I went to the ophthamologist yesterday and here is what I learned from my eye test

I am back from the ophthamologist! I will tell you
everything that happened in order.

I went to an eye exam room and tried on trial lenses. For my left
eye I found that -5 was all I needed. -5.5 didnt help things any and -6
actually started to give me hyperopic blur. -4.5 was only a tiny bit
blurry. For the right eye it was trickier but a -4.5 lense seemed to
give the clearest vision but the BCVA wasnt as good as my left eye. I
also tried a -4 and a -1 cylindar and it appeared to work as well as
the -4.5 lense. I then placed minus lenses over my -4.25 glasses and
-.75 and -1 both appeared to give me the best vision. The right eye
didnt benefit much from more minus. I tried other minuses as well and
for fun I tried -20, whoa! so blurry! Then I tried +20 and superman
blur! I then put two +20 lenses together and looked thru them and I
could barely see my own arm! Two +20 lenses plus my -5 simulates -45
diopters but with 1.8x magnification, something a real -45 wont have.

The lady(optician?) then confirmed with a machine that my distance
glasses were indeed -4.25 First she tested my distance vision in each
eye. First the right and I saw all of the 20/50 line and I believe 2 of
the 20/40 line although I admit I kind of guessed. The left eye saw all
of the 20/50 as well and none of the 20/40. Then I looked with both
eyes and got all of the 20/40 line minus one or two. She put down 20/40
OU, I mentioned I am between 20/40 and 20/50 with those -4.25 glasses
and she and my dad agreed. It was one of those projector eyecharts and
the room was 20 feet long and the chart projected onto a square frame
hanging on the wall. No mirrors needed. She also used a near chart and
held it like 10 inches from my eyes. I mentioned I had presbyopia and
that this was too close to see clearly with my glasses(which werent
even full power!). I read the 20/50 line and she wrote that down
too(for near vision).

I went back to wait for my turn for more testing. I then went into the
other eye exam room and given numbing drops so I can get a glucoma test
with reduced discomfort. The drops burned somewhat for half a minute
and I said wait till they take effect so he waited a minute then
proceeded to do the tests.

Next came the cyclopegia. He used cyclogyl, also known as
cyclopentolate. I expressed concern with this conflicting with the
numbing drops I got earlier but he said the two act seperately and
have absolutely no relationship with each other. I believe he inserted
2 drops in each eye then said come back in an hour where its effects
will take on. I went to the bathroom to look in the mirror and sure
enough my pupils had started to dilate! Soon they were absolutely huge!
I noticed lights were overly bright and there was glare around the
bathroom light! When we went outside, I was blinded by the light and
couldnt even keep my eyes open! My mom came and handed me her
sunglasses which helped immensely but I was still extremely senestive!

After an hour and a half I returned and the ophthamologist's assisant
looked into my eyes, holding a minus lense in front and said my myopia
went down half a diopter. I then requested to look thru a phororaptor
and see which minus power I now needed. The ophthamologist says he
doesnt believe in doing that under cyclopegia because my pupils are now
huge among other factors and the results wouldnt matter. He looked into
my dilated eyes with a bright little light(that hurt!) then looked
holding a +90(!!!) diopter lense for magnification! The lense was about
half inch and so thick it was nearly sphere! Anyway my eyes are just
fine. No cateracts, no diseases, no glucoma, no pathalogies. Just I
have lots of myopia. He did say come back next week and he will give me
a manifast refraction so I can update my records and pescription.


I asked him some questions and got answers. Heres the answers:
He agrees alot of people, more than 25% cant be corrected to 20/20. He
doesnt believe in eye exercises, not even to improve pseudomyopia. He
belives some people are happier being undercorrected, especially with
presbyopia because full power glasses gives headache, eyestrain and
will make your eyes worse. He also agrees I have presbyopia, something
"not very common" at my age of 23.


I will ask the ophthamologist several questions when I return.

1. What factors determine BCVA? High order aberrations appear to be the
most talked about factor and may be true in my case.

2. What is the difference between presbyopia and accomodative
dysfunction?

3. Whats your stance on contact lenses, including RGP and orthoK?

4. If someone asked you if he should consider laser refractive surgury,
whats your stance and opinion on this?

5. What amount of magnification does this +90 diopter lense give?
I am also very curious the effects of placing that in front of your eye
since your eyeball is about +60 diopters, that lense would cause an
image to focus way in front of your retina, in fact the focus point
would be outside your eyeball! How high can plus lenses get and would
the focus come in front of the plus lense itself if high enough?

6. How high can myopia get? I have heard a few reports of -100s on the
internet and of one guy who was a -96 then a year later he progressed
to -104!

7. I will think of more questions. Any of you have stuff I should ask
him?

 

Sigh. A bit of judicious editing is rarely a bad thing.

[caffeinated yakking snipped]

Ace-

Maybe you could limit your questions to actual, meritorious, relevant
questions that have to do with *your* two eyes.

Also, I think the Internet is a better place for satisfying yourself
concerning academic issues. The ophthalmologist is the appropriate
person to talk to about issues that would inform an actual course of
treatment (e.g., Ortho-K, refractive surgery, etc.).

The doc is likely to be more responsive to you if you are respectful
of his/her time.

 

Oh I almost forgot to mention this. The ophthamologist said I can test
my myopia by doing the near point test. Measure how far you can see
clearly and this is your diopters. If you can see from 20cm you are a
-5, if 25cm, you are a -4, and so on. Its accurate to determine the
changes in my myopia. This is something I already knew but I bet many
people didnt!

I also want to mention things became clearer with my -4.25 glasses
while I was cyclopegized. I also want to mention the cyclopegia was
incomplete since I could still see well enough from near to read with
those -4.25 glasses. I measured +1.25 diopters of accomodative
amplitude under cyclopegia as opposed to +2.5 diopters normally.
Therefore I have reason to believe I got more than -.5 diopters
pseudomyopia. I may have more like -1.5 diopters of pseudomyopia. At
least I am satisfied in knowing not all my myopia is real. I will
countinue to work on vision improvement to resolve all my pseudomyopia.

 

Yeah. I really wasn't impressed with the idea of asking a newsgroup if
they have any questions for *his* doctor! I have my own doctor. And if
I have general questions I'll ask them here or do a Google.

 

The 14 year old abberrated "presbyope" from hell.

The doc might have to schedule more than 30 minutes?

 

It does not seem that you are being very supportive. Here is a kid
who seems to have a real vision problem. Certainly he does not
understand it, nor communicate about it very well.

Wouldn't you be interested to find out more about it, even if you
can't figure it out right away?

Or is this group, ostensibly offering advice to ordinary people, here
more truly for the purpose of sassing them?

 

"It does not seem that you are being very supportive."

Hello... It appears someone made a wrong turn...

You have arrived at

sci.med.vision

NOT

alt.support.myopia

Please sound your ship's bell as you depart.

Goodbye and Good Luck

 

Let me quote from the original post in this thread:

"3. Whats your stance on contact lenses, including RGP and orthoK?

4. If someone asked you if he should consider laser refractive surgury,
whats your stance and opinion on this?

5. What amount of magnification does this +90 diopter lense give?
I am also very curious the effects of placing that in front of your eye
since your eyeball is about +60 diopters, that lense would cause an
image to focus way in front of your retina, in fact the focus point
would be outside your eyeball! How high can plus lenses get and would
the focus come in front of the plus lense itself if high enough?

6. How high can myopia get? I have heard a few reports of -100s on the
internet and of one guy who was a -96 then a year later he progressed
to -104!

7. I will think of more questions. Any of you have stuff I should ask
him?"

You'll notice I snipped #1 and #2. That's because they were about Ace.
The rest of these aren't. Perhaps you are correct, and it is just poor
communication. Perhaps he meant that he was going to ask, "What should
*I* do?", but that isn't what they say.

 

My experience has been that doctors will answer a couple of "gee whiz"
questions. After that, it depends on their schedule. If they have a
waiting room full of patients, that's it.

Same thing with multiple subjects. At some point, it's time for a
separate appointment, either with them or someone else.

Want advice on RGPs or orthoK? Make an appointment with the contact
lens fitter (I'm assuming that's correct).

They are also good at redirecting and focusing. If the patient wants to
find out everything the doctor knows about LASIK, then the doctor turns
it around by asking if the patient is thinking about it. If not, then
no talk. If Aunt Hilda is thinking about it, well she needs to make an
appointment.

My HMO has a policy of one subject, one appointment. If you want to
talk about three things, then you need three appointments. I've never
been held to that, and I doubt that most are. Still, there are those
with a laundry list of petty questions. If they have to make multiple
appointments (suffering multiple waits) and pay multiple copays, then
perhaps they will pare down their list.

 

Maybe his optometrist can figure it out.

Can't figure why this thread got Dr. Stacy's fanny so far out.

 

It wasn't this thread alone; I'm just completely tired of discussing
myopia prevention. It is a proper topic for discussion here, of course,
but I'm really annoyed by the incessant and mindless repetitions of
archaic mantras by certain posters together with the nearly as
repetitive responses from legitimate sources, which have once again come
to dominate this little corner of the internet. Therefore, I've decided
to completely ignore the threads that are related to this topic
(excepting maybe those that come from NEW posters). So that's my new
year's resolution, and maybe it will also help keep me from getting into
so many little nasty exchanges with complete strangers (as well as free
up some time!).

w.stacy, o.d.

 

I keep hoping to be the lightning rod, freeing up the OD's and MD's to
take good care of the legitimate posters with their legitimate
concerns.

As somebody (Dr. G, perhaps) pointed out: I derive great joy out of
this, though I confess that when we get as outnumbered as I feel we
are these days, even I begin to grow weary of the incessant inane
chatter (even my own!).

Meanwhile, if--in the alluvium--you find something sincere or
interesting, feel free to jump in. If it's nothing but the usual
bull$hit, though ... leave it to me. I was born for this [cracking
knuckles...].

The doctors who frequent this site--as I've said many times--are
really quite meritorious for their contributions here. Leave
yourselves unsullied. Stay out of the mud with the likes of Dear,
Sweet Uncle Otie.

I'll set the pick. Y'all just drive toward the ocular net....

Meanwhile, etch this picture into your respective minds:

http://nbeener.com/Otis_Brown_BARS.bmp

 

Dear Ace,

Subject: Diopter measurement standard.

Re: Average refractive power of the
natural eye is about 60 diopters
with a "length" of about 2.4 cm.

A very strong myopia will be
about -10 diopters. I have
heard of -23 diopters.
I think the eye would tear
itself apart beyond that point.

The probability of the retina
"floating" lose (i.e., detached
retina) goes up rapidly much beyond
-6 diopters.

As you get older, look for "flashes"
of light, or "curved" lines -- when
you know they are straight.
Be perepared for this.
Call an ophthalmologist
and have this checked.
The consequence of ignoring
these symptons can be
serious.


Best,

Otis

_______________


6. How high can myopia get? I have heard a few reports of -100s on the
internet and of one guy who was a -96 then a year later he progressed
to -104!

 

Yes... everyone agreed to try this months ago...
and the saying goes something like "don't wrestle
with pigs. You both get dirty but the pigs like it".

-Quick

 

Not to be picky, but I like:

Don't wrestle with pigs. The pig will win, you'll get dirty and the pig
likes it.


Still, even though I like this and use it on newsgroups, I don't think
it applies here.

 

This ophthmalogist happens to be a friend of ours and a really nice guy
too. He did not mind the questions I asked him. Theres alot I can learn
about my eyes and vision in general from him. Like for example, while
unusual, 23 year olds can have presbyopia. Also alot of people dont
correct to 20/20, doesnt mean theres any pathalogies, just that their
optics arent perfect.

Otis, ive heard of several cases being more than -23. Ive heard two or
three being in the triple digits! One of them had -104 diopters! LOL he
would be your worst nightmare of abuse of minus lense! Imagine getting
worse from -96 to -104 diopters in 1 year! How fast can myopia progress
in a year? You said most people go down by 1/2 diopter but whats the
worst case you know, Otis? As for the retina, all myopes are at
increased risk and have to watch out for signs of trouble.

No one commented on the fact my cyclopentolate left +1.25 diopter
residual accomodation. Should I be having NO accomodation when
cycoplegized with this agent?

 

So your ophthalmologist says that a 23 year old can suffer from the
same mechanism at that which causes prebyopia in a 50 year/old?

Just FYI, the cycloplegic and manifest refractions are typically the
same in a 50 y/o patient. A difference of 1.25 diopters does not
indicate presbyopia.

DrG

 

What I meant is I have an accomodative amplitude of +2.5 diopters but
the cyclopegia reduced my ability to accomodate by +1.25 diopters. I
could still accomodate but only half the amplitude. I had a near point
test and was seeing 20/50 with my glasses. If I had a high accomodative
amplitude I theoratically should be seeing 20/20 near point. However my
accomodation is not good anymore.

 

by the way, my near point vision of 20/50 was with the card held about
10" away and that was before I got cyclopegized. It was also used with
-4.25 glasses which slightly undercorrected me

 

Sorry, Ace. I misread your original narrative, and so I went back. I
see that your ophthalmologist did NOT do a cycloplegic refraction, and
so the question still hasn't been settled. I almost always perform a
cycloplegic refraction, when I dilate, especially if there is any
question.

An accommodative amp. of 1.25 under cycloplegia indicates incomplete
cycloplegia, but does NOT indicate presbyopia. If your normal amp. is
low, even without cycloplegia, I would call it accommodative
insufficiency, and ask you certain questions about your medical
history, including childhood febrile or viral illnesses. You don't
have presbyopia, and that term is not appropriate for a 25 y/o.

DrG