Need Help - Desperate to Help 8 year old with myopia

Discussion in 'Optometry Archives' started by ally down, Oct 16, 2005.

  1. ally down

    p.clarkii Guest

    children's visual acuity can vary dramatically when testing from day to
    day. they can have very active accommodative systems.

    if she's 20/40 + in one eye and 20/50 there isn't much anisometropia.
     
    p.clarkii, Oct 18, 2005
    #21
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  2. ally down

    Dr. Leukoma Guest

    Anybody who claims to be desparate to help their child with myopia
    would do well to get them some glasses and follow the advice of the
    optometrist. It sounds more like someone who is desperate to do
    nothing and wants someone to bless it.

    DrG
     
    Dr. Leukoma, Oct 18, 2005
    #22
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  3. ally down

    p.clarkii Guest

    sorry to be so "nuts".

    i guess what caused me to believe that she might be a myope is what mom
    quoted her eyedoc as saying in her earlier post... "What was mentioned
    was that
    she had a very mild astigmatism and that she couldn't see as well far
    away as normal. The doctor was the one that said "her world is very
    close up and she isn't driving,etc.etc, so to come back in 6 months to
    a year". " that plus this... "and nothing
    mentioned about her being anisometropic."
     
    p.clarkii, Oct 18, 2005
    #23
  4. That's nuts. Consider the following refraction:

    R + 1.00 sph

    L - 1.25 sph.

    This person could easily be

    R 20/40 +

    L 20/50

    unaided, at ANY AGE.

    Anyone who tries to figure out anything from unaided VAs alone has gone
    way out there on a limb...

    w.stacy, o.d.
     
    William Stacy, Oct 18, 2005
    #24
  5. Why don't you post the recommended or measured Rx from that exam?


    What was mentioned was that
    Not good enough. Give us the Rx


    It is obvious that her vision has gotten a little worse in a

    Thank you. I can't wait. You should have an Rx in your hand tomorrow
    at the end of the exam. Post it.

    w.stacy, o.d.
     
    William Stacy, Oct 18, 2005
    #25
  6. Quit already with the home VAs. They are way too variable to be of much
    use. Almost as variable at the eye doc's office as at home. Post the
    Rx. That will tell us volumes.

    w.stacy, o.d.
     
    William Stacy, Oct 18, 2005
    #26
  7. ally down

    Dr. Leukoma Guest

    Funny how we often pander to the concerns of the parents, especially if
    they make a fuss about their children needing eyeglasses.

    DrG
     
    Dr. Leukoma, Oct 18, 2005
    #27
  8. Go back and read the entire thread. This could even be a troll, what
    with all the emphasis on downloading Snellens and home VA testing and
    all. Whatever, my FIRST RULE is: question everything, especially
    authority. The mom's in charge here, so I question HER. If she won't
    tell me what I need to know, then I won't listen to whatever she does
    tell me...

    w.stacy, o.d.
     
    William Stacy, Oct 18, 2005
    #28
  9. ally down

    The Real Bev Guest

    That sounds fairly stupid, but every once in a while you run into a doc for
    whom this sort of scenario makes sense. A friend's mom was better at
    balancing her husband's insulin dose than the doc (actually a GOOD doc) was,
    and he admitted it.

    Remember, SOMEBODY was in the bottom 10% of his med school graduating class.
     
    The Real Bev, Oct 18, 2005
    #29
  10. This thread reminds me of the mother who walks into the pediatrician's
    office saying "I think my son needs an antibiotic for his infection". He
    has a fever and doesn't sound too good.

    Like the pede is supposed to accept the diagnosis, let alone give an
    opinion as to the efficacy of the proposed treatment...

    w.stacy, o.d.
     
    William Stacy, Oct 18, 2005
    #30
  11. ally down

    ally down Guest

    Thank you for your advice.. I will post the RX tomorrow. I don't have a
    RX from the initial appt becuase the orders were to come back and he
    would write the RX then, it wasn't that necessary at the time and he
    said he would be abe to get a better RX if she was older (she wasn't
    really behaving and was only 6.

    Please understand, I want what is best for my daughter. If it's glasses
    then so be it, if it is not glases, than so be it. What I am trying to
    do is educate myself, for the sake of my child, so that I can make an
    informed decision. I don't believe that OD's are infallible and that
    whatever anybody says goes - One of my college professors once told "It
    is just as important to evaluate where the information came from as to
    the information itself"

    We are not "trolls" or undereducated wacko's (my husband and I both
    hold advanced degrees". I just believe in doing whatever I can to help
    my child and I need to educate myself in order to do that. I am not an
    OD, just a loving a parent who has a difficult decsion to make. I know
    that my child will need glasses, maybe today, maybe in 6 months, I know
    that day will come. I know that she will eventually want contacts -
    that day will come. I just want to make sure that putting minus lenses
    on a child with binocular 20/40 vision is the appropriate thing to do,
    knowing that the glasses will effect her lifestyle right now at this
    point in time - she is too young for contacts.

    I live in a town where the University is across the street and it is a
    College of Medicine. Just about everyone I know is affillitated with
    the medical profession in one way or another. do I take every opinion
    of their's to heart. No I do not - they are human.. not infallible.

    I know that my daughter has a reflective disorder. I know that the OD
    will prescribe her glasses. I know that he will most likely tell me
    that she needs them all the time (that is his preference). Do I have to
    agree with him?

    ally
     
    ally down, Oct 18, 2005
    #31
  12. ally down

    Dr. Leukoma Guest


    I prescribe glasses for 3 year-olds, some of whom behave as if they
    were 2.
    I'm not sure how to take the phrase "where the information came from.."
    Why wouldn't corrective lenses be the "appropriate thing to do"? Which
    authority on the subject made you think otherwise? Did you ever admit
    to the possibility that vision correction might have a positive effect
    on your daughter's so-called "lifestyle"? Did you know that a number
    of professional athletes are nearsighted?
    I think that you are confusing human fallibility and scientific
    knowledge. Humans make errors, and scientific knowledge is never
    complete, but people have been wearing spectacles for hundreds of
    years. Some of the greatest and most accomplished of our species were
    nearsighted and wore spectacles. On the other hand, some nearsighted
    people have squandered their talents, and need a convenient scapegoat.
    Of course you don't have to agree with him. There have been other
    cases where the religious beliefs of the parents caused them to deny
    necessary medical treatment for even more serious and life-threatening
    decisions. Thank goodness this isn't one of them.

    By the way, what is a "reflective disorder?"

    DrG
     
    Dr. Leukoma, Oct 18, 2005
    #32
  13. ally down

    ally down Guest

    I am sorry.. I meant refractive - I was typing pretty fast while trying
    to get the girls ready for school.. Sometimes i think I might have a
    "reflective disotrder" as in - I don't always like what I see in the
    mirrior. it is another dark and dreary day here in the northeast and
    if we don't see the sun here pretty soon I think my eyes are going to
    glaze over and we might all need glasses..

    Speaking of glasse.. Here is my history..long story short

    Never needed glasses.. never failed vision screenings.. Went to
    college.. big big classrooms, board very far away.. started getting bad
    headaches.. went to ENT - thought it was sinuses, ruled that out,
    headaches persisted.. still headaches.. time went on, went to eye
    doctor after everything else was ruled out (at one point I thought I
    had a brain tumor - headaches were pretty bad). I needed eye glasses
    - very mild myopia with astigmatism. Got glasses, wore them sometimes,
    mostly for lecture hall and the movies..but.. being in college, vanity
    won out and after a couple of years I stopped wearing glasses -
    eventually I lost them and that was 15 years ago. Last year I had an
    eye exam - 20/20 no problems. Mild astigmatism with no need to treat
    unless it was causing me problems. Weird..

    I do have an important question that I would love a clear anser to.

    What exactly does eye shape have to do with myopia? In laymans terms
    please. If eye shape is the cause, will the myopia stop progressing
    when the eye stops growing (after puberty so to speak). Is it strictly
    an anatomy thing or is there more at work here. Also does anyone know
    about the trials for perizipine? Just curious..

    Again - just trying to educate myself..
     
    ally down, Oct 18, 2005
    #33
  14. ally down

    Dr. Leukoma Guest


    But, did the glasses stop the headaches? Wouldn't that be a medically
    necessary reason for eyeglasses, even though the refractive error was
    transient (further proof of course that minus lenses do not lead to
    irreversible or stairstep myopia)?

    Let's distinguish between axial, or true myopia, and accommodative, or
    pseudomyopia. The accommodative system is like a spring: it's flexible
    and has a memory. However, it typically cannot account for more than
    one or two diopters of myopia, max. Some people have ONLY
    pseudomyopia, some have ONLY axial myopia, and some have a COMBINATION
    of both. Pseudomyopia will go away, eventually. Axial myopia will not
    go away because it is caused by elongation of the posterior eye. The
    mechanism by which this occurs is not completely understood at this
    time. Authorities used to believe that all myopia was produced by
    mechanical stress. Some people still believe that axial myopia is
    always preceded by accommodative stress, but that number is fast
    dwindling.

    So, in the simplest sense, the relationship between eye shape and
    myopia is one of variable length. However, two famous myopia
    researchers, DI Flitcroft and RA Stone have studied eyeball shape, and
    have come up with some interesting findings regarding one's eye shape
    and on-axis image quality, and that this image quality may be linked to
    the development of myopia via a local neuro-regulatory system. We also
    know that this local neuro-regulatory system can be blocked by certain
    drugs know as muscarinic inhibitors, such as atropine and pirenzepine.
    In summary, myopia research is now looking more at image quality and
    blur as a function of (1) eyeball shape, or (2) accommodative lag plus
    some other variable(s).

    DrG
     
    Dr. Leukoma, Oct 18, 2005
    #34
  15. Looking forward to it.

    I'm glad to hear that.

    You don't *have* to do anything. But I will recommend one of three
    things when I see the Rx. I might suggest anything less than full time
    wear would be abusive to the child. I might suggest part time wear is
    fine. I might suggest no Rx is needed at this time. The numbers will
    tell me which. Also, see if you can get her unaided acuities plus her
    best corrected acuities with the new Rx.

    thanks

    w.stacy, o.d.
     
    William Stacy, Oct 18, 2005
    #35
  16. ally down

    Dick Adams Guest

    Could you point me to a review of such studies?

    Are there studies where children prone to myopia are
    required to read with reading glasses (like +2.5, also with
    prisms to set convergence at infinity)?

    TIA for any response.
     
    Dick Adams, Oct 18, 2005
    #36
  17. ally down

    Dick Adams Guest

    What is really weird is that "professionals" still use such a crude measure
    as 20/XX to describe quality of vision.

    Let me give you an example: Last week I had the final check by my
    surgeon after IOL implants. I read a few lines on the chart, and he
    exclaimed "excellent!, you have 20/20", and then walked out. Very
    busy man! Cheerful, hopeful, optimistic! Gone!

    Well, I definitely need eyeglasses to read, but +1.25 Walgreens are
    good, at least for now. I see quite sharply at one meter, and I can
    guess that I have a quarter or half diopter of unresolved astigmatism
    in each eye (ears on the full moon). Although I see fine in sunlight,
    I will definitely need about a minus diopter of combined sphere and
    cylinder for night driving, if I expect to read the small signs, like street
    signs and house numbers. Probably I should consider some prismatic
    correction, too, because my paths of convergence are vertical after
    horizontal (like rounded "L's" on their sides).

    The main purpose of eyeglasses is to see things sharply. There are much
    better measures of visual acuity than 20/XX. It does make some sense
    to say which line on the chart one can finally read, and call that line a
    20/XX line for the purpose of identifying the angle subtended by the
    characters (or the linear size divided by the distance to the chart). But,
    as is apparent at this newsgroup, 20/XX-talk lumps a whole bunch of
    other sources of poor vision as well as refractive errors.

    Our professionals apparently think that we are all too dumb to know what
    is going on with our eyes, and those of the ones we should try to help, so
    that may be why they speak to us in this crude 20/XX gibberish. (When
    you are so old as me, they assume you are senile as well as dumb.)
    Eye length is important. Longer eyes tend to be nearsighted, and
    conversely for short eyes. The shape of the cornea is important, because
    it behaves as a lens, in addition to the acommodative lens, and because its
    irregularities are the major causes of astigmatism.

    A great deal of the mystery lies an a small internal body called the
    ciliary process, which appears to be both a muscle and a gland,
    which may be thought of as circular, and some cartilaginous elements
    against which it works to allow the eye's lens to relax and round up
    to a quite convex shape, as it does when the eye finds the characters
    in a book, for instance.
    It is quite amazing that eyes can see quite well, in some instances, while
    their owners grows up and eyeballs change shape and length. By my
    guess, it is due to a long-term accomodative mechanism affecting the
    anatomical parts that suspend the accomodative lens.

    The going wrong of that accomodative mechanism is probably a big
    factor in bad eyesight. So I think. No, I can't prove it. Shit, I am not
    even a professional.
    More, perhaps -- one can envisage a conspiracy of folks who would
    rather sell you eyeglasses than to try to find out why you need them,
    and need them ever stronger if you are a typical myope.
    I don't know, but I'd advise to leave it alone. A joint every now and
    then might be good for relieving ciliary spasms, however.
     
    Dick Adams, Oct 18, 2005
    #37
  18. ally down

    ally down Guest

    Okay Guys.. here goes..

    We are back from the eye doctor with some interesting results. It
    turns out my daughter does not have myopia. She has an astigmatism.
    This is what he said in a nutshell: Her eyes are healthy, they are
    working well together, no lazy eye (I was worried about that and asked
    him about it).

    She does not have myopia. She has astigmatism - one mild eye, one
    moderate eye. He prescipred glasses and said she should use them while
    she is reading, doing school work, working on the computer, etc. but
    does not need to wear them 24/7.

    the RX is as follows:

    OD: Sphere: +0.50 Cylinder -0.75 Axis 6
    OS: Sphere: +1.00 Cylinder -3.25 Axis 158

    Let me know what you think..

    allyson
     
    ally down, Oct 18, 2005
    #38
  19. ally down

    Dan Abel Guest


    As someone else posted, glasses will indeed affect her lifestyle. For
    one thing, she'll be able to see better. I firmly believe that the
    reason that my wife and I were so bad at sports is because we just
    couldn't see.

    As for contacts, I don't believe that there is any age limit. Certainly
    it would be more difficult at her age, but somebody at work said her
    granddaughter, who was just a little baby, was getting contacts. I
    don't know how well they work, but there are tools to help insert and
    remove contacts.



    There are scientific facts, and there are opinions based on those facts.
    You know your daughter better than the OD, but the OD knows how things
    work for most people better than you do. My suggestion is that you find
    out *why* the OD recommends certain things, and then you can decide if
    your family situation fits. As someone posted, a good reason to wear
    glasses all the time for a kid is that otherwise they lose them.
     
    Dan Abel, Oct 18, 2005
    #39
  20. ally down

    Neil Brooks Guest

    I think you know me well enough to know that I'm not engaging to
    troll, but ... serious question:

    People seeking to prevent/reverse/? myopia with bifocals or plus
    certainly /have/ occasionally advocated the addition of prisms to
    offset the 'break' in the near vision triad
    (accommodation-convergence-mydriasis).

    Absent that use of prism, though (eg, if somebody merely put dime
    store plus readers on their myopic kid's eyes), couldn't that disrupt
    normal fusional amplitudes, potentially harming a developing fusional
    system?

    I know that--despite my high hyperopia and ciliary spasm, wearing plus
    lenses for near work throws my exophoria into a tizzy, driving excess
    convergence and accommodation....

    TIA,

    Neil
     
    Neil Brooks, Oct 18, 2005
    #40
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