I have a few questions for you guys and optometrists

Discussion in 'Optometry Archives' started by acemanvx, Jul 22, 2006.

  1. acemanvx

    acemanvx Guest

    1. What is the minimum prescription someone has to be for you to
    prescribe glasses?

    2. Do you double check the subjective manifast refraction to be sure
    its correct, accurate and repeatable?

    3. How often do you administer cycloplegic refractions?

    4. http://www.tc.umn.edu/~schw0709/stories/VisionTherapy.html

    Need I say more? *why* was he prescribed a minus lens? *Why* was I
    prescribed a minus lens? Why wasnt I told about the plus lens which
    could have cleared my vision like it worked for him????????
    acemanvx, Jul 22, 2006
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  2. acemanvx

    Dom Guest

    There is no fixed limit as it depends on the individual and his/her
    personality and symptoms. Some people appreciate a correction of, say
    -0.25sph (I know you are obsessed with myopia so I'll make it easy for
    you). Other people with larger refractive errors are quite happy
    uncorrected. In my opinion, and as a generalisation with plenty of
    exceptions, more intelligent people have more exacting visual requirements.
    As in 'start the entire process from scratch & do it again'? No. But
    inherent in the refractive process is a system of confirming & verifying
    the patient's answers so that any inconsistencies are picked up and
    corrected along the way. The final refraction does not rely upon any
    single patient response.

    P.S. It is manifest, not manifast.
    Personally not very often as I feel I can get good information using
    other techniques. But different optometrists have different preferences.
    Certainly there are times when it's definitely indicated and therefore
    is definitely used.
    I didn't even bother trying to read this... if you want to know why,
    google 'protanomal'. But it appears to be what is known as 'anecdotal
    evidence' (again, google it). Therefore, interesting to some, but not
    really relevant when it comes to patient care.

    Dom, Jul 22, 2006
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  3. acemanvx

    acemanvx Guest

    Thats crazy if anyone insists on bothering you or another optometrist
    to fill out a prescription form and record it in paperwork for -.25
    which blurs so little, it costs about half a line(instead of 20/20, may
    be 20/20-) The hassles of glasses would be far more than a minimal
    difference in vision(no difference less than 4 meters at that) I am
    betting once they try the glasses and see how it makes vitrually no
    difference, they probably put the glasses away and forget about them. I
    had a friend who was -.25, he tried the glasses for a week and was
    wondering what good were they as the difference was very neglectable.
    He ended up breaking them by "accident" and throwing them out. His
    parents just shrugged and said they wasted money buying him glasses
    when he didnt need them anyway. You are correct about others(which
    means majority from what ive seen) are happy to go uncorrected with
    refractive errors of -.75, -1, -1.25 and sometimes higher even. At -2,
    not many people forgo glasses except for near work.

    I ask this question because when I got a manifest refraction, it got to
    a point where I couldnt tell the difference between two lenses so I
    just chose one at random. Should I have said "no difference" or "same?"
    Maybe the optometrist just gave me the stronger lens anyway when I
    didnt need this much minus. Do you ever find it tricky what to give
    exactly if the patient cant tell the difference between two values of a
    quarter diopter apart?

    How would you then know how much plus to give a hyperopic child who can
    accomodate around most or all of it? How do you know when a child is
    "eating up" excess minus or has tonic accomodation/ciliary spasms,
    accomodative excess?

    protanomal means colorblind in the red spectum, has nothing to do with
    manifest refractions. Anecdotal evidence does matter. In the link, his
    optometrist gave him a -1 when he was not really myopic and just had
    what can be known as tonic accomodation/ciliary spasms, accomodative
    excess? He figured it out on his own and relaxed his ciliary muscles
    with a plus lens and not filling out his prescription for -1. I feel
    alot of people are presribed more minus than their cycloplegic
    refraction(for hyperopes, less plus) and this can cause problems like
    eyestrain, blurred near vision, worsening of ciliary spasms, increase
    in both pseudomyopia and axial myopia.
    acemanvx, Jul 22, 2006
  4. acemanvx

    retinula Guest

    ace you idiot. the guy got glasses because he went to the doctor and
    complained of blurry vision. it was bothering him in his day to day
    life. he couldn't see clearly in class and he likely had problems
    driving too. the eye doctor gave him a -1.00 Rx which is reasonable
    for a 20/40 acuity assuming he is a simple myope.

    the cause of his distance blur is what confuses the situation for you
    and other idiots like Otis. in his case the problem is likely
    accommodative dysfunction (aka pseudomyopia). because so much of his
    visual world reqiures near work his ciliary muscle mainains some
    contraction and doesn't completely relax. this is not typical myopia
    but it nonetheless causes real symptoms. he was treated entirely
    appropriately. you give such a person a weak minus Rx and tell them to
    wear them only when they need them at school and when driving and don't
    use them otherwise. you should also tell them to take frequent breaks
    from prolonged near work. GIVING PEOPLE MINUS LENSES DOES NOT INDUCE

    did you want the eye doctor to tell him to go away and "tough it out"?
    retinula, Jul 22, 2006
  5. acemanvx

    Dom Guest

    Well ace when you eventually get your drivers licence you will realise
    that driving a car (and many other activities that people 'with a life'
    participate in) involve seeing objects at a distance of more than 4
    metres. Some people, not all but some, would argue that it's well worth
    it. Just because it's not worth it for you doesn't mean it's not worth
    it for someone else. Again you are expecting others to share your
    opinion & perceptions - not everyone is the same as you.

    "Hassles of glasses" - what hassle?

    I am
    If patients don't want the glasses then they don't order them in the
    first place. You seem to think that we optometrists tell people that
    they *must* get glasses if we find more than about 0.12D of myopia. You
    may be surprised to hear that the patient actually gets to choose
    whether or not to get them. This way we cater for different
    personalities and the different visual requirements of various
    individuals. Why on earth did your friend buy the glasses if he was not
    having any visual problems in the first place?

    You are correct about others(which
    I'm so relieved that you have endorsed my statements about uncorrected
    refractive errors.
    If two choices look the same then of course yes you should say 'the
    same'. If you choose one at random then you can expect a random
    It's not the most challenging part of an optometrist's day.
    Exactly how much plus to give a young hyperopic child is not a simple
    subject and I'm not about to answer that question in just a few lines.
    But rest assured there are ways of telling... cycloplegic refraction
    being one of those ways. I didn't say I don't use it, but there are
    other tests & techniques besides cycloplegic refraction.
    But plenty to do with why I couldn't be bothered reading it.

    Anecdotal evidence does matter.

    Anecdotal evidence may be interesting, and it may be a pointer towards
    future research, but it doesn't matter when it comes to patient care.
    From http://en.wikipedia.org/wiki/Anecdotal_evidence:
    "Misuse of anecdotal evidence is a logical fallacy and is sometimes
    informally referred to as the "person who" fallacy ("I know a person
    who..."; "I know of a case where..." etc.) The problem with arguing
    based on anecdotal evidence is that anecdotal evidence is not
    necessarily typical; only statistical evidence can determine how typical
    something is."

    In the link, his
    Then I look forward to your campaign to eradicate worldwide uncorrected
    hyperopia - there are plenty of uncorrected +050's running around
    without glasses on who need someone to save them from staircase myopia.
    If you approach one of the big lens labs they may supply you with free
    pairs of +3.00's to give to all these potential myopes. If the wearers
    complain that +3.00 seems a little strong you can reassure them that
    it's OK because you feel there would probably be more plus under

    Dom, Jul 22, 2006
  6. acemanvx

    Charles Guest

    How many times do we need to tell you that some people like to be able
    to see? Personally, I find 0.25 to be a very noticeable difference. I
    actually happen to have two pairs of glasses, one which has an extra
    +0.25 in it (too much), and the difference is night and day to me when
    I look far away.

    Having said that, it would be a tough choice if all I had was -0.25 in
    each eye. I might go without in hopes that my eyes would somehow adapt
    or something. If they didn't do anything in a year or so though, I
    think I'd get some Rx glasses and wear them for driving and other
    outdoor activities (e.g. sightseeing on vacation).

    Here's a question for the eye docs though. Have you seen patients with
    an Rx like +0.5 in one eye and PL in the other? Does the
    non-independence of the focus mechanism make this situation annoying,
    such that most patients would choose to wear a weak plus in one eye to
    even things up?
    Charles, Jul 22, 2006
  7. acemanvx

    otisbrown Guest

    Dear AceMan,

    Subject: Giving "candy" (minus) to a child.

    I is profoundly EASY to put a -1.25 diopter
    on a child.

    The child LOVES that minus lens -- and the
    parents are impressed with how EXPERT that
    majority-opinion OD is.

    So what is the problem.

    To "change" this situation, you must "buck":

    1. The M.O. OD

    2. The parents. and

    3. The child.

    There is no "percentage" in "bucking" this sytem -- now is there.

    Why DENY the child the "candy" that he loves?

    But some issues are "not so simple".

    When you begin to understand this "preventive" issue -- then you will
    be in a position to help your kids with prevention.

    The second-opinion ODs have FINALLY WOKEN UP to the necessity of
    helping -- EXCLUSIVELY THEIR ON CHILDREN -- because of the three items
    stated above.

    When you realize how POWERFUL those three items are in DESTROYING any
    concept of prevention -- they you will BEGIN TO UNDERSTAND THE TRUE

    Profoundly arrogant (and ignorant) people like Retinula must be avoided
    -- in my humble opinion.

    The above issues MUST BE UNDERSTOOD.

    Only AFTER they are understood -- is it possible to have an intelligent
    discussion of plus-prevention.

    Just one man's opinion.



    otisbrown, Jul 22, 2006
  8. acemanvx

    Salmon Egg Guest

    You forgot the school system and child protection people.

    -- Ferme le Bush
    Salmon Egg, Jul 22, 2006
  9. acemanvx

    otisbrown Guest

    You are right, Bill.

    That truly "pushes" the issue onto the parents.

    You can never "help" a person with plus-prevention -- until
    the person himself -- FIRST understands these issues.

    But there are ODs who "support" plus-prevention -- and maybe,
    as the years go by, these issues can be addressed.

    There is nothing "easy" about prevention -- I think
    we all recognize that fact.


    otisbrown, Jul 22, 2006
  10. acemanvx

    acemanvx Guest

    Hey take it easy. Dont be rude, kind old optometrist. You are making
    asumptions why he got glasses which he didnt, he went strait to the
    plus to "fix" his blurry vision. He was NOT a myope yet, something you
    and his optometrist failed to realize. All he had to do was use the
    plus lens to clear his vision to 20/20. Wearing a minus lens would do
    NO good at best and likley harm. Optometrists are too quick to push the
    minus when all he needed to do was relax his ciliary spasms. He did NOT
    need glasses, he did NOT have to wear glasses. It was likley he would
    have developed axial myopia like I did when I wore my first minus lens
    and didnt do anything about the near work stress.
    acemanvx, Jul 23, 2006
  11. acemanvx

    acemanvx Guest

    Dom said:

    The DMV is 20/40 almost everywhere. In florida its 20/70. I will wear
    glasses that fully correct me for distance to drive, but for anything
    else, full correction is not neccessary, especially for near. Everyone
    should have a seperate pair of glasses for the computer that corrects
    them just enough so they dont have to accomodate and strain their eyes.

    Just ask all those people who chose to get lasik instead or those with
    very low prescriptions who would rather go uncorrected than deal with

    I was under the impression the optometrist can decide if the patient
    doesnt need glasses. Some optometrists wont prescribe myopes that see
    20/40 or better because their vision is not bad enough to need glasses
    and besides they fear glasses will quickly worsen their vision. I had a
    friend who had to argue and insist his optometrist to prescribe him
    glasses even though he was 20/20 UCVA. He sees like 20/13 BCVA. His
    fault because now his eyes have gotten much worse ever since he first
    wore glasses. He should have listened to his doctor, something people
    have a bad habit of not!

    You are welcome!

    Well he had it narrowed down to two lenses and only the pickiest person
    is gonna complain about 1/4 diopter. Anyone with a moderate or high
    prescription can just simply slide their glasses half a milimeter
    closer or further from their nose. I slide my full power glasses way
    down my nose when I view something close or I take them off

    If someone is not myopic, but has whats known as pseudomyopia,
    prescribe him a plus lens to fix that. A minus lens wont solve
    pseudomyopia and make things worse.
    acemanvx, Jul 23, 2006
  12. acemanvx

    acemanvx Guest

    Charles said:

    Well, theres a difference between wearing the wrong prescription
    glasses and having near perfect uncorrected vision with a prescription
    too small to spend money and time dealing with correction. If I saw
    20/40 with glasses then yes id get new glasees. If I saw 20/40 without
    glasses, I would not need glasses. .25 diopters is neglecable
    difference. Even half diopter is a very small difference and just big
    enough for people to start to notice. I have a 2nd pair thats half a
    diopter weaker and I barely notice, its still so much clearer compared
    to my *uncorrected* vision and not only that, the slightly weaker
    glasses are easier on the eyes when viewing things at half to two
    meters away. So in a way, I see better with the half diopter

    If you arent a picky perfectionist, youll adapt in a few hours to 20/25
    uncorrected vision instead of 20/20(.25 to .5 diopter refractive error)
    Im sorry, but I laugh at anyone that says they cant "see" when their
    eyes without glasses is as good as mine *with* glasses! If they want to
    know what *not* seeing is, I suggest they put on two pairs of strong
    reading glasses. This is how bad I see without correction(-4 with
    You should *never* get lasik even if they paid you big money. Youll
    complain nonstop how much worse you see. Picky perfectionists should
    realize lasik is the biggest mistake and to never consider lasik or
    even think about it. I know people as picky as you who ended up 20/25
    after lasik and werent happy, nevermind they see 20 times better
    without correction than they did before lasik!
    acemanvx, Jul 23, 2006
  13. acemanvx

    acemanvx Guest

    Another couple questions for you optometrists:

    1. Have you heard of adaptive optics? (ill make a thread on this) But
    when you test people's vision, what % have a BCVA of worse than 20/40,
    20/40, 20/30, 20/25, 20/20, 20/15, 20/13, 20/10, better than 20/10? One
    optometrist said 20/10 is so rare, less than 2% see it with
    conventional glasses/contacts, lasik or uncorrected.

    2. You optometrists, including Dom would know the relationship between
    diopters of myopic defocus and snellen acuity. This question comes up
    all the time and dozens of others have asked this too. Your answer here
    would provide insight to everyone reading this. How bad is -.5, -1,
    -1.5, -2, -3, -4, etc?
    acemanvx, Jul 23, 2006
  14. acemanvx

    otisbrown Guest

    Dear AceMan,

    The difference was that August figured out that a "minus" was not a
    good idea.

    The minus is knee-jerk simple. No discussion is required. It is like
    for a baby.

    Agust "read" aroung the "net" and discovered that the minus was
    not "a good idea".

    He recognized that he MUST pass the DMV (to avoid any use of a minus).

    He personally made the decision to use the "plus" and monitor
    his Snellen.

    In as much as the "un-protected" natural eye will go "down" at
    a rate of -1/2 diopter per year, so also, an eye that has the
    "near" environment elliminated (optically) with a plus will
    SLOWLY change its refractive STATE in a positive direction
    at a rate of +1/2 diopter per year.

    In the case of August, this plus-vision-clearing seems to
    have been faster that that.

    As long as August takes the responsibility to check his
    Snellen and PASS the DMV (when required) there is no
    good reason for him to be wearing a minus lens.

    But some people do prefer the easy quick-fix of the minus.
    But that becomes a matter of personal choice.

    i.e., Clear your vision with the plus (at the threshold) or
    get stair-case myopia from the minus.

    Tough choice.


    otisbrown, Jul 23, 2006
  15. acemanvx

    Charles Guest

    I think being +0.25D off from the correct Rx is the same regardless of
    baseline. If your correct Rx is -0.25 and you wear nothing, you'll see
    the same as someone who has a -3.25 Rx and wears -3 - assuming the
    properly Rx'd corrected vision is 20/20 in both cases (or 20/15, or

    Charles, Jul 23, 2006
  16. acemanvx

    p.clarkii Guest

    Otis is just making up data again!

    p.clarkii, Jul 23, 2006
  17. acemanvx

    otisbrown Guest

    No, P.Clark, I got it from a SECOND-OPINION scientific
    paper, prepared, peer-reviewed and published in
    Vision Science.

    otisbrown, Jul 23, 2006
  18. acemanvx

    retinula Guest

    is that the Flitcroft paper you talked about in another thread? Otis
    you are so ridiculous. Do you ever actually READ these scientific
    papers? Flitcroft doesn't say anything about what you are talking
    about. this is just like the Oakley Young paper that you have a
    strange interpretation of.

    your mind seems to work a lot different from everyone elses. you are
    an illogical man.

    retinula, Jul 24, 2006
  19. acemanvx

    Dr. Leukoma Guest

    Amen to that.

    Dr. Leukoma, Jul 24, 2006
  20. acemanvx

    acemanvx Guest

    Like I said, if someone already has bad vision and needs correction, it
    will make no difference if the glasses are a fraction thicker. Might as
    well get the right prescription that gives you BCVA for distance. But
    if someone had such a low refractive error, glasses arent worth the
    hassle for the tiny difference you see. Glasses cost money, they
    scratch, they smear, they get dusty, they slide down your nose, they
    reflect light causing glare, etc. All those problems alone is going to
    be much worse than going around with -.25 or -.5 uncorrected vision. In
    fact, most people I know choose to go without correction for -1
    prescriptions! They arent picky perfectionists like you. Lots of people
    after lasik do NOT end up exactly plano, yet their dependancy on
    glasses is greatly reduced!
    acemanvx, Jul 24, 2006
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