questions about partially hyperopic 12 year old

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
glasses.
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

 

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

 

thanks dr judy.
my responses are below.
max

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

 

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.

DrG

(max) wrote in

 

Thanks so much DrG,
given your feedback, i've arranged an exam by a different doc in a different
practice.
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

 

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,
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

 

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

 

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.

DrG

(max) wrote in