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Medical Forum / General / Vision / January 2005How much is "enough"?
I wasn't able to get a straight answer out of the doc today so I'll put the question to the Collective: At what point does a vision deficit qualify for correction? My son has been squinting at his schoolwork for the past month or so and has complained on at least two occasions of "things being fuzzy". So I dragged him into the ophthalmological practice I use. One exam later he's been confirmed as having mild astigmatism (-.25) in his right eye and as having "minor" farsightedness in both eyes, of +.25 sp. The refraction was a wet refraction, much to my son's dismay *grin* The doc (one of several in the practice and one I've not seen before) advised me that farsighted kids are generally not corrected "because they'll correct through it", whatever that means; in my son's case it seems to mean that he'll learn how much he needs to squint to be able to see his work. I asked but she managed to avoid answering how the astigmatism combined with the spherical Rx might be affecting the kiddo's vision and whether that warrants further consideration for correction. Comments please? >I wasn't able to get a straight answer out of the doc today so I'll > put the question to the Collective: > > At what point does a vision deficit qualify for correction? When correction provides an improvement that the patient can notice and thinks is worth it. Or, in the case of childhood amblyopia, when the amblyopia is due to uncorrected refractive error. > My son has been squinting at his schoolwork for the past month or so > and has complained on at least two occasions of "things being fuzzy". [quoted text clipped - 12 lines] > kiddo's vision and whether that warrants further consideration for > correction. In terms of affecting vision, the question is what is his unaided acuity? Only his doctor knows. The amount of astigmatism and hyperopia he has is the smallest measurable amount and most of us would not prescribe it. Children tend to "out grow" farsighted ness; the amount he has is well within the ability of the visual system to compensate without any blur or eyestrain. Did the doctor check his binocular function? If he has esophoria, he might benefit from reading glasses. Is your child happy at school? Getting along with teacher and school mates? Finding the work too hard? Under stress at home? Under pressure from non school activities like sports, music lessons? Stress can cause children and adults to feel vision is fuzzy. Dr Judy >When correction provides an improvement that the patient can notice and >thinks is worth it. Or, in the case of childhood amblyopia, when the >amblyopia is due to uncorrected refractive error. That's entirely too sensible, and I was obviously tired last night not to have reached that conclusion. >In terms of affecting vision, the question is what is his unaided acuity? Reportedly something approaching 30/20. The kid can spot bugs on trees from halfway down the block :) >Only his doctor knows. The amount of astigmatism and hyperopia he has is >the smallest measurable amount and most of us would not prescribe it. >Children tend to "out grow" farsighted ness; the amount he has is well >within the ability of the visual system to compensate without any blur or >eyestrain. That's a more reasonable answer than the simple "he'll correct through it" I was able to get out of the doc. Based on my kiddo's performance on the distance exam I was expecting a different report altogether *shrug* >Did the doctor check his binocular function? If he has esophoria, he might >benefit from reading glasses. Yes, and its fine. >Is your child happy at school? Getting along with teacher and school mates? >Finding the work too hard? Under stress at home? Under pressure from non >school activities like sports, music lessons? Stress can cause children >and adults to feel vision is fuzzy. Heh. He's 7 years old; I may be the only mother at our school who doesn't keep her kid's schedule in a PDA. He has a violin lesson once a week and a single worksheet as homework on a daily basis. After he does his homework and 15 minutes of violin practice he's scot-free, so to speak. > Dr. Judy wrote: > > [quoted text clipped - 8 lines] > does his homework and 15 minutes of violin practice he's scot-free, so > to speak. Congratulations! I feel so sorry for kids who have schedules and have to make playdates.  SignatureCheers, Bev +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Warning -- Driver carries less than $20 worth of ammunition Dear Wooly, I think the "Doc" was giving you good answers. Question: Was any prescription given. Or was the recommedation made for "no glasses"? Best, Otis > I wasn't able to get a straight answer out of the doc today so I'll > put the question to the Collective: [quoted text clipped - 19 lines] > > Comments please? I am not a health professional. You did not say how old your son was. Glasses were slapped on me before I had sufficient intellect to reject them. The result has been progressive myopia. I still remember, almost 70 years later, how intimidating the examination was. During this better or is this better routine, I gave answers even though I did not have a firm opinion. Also, because of the peculiarity of how astigmatism is measured in optometry, a prescription for a combination of spherical and cylindrical correction can be written in several ways. This makes it impossible to call the spherical correction positive or negative. That is, a spherical correction is a sum of two equal cylincrical corrections at right angles to one another. Bill There are ways to prescribe a combination of spherical uniquely. Dear Bill, Subject: Compassionate ODs, and your right to an informed "second opinion" I know you to be an intelligent Ph.D. You have probably read the "fractured" statistics discussed on this site, along with the absolute statement that, "the concept of the dynamic eye, ...must be destroyed". I think that, had you been offered the use of the plus, along with the supporting rationale -- you would have taken prevention seriously. Steve Leung OD, is now using the plus on his own child, and is attempting to offer this preventive method to the public -- and an "open" discussion of choice -- at the threshold. I have held my hand out in friendship to these ODs, and asked that we "learn together" and "work together" on this subject. I do acknowledge the difficulties -- but also the opportunities. Instead I get endless stone-walliing of people who are more interested in defending their "professional position" than discussing and honest choice. I hope your own children reveive a more "open" discussion of prevention as advocated by Steve Leung on www.chinamyopia.org Just my opinion. Best, Otis Engineer Otis Brown wrote, in part: > I have held my hand out in friendship to these ODs, and asked that we > "learn together" and "work together" on this subject. I do [quoted text clipped - 3 lines] > in defending their "professional position" than discussing and honest > choice. I believe the consensus on this board has merely been "Prove it." Nothing you've /ever/ offered has come /close/ to /resembling/ proof. You fail to provide evidence, citations, or actual facts or figures. Hard to take you seriously when your assertion that something /is/ is really all that you have. Just prove your assertions, Otis--the old fashioned way: proper controlled testing with randomization, ample sample size, double-blind, and peer-group validation. That's how theories gain acceptance--not simply by repetition, and by asserting that those who argue are conspirators against you. > I hope your own children reveive a more "open" discussion of prevention > as advocated by Steve Leung on > www.chinamyopia.org And I hope Dr. Leung one day publishes some evidence that this works. -MT This profession is blasphemous. They know nothing ar all. The only doctor who started to understand, was thrown away many years ago. Not this kid will be a good candidate to test rest methods, given the freshness of his "refraction". Why don't you teach him those rest methods by the use of a Snellen test card in the classroom or at home? http://TheCentralFixation.com Well, that was helpful. "Wooly" <nobody@nun.ya> >I wasn't able to get a straight answer out of the doc today so I'll > put the question to the Collective: > > At what point does a vision deficit qualify for correction? Most of us would recommend against glasses of +025-025. That's as minimal as it gets - any less would be zero. I'm guessing your son is 8? Squinting is often attention-seeking at that age. If his binocular coordination and visual perception are normal, it's OK to reassure him that "it will get better." Unless you decide to employ placebo effects. Functionally, he has no significant refractive error. Only a small number of people have absolutely zero refraction.. -MT, OD I would add one more comment, and that is since your child is squinting during nearpoint tasks, were any tests done at the nearpoint? It is possible that your child has an accommodative disorder, i.e. trouble focusing at near, or a convergence insufficiency which requires him to accommodate excessively. Occasionally -- and thankfully rarely, I might add -- I have performed a cycloplegic refraction, and still underestimated the child's hyperopia simply because of insufficient cycloplegia, i.e. the pupils were dilated, but the accommodation wasn't relaxed. DrG |
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