 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Vision / March 2005Myopia Progression in Pre-Teen
My 11 year old daughter had perfect vision until she was about a year and a half ago. Since then she has become more and more nearsighted and she gets new lenses made every 6 months. She is now at -5.75/-5.25 with a progression of about (-1.75) every 6 months. We have tried contacts, but her eyes are relatively dry and she doesn't tolerate them well so she has glasses. Unfortunately, she seems to in denial about her vision and wears her glasses only when absolutely necessary (in class, TV). When she goes out with her friends she doesn't take them, and she doesn't wear her sports glasses in gym class either. Both my husband and I are nearsighted, and I am -4 in both eyes and couldn't imagine getting through the day without my lenses. I can only imagine trying to function at almost a -6 level in the mall or playing sports. This is a safety issue. What should I do? Karen > My 11 year old daughter had perfect vision until she was about a year and a > half ago. Since then she has become more and more nearsighted and she gets [quoted text clipped - 11 lines] > to function at almost a -6 level in the mall or playing sports. This is a > safety issue. What should I do? You're not even getting "warm" yet. My prescription was -12 D before cataract surgery, although it's plano now. Your daughter seems on track for fairly high myopia, but there is no reason to believe, based on your statements, that there will be sight-threatening complications. If she wishes to do without glasses for cosmetic reasons, as appears to be the case, contact lenses are indicated. With frequent prescription changes still taking place, Lasik would not be appropriate.  SignatureRobert T. Kopp http://analytic.tripod.com/ >> My 11 year old daughter had perfect vision until she was about a year and >> a >> half ago. With frequent prescription changes > still taking place, Lasik would not be appropriate. The child is 11 years old, LASIK at least in Europe is not done at such an age and as far as I know not in the USA either. Eighteen years of age and at least for two years having no changes in prescription is the minimum. SignatureJan (normally Dutch spoken) > My 11 year old daughter had perfect vision until she was about a year and > a half ago. Since then she has become more and more nearsighted and she [quoted text clipped - 12 lines] > imagine trying to function at almost a -6 level in the mall or playing > sports. This is a safety issue. What should I do? Until she has a driving license, it isn't a safety issue. The more you nag her, the less she will wear them. When she gets tired of blurry vision she will wear them. Remember being a pre teen? How everything that made you different from the other girls was a big deal? Take heart in knowing that about 20% of her classmates will become nearsighted in the next two to five years and she will not feel so different from her peers. In the meantime, you could try taking your daughter and two or three of her closest friends to help her look for new frames. Make sure she tries some really funky shaped and coloured ones; her friends will likely ooh, ahh and try on some too. At least one will say "I wish I needed glasses so I could get this cool pair". No matter how weird a pair she picks, let her get the frames she wants and that her friends think is cool. You may be surprised to find that she wears them.. Dr Judy >Until she has a driving license, it isn't a safety issue. The more you nag >her, the less she will wear them. When she gets tired of blurry vision she >will wear them. Not being able to see oncoming traffic while crossing the street *is* a safety issue. Not seeing a flight of descending stairs ahead *is* a safety issue. Not seeing the gaping construction hole in the sidewalk *is* a safety issue. Not being able to see a basketball, baseball or other inbound missle during phys ed *is* a safety issue. The phys ed instructor needs to be apprised of the situation and should be directed to REQUIRE the kid to wear her glasses during PE. No spex, no participation; enough non-participation days produces a failing grade. If PE operates the way it did when I was in school she'll have a lot of stairlaps to run in order to buy back that failing grade (while wearing her spectacles, of course). >>Until she has a driving license, it isn't a safety issue. The more you >>nag [quoted text clipped - 6 lines] > safety issue. Not seeing the gaping construction hole in the sidewalk > *is* a safety issue. Sorry, I disagree. With about 6D of myopia she will have no trouble seeing a car, stairs, holes in the sidewalk, basketballs and baseballs. All those objects are certainly large enought to be seen with the kind of unaided acuity she likely has. She is not blind, she merely has blurred vision without glasses. When I was in school, they made me take my glasses off for PE so they wouldn't get broken. Dr Judy > Not being able to see a basketball, baseball or other inbound missle > during phys ed *is* a safety issue. The phys ed instructor needs to [quoted text clipped - 4 lines] > in order to buy back that failing grade (while wearing her spectacles, > of course). > Sorry, I disagree. With about 6D of myopia she will have no trouble > seeing a car, stairs, holes in the sidewalk, basketballs and baseballs. > All those objects are certainly large enought to be seen with the kind of > unaided acuity she likely has. She is not blind, she merely has blurred > vision without glasses. I think -6 is too much for softball, certainly for hardball. But being 9 is tough enough without being forced to wear glasses. They make adaptations and get along very well. If outdoor sports are important to her, she'll wear glasses. If not, she won't. The sad thing is that social pressures are usually more perceived than real. -MT > The sad thing is that social pressures are usually more perceived than real. Good point. In the behavioural model that i believe in, myopia is a perceptual distortion. What is around the myope appears a certain way but in reality its not quite like that. http://www.optometrists.org/Boston/articles.html The perception of distance alters our ability to accommodate to that distance. Even being present in a classroom and feeling anxious can cause a child to shrink their area of attention. It like all eyes are upon them at times. If your own eyes (your attention) is upon yourself what does that do to your ability to also attend to what is further away? Playing ball games like basket ball (where you move around a known area and learn its dimensions very accurately) is an excellent way of building accurate judgements between perceived sense of distance and actual distance. Its not just 'over there', its also known about in terms of how quickly we can move to 'over there' We learn to use our visual system. Does how we feel about 'over there' and 'way way over there' affect our accommodation. Quite possibly it does. Walking a long way to a distant place visible from a location you commonly spend time in, is an excellent way of appreciating that 'over there' can also be 'Wow! thats a long way away from where i am now!' Reading a great deal and using the mind a great deal in the small area and distance of reading may well create the habit of limiting our ability to perceive what is further away quickly and accurately. If we read about 'over there' its possible that visually 'over there feels' no different from what we read about because thats now become our habit. Children and adults who live a great deal in fantasy in books might think they know about the space around them. But only experience in space can really give you accurate knowledge and rapid ability to calculate where to place your eyes in an effortless stress free confidant manner. People underestimate how difficult it is to be a child and to learn to see normally. Andrew >>>Until she has a driving license, it isn't a safety issue. The more you >>>nag [quoted text clipped - 11 lines] >objects are certainly large enought to be seen with the kind of unaided >acuity she likely has. I could never play a sport without my glasses nor cross the road safely and my glasses are not quite -6. But if the child doesn't want to wear glasses even though she sees that badly, there must be a reason. Maybe she hasn't been correctly tested and the glasses aren't the correct presction for her. I'd get a second opinion. Ann >She is not blind, she merely has blurred vision >without glasses. [quoted text clipped - 12 lines] >> in order to buy back that failing grade (while wearing her spectacles, >> of course). > of about (-1.75) every 6 months. We have tried contacts, but her eyes are > relatively dry and she doesn't tolerate them well so she has glasses. "Relatively dry" eyes are rare in an 11 year old. OTOH, ill-fitting contacts are often described as "dry," especially late in the day. They may also be difficult to insert, or pop out easily, signs that the fit is poor. How many different contacts has she tried? If the answer is "one" or "two" then there are likely more comfortable contacts. -MT > My 11 year old daughter had perfect vision until she was about a year and a > half ago. Since then she has become more and more nearsighted and she gets [quoted text clipped - 13 lines] > > Karen I agree with Mike Tyner, look at the contact lens option again. There are many types to try before you give up on them. The new silicone hydrogels are very good. A progression of -175 evey six months? Wow, that's a lot. Has she had a cycloplegic refraction? Does she read a lot (i.e. too much?). I wonder if there is an element of pseudomyopia or accommodative spasm, meaning her outside vision may not be as bad as the numbers would suggest. Dom Dear Dom, I suspect "over-prescription" due to: Dark room measurements, and a poorly illuminated eye chart. Also, perhaps "instrument myopia" produced by a small aperture effect. One young man, "Mike" had cleared his vison to 20/40 on a well-illuminated (DMV Standard) Snellen. When an OD put him in a very dark room, using a poorly illuminated (porjected) Snellen, the OD said his vision was -2.0 diopters. Since Mike passes the legal standard, you might say he was over-prescribed by -2 diopters. Perhaps this young woman should check against the legal Snellen -- but it might be too late. Best, Otis > an OD put him in a very dark room, using a > poorly illuminated (porjected) Snellen, the > OD said his vision was -2.0 diopters. > > Since Mike passes the legal standard, you might say > he was over-prescribed by -2 diopters. No, _you_ might say that. The far point of refraction is measured in diopters, not Snellen letter sizes. Diopter measurements are more accurate when depth of field is reduced. > Perhaps this young woman should check against > the legal Snellen -- but it might be too late. Yes. She should be publicly humiliated for letting her daughter use glasses. -MT Subject: Over prescription -- easy to do -- hard to catch. The standard driving license check is for a Snellen -- reading 1.8 cm letters at 6 meters. (Obviously there are modifications to this basic measuement.) If a person verifies that he passes this line, and goes and passes the DMV test for driving -- then he can make up his mind if he wishes to wear a -2 diopter lens -- when there is NO LEGAL REQUIRMEMENT TO DO SO. In deep dusk, the natural eye assumes a status called "tonic accommodation". In this situation, the eye has a refractive status -- normally -- of about 1 to 3 diopters more negative than the room-illumination status. If we lived in semi-darkness, the perhaps you or your patients will loved that excessive -2 diopters. A -2 diopters has the effect of moving all objects "in" to 20 inches. All objects, then are linearly that much closer to the ehe. If you place a minus 2 diopter lens on a poulation of natural primate eyes, the primates wearing the minus lens will have theri refractive status move in the direction and approximate magnitude of the applied minus lens. Over the year, some ODs have been very reluctant to use the minus -- and will attempt to limit its use -- consistent with passing the 20/40 line. Tragically, the do no discuss their concerns about the risks of the minus lens -- and a need to "go slow" with it -- if possible. Since Mike is now passing the required legal standard, and is well-aware of the direct scientific tests (primates) it is up to him to make up his mind if he wants to wear a -2 diopter lens all the time -- then there is no need for it. Karen says her daughter shows "stair-case" myopia. One has t suspect that a "down" rate of -3.5 diopters per year might be an "error of measurement" as stated above. The OD might be using an "auto-refrator" an MIGHT be getting a "bad" measurement -- but Karen has no way of knowing this. For that matter, "Mike" might be getting "bad" measurements from a auto-refractor. The only means "Mike" has to protect himself from an excessive or "accidental" over-prescription is to make these measurements himself. If he has a low-cost trial-lens kit I am certain he could make the "refractive" measurement himself also. He is intellectually competent -- and his right to a "second opinion" on this issue should be respected. You tend to treat people like they are not owed a discussion of alternatives -- even difficult alternatives. I argue that, at least at the threshold, they have a right to understand some of this history of this situation, and if the have the fortitude to work on prevention -- do is successfully under their own control. But that is the nature of our disagreement. Best, Otis Engineer > Subject: Over prescription -- easy to do -- hard to catch. > > A -2 diopters has the effect of moving all objects "in" to 20 inches. > > All objects, then are linearly that much closer to the ehe. Does that mean that a -2.00 diopter myope wearing a -2.00 diopter lens now has to accomodate to 20 inches when looking at an object at infinity? How much more does he have to accomodate when reading at 20 inches then? Please do the math for me, I tried but still can't get it. Regards Roland Izaac > Best, > > Otis > Engineer Dear Roland, Wow! You totally missed the point. If you take a normal eye -- and place a minus 2 or 3 diopter lens on it -- the refractive status of the eye moves in the direction, and proportional to the applied minus lens. (Pure science -- not medicine.) This young man is well aware of that scientifc truth concerning the dynamic behavior of the natural eye. The point is that in deep darkness, or very poor illumination it does take a -2 diopter lens to clear for Best Visual Acuity. But how much time does is spend in deep-dusk conditions? He in fact passes all visual tests required of him. So why the hell should he run risks wearing a -2 diopter lens -- when he can retain his distant vision at 20/40 or better through the next six year in high school and college? He thinks more of retaining clear distant vision for himself than you do -- and that is a fact. Further, by continuing use of the plus (under his control) it is possible that he can "clear" to 20/20 -- but not if he wears that un-necessary -2.0 diopter lens -- all the time. It is clear that the scientific issue is under "Mike's" control -- and not your control. That is the true nature of the "preventive" second-opinion. Best, Otis Engineer >Dear Roland, > >Wow! You totally missed the point. Dear Otis, Wow! You totally missed the sarcasm. You said in your original post that the use of a -2.00D lens causes a LINEAR change in effective viewing distance that equals viewing an object at 20 inches rather than infinity. > -2 diopters has the effect of moving all objects "in" to 20 inches. > All objects, then are linearly that much closer to the ehe. Roland was pointing out the inherent flaw of your observation. Namely that not all people wearing a -2.00D lens are overminused by 2.00D. Do you really believe there are no actual myopes in the world? Are you saying that everyone could clear their vision by overplussing themselves? Roland didn't explicitly point out the blatant absurdity of your explanation -- that is if everything were moved closer to the eye linearly you would create an infinite amount of accommodation. I suppose that would happen as soon as an object was 20" closer than infinity, whatever that means. > Please do the math for me, I tried but still can't get it. While it is true that overminusing a person by 2.00D does cause the eye to accommodate the same amount as viewing an object at 20 inches, the effect is not linear. Since diopters are equal to inverse focal length (as a good high school physics student could tell you), overminusing would not cause a linear change in equivalent focal distance. Infinity goes to 20"; 20" goes to 10"; 13" goes to 8". This is not a linear relationship. If you are going to lecture us on engineering-science rather than medicine, at least get the basic physics right. Otis Brown wrote: >Dear Roland, >Wow! You totally missed the point. Roland: And your point is?.........Come on Otis you said it before , ---A minus lens brings distant objects closer. Overminusing a person by -2.00 diopters only makes him see like a hyperope. Is a hyperope's world a little closer? Otis: If you take a normal eye -- and place a minus 2 or 3 diopter lens on it -- the refractive status of the eye moves in the direction, and proportional to the applied minus lens. (Pure science -- not medicine.) Roland: I wouldn't do that, no not to a normal eye. (Medicine--not pure science) Otis: This young man is well aware of that scientifc truth concerning the dynamic behavior of the natural eye. Otis: The point is that in deep darkness, or very poor illumination it does take a -2 diopter lens to clear for Best Visual Acuity. But how much time does is spend in deep-dusk conditions? Roland: Are you sugesting that a refraction is carried out in "in deep darkness, or very poor illumination"? Maybe you should understand why a refraction is not carried out in bright light. Clue for you Otis----Pupil size---Depth of Field----answere 1 or two may not be reliable. Otis:He in fact passes all visual tests required of him. So why the hell should he run risks wearing a -2 diopter lens -- when he can retain his distant vision at 20/40 or better through the next six year in high school and college? Roland:Why the hell indeed; should he sacrifice his 20/20 vision when he has no Evidence based MEDICINE to show that the plus lens works. Indeed we have a study that shows that undercorrection may cause an increase rate in myopic progression. So does myopic blur. Who should he believe Otis? YOU? Roland:You did not answere my earlier questions on the accomodation differences between an emetrope and a high myope wearing spectacles. Your answere left several important steps out of the equation. That really shows how little you know about optics. But still you want us to believe you by pushing statements down our throats. Otis:He thinks more of retaining clear distant vision for himself than you do -- and that is a fact. Roland:Of cause he does, and when he runs out of Ideas and becomes desperate enough to try anything-----you take over. Otis:Further, by continuing use of the plus (under his control) it is possible that he can "clear" to 20/20 -- but not if he wears that un-necessary -2.0 diopter lens -- all the time. Roland:It is up to medicine not pure science to decide If and when a -2.00 diopter lens becomes necessary, I don't see how you can have any role in this decision. You won't even have the oportunity to provide the second opinion as to wheather it is necessary. Sad isn't it, but the law must protect the innocent. Otis:It is clear that the scientific issue is under "Mike's" control -- and not your control. Roland:Mike does not control any scientific issues. All he is doing is trying to control myopia. His belief in you is strong, don't let him down. Otis:That is the true nature of the "preventive" second-opinion. Roland:Yes, I agree. Roland Best, Otis Engineer > > Subject: Over prescription -- easy to do -- hard to catch. > > [quoted text clipped - 15 lines] > > Otis > > Engineer night myopia accounts for about -0.50 diopters-- not 1-3 diopters. what is the scientific evidence that if you place a -2.00D lens in front of a human eye that it's refractive status gets more myopic? to my knowledge there is no proof of this. please educate me. I think this is an exaggerated misstatement that you are making (again) to try to support your point of view. most refractions are not done in total darkness. there is usually mild environmental lighting so as to reveal ambient room details to stave off night myopia. > > Perhaps this young woman should check against > > the legal Snellen -- but it might be too late. > > Yes. She should be publicly humiliated for letting her daughter use glasses. Not to mention the two year prison sentence for using an illegal Snellen. :-( SignatureDan Abel Sonoma State University AIS dabel@sonic.net > My 11 year old daughter had perfect vision until she was about a year and a > half ago. Since then she has become more and more nearsighted and she gets > new lenses made every 6 months. She is now at -5.75/-5.25 with a progression > of about (-1.75) every 6 months. Dear Karen This is not an easy situation to resolve but I believe it is possible. Importantly as far as you are able take a relaxed view to what is happening and dont make this difficult situation the focus of stress in your family. I know these things are not easy and they are highly personal to each family, but can you think of any difficult set of experiences that your daughter may have be finding it hard to resolve? You mentioned denial about her eye problem. Are there other problems she might be wanting to avoid? Growing up is necessarily not an easy thing for any child who begins to enter teenage and then begins the journey to adulthood. Areas to consider which could be related are: Separation from school friends. Change of school. Berievement in the family. Difficulties coping with developing sexual awareness. Problems with significant adults in her life or sibling rivalry. Potential boy friend issues. That kind of thing. In this context it might help if you and your family also look at what was happening in your own lives as you got a vision problem. Myopia tends to have specific times in our lives when it most commonly begins For example. 7-8. This is a time when children begin to get some self awareness and awareness of others. For example I was 8 before I became aware my father was disabled. 10-11. This is when we move into becoming independant young people. Begin to assert our own way of doing things and prepare for life as independant adults. It is also for many girls the beginning of menstruation. For many children it is a bewildering time to be still children but beginning the path to adulthood. This list has a strong focus on physical aspects of eye problems, however there is a branch of optometry called behavioural optometry. If you want to pursue a more holistic approach to the problems you are facing this might be a possible path to take. If i can help further please by all means write to me privately Best Wishes Andrew Karen, There is no scientific evidence that behavioral or psychological problems have anything to do with a person's eyeglass/contact lens prescription. Be aware that there are some people with very "alternative" points of view that post in this newsgroup and already two of them have replied to your original message. I recommend, as another doctor already did, slowly getting your daughter interested in eyeware and contact lens types. Maybe some of her friends wear "cool" glasses or colored contacts or something of that sort. Be aware that it doesn't hurt her eyes in any way not to wear her glasses-- they just help her see better when they are on. Within the last few months some very good new brands of contact lenses have become available-- maybe she should try contacts again. I addition I recommend taking your daughter for another eye exam. Simply tell the doctor what her refractive history has been and what your concerns are. A change of -1.75 every 6 months is indeed high and perhaps is not real. Some people respond inappropriately during the question and answer phase of the eye exam and can easily be overminused. Perhaps this is happening to your daughter. Good luck ======================== > You mentioned denial about her eye problem. Are there other problems > she might be wanting to avoid? [quoted text clipped - 37 lines] > > Andrew > Karen, > > There is no scientific evidence that behavioral or psychological problems > have anything to do with a person's eyeglass/contact lens prescription. At best this is a distortion of the truth. At worst it is a blatant lie 1. Those who read a great deal or who read at very close distances have been shown to be likely to get eye sight problems. 2. Those who eat diets high in sugar and other refined foods are likely to get vision problems A person who believes that behaviour does not affect vision has a poor memory or an axe to grind. >> There is no scientific evidence that behavioral or psychological > problems [quoted text clipped - 9 lines] > 2. Those who eat diets high in sugar and other refined foods are likely > to get vision problems I do not call these behavioral or psychological problems. I call behavioral problems things like "anxiety" or "conflicting messages from parents"-- you know the things that YOU think cause ammetropias. I restate my point-- there is no evidence that such things have anything to do with a persons eyeglass/contact lens prescription. > A person who believes that behaviour does not affect vision has a poor > memory or an axe to grind. ???? Poor memory of what? Hi Karen, My name is Yan. I have a daughter who is nearsighted. At age four, she was prescribed -2.5 glasses both eyes. At age five she was prescribed -4.00 glasses both eyes. So I can really relate how you feel. I would like to tell you what we have done so far to help my daughter with this problem, and what we have achieved so far, just for your reference. Background: Both my husband and I are nearsighted. I myself am severe nearsighted (-8 both eyes). So many people will say my daughter's nearsightness is "genetic". 1. We studied extensively about eyes, including text books for medical students. So we understand what and why people say what they say. Based on our knowledge and our reasoning, we decided to give our daughter a chance to reverse her myopia. 2. Under her behavour OD, we had done one year VT. During this one year period, her vision improved from -4.00 to -1.5. 3. After one-year VT, we stoped going to the ODs office for VT. Instead, we continue doing VT at home three to four times a week. Then go to her OD's office for eye exam every three months. She has just had her eye check up last week, and her left eye improved about -0.5 but right eye improved less than that. The important point is this: it is about 20 months since we started the VT, not only my daughter's vision had not progressed worse, but improved steadily. She is almost seven now. So you can be sure we will continue what we have been doing with her vision, and hopefully she can be 20/20 next year. 4. There is not much magic about what we had done. The one-year VT improved my daughter's overall eye health, including eye movement, tracking, binucular vision, relaxing etc. The very important component is the overall environment change. We re-arranged my daughter's study environment, make sure she has sufficient lighting when reading, and rest her eyes after twenty minutes close work. Also, she wears a "plus 3" glasses when reading. So you see, on one hand, we do near-far accomodation, deep-blink reading eye-chart, and push-plus eye exercises three to four times per week, to stretch her eyes to see far, on the other hand, we use the plus-lens to convert her close work to far work. So far this method works for my daughter. Well, this is a bit too long. I seldom post to this news group, as you may already know the heated argument on myopia prevention on this group. I don't want to be any part of it. As a parent, I understand your desperation on helping your child. I was so grateful for any help I got when I started seeking answers to my daughter's myopia. I hope my post will give you some light, if not, just ignore it. If you need further infomation, you may email me directly. Take care and good wishes to you and your daughter. Yan > My 11 year old daughter had perfect vision until she was about a year and a > half ago. Since then she has become more and more nearsighted and she gets [quoted text clipped - 13 lines] > > Karen |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.