vision check in 5 year old (long)

Discussion in 'Eye-Care' started by janesire, Apr 17, 2008.

  1. janesire

    janesire Guest

    I took my 5 yo DD to a pediatric ophthalmologist. He dilated her eyes
    and checked and came up with a prescription, let's say "x" which was
    rather high (worse) reading. Since we don't have anyone in family that
    had glasses DH wanted a second opinion so I took her to an optometrist
    today. She was very thorough and fully engaged DD and tested for a
    while without dilating and came up with a prescription that pretty
    much identical to "x". Then she said this reading is a bit on the
    higher side and also since I never noted any problems with DD's vision
    at home, she wanted to dilate and check again. She used a stronger
    solution to dilate her pupils and checked again after 45 minutes. This
    new reading "y" turned out to be negligible enough that she doesn't
    need glasses.

    But, DD also has astigmatism. So she gave me 3 choices:

    1. The biggest problem with DD is that she's unable to relax her eye
    muscles and she's over focusing. So she said we can use a solution to
    dilate her pupils that lets her relax her eye muscles. We can use it a
    few times a week after school. During that time she has to have
    bifocals with reading glasses in the bottom half in case she wants to
    read etc.

    2. Get prescription glasses that address astigmatism and try to get
    her to relax her eye without dilating or anything.

    3. Get a 3rd opinion if that makes me more comfortable.

    I felt that the optometrist did a more thorough job than the Ped
    Ophthalmologist but I don't know who knows better. Also, does anyone
    know if there any eye-muscle-relaxation-exercises that I can have my 5
    yo do every day?

    Any comments are appreciated. Thanks.
     
    janesire, Apr 17, 2008
    #1
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  2. janesire

    otisbrown Guest

    Dear Janes,

    You will get a lot of commentary on what your child should be doing --
    most
    of it explosive.

    If you wish the second-opinion on helping your child avoid glasses
    you might click here and join the discussion:


    http://health.groups.yahoo.com/group/i-see/

    Or here for a general review:

    www.i-see.org
     
    otisbrown, Apr 17, 2008
    #2
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  3. janesire

    Neil Brooks Guest

    1) Can you post all the various prescriptions -- with and without
    cycloplegia (dilation)?

    2) It might help to know if DD has had any history of binocular
    function disorders (strabismus) or surgeries, and the specifics on
    that, too -- perhaps including her alignment pre- and post-
    operatively, if applicable.

    3) Also, there's nothing to be gained ... and much to be lost ... in
    paying any attention to Otis Brown.

    I'm not an eye doctor, but a very interested patient.
     
    Neil Brooks, Apr 17, 2008
    #3
  4. wrote in :

    Was there any complaint that brought you to a pediatric
    ophthalmologist in the first place??
     
    Scott Seidman, Apr 17, 2008
    #4
  5. janesire

    janesire Guest

    She had a vision/hearing test at her preschool (I don't know how they
    tested but they didn't dilate her pupils). They said I have to get her
    checked by ophthalmologist. That's why we went.
     
    janesire, Apr 18, 2008
    #5
  6. janesire

    janesire Guest

    First (x) from the Opthalmologist with dilation and optometrist
    without dilation:

    Right: sphere -3.00 Cyl: +1.25 Axis 123
    Left: sphere -3.25 Cyl: +1.25 Axis 080

    Second (y) at optometrist with dilation:

    Right: sphere -0.25 Cyl: -0.75 Axis 021
    Left: sphere 0 Cyl: -1.50 Axis 175

    None of the above.
     
    janesire, Apr 18, 2008
    #6
  7. janesire

    Zetsu Guest

    Wow, you mean there's a whole 3.25 diopters of tonic accomodation in
    the left eye? I am quite surprised!
     
    Zetsu, Apr 18, 2008
    #7
  8. janesire

    Neil Brooks Guest

    I'm not surprised.

    I'm not at ALL surprised. This is yet ANOTHER reason why Mike Tyner
    KNOWS that you don't understand how LITTLE YOU know.
     
    Neil Brooks, Apr 18, 2008
    #8
  9. janesire

    Neil Brooks Guest

    The difference between the two prescriptions is largely accounted for
    "convention" in writing prescriptions. One is written in "minus
    cylinder." The other, in "plus cylinder."

    The latter prescription -- written in the same 'convention' as the
    former -- works out to:

    RE: -1.00 +.75 x111
    LE: -1.50 +1.50 x85

    The difference, then, is far less than it first appears. She's
    slightly myopic with a bit of astigmatism.

    Have they actually /diagnosed/ your DD for "accommodative excess??"
    It is an actual clinical condition* that has diagnostic criteria and
    for which various treatments DO exist.

    It's also a good idea to have a pediatric /strabismus/ ophthalmologist
    "intervene" while your DD is young. There is a physiologic link
    between accommodation (the eye focusing) and convergence (the eye
    turning inward to view near objects). If she truly has accommodative
    issues, then a strabismus ophthalmologist (or binocular function
    optometrist) is the one to monitor and advise.

    The eye drops you referred to are virtually always preserved with a
    chemical agent that's /really/ bad for the eyes ... over time. If
    this were a temporary use thing, then I might consider it.

    If it were "during school" as in ... years ... I would strongly
    recommend avoiding it, in lieu of other treatments (glasses and/or
    vision therapy ARE options).

    Reading glasses or bifocals ARE a treatment for accommodative excess,
    but I'd be sure that a 'thorough' dilation (perhaps using cyclogyl, or
    stronger agent) is/was performed to be sure.

    Young accommodative mechanisms are strong. They need to know exactly
    how much accommodative spasm this young one might be hiding before
    prescribing.

    A really competent strabismus doc will be able to balance all the
    factors and prescribe the right glasses, if necessary.

    Neil

    *http://www.aoa.org/documents/CPG-18.pdf
     
    Neil Brooks, Apr 18, 2008
    #9
  10. janesire

    Zetsu Guest

    Well I didn't know about the difference of convention for writing
    prescriptions with some of them in 'minus cylinder' and others in
    'plus cylinder', so I didn't know there wasn't really a big difference
    in the two prescriptions, so it just sounded like a huge amount of
    accommodative spasm, so I was surprised. I am just a layperson, how am
    I to know these things =P
     
    Zetsu, Apr 18, 2008
    #10
  11. janesire

    Jan Guest

    Zetsu schreef:

    By keeping your eyes open and your mouth shut when reading the messages
    in this newsgroup.

    Jan (normally Dutch spoken)
     
    Jan, Apr 18, 2008
    #11
  12. I notice you wrote the prescription "x" from the ophthalmologist was the
    same as the optometrist, yet this is a plus-cylinder prescription.

    You note the optometrist's dilated prescription, written in minus-cylinder.

    Therefore, I wonder if the undilated numbers you got from the optometrist
    may LOOK like the numbers from the ophthalmologist, but really are
    different.

    I suspect that the undilated numbers really are more minus than the dilated
    from the ophthalmologist. However, I still cannot explain the difference
    between the dilated numbers from the two exams, which should be more equal.
    The strenght of the drops , as you said, may have had something to do with
    it, and it is not clear which is correct.

    A cylinder 1.00 or higher is a relative reason to prescribe glasses at age
    6, per the Ophthalmology Academy guidelines. However, some kids see fine
    anyway, and do not need glasses, and others see not so fine, and need the
    glasses.

    This is a quandry here. You have to put your faith I who you believe more,
    or get a third opinion to help settle it.


    David Robins, MD
    Board certified Ophthalmologist
    Pediatric ophthalmology and adult strabismus subspecialty
     
    David Robins, MD, Apr 19, 2008
    #12
  13. janesire

    Dr Judy Guest


    As others have noted, the prescriptions are more similar than you
    think due to being written in different forms.

    The missing information for me is unaided and corrected acuity. If
    the corrected acuity is not 20/20 in each eye and especially if the
    corrected left acuity is less than the corrected right acuity, she
    should wear glasses with astigmatism correction so as to prevent
    amblopia.

    Dr Judy
     
    Dr Judy, Apr 20, 2008
    #13
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