Ok dad will take me to an optometrist or ophthamologist for an exam IF....

Discussion in 'Optometry Archives' started by acemanvx, Dec 7, 2005.

  1. acemanvx

    acemanvx Guest

    Ok dad will take me to an optometrist or ophthamologist for an exam IF
    the following questions can be answered to convinence him WHY he should
    take me.


    1. Please educate dad on the difference between an optometrist and an
    ophthamologist. He says optometrists arent allowed to pescribe any
    medicines or even insert eye drops. All they can do is "look" at your
    eyes and give you a refraction and pescribe glasses. I told dad an
    optometrist can do whatever he pleases except for surgury and treating
    the more serious diseases. Clarify.

    2. Dad wants to know why would it matter if I get tested for presbyopia
    or accomodative dysfunction if nothing can be done about it. Whats the
    best cycoplegic agents in order to be used? he may have more than one
    type and I want the best to uncover the most pseudomyopia.

    3. Dad also wants to know the point of a cycoplegic refraction. I told
    him I probably have pseudomyopia and by knowing, I can better take the
    approperate action.

    4. Ill also ask to be tested for BCVA and find out why its "only" 20/30

    5. what else should I ask to get tested for?

    6. should I see an optometrist or an ophthamologist?
     
    acemanvx, Dec 7, 2005
    #1
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  2. acemanvx

    Dr. Leukoma Guest

    You should see an optometrist. Your problems are clearly functional
    and not related to any eye disease. Optometrists are better trained in
    refraction, and in prescribing lenses and eye exercises for the
    remediation of accommodative problems. There is no surgical solution
    for your problem. In all states, optometrists can prescribe medication
    for the treatment of some eye diseases.

    By definition, you cannot have presbyopia because you are only in your
    twenties. Accommodative dysfunction can be treated with lenses, and/or
    eye exercises. The strongest practical cycloplegic agent is
    cyclopentolate, which has a duration of action of from 6 to 12 hours.
    Atropine is stronger, but lasts several days. The point of a
    cylcloplegic refraction is to paralyze the ciliary muscle and to relax
    accommodation in order to measure the amount of axial myopia as well as
    the amount of accommodative myopia.

    You should also be tested for glaucoma, cataracts, and macular disease.
    All of those would be discovered during a comprehensive eye
    examination by an optometrist. Given the fact that your topographies
    contain a central corneal irregularity, I would also request of the
    doctor that s/he place a rigid contact lens on the eye to see if the
    vision could be improved beyond 20/20. This is another reason to see
    an optometrist -- because of their training in contact lenses.

    DrG
     
    Dr. Leukoma, Dec 7, 2005
    #2
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  3. acemanvx

    acemanvx Guest

    thanks for your reply. I searched the net and heres what I found:



    Why is there a need to dilate my child’s eyes to check for
    refractive errors? Won’t the cycloplegic drops have harmful side
    effects?

    Children have great accommodative amplitudes and they can change the
    measurement of refraction. In a child who has no error of refraction
    (emmetropic), a significant myopia, and sometimes astigmatism, may be
    picked up if he or she accommodates. The only way to get an accurate
    measurement of error of refraction in children is to inhibit
    accommodation with the use of cycloplegic agents.

    There are several agents commonly used in practice and these include
    tropicamide, cyclopentolate, and atropine. The first two agents have
    rapid onset of accommodation, short duration and few side effects. The
    last one has a longer onset, requiring three days of drug application,
    and longer duration, but provides the greatest amount of cycloplegia.
    Most children may be refracted using the first two. However, children
    with dark irides like Asians are not as responsive as Caucasian
    children to the cycloplegic action of the first two agents. Atropine
    refraction is therefore recommended for this set of children.

    Minor side effects of cycloplegic agents include transient stinging,
    blurring of vision, and photophobia. The stinging sensation is
    diminished by the application of a drop of anesthetic prior to the
    application of the cycloplegic agent. Photophobia may be addressed by
    wearing wrap-around sunglasses or hats. The duration of photophobia
    and blurring of vision is related to the duration of the drug’s
    mydriatic effect. The shorter-acting agents provide faster recovery of
    accommodation and of resolution of symptoms. Atropine is associated
    with relatively more adverse effects such as dry mouth, flushing of the
    face, fever, allergic reaction, irritability, tachycardia, and
    hallucinations. Therefore, the child’s weight and age are
    important considerations in the choice of atropine concentration or
    dose for cycloplegic refraction. Punctal occlusion during drug
    administration of atropine helps in decreasing the systemic absorption
    of atropine and greatly diminishes the occurrence of severe adverse
    drug reactions. Any child with severe adverse drug reaction should be
    brought to the hospital for immediate treatment.



    How does it work?

    Atropine belongs to the group of medicines called anti-muscarinics.
    Atropine blocks the receptors in the muscles of the eye (muscarinic
    receptors). These receptors are involved in controlling the pupil size
    and the shape of the lens.

    By blocking these receptors, atropine produces dilatation of the pupil
    (mydriasis) and prevents the eye from accommodating for near vision
    (cycloplegia).

    Atropine is given as eye drops to dilate the pupil and relax the lens
    so that eye examinations can be carried out thoroughly. It is often
    used to aid eye examinations in young children. It is also used to
    relax the muscles that inflame and over-contract in the eye in
    conditions such as uveitus.



    comments:

    I read that atropine is used for amblyombia by blurring the good eye. I
    also read atropine can last 2 weeks! It does fully cycoplegize you but
    at the expense of making your vision blurry, especially from near. I
    also read you need to take it twice a day for 4-7 days then again half
    an hour before your cycoplegic eye exam! I read that its known for
    risks of side effects, especially long term. tropicamide is not
    normally used for cycloplegic refraction as the cycloplegia obtained
    with this drug is incomplete. The drugs most frequently used in
    cycloplegic refraction are atropine and cyclopentolate, as there is
    significant residual accommodation with other drugs.

    I have found useful instructions:


    http://www.eyetec.net/ce/M4S1.htm


    They say cyclopentolate is the best option and works very well and
    atropine isnt really needed unless your a little kid with high
    accomodation. Half hour is needed for the drops to take effect. The
    optometrist can work on other patients in the meantime. Is
    cyclopentolate known for blurrying distance vision like atropine does?
     
    acemanvx, Dec 7, 2005
    #3
  4. acemanvx

    Dr. Leukoma Guest

    All of the cycloplegic agents have similar side-effects, as they are
    all anticholinergic agents. Those effects are dose-dependent.
    However, tropicamide and cyclopentolate have a greater therapeutic
    index, i.e. fewer side effects at the recommended dose. Also, the
    systemic side-effects are dependent upon the person's weight.

    DrG
     
    Dr. Leukoma, Dec 7, 2005
    #4
  5. acemanvx

    Dan Abel Guest


    Because you have vision problems?

    Laws vary by state. What an optometrist can do depends on the state and
    what kind of license they have. They all insert eye drops. They can't
    do their job without it. What kind might vary.


    It's important to talk to the doctor to agree on what to do. Telling
    them how to do it isn't a good idea.

    An optometrist. I don't know your money or insurance situation. In my
    case, you can't just make an appointment with the ophthamologist. They
    are seen by referral only. The optometrist will check you out and do a
    diagnosis. If you need to see an MD, they will refer you.
     
    Dan Abel, Dec 9, 2005
    #5
  6. acemanvx

    acemanvx Guest

    "Because you have vision problems?"


    dad says I already have glasses so what does it matter? I told him
    myopia isnt my only problem!


    "They all insert eye drops."


    I told dad this! They have to be able to insert drops for things like
    cycoplegia.


    "It's important to talk to the doctor to agree on what to do. Telling
    them how to do it isn't a good idea."


    Of course. hes the expert, maybe he thinks what to do is best for me. I
    will discuss my options and let him be the judge of what action to take
    with the given infomation ive provided.


    "In my
    case, you can't just make an appointment with the ophthamologist."


    Over here I can.


    "The optometrist will check you out and do a
    diagnosis."

    Then ill see one.


    Thanks for your replies. I will have dad schedule me an appointment and
    I am going to get a cycoplegic refraction among other things. Exactly
    what should I ask to be tested for, clarify the above mentioned
     
    acemanvx, Dec 10, 2005
    #6
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