Help 7 month old with anisometropia and possible amblyopia

Discussion in 'Optometry Archives' started by Rafael, Nov 7, 2003.

  1. Rafael

    Rafael Guest

    Sorry if I did not make it clear. In all 4 visits they dialated the
    eyes. (2 sets of drops over half an our, then the tests were done).
    One doctor mentioned that if the dialation process was not done
    correctly, it could account for the meassurment difference between
    I did hear in the different offices that they were diluting the drops
    with something for the baby. In some they used 2 different drops in
    the last one they used 3...

    We greatly appreciate the time you are taking to answer our concerns.
    Your information makes sense of what is going on with the different
    doctor recommendations. None of the OP's took the time to explain this
    much detail to us.

    We beleive we need to make a choice ASAP one way or the other.

    1. Now if we decide to go with #3 (glasses, not full rx), is it true
    that once we start with glasses, there is not going back and will have
    to keep the glasses for many years? Somewere I read that taking them
    off later will actually make the whole thing much worse than having
    never wore glasses. This makes the desicion much more final....

    2. Given the 4 opinions, does it seem that Sabrina will use glasses
    within the next 2 years regardless? If so it seems to us that we might
    as well start early and give the baby the same development
    opportunities as other children without anisometropia and RX < 3.0....

    Our goal is to have her sight be the best possible by age 7 and making
    sure that from now to that age she has all the stimulus necesary to
    create the best visual cortex develoment.

    Rafael, Nov 8, 2003
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  2. Rafael

    Dr. Leukoma Guest

    Here, read this. It might help you to understand where you have missed the
    boat. Your "minority opinion," if followed, might result in harm to the
    child's vision, if the child has amblyopia. Since there is no assurance at
    this age that the child does not have amblyopia, and that the eyeglasses
    will not interfere with the normal growth of the eye, and that the child
    has already two risk factors for amblyopia (heredity, anisometropic high
    hyperopia) in addition to the opinions of two specialists, there is no
    other logical alternative except to treat. Whether you regard me as a non-
    expert or an expert has nothing to do with the facts. Since I am licensed
    to treat refractive error and amblyopia in my state, it behooves me to
    understand the facts, and I will continue to take you to the mat whenever
    you set off my highly attuned BS detector.

    This study was published in Investigative Ophthalmology and Visual Science,

    Normal Emmetropization in Infants with Spectacle Correction for Hyperopia
    Janette Atkinson1, Shirley Anker1, William Bobier2, Oliver Braddick1, Kim
    Durden1, Marko Nardini1 and Peter Watson3
    1 From the Visual Development Unit, London and Cambridge, Department of
    Psychology, University College London, United Kingdom; the 2 School of
    Optometry, University of Waterloo, Canada; and the 3 Department of
    Ophthalmology, Addenbrooke’s Hospital, Cambridge, United Kingdom.


    (Otis Brown) wrote in
    Dr. Leukoma, Nov 8, 2003
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  3. Rafael

    Dr. Leukoma Guest

    (Rafael) wrote in
    Studies by Atkinson and others have demonstrated that early intervention
    and partial correction of hyperopia in infancy resulted in better acuity
    for both single and crowded letters, and a lower incidence of strabismus in
    early childhood. In addition to the developmental benefits, partial
    correction does not appear to significantly effect the process of
    emmetropization, whereby the refractive error is normalized.
    Statistically, given the already high hyperopia, it is quite unlikely that
    your child will be emmetropic by age 3, even if nothing was prescribed.
    However, it is also highly likely that once given spectacles, you will be
    taking your child back for periodic refractions. This will present the
    opportunity to adjust the prescription to match the level of hyperopic
    reduction that should take place in any event. As you have so
    appropriately observed, providing the opportunity for visual and cognitive
    development should take precedence over the concern for wearing corrective
    lenses later in life.

    Dr. Leukoma, Nov 8, 2003
  4. Rafael

    Otis Brown Guest

    Dear Rafael,

    Is I suggested, Dr. Dave Robins made excellent suggestions
    concerning a "go slow" use of that plus lens on you child.
    Remember, there are strong "second opinions" on this
    issue. This is was DrG. had to say about Dr. Robins
    and my opinion about putting a "plus" on so young
    a child.

    Re: Hopefully nobody takes this nonsense seriously. Hopefully. Dr. Allen
    retired many, many years ago. To my knowledge, his area of expertise was
    in the design of highway markers and stop signs. DrG

    Notice the denegration of Dr. Allen. It does DrG. no credit
    that he does this and this arrogance is not professional
    as he shoud well no. It does not inspire confidence, nor
    does it respect YOUR RIGHT to an informaed "second opinion".

    All the doctors should have discussed these two contradictory
    opinions with you -- and your options. Apparently, only
    Dr. Dave Robins fully spelled out what your choice is.

    I respect people who discuss options with me. I respect
    your intelligence in this manner. Obviously,
    if it were HIS child the child would not wear
    a plus lens at this point.

    Denegrating another professional like Dr. Allen is not

    Think about it.


    Otis Brown, Nov 9, 2003
  5. Rafael

    Otis Brown Guest

    Dear Rafael,

    You should be aware of experimental studies of very
    young primate eyes. (Smith in Houston)

    When a strong plus (different between the two eyes)
    was used on these primates the difference in visual environment
    resulted in a "diverging" of focal states between the two eyes,
    thus creating anisometropia.

    Also, use of a strong plus will slow down the "emmetropization process."
    There are some of the reasons WHY there is a suggestion by
    #4 and Dr. Dave Robins to "go slow" at this point.


    Otis Brown, Nov 9, 2003
  6. Rafael

    Otis Brown Guest

    Suject: Difference of opinion by Dr. Robins

    I have read this type of statment many times. I have
    also read "the facts" concerning the natural or
    dynamic behavior of the eye.

    It is clear that you honestly believe in YOUR OPINION.

    Medicine can not work in a manner different than that.

    But when to doctors (MD and OD) disagree, and give
    recommendations that contradict each other, then the
    issue must be understood by the parent that is very
    concerned witht the long-term welfare of the child.

    In the end, Rafael will read all of this and make
    a choice. That is the purpose of these discussions.

    I have only surfaced the fact of thes honest but
    contradictory opinions. And you give me a "hard time"
    for clarifing these issues for Rafael. He sounds
    like an intelligent, professional person -- and
    he understands the need for the "second opinion"
    on these subjects. Exchanging insults is not
    how you deal with a person in a rational manner.

    It still remains true that a substantial number
    of professionals would NOT put a plus lens on
    a very young child at this point in her life -- and
    there are good technical reasons (and explict facts
    which you choose to ignore) to not use a plus lens
    at this point.

    Rafael will make a decision. Not you, not I, not
    Dr. Allen, and not Dr. Dave Robins.




    Subject: Dr. G's opinion and references for the "majority opinion".
    Otis Brown, Nov 9, 2003
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