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Medical Forum / General / Vision / May 2005Opinions Sought
Hi, Have just been to get my eyes tested: Previous Results: April 2002: Right Distance +0.50 Sph, -0.25 Cyl, 130 Axis Left Distance +0.50 Sph, -0.50 Cyl, 30 Axis May 2004: Right Distance ~ Sph , -0.25 Cyl 130 Axis Left Distance ~ Sph, -0.50 Cyl, 25 Axis May 2005: Right Distance +0.50 Sph, -0.75 Cyl, 135 Axis Left Distance +0.75 Sph, -0.50 Cyl, 35 Axis No value for Sph was recorded in 2004 apart from a sideways eight (I've marked above using ~) The optician said there was nothing wrong, but gave me the impression of just bordering on needed glasses since its my close up vision that's apparently suffering. He said I didn't need to get any unless I wanted to, but suggested that if I get eye strain or headaches, to consider more seriously getting glasses. He recommend I return for another test in two years though, so he obviously doesn't think it's that serious. What do you think? Should I consider glasses, or just hold off and see what my next results show next year? Do the results indicate any kind of progressing problem, or is this just a blip? I must admit just sitting here writing this email, my vision feels a little uncontrolled, blurry and almost looking past the screen... Im probably just tired though. Cheers Simon Dear Simon, You OD gave you excellent advice, to hold-off on getting glasses. He could have eaily have SOLD you a pair -- and made the money! A real PROFESSIONAL. The next step is up to you. You could go back to him and request "reading" glasses of about +1.5 diopters spherical. These are often worn for comfort when doing a lot of "close" work. You can also find these glasses over-the-counter if you look for them. The next step is up to you. Best, Otis Engineer Question; He is already hyperopic, isn't he? Then if he gets plus lenses, wouldn't it be against "holding off getting the glasses"  SignaturePV2 Yasar, M U.S. ARMY AH-64D "Armt Dawg" A Co/602d ASB/2ID/EUSA - South Korea Dear John, These measurements are a good indication of the "noise" in these measurements. In May, his refraction was zero. At other times it was +0.75 diopters! If there is that much variation in these measurements then NONE can be very accrate for a prescription. However, as long as his he has 20/20 and a positive refractive state -- nothing is said about this issue. One of the things I do suggest it that the person himself obtain a low-cost trial lens kit, and make these measurements himself -- just to see these variations. In that sense, the Snellen is more accurate that these "diopter" measurements. In suggesting your own trial-lens kit I do not suggest you PRESCRIBE to such a kit. It would be like a personal blood pressure gage. For technical information and to understand how to measure the refractive states of the natural eye -- both plus and minus, and so you get OBJECTIVE knowledge about the natural eye's behavior. Sounds like the basis of a true scientific effort -- where the person himself makes the measurements. Best, Otis Engineer > Dear John, > [quoted text clipped - 6 lines] > If there is that much variation in these measurements > then NONE can be very accrate for a prescription. That is an incorrect statement. The sphere varies from plano to plus, indicating hyperopia. When is it wrong to prescribe a hyperopic prescription for close work? > However, as long as his he has 20/20 and a > positive refractive state -- nothing is said > about this issue. At near or far? Does the patient have a symptom? > One of the things I do suggest it that the > person himself obtain a low-cost trial > lens kit, and make these measurements > himself -- just to see these variations. You've gone off your rocker. How is he going to go about measuring his astigmatism? Is that in you little instructional booklet? > In that sense, the Snellen is more accurate > that these "diopter" measurements. The Snellen chart is notoriously imprecise. Many hyperopes can read 20/20 at a certain age, with values of hyperopia ranging from +0.25 to +4.00 and maybe more. If the Snellen chart cannot discriminate between such diverse values, how can you say that it is more accurate than diopter measurements? > In suggesting your own trial-lens kit I do not > suggest you PRESCRIBE to such a kit. [quoted text clipped - 10 lines] > effort -- where the person himself makes > the measurements. Sounds like the patient who has a fool for a doctor. DrG >> If there is that much variation in these measurements then NONE can >> be very accrate for a prescription. > > That is an incorrect statement. The sphere varies from plano to > plus, indicating hyperopia. When is it wrong to prescribe a > hyperopic prescription for close work? If I understand this more though, it varies from plus to plano over two years then back to plus a year later... Which I kind of guess he was trying to get at with that statement, before talking about diagnosing your own eyesight... Though if it's linked to my thyroid, well, it might just be Im naturally slightly hyperopic, and I became plano under subclinical hypothyroidism and then reverted back to slightly hyperopic now Im on 100 mcg of thyroxine??? > Dear Simon, > [quoted text clipped - 5 lines] > > A real PROFESSIONAL. Dear Simon. Otis is not in a position to determine whether an OD is a professional or not. He is not in the medical profession and not in the position to make a decision whether an OD's decision is professional or not.. Please ignore Otis. Thank you! Allen > Dear Simon. > [quoted text clipped - 7 lines] > > Allen I am not a fan of Otis. But what does it take to be qualified to tell whether an OD is professional? Only other OD's? Is an ophthalmologist qualified? How about a mere optician? How about a podiatrist? How about a lens designer? Judging who is professional is highly subjective. And almost anyone can judge certain aspects of professionalism even if not able to judge other aspects. Bill I guess if the OD was observed urinating in a public place, virtually anybody could pass judgement. However, in matters concerning something of a technical nature related to the practice of medicine or optometry, such as performing a cover test to determine the presence of a heterophoria, or prescribing eyeglasses for the treatment of hyperopic astigmatism, the matter should be referred to the appropriate regulating body, such as the state board of optometry, established to make such judgements. Otis used the term "professional" only in the sense that he agrees with the actions of the optometrist in this case, i.e. the witholding of eyeglasses. Allen spoke appropriately when he questioned the credentials of Otis to make that kind of judgement, when Otis himself clearly makes his non-qualified status known by including the title of "engineer" in his signature. DrG > I am not a fan of Otis. But what does it take to be qualified to tell > whether an OD is professional? Only other OD's? Is an ophthalmologist > qualified? How about a mere optician? How about a podiatrist? How about a > lens designer? Hi Bill, Just as Dr Luekoma statted, Otis is not in any position to evaluate whether an OD's decision is professional or not. Otis has no medical training or background to base his opinion. Now, if Otis had gone to the doctor himself and said, wow, this doctor was good to me, and was wonderful in treating me, I would have no problem with that. Sharing personal experiences is one thing, to sit back and make judgment in an area where he has no professional training in my opinion is reckless. Allen Dear Bill, Subject: The professional second-opinion Yes, it is true that some people believe that the natural eye is not dynamic when tested on and "input" versus "output" basis. But the science of it tells it is true that over-all the natural eye is dynamic. In fact, a growing number of ODs support this concept -- as the second-opinion -- and support people who request prevention with the plus. It is also true that there are ODs who are hostile to the cocept -- and this is COMPLETELY NORMAL. All I have ever said it that a person has a right to be informed in a "positive" manner about this preventive method -- and the science behind it. If the person "can't be bothered", or refuses to use the plus "properly" then nothing is lost. The point is that "medicine" is NEVER a serttled business -- and anyone who thinks so is simply not looking at the objective facts themselves. In fact I do support the ODs who will develop this "preventive" method -- with the people who have the motivation for it. I would gladly PAY THEM for this professional choice. But encountering the massive hostility to an honest review of these objective facts leaves the person with very little choice but to learn how to do this work himself, under his own control. We should all be aware of the need for fundamental change in the "traditional" minus lens concept. But it is indeed profoundly easy to apply the minus and impress the patient with it. Best, Otis Engineer > Dear Bill, > [quoted text clipped - 6 lines] > But the science of it tells it is true that > over-all the natural eye is dynamic. That has nothing to do with this conversation. > In fact, a growing number of ODs support > this concept -- as the second-opinion -- and > support people who request prevention > with the plus. That has nothing to do with this conversation. > It is also true that there are ODs who > are hostile to the cocept -- and this > is COMPLETELY NORMAL. That has nothing to do with this conversation. > All I have ever said it that a person > has a right to be informed in a "positive" > manner about this preventive method -- and > the science behind it. That has nothing to do with this conversation, this was never advised yet you explain how the OD was a "professional" based on my own personal subjective evidence. > If the person "can't be bothered", or refuses > to use the plus "properly" then nothing > is lost. That has nothing to do with this conversation. > The point is that "medicine" is NEVER a serttled > business -- and anyone who thinks so is simply > not looking at the objective facts themselves. That has nothing to do with this conversation. > In fact I do support the ODs who will develop > this "preventive" method -- with the people > who have the motivation for it. I would gladly > PAY THEM for this professional choice. That has nothing to do with this conversation. > But encountering the massive hostility to > an honest review of these objective facts > leaves the person with very little choice > but to learn how to do this work himself, > under his own control. That has nothing to do with this conversation. > We should all be aware of the need > for fundamental change in the "traditional" > minus lens concept. But it is indeed > profoundly easy to apply the minus and > impress the patient with it. That has nothing to do with this conversation. I fail to see how any of your comments here relate to the conversation, and your assertion that the OD was professional merely because he didn't advise me to get glasses unless I suffered eye strain. Just another form-letter. Cya Simon > In fact, a growing number of ODs support > this concept -- as the second-opinion -- and > support people who request prevention > with the plus. The OP should be reminded that many of Otis' "facts", like this one, are patently false. > But encountering the massive hostility to > an honest review of these objective facts > leaves the person with very little choice > but to learn how to do this work himself, > under his own control. Please offer some documentation showing that plus lenses prevent or reverse myopia. Most eye doctors would offer this to patients if you'd simply show us convincing evidence of your "objective facts." Until then, they are neither objective nor factual. -MT > Dear Simon. > [quoted text clipped - 3 lines] > > Please ignore Otis. Don't worry. Already have done. Im a regular lurker here, so I know what Otis is like, although I found his positioning here to be rather conservative actually compared to normal, and basically just re-itereated what my optician told me... in effect... it's up to me... One thing I forgot to mention, is that last year I was diagnosed with subclinical hypothyroidism, Im now on 100 mcg of thyroxine, but about three months ago, I've started feeling particularly tired and think I need more thyroxine. Of course, the readings havent changed too much since 2002 though, only .25 on L Sph. Cheers Simon >Hi, > [quoted text clipped - 37 lines] >Cheers >Simon Simon, How old are you? Did the same doctor perform all three of these exams? Were any of these measurements done with your eyes dilated? Were you given your prescription for *near* vision? THanks for the reply Neil. Should be easy this one... > Simon, > > How old are you? 27... > Did the same doctor perform all three of these exams? No. Three different OD's, same practice, same equipment. > Were any of these measurements done with your eyes dilated? No. Presume it would be hard to see the chart and focus with them dilated. Or have I got those confused with those drops they put in? > Were you given your prescription for *near* vision? No. There's three rows for the prescription, Dist, Int, and Near. Only Dist is completed. Can't wait to see what all this means... Cheers Simon >THanks for the reply Neil. > [quoted text clipped - 14 lines] >No. Presume it would be hard to see the chart and focus with them >dilated. Or have I got those confused with those drops they put in? That's actually the point, though. If your "accommodative system" is working too hard to give you clear vision, they can uncover that by paralyzing your ability to focus. That gives a 'true' idea of how much refractive error you 'really' have when you're not working so hard to focus. >> Were you given your prescription for *near* vision? > [quoted text clipped - 5 lines] >Cheers >Simon You're a little farsighted. Probably not presbyopic yet, but . . . between the slight farsightedness and slight astigmatism, it's not uncommon to have symptoms of eyestrain at near. If it were me, I'd get a cycloplegic (dilated) exam, and consider a prescription for glasses, even if you only wear them for reading/computer use. You could also try using some drug store +1.00d reading glasses while you do near work. Trying that for a week or two may help ease the slight symptoms you're having. If that helps, you may want to consider the prescription glasses. Good luck! Neil (I'm not a doctor....) I'm not sure what the confusion is about. The refractions fairly consistently indicated hyperopic astigmatism. The fact that one refraction out of three was plano isn't at all unusual for low refractive errors. At 27, you are too young to be presbyopic, but there may be times when your eyes get tired. The glasses would probably help. I would also probably say "glasses optional for reading or long distance driving." DrG DrG, my emails are bouncing back from your address, can you check it out, maybe your inbox is full... SignaturePV2 Yasar, M U.S. ARMY AH-64D "Armt Dawg" A Co/602d ASB/2ID/EUSA - South Korea Try again. DrG >Try again. > >DrG > > Roger that... SignaturePV2 Yasar, M U.S. ARMY AH-64D "Armt Dawg" A Co/602d ASB/2ID/EUSA - South Korea > I'm not sure what the confusion is about. The refractions fairly > consistently indicated hyperopic astigmatism. The fact that one [quoted text clipped - 3 lines] > probably help. I would also probably say "glasses optional for reading > or long distance driving." So basically down to personal choice... maybe wear them at times when I feel tired and can't see close up properly, or like the optician said, if I experience eye strain or headaches etc... No confusion at all... Just wondered whether it would be absolutely necessary, or whether I should just hold off until I get some more excessive readings... Or whether I should pre-empt things and get some glasses now. Cya Simon
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