questions about partially hyperopic 12 year old

Discussion in 'Optometry Archives' started by max, Dec 16, 2003.

  1. max

    max Guest

    took my 12 year old son to the eye doctor.
    he has never had glasses.

    here is the rx:
    OD +3.50 +75 * 90 (i assume she meant +.75)
    OS +50 sph ( i assume she meant .50)

    before dialation i observed he read 20/20 just fine with the left eye

    now my questions:

    1. she dialated his pupils BEFORE using the phoropter to arrive at his
    perscription. shouldn't the dialation have been done AFTER ?
    i didnt expect him to need any correction on the left eye.
    Doesnt the glare of the eyechart against the dialated pupil screw up
    the results ?

    2. the big question: should he get glasses. this doctor says yes.
    i have the impression this
    is a subjective judgement because his Rx was about the same last year
    and the other doctor from the same practice didnt even suggest
    he has not reported any headaches or problems with school work.

    3. any chance the right eye could be corrected with spherical soft
    contact lense.
    the astigmatism itself seems modest, but is it too high a ratio ?

    thanks, so much, in advance
    max, Dec 16, 2003
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  2. max

    Dr Judy Guest

    Not surprising, that eye has very little refractive error. What is the
    vision of the right eye, with and without correction?
    No. With hyperopia, it is more accurate with cycloplegia, which the
    dilating drops provide.
    Again, what is the uncorrected and corrected acuity for the right eye?
    Usually, hyperopia of that degree needs correcting. What was the refraction
    and vision last year?
    Soft lens correction would be a good idea, the astigmatism is slight.
    Successful soft lens wear also depends upon tear quality, cornea surface and
    cornea shape.

    Dr Judy
    Dr Judy, Dec 17, 2003
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  3. max

    max Guest

    thanks dr judy.
    my responses are below.

    20/20 with correction
    worse than 20/40 without correction (she started at 20/40)

    (1) 20/20 with correction
    worse than 20/40 without correction (she started at 20/40)
    (2) the doctor said there was really almost no change from last year.
    [ which is why i'm surprised that she recommends glasses
    and her colleague did not ]
    ok, thanks. obviously questions of maturity with respect to being compliant with
    cleaning and care is for the doctor and me to decide. you dont seem to object
    to a 12 year old with proper maturity to wear contacts (?)

    thanks so much.
    max, Dec 17, 2003
  4. max

    Dr. Leukoma Guest

    Your child will be presented with this conundrum for the rest of his life.
    Yes, something is wrong with his right eye, but what to do? The most
    pressing issue would be to treat amblyopia, but there apparently is none,
    i.e. the right eye sees 20/20 with correction. The next consideration
    would be other symptoms of eyestrain, headaches, double vision, poor
    reading skills, etc.

    Even if there are no symptoms, no amblyopia, there is the final issue of
    improving visual quality for the patient in some appreciable way. By this
    I mean improving depth perception, or stereoacuity. Stereoacuity is
    important for fine descrimination of depth and more precise spacial
    localization. It requires that both eyes are contributing to the image.
    If your son always suppresses the vision in the right eye, he will have no
    stereoacuity. However, it is likely that he has some.

    In terms of heirarchy of treatment, eyeglasses will correct the vision, but
    will also produce more magnification in the right eye due to the high
    prescription. The inequality in image size makes it difficult for the
    brain to fuse the two images into a single image. Therefore, your son may
    test well for each eye with eyeglasses, but may only have a partial
    improvement in the stereopsis. Additionally, double vision may ensue, or
    rapid alternation of fixation from one eye to the other may occur. Or, he
    may not feel that there is any difference in how he sees. The contact
    lens, being located on the eye, creates a minimal amount of size
    difference, and will create the best opportunity for binocular fusion.

    A fairly recent case of mine involved a young child with a similar
    prescription, and a very slight amount of amblyopia that responded briskly
    to patching. I recommended the contact lens, but the parents were never
    able to achieve compliance. However, within a couple of years, the child
    had matured sufficienty to once again consider the option. I did a simple
    demonstration for him and his father. I had the child repeat a simple
    stereo test without correction, then with a spectacle lens, and finally
    with a contact lens. Stereopsis was very poor in the first two instances.
    But with the contact lens, he easily scored 9/9. Moreover, he developed a
    huge grin on his face as he looked around the room, seeing all of the
    objects in 3-D for the very first time in his memory. The perception of
    this extra dimension of vision was a powerful motivator. The second
    powerful motivator was the fact that he loved baseball. His batting
    improved immensely with the contact lens

    End of story.


    (max) wrote in
    Dr. Leukoma, Dec 17, 2003
  5. max

    max Guest

    Thanks so much DrG,
    given your feedback, i've arranged an exam by a different doc in a different
    i plan to bring up the concerns you've raised.

    i didnt mention it, but my son did, in fact, have patch treatment several
    years ago for a lazy eye (his right eye). thankfully it was a success.

    max, Dec 18, 2003
  6. max

    Dr Judy Guest

    I have patients much younger than your son using contact lenses.

    Oh ho, the patching explains why he is able to see clearly with that eye!
    Perhaps the reason this doctor is suggesting glasses now and the one
    previously didn't is a drop is uncorrected acuity or best corrected acuity
    and this doctor is concerned that he maintain his success. Also, at age
    12, school work is getting more difficult and there are advantages to having
    correction. Your son may not realize how much more comfortable he would be
    with correction. OTOH, if he does correct now to 20/20, had the patching
    way back when, and is really not having any headache, eye strain, difficulty
    reading, problems with catching baseballs you will not be doing any harm in
    not correcting.

    I don't think you need to waste money on a second opinion. The advice you
    got was good, reasonable advice. If you and your son choose to not correct
    the eye, that is a decision you can make based on his lack of headaches etc,
    but the advice the eye doctor gave you remains sound. If that is your
    decision, make it, don't go looking for a doctor to agree with you.

    Instead of spending money on a second opinion, ask the first doctor if your
    son can try out a soft lens on the right eye, usually a free or low cost
    trial is possible. That way your son can decide for himself how much his
    visual experience is enhanced or not affected by correction.

    Dr Judy
    Dr Judy, Dec 18, 2003
  7. max

    max Guest

    dr judy,
    thanks so much for your reply.
    based on dr g's response (the key snippet is just below),
    don't i need a doc to decide this stuff ?
    how can i know that glasses are working correctly or causing
    the difficulties described below ?
    maybe i'm overreacted to dr g's post ?

    thanks in advance
    max, Dec 18, 2003
  8. max

    Dr Judy Guest

    You need to have him wear glasses for a few weeks to find out what will
    happen. It is difficult to predict with only a few minutes of wear in the
    exam room. Your current doctor has enough info to provide glasses. Contact
    lens correction will lessen the magnification effects due to the difference
    in Rx between the eyes and likely will result in better fusion and
    stereopsis. So a contact lens trial would be useful when trying to decide
    if you want to have him wear correction.

    In your first post you asked why the doctor wants to correct now and didn't
    last year. There may be a good reason like his best corrected vision or
    uncorrected vision has declined from last year; you should ask this question
    of the doctor, as she has the information to answer.\

    Dr Judy
    Dr Judy, Dec 20, 2003
  9. max

    Dr. Leukoma Guest

    I mostly agree with Dr. Judy.

    We (optometrists) all agree that the contact lens seems to work best in
    cases of anisometropia (unequal prescriptions), but sometimes eyeglasses
    can work, too. The means to test the various options should be readily
    available to the eye doctor in the office, such as a trial frame with trial
    lenses, trial disposable contact lenses, and a test of stereoacuity and
    suppression. Using the in-office battery of tests for binocular vision,
    the doctor can determine the effects of the options of (1) doing nothing,
    (2) wearing spectacles, or (3) wearing a single contact lens. Personally,
    given your son's age, prescription, and history, I would be advocating the
    use of the contact lens. But, professionals can and do disagree over this
    issue, and your son is ultimately the one who will decide.


    (max) wrote in
    Dr. Leukoma, Dec 20, 2003
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