagenesis
and minus for hyperopes to stimulate emmetropization. Haven't you
heard.....?

DrG