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Medical Forum / General / Vision / November 2005Child needs glasses?
Hi, I have a son who is 6 years old. He recently had his eyes tested at Boots Opticians (UK) and had the following reading: Right: -Sph: +0.50 -Cyl: DS Left: -Sph: +0.50 -Cyl: DS The optician was adamant that he needs glasses. I'm suspicious of Boots Opticians because I have had pressure from them in the past to change my glasses for a very marginal change in my eyesight. Needless to say the ones that suited me cost £200. My son doesn't want glasses (to put it mildly) and I have no doubt that if we do get him glasses they will rapidly be 'lost' or broken - I'd give them a life expectancy of less than one day. I have read that if a child does not show symptoms such as constant headaches and blurry vision, they should not be prescribed glasses and that, anyway, almost all children have low-grade long-sightedness, which they grow out of at about age 8-10. I have also read that children below the age of l0 should have their pupils widened with eye drops before being tested: the optician did not do this. My inclination is to hold off and have him tested again in a year or two. I'd appreciate any comments. Regards Emmett Dear Emmett, I am not a "doctor", but a from the study of primate eyes, refractive states from zero to plus 1.5 diopters are normal. There might be some "reason" for this "prescription", but the OD should give you a COMPLETE explanation. Just my opinion. Otis Dear Emmett, Subject: The second-opinion The ODs on this site will provide their opinion -- shortly. I would suggest holding off on getting the glasses. I would strongly suggest that you personally check your child's vision under your control. (You have nothing to lose by doing this.) You will find two eye charts on my site: www.myopiafree.com For that checking. I suspect his distant vision is close to 20/40 or better. The ODs on this site don't like me providing a layman's opinion. But I always suggest that you be provided with a competent second opinion. Best, Otis Dear Otis, Thanks for the feedback. I'll check him on your charts. Regards Emmett > Dear Otis, > [quoted text clipped - 3 lines] > > Emmett According to Otis Brown, engineer, wearing plus lenses can prevent myopia from developing. DrG Dear Emmett, Subject: Child with refractive status of +1/2 diopter and (potentially) 20/20 vision. I also suggest you obtain a WRITTEN description of WHY your child is being put into a +1/2 diopter lens. Once you are clear on the REASONS, the some further discussion would be in order. The REASONS are far more important that the use of any lens -- at this point. Best, Otis > Thanks for the feedback. I'll check him on your charts. Visual acuity tells you essentially nothing at this point. Children with +4.00 refractions can often see 20/20. Otis is raising concerns about a problem your son does not have. -MT Hi, I have a son who is 6 years old. He recently had his eyes tested at Boots Opticians (UK) and had the following reading: Right: -Sph: +0.50 -Cyl: DS Left: -Sph: +0.50 -Cyl: DS The optician was adamant that he needs glasses. I'm suspicious of Boots Opticians because I have had pressure from them in the past to change my glasses for a very marginal change in my eyesight. Needless to say the ones that suited me cost £200. No one "needs" glasses, unless they are doing something that requires better vision than they can achieve without them. (The exception is infants, who will not develop binocularity unless they see well.) Optometrists usually make a living by selling glasses, and one must never forget this. >Hi, > [quoted text clipped - 34 lines] > >Emmett Emmett, See a pediatric ophthalmologist to rule out amblyopia (lazy eye) and/or other diagnoses that *must* be treated at an early age. Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical robopt@execpc.com ~~~~~~~~~~~~~~~~~~ "An expert is a person who has made all the mistakes that can be made in a very narrow field." - Niels Bohr Robert, that's silly. Any optometrist can also rule-out amblyopia, and there are far more of them than pediatric ophthalmologists. Where do you live? DrG DrG/Robert, I live near London, where there is every sort of specialist going, so I am sure that it's possible to find a pediatric ophthalmologist if need be. It would be time-consuming and expensive though: specialists do not come cheap in London. Regards Emmett I agree that the over-use of specialists contributes to the high cost of healthcare. However, you have socialized medicine. If the GP thinks you need to see a specialist it may cost you nothing. Here in the U.S., optometrists are extremely well-trained, especially in the diagnosis of amblyopia. Children half the age of your son are regularly seen in my practice. Despite the well-meaning(or not so well-intentioned) comments of Mr. Kopp and others, most of us do not check our ethics at the door when we come to work each day. What Mr. Kopp and others fail to mention is that pediatric ophthalmologists also make a living....from surgery and treatments for -- and I bet you saw this coming -- amblyopia. Some of them even own dispensaries and sell (gasp) eyeglasses. I could tell some very interesting stories. DrG Hi Emmett, At that prescription I would not prescribe spectacles UNLESS there was a very good reason, which is not evident from your initial posting. For a second opinion try the Institute of Optometry, 56-62 Newington Causeway, London SE1. or Moorfields Eye Hospital, City Road, London or Great Ormond Street Hospital for Sick Children. But I'd try the Institute first. Regards Ian Hodgson - Isle of Man > DrG/Robert, > [quoted text clipped - 6 lines] > > Emmett > Robert, that's silly. Any optometrist can also rule-out amblyopia, and > there are far more of them than pediatric ophthalmologists. Plus, it's a pretty big leap to expect amblyopia when acuity is normal and equal in both eyes. If there are no signs or symptoms, it's because you haven't ordered more expensive testing? -MT >Plus, it's a pretty big leap to expect amblyopia when acuity is normal and >equal in both eyes. >-MT Right. On the other hand it sounds like they are "selling" a pair of glasses to a child that probably doesn't need them. All speculation of course, but If true, the child may not have been given the proper care in the past as well as the present, and at this age the clocks ticking. Regards, Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical robopt@execpc.com ~~~~~~~~~~~~~~~~~~ "An expert is a person who has made all the mistakes that can be made in a very narrow field." - Niels Bohr > Right. On the other hand it sounds like they are "selling" a pair of > glasses to > a child that probably doesn't need them. Agreed. -MT Especially with only .5 hyperopia, which is completely insignificant in a young child, no matter what. If there is an issue with amblyopia or heterotropia, they are not due to the .5, that's for sure. Bogus advice from the gitgo... w.stacy, o.d. >>Robert, that's silly. Any optometrist can also rule-out amblyopia, and >>there are far more of them than pediatric ophthalmologists. [quoted text clipped - 6 lines] > > -MT >Especially with only .5 hyperopia, which is completely insignificant in >a young child, no matter what. If there is an issue with amblyopia or >heterotropia, they are not due to the .5, that's for sure. Bogus advice >from the gitgo... > >w.stacy, o.d. The hell it is. You don't have the chart in front of you, you don't have the VA, for all we know the Rx is +5.00DS. We do know that the poster doesn't trust the doctor, and that there may be an ethical or legal question with the Rx for glasses recommendation, and that the poster is seeking medical advice from the Internet for a six year old adolescent. I say it's smart to play it on the conservative side and tell him to take the kid to a specialist, or at the very minimum a second opinion from any OD or OMD, and that to say otherwise would be clearly irresponsible. Robert. >>>Robert, that's silly. Any optometrist can also rule-out amblyopia, and >>>there are far more of them than pediatric ophthalmologists. [quoted text clipped - 6 lines] >> >> -MT You are correct that I don't have the chart in front of me. But I do know that no matter what the "real" refraction is, +.50 O.U. is going to do absolutely nothing for anything. I have no problem with getting a 2nd opinion, but to get all worked up about the +.50 is idiotic. Nothing in the post suggests anything serious is happening. Enough of this; I'm out of here for 2 weeks (sailing to Cabo San Lucas). w.stacy, o.d. >>Especially with only .5 hyperopia, which is completely insignificant in >>a young child, no matter what. If there is an issue with amblyopia or [quoted text clipped - 25 lines] >>> >>>-MT >You are correct that I don't have the chart in front of me. But I do >know that no matter what the "real" refraction is, +.50 O.U. is going to [quoted text clipped - 5 lines] > >w.stacy, o.d. Hmmm...I'd strongly recommend a life jacket lest you actually believe you can walk on water. Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical robopt@execpc.com ~~~~~~~~~~~~~~~~~~ "Science is a way of trying not to fool yourself." - Richard Feynman >Robert, that's silly. Any optometrist can also rule-out amblyopia, and >there are far more of them than pediatric ophthalmologists. Where do >you live? > >DrG Agreed. My recommendation is based on my uncertainty of the Doctors qualifications in the UK and the posters stated distrust of the prescribing doctor. I tell my clients with low risk children that in addition to normal pediatrician vision screening, they should consider taking their children to an OMD or OD that specializes in pediatric eyes. From age ten to age sixty I recommend an OD or OMD, and over age sixty an OMD. Wauwatosa Wi., a suburb of Milwaukee. It's an unlicensed state for opticians, with numerous poor quality chain opticals ("Eyeglass World" and " America's Best" to name a few). I am an independent optician-no doctors, no insurance. Regards, Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical robopt@execpc.com ~~~~~~~~~~~~~~~~~~ "An expert is a person who has made all the mistakes that can be made in a very narrow field." - Niels Bohr >>Robert, that's silly. Any optometrist can also rule-out amblyopia, and >>there are far more of them than pediatric ophthalmologists. Where do [quoted text clipped - 5 lines] >qualifications in the UK and the posters stated distrust of the prescribing >doctor. It wasn't a doctor, it was an optician. >I tell my clients with low risk children that in addition to normal pediatrician >vision screening, they should consider taking their children to an OMD or OD [quoted text clipped - 15 lines] >"An expert is a person who has made all the mistakes that can be made in a very narrow field." > - Niels Bohr > >>Robert, that's silly. Any optometrist can also rule-out amblyopia, and > >>there are far more of them than pediatric ophthalmologists. Where do [quoted text clipped - 7 lines] > > It wasn't a doctor, it was an optician. In the UK the term optician is used by the general public to refer to an optometrist. It is only in the last 10 years or so that the term optometrist has started being used in the UK because prior to that it was not a protected title. The protected title was 'Ophthalmic Optician', a change in the legislation protected both titles. An eye examination may only be carried out by an Optometrist/Ophthalmic Medical Practitioner/Ophthalmologist Incidently Optometrists in the UK are not officially doctors as the degree is first level ie a BSc some are but have a second level degree ie a PhD. This is due to the education system, rather than the level of training. As an aside some GP's are not in degree terms Doctors as they hold a Bachelor in Medicine degree Doctor is a courtesy title. Regards Ian Hodgson BSc FCOptom - Isle of Man > >I tell my clients with low risk children that in addition to normal pediatrician > >vision screening, they should consider taking their children to an OMD or OD [quoted text clipped - 15 lines] > >"An expert is a person who has made all the mistakes that can be made in a very narrow field." > > - Niels Bohr > I have read that if a child does not show symptoms such as constant > headaches and blurry vision, they should not be prescribed glasses and > that, anyway, almost all children have low-grade long-sightedness, > which they grow out of at about age 8-10. Most eye doctors will agree, if a) there are no symptoms, and b) the child sees stereograms properly, and c) there is no significant esophoria (eye turn stimulated by hyperopia.) > I have also read that children below the age of l0 should have their > pupils widened with eye drops before being tested: the optician did not > do this. In the US it's substandard to perform a child's first examination without dilation. > My inclination is to hold off and have him tested again in a year or > two. If there are no symptoms and he sees stereo OK, there's little risk in waiting. -MT >Hi, > [quoted text clipped - 30 lines] > >I'd appreciate any comments. When my children were small, they are now 24 and 27, there was a programme on television, one of the Watchdog type of things, which investigated opticians and their over prescribing of glasses to children. Just after seeing the programme, I took my son to an optician and was told he needed glasses. I then took him to a smaller non chain optician who said that was rubbish. So I'd say avoid the optician chains and go for one of the little independents. Ann > Hi, > [quoted text clipped - 16 lines] > if we do get him glasses they will rapidly be 'lost' or broken - I'd > give them a life expectancy of less than one day. At that age, for .5D, I don't think it's worth the battle. I'm speaking as a parent, not an eye professional. I would watch him carefully, especially reading, and let his teacher know so they will watch for problems. > My inclination is to hold off and have him tested again in a year or > two. One year, I would say. And maybe a different optician.  SignatureDan Abel dabel@sonic.net Petaluma, California, USA Bottom line here, Emmett, is that if your 6 year/old child is asymptomatic(i.e. has no headaches), has normal and equal acuities in both eyes, is binocular, and has no trouble reading at grade level, then such a small prescription seems to be a moot point, in my opinion. I know that there are a number of good ophthalmic opticians in the London environs who are not affiliated with Boots or similar. DrG > Bottom line here, Emmett, is that if your 6 year/old child is > asymptomatic(i.e. has no headaches), has normal and equal acuities in > both eyes, is binocular, and has no trouble reading at grade level, > then such a small prescription seems to be a moot point, in my opinion. Hypothetically now: What would be the opinion of the child were myopic by ~0.50D, that is to say, calling for a correction of -0.50D in each of the two eyes? Another hypothetical: What if the child had astigmatism to the extent of 0.50 diopers in one or more eyes? -- Dicky > What would be the opinion of the child were myopic by ~0.50D, Since there is no physiological harm in leaving it uncorrected, we'd look for a reason why the child might _need_ a half-diopter correction. Without a compelling reason, most doctors would leave parents the option but would not urge correction. Glasses with this prescription tend to get lost. > What if the child had astigmatism to the extent of 0.50 diopers > in one or more eyes? Figure the blur of astigmatism is about 1/2 or 1/3 that of an equivalent amount of nearsightedness. So correcting it is about 1/2 to 1/3 as important as correcting myopia. Just one opinion. -MT At least, from Academy of Ophthalmology, regarding astigmatism specifically: at age 6, if >= 1.00 D of cylinder, should be ordered,. (But I also order if the vision is less than expected, and the cyl is less than 1.00 D ) Myopia of -0.50 probably would not both a 6 year old at all, even in school. If they were older, and the teacher is writing small and far away, or they are driving age, then it starts to become significant. Hyperopia of +0.50 is not normally significant at all, except perhaps in an adult who is presbyopic age and is uncomfortable. David Robins, MD Board certified Ophthalmologist Pediatric and adult strabismus subspecialty Member of AAPOS (American Association of Pediatric Ophthalmology and Strabismus) )On 10/29/05 11:28 AM, in article X3Q8f.663$zb5.542@bgtnsc04-news.ops.worldnet.att.net, "Dick Adams" <bad.addr@nonexist.com> wrote: >> Bottom line here, Emmett, is that if your 6 year/old child is >> asymptomatic(i.e. has no headaches), has normal and equal acuities in [quoted text clipped - 13 lines] > -- > Dicky As far as I am concerned, +0.50s is a homeopathic, insignificant refractive error. When it is equal and bilateral, it serves no purpose whatsoever to order it, except to pad the optician's pocket. David Robins, MD Board certified Ophthalmologist Pediatric and adult strabismus subspecialty Member of AAPOS (American Association of Pediatric Ophthalmology and Strabismus) On 10/28/05 5:52 AM, in article 1130503965.560047.202740@g14g2000cwa.googlegroups.com, > Hi, > [quoted text clipped - 34 lines] > > Emmett Dear David, I am pleased to hear you say that. But that begs the question, why was the Optician "adamant" about prescribing a "plus 1/2". Was he taught that all "refractive errors" must be fixed, or serious consequences will follow? Perhaps Emmett could check on the reason for this man's adamant requirement. It would be worth it to here a more complete reason. Best, Otis _________ Emmett> The optician was adamant that he needs glasses. I'm suspicious of Boots Opticians because I have had pressure from them in the past to change my glasses for a very marginal change in my eyesight. Needless to say the ones that suited me cost £200. > As far as I am concerned, +0.50s is a homeopathic, insignificant refractive > error. When it is equal and bilateral, it serves no purpose whatsoever to [quoted text clipped - 6 lines] > Member of AAPOS > (American Association of Pediatric Ophthalmology and Strabismus) I beg to differ. Dozens of patients have presented to me over the years c/o frontal HAs put down to "sinus", "stress" or idiopathic by their doctor but subsequently resolved very quickly and effectively with +0.50s once mild hyperopia was detected in the eye exam. Not every one with a refraction of +050 is symptomatic or requires correction, and the child at the start of this thread may well be in that group... however it would be irresponsible not to at least offer correction to those patients who do experience relevant symptoms (e.g. frontal headaches, eye strain, difficulty concentrating, a child falling behind in reading or comprehension, etc, etc). To suggest that +0.50s are prescribed as some sort of misguided amblyopia treatment is missing the point entirely. Dom > > As far as I am concerned, +0.50s is a homeopathic, insignificant refractive > > error. When it is equal and bilateral, it serves no purpose whatsoever to [quoted text clipped - 23 lines] > > Dom IMHO, it is a rarity that +.50 specs would be more than a placebo (but more on that coming!). But as Dom wrote, when there ARE symptoms for which you can not identify any pathology, that low plus rx might, for whatever reason, resolve those symptoms. Is it a spasm in accomodative-convergance? Is the cause an iris sphincter over reaction to that itsy bitsy accomodation? Does that +.50 just push the fusion system to finally lock? And so what if it is a placebo effect? As long as the parent and child understand that the specs are "therapy or treatment" that will be discontinued after a short time when the vision system is "healed", so be it. Sure, there might be unethical scam-and-rip-off eyeglass sellers willing to rx +.50s, but consider the ethical and responsible doctor actually listening to the patient's symptoms and trying something that actually be of benefit and doing so for that, and only that reason. I think it is far, far worse for MDs to rx antibiotics for a child with sniffles and runny nose caused by virus because the parent expects a pill to fix the symptoms. Or the doc who dispenses sodium sulfacetamide drops for the associated "pink eye." Eh, David? --LB, O.D. > IMHO, it is a rarity that +.50 specs would be more than a placebo (but > more on that coming!). But as Dom wrote, when there ARE symptoms for [quoted text clipped - 6 lines] > treatment" that will be discontinued after a short time when the vision > system is "healed", so be it. > --LB, O.D. Many who argue that +050s are unecessary claim it's because a young kid has many dioptres of accommodation in reserve, therefore to focus through the half dioptre of hyperopia should be well within their capabilities. But here's an analogy: - it's very easy to raise your straightened arms out away from your sides and hold them in a horizontal position, and in fact we could do it while holding an object in each hand, indicating that we have strength in reserve... but even empty handed, maintaining this position for more than a few minutes, or for six hours a day would be too much to ask. This is what we're asking a +050 hyperope to do when we send him to school for a day. It's not the acute demand, it's the continuous nature of the demand that causes the symptoms. There may well be a little bit of placebo in there too, and as Larry Doc says, who cares! But I think most of the effect is physical, real, and pretty simple to understand. Dom On 10/30/05 9:58 AM, in article larrybic-A15122.09585330102005@news.verizon.net, "LarryDoc" <larrybic@yahoo.remove.com> wrote: >>> As far as I am concerned, +0.50s is a homeopathic, insignificant refractive >>> error. When it is equal and bilateral, it serves no purpose whatsoever to [quoted text clipped - 46 lines] > > --LB, O.D. The answers are, Yes, Yes and Yes. There are those rare times. Well, I beg to differ also. (And yes, we can agree to differ - that is what this group is all about.) I still think +0.50 cannot be the cause of headache. It is too insignificant (NORMALLY). I say normally, because a child's accommodation is many times that of the +0.50 hyperopia, and as such should not cause headache. It just doesn't make sense. Yes, if they have a real lack of all accommodation, thenit is possible, but those are very rare indeed. I'll bet some of those kids would have stopped having headaches with a plano Rx, as a lot is in their head, not their eyes. (This is based on my 25 years of experience of doing kids.) On 10/30/05 4:33 AM, in article 4364BD87.9090905@spam.me, "Dom" <dont@spam.me> wrote: >> As far as I am concerned, +0.50s is a homeopathic, insignificant refractive >> error. When it is equal and bilateral, it serves no purpose whatsoever to [quoted text clipped - 23 lines] > > Dom Interestingly enough, +0.50 is easily capable of causing symptoms. Ciliary muscle is smooth muscle, and not designed for continued constriction. Smooth muscle tends to fatigue over time, and this is where low plus helps. The ciliary muscle does not get stronger with continued use, that is striated muscle that does this. The reason kids grow out of low plus is development of better control of the A/C system over time. Low plus helps continued concentration on near work until this happens. Why do we see more low plus being prescribed? Mainly due to increased reading at younger ages. What happens in your scenario is the child stops reading, reduces reading or changes technique to skimming to reduce the stress. My approach is to keep reading performance at optimal levels. (This is based on my 22 years of experience doing kids.) Dear Catman-X, Subject: Explaining the "reasons" for providing a plus. I am going to agree with the use of the plus -- but not for the reasons you suggest. As per Dr. T. Grosvenor, I believe that a strong plus should be STARTED when the child is a +1/2 diopter -- provided the parents FULLY UNDERSTAND THE PURPOSE AND INTENTION OF THE PLUS. See: www.chinamyopia.org The failure develops when the parents are not completely informed of the need for the plus. If they are not -- the "plus" can not be used. I believe that this is the major point being made on this thread. Best, Otis > I am going to agree with the use of the plus... Plus what, fercrisakes? A convex lens with a certain value, in diopters focal length? Possibly compounded with cylinder and prism? Maybe more than one? In a frame supported by the nose and ears? Used how? ??? > In a frame supported by the nose and ears? > Used how? Otis wants us to follow kids around to make sure they wear their plus properly and don't step into traffic with their 20/200 vision. -MT > Otis wants us to follow kids around to make sure they wear their plus > properly and don't step into traffic with their 20/200 vision. Does he want convex lenses to blur distance vision or to lessen some of the work (strain?) to of accomodating for reading and other close vision? "Plus" I think is adjective. Certainly not a noun. You are using it as a noun, as well as Otis. You guys are letting Otis make you silly. -- Dicky Dear Dicky, Thanks for your response. As ususal, Mike will distort what I have said about the natural eye's proven behavior -- for his own purposes. I personally agree that "prevention" is difficult but possible -- if the person is prepared to agressively use the plus -- before he starts wearing that minus. > Otis wants us to follow kids around to make sure they wear their plus > properly Otis> If the kid does not want to develop stair-case myopia (ref: Oakly-Young study) maybe he will take prevention seriously. In which case "compliance" will be up to this kid, won't it? Dicky> Does he want convex lenses to blur distance vision Otis> The "situation" is that the parents and kid verify eye-chart as 20/40 or better. That passes the DMV test in most states. Thus his eyes are on the threshold of nearsighedness. The issue is clearing to better-than 20/40 under the person's control. It is indeed a difficult thing to do, because most people only want instant sharpness of vision -- with a minus lens. Certainly the "minus" is far easier than the preventive-plus, but that issue must be discussed. Dicky> ... or to lessen some of the work (strain?) to of accomodating for reading and other close vision? Otis> With the conditions I stated, the proper-strength plus would be used for all reading. The eye-chart would be monitored by the kid -- to make certain he always passes all legal visual-acuity requirements that apply to him. Dicky> "Plus" I think is adjective. Certainly not a noun. You are using it as a noun, as well as Otis. You guys are letting Otis make you silly. Otis> Yes, they seem to go "off" when I state basic objective facts that prove that the natural primate eye is a dynamic device -- when correctly tested. That is because they can not allow scientific truth to be, well, scientific truth. [The usual "explosions" will follow.] Best, Otis Dicky >As ususal, Mike will distort >what I have said about the >natural eye's proven behavior -- for >his own purposes. And the award for Greatest Irony of the Year goes to ... Otis Brown, King of Distortions, Misrepresentations, and Outright Lies. SignatureLive simply so that others may simply live Dear Mike, Again you totally mis-quote me. 1. If a plus is to be used, I suggest that the parents be informed of the basic concept -- before their eye chart goes below 20/40. This information is "free" and you can find it on Steve Leung's web site. 2. It is essential that the person (kid) understand this issue clearly. If he has no interest -- then that ends the discussion and the possiblity of prevention for that kid. (He can always wear a -1.5 diopter lens all the time -- and develop stair-case myopia.) 3. But equally, if the "kid" figures it out, uses the plus and passes the 20/20 line, then the issue is not a medical issue. In fact you suggested that the people who did this had "pseudo-myopia" and if so, could always clear on their own -- with out your involvement. Best, Otis >Dear Mike, > >Again you totally mis-quote me. Weren't you going away?? Didn't you vow to leave this place and have no further part of it? What happened? SignatureLive simply so that others may simply live > 1. If a plus is to be used, I suggest > that the parents be informed of > the basic concept -- before their > eye chart goes below 20/40. Yes, you suggest that, but you don't have a license to maintain. > of prevention for that kid. (He can > always wear a -1.5 diopter lens > all the time -- and develop > stair-case myopia.) Yes, but you believe kids who wear glasses get worse than kids who don't. Despite all evidence to the contrary. -MT Dear Mike, Subject: Prevention -- not "cure" > 1. If a plus is to be used, I suggest > that the parents be informed of > the basic concept -- before their > eye chart goes below 20/40. Mike> Yes, you suggest that, but you don't have a license to maintain. Otis> That is correct. That is why the person himself MUST make up his mind about the use of the plus, i.e., take complete control as Dr. Stirling Colgate did. Further, my nephew did for the same reason. And specifically, Keith was presented with the Oakley-Young study (over 4 years) that proved that the plus group went down at approximately zero diopters, and the single-minus went down at -1/2 diopter per year AVERAGE. Otis> The result (potentially) is that a person using a stronger plus -- UNDER HIS OWN CONTROL -- can clear his visoin, while his fellows are developing -2 diopters during four years in school. Otis> But you are in NO POSITION to help anyone with true-prevention are you. This fact FORCES the person (Keith) to do it himself. His last report is 20/20 (actually better). > of prevention for that kid. (He can > always wear a -1.5 diopter lens > all the time -- and develop > stair-case myopia.) Yes, but you believe kids who wear glasses get worse than kids who don't. Despite all evidence to the contrary. Otis> Cut the self-serving bull s___. "All evidence to the contrary". No that is just your "majority opinion" talking. You don't speak for all ODs, and many, including Professor T. Grosvenor has suggested prevention with the plus as you well know -- but TOTALLY IGNORE. Otis> But eqully, I do agree that implementation is tough, which again means that the person must decide for himself how much he values his distant vision -- before he loses it to an over-prescribed minus. Best, Otis -MT >Dear Mike, > [quoted text clipped - 16 lines] >and the single-minus went down at >-1/2 diopter per year AVERAGE. Anecdotal, n=1, useless information, but ... considering the source.... >Otis> The result (potentially) is that a person >using a stronger plus -- UNDER HIS OWN CONTROL -- [quoted text clipped - 7 lines] >to do it himself. His last report >is 20/20 (actually better). Your nephew has a fool for an uncle. >> of prevention for that kid. (He can >> always wear a -1.5 diopter lens [quoted text clipped - 10 lines] >T. Grosvenor has suggested prevention with the >plus as you well know -- but TOTALLY IGNORE. Moron. >Otis> But eqully, I do agree that implementation is tough, >which again means that the person must decide >for himself how much he values his distant >vision -- before he loses it to an over-prescribed >minus. ibid. SignatureLive simply so that others may simply live >Otis> But you are in NO POSITION to >help anyone with true-prevention are you. >This fact FORCES the person (Keith) >to do it himself. His last report >is 20/20 (actually better). Neil> Your nephew has a fool for an uncle. Otis> Your opinion -- of course. He simply followed the scientific analysis of the eye's behavior as proven by the primate studies. This is of course the second-opinion -- and he was wise to understand it that way. Otis> He also has run the Iron-man, and looks after his personal health. At his last check he had better than 20/20. Otis> At 12 years of age he was decleared "nearsighed". Otis> The records at both Annapolis and West Point show that the fundamental eye goes "down" in a four-year college. At West Point, the rate is -1.3 diopters for four years, with the spread of -1.1 diopters to -1.6 diopters. Otis> If he had not worn the plus (and verified clearing) he would be at about -2.0 diopters today (about 20/140. Otis> To bad we don't have more people who actually SUPPORT us with true-prevention as Steve Leung OD is now doing it. www.chinamyopia.org Otis> You don't like true-prevention? Find, don't use it, and develop stair-case myopia. No skin off my nose. Best, Otis >Otis> To bad we don't have more people who >actually SUPPORT us with true-prevention >as Steve Leung OD is now doing it. > >www.chinamyopia.org This post is more on point: http://www.voy.com/146745/46.html SignatureLive simply so that others may simply live > Otis> The records at both Annapolis and West Point > show that the fundamental eye goes "down" in a > four-year college. At West Point, the rate > is -1.3 diopters for four years, with the > spread of -1.1 diopters to -1.6 diopters. Shotwells study at the Naval academy show no myopia prevention using plus OR bifocals. just give it up Otis. your understanding of the literature and the state of myopia research is fragmentary at best! --- Am J Optom Physiol Opt. 1984 Feb;61(2):112-7. Plus lens, prism, and bifocal effects on myopia progression in military students, Part II. Shotwell AJ. Military academies routinely lose a percentage of their pilot-qualified students to myopia during the 4-year academic program. This study investigated the progression of myopia during such a program and evaluated the usefulness of reading glasses to prevent myopia progression and subsequent acuity loss. A group of students at the United States Naval Academy comprised three randomly divided groups: a placebo group (no. 1 pink tint), a plus with prism group (+1.25 D with 2 delta base-in each eye), and a bifocal group (+1.50 D near addition). All the lens powers were relative to the experimental subject's distance refraction and were for use full-time when reading. The pre- and post-test refractive errors at distance were determined using 1% tropicamide HCl. At the end of 4 years, the tropicamide refraction showed approximately -0.25 D of myopic shift in all groups. There were no significant differences between the myopic shifts in the controls and experimental groups. ---- Your logic is flawed. Myopia is predominantly due to peripheral retinal blur. THis can happen with genetic inheritance or environmentally or both. Wearing plus for myopia retardation only resolves one of these issues, not the other. Secondly, MOST kids of +0.50 are not going to go myopic, so why put high plus on them for no reason. Secondly, one study found over-plussing was worse than no script in on group of kids (B1 type). The issue in this thread is what was the reason for the script in the first place? Sounds like either: 1) Child needs glasses and optometrist not explaining reason to mum, 2) Mum not listening/understanding optometrist, 3) Need more sales for the day. I do not know which is correct. I do know that plus can be beneficial in some children, but you need to do the tests to estabkish this and you need a reason to prescribe, such as symptoms or academic problems. grant >Your logic is flawed. You've just met Otis Brown. SignatureLive simply so that others may simply live LOL grant LOL grant i disagree. if a hyperopic child is symptomatic with eyestrain, headaches, blur, etc. when doing prolonged nearwork, or has difficulty concentrating on schoolwork then i have found +0.50 readers to be quite effective. what else would you recommend? At the risk of seeming unpleasant, this is precisely the sort of knee-jerk, dogmatic, condescending type of response I find it difficult to understand. DrG i am not trying to be unpleasant. i apologize if my response seems strong. I guess i can't understand why anyone would make a sweeping statement that +0.50 readers are useless and only serve to make opticians money. do you use +0.50 readers? do you think they are useful for hyperopes who have eyestrain associated with reading? i use them for symptomatic patients; i think they are effective; and i can't think of an alternative solution. again, i'm not trying piss anyone off but i just don't understand and i think its reasonable to ask for clarification. it could be that i'll learn something. ----- > At the risk of seeming unpleasant, this is precisely the sort of > knee-jerk, dogmatic, condescending type of response I find it difficult > to understand. > > DrG Ha! Sorry about that. I was referring to the post to which you were responding. My remarks were not meant for you. I was agreeing with you. I do believe that there is a place for +0.50 spectacles as I have stated in previous posts. DrG thanks for the reply. i try not to be a jerk but sometimes it just happens ;) I have never ordered less than +1.00 readers in children. I have tried trail lenses with less, and never found it to make any more improvement than I got with plano. (PS. I wonder if Dr.G was referring to my remark, not yours, where I blanket-statement said +0.50 is homeopathic., which may have overstated it just a slight bit... ) On 10/30/05 4:49 PM, in article 1130719775.117337.43250@z14g2000cwz.googlegroups.com, "p.clarkii@gmail.com" > i am not trying to be unpleasant. i apologize if my response seems > strong. I guess i can't understand why anyone would make a sweeping [quoted text clipped - 15 lines] >> >> DrG > (PS. I wonder if Dr.G was referring to my remark, not yours, where I > blanket-statement said +0.50 is homeopathic., which may have overstated it > just a slight bit... ) *I* thought it was great! Consider it stolen! -MT if a child truly has just +0.50 refractive error then what you say is true. however commonly they cycloplege much higher than that. so say they are truly +1.50-- then giving them +0.50 readers leaves them just enough hyperopia that they can handle comfortably themselves via accommodation without blurring their distance. so i usually try to give a child with near complaints a spectacle correction using the maximum plus that they can accept and still retain their maximum distance BVA (20/20, 20/25 or whatever i find it to be). in my experience patient acceptance is better by reducing distance blur complaints and they still get benefits from the Rx. frequently i cannot get a child's "maximum plus to maximum acuity" more than +0.50. >At the risk of seeming unpleasant, this is precisely the sort of >knee-jerk, dogmatic, condescending type of response I find it difficult >to understand. Which response is that then? You don't even give us a hint. Ann The same post to which "p.clar...@gmail.com" was responding, Ann. DrG >The same post to which "p.clar...@gmail.com" was responding, Ann. LOL.. long since deleted. But never mind, I've forgotten all about it now. Ann Ahah! The HYPEROPIC child. How hyperopic? Yes, if they are strainging near the limits of accommodation, then 0.50 might tak e the edge off it. I'm talking about the "normal" child, who is not very hyperopic. Certainly, if their cycloplegic is +0.50, then +0.50 Rx is not going to do much of anything. IF they are going through a growth spurt, I do somethimes see a child, usually in the 7-11 y/o range where they complain of reading problems. I get some over the counter readers, perhaps +1.00 or +1.25, which sometimes seems to help. They use them a couple of months, and the symptoms go away. (My own daughter did have that problem.) On 10/30/05 9:01 AM, in article 1130688299.260674.100690@g44g2000cwa.googlegroups.com, "p.clarkii@gmail.com" > i disagree. if a hyperopic child is symptomatic with eyestrain, > headaches, blur, etc. when doing prolonged nearwork, or has difficulty > concentrating on schoolwork then i have found +0.50 readers to be quite > effective. what else would you recommend? I would expect that response from a paediatric ophthalmologist. However, you have not ascertained whether there were symptoms or what the child's reading performance is like. What are their phoria, accommodative skills, ocular motility and vergences like? What is the child's reading level? Are they complaining of headaches, distractability, fatigue, etc? As a huge generalization, mothers do not take their children for eye tests unless there is some problem initially. Was there in this case? Before we start flaming optometrists for lining their pockets, why don't we get a few details first? Grant Mason BScOptom MOptom FACBO FCOVD PGCOT Board Certified Optometrist Paediatric Specialty Senior Optometrist Sydney Olympics 2000 Senior Optometrist Special Olympics 2002, 2003, 2004 When I see a patient like your son, I really want to know what his symptoms are: does he get sore eyes or headaches...hows his reading progress ... how's his comprehension...how's his concentration at school and for doing homework... (all relative to the norms for age) If I find +050 in the eye test, then the decision to get glasses or not is based almost entirely on whether he's coping well. If he's a straight A student with no problems (if you can be a straight A student at age 6!) then there's no way I'd recommend glasses. However if I hear comments like "he avoids reading" or "he's a smart kid but just can't concentrate" or "he's always rubbing his eyes and blinking" then I do recommend the specs. Dom > Hi, > [quoted text clipped - 34 lines] > > Emmett I agree with you in that the child must be symptomatic. But I also tell the parents that this is probably a temporary measure, that the child will outgrow the problem, and that the child will outgrow the need for the glasses as well. DrG Dear Dom, Subject: Surprise -- I can agree with you. The real difficulty was that NO INFORMATION was given to Emmett. This clearly is a "second-opinion" situation, where you would "prescribe a +1/2 diopter lens, and other OD would not. Thus, any use of a lens (or not) should have been preceeded by a discussion with Emmett about this issue. In fact the OD did nothing of the kind, and INSISTED that the child wear the +1/2 diopter -- with full knowledge that he was doing something that many OTHER ODs would object to. That is the issue. Otis otis, does your term "the second opinion" refer to wearing plus lenses whether they are intended for myopia prevention or for ANY problem? Dom alludes to the issue of whether the patient might have latent hyperopia or an accommodative disorder that might produce problems when he is doing near work. he recommends, as almost all ODs would recommend, that such patients use +0.50 readers. these are almost alway beneficial to the patient. on the otherhand, if the patient is nonsymptomatic then their use is unnecessary. fyi, this is standard-of-care, or as you would say "the majority opinion". this topic has nothing to do with myopia prevention. you know even less than normal about this topic. just go away. go post in alt.med.vision.improve Clar> otis, does your term "the second opinion" refer to wearing plus lenses whether they are intended for myopia prevention or for ANY problem? Otis> No, that was NOT the issue. The issue was that this OD (optician) totally FAILED to discuss the REASON why $400 reading glasses were prescribed -- with no discussion with Emmett about this issue. Had Emmett had the reason explained to him, and understood it, then I do not think he would have posted his objection. Consulting with the person RESPECTS that person's right to understand alternatives. In this case, NOT prescribing a +1/2 diopter was the second opinion at stated by Dr. David Robins. Clar> Dom alludes to the issue of whether the patient might have latent hyperopia or an accommodative disorder that might produce problems when he is doing near work. Otis> Fine. This SHOULD have been part of a discussion and review with Emmett BEFORE anything was done. The optician should have said that he believes that that +1/2 diopter was "right", but that the second-opinion, was that nothing should be prescribed. A true professional would have no problem making that statement to Emmett. Clar> he recommends, as almost all ODs would recommend, that such patients use +0.50 readers. Otis> It is obvious that this optician ORDERED the kid to get a +1/2 diopter with NO intelligent discussion with Emmett as to WHY this was done. Clar> these are almost alway beneficial to the patient. Otis> And you know I agree with that statement! But even though I personally advocate this -- I still think that Emmet must be informed of the nature of his choice. Otherwise you wind up with Emmett deeply distructing the optician and the "reasons" for that "prescription". Clar> on the otherhand, if the patient is nonsymptomatic then their use is unnecessary. Otis> But again, the opticain totally failed to explain ANY OF THIS to Emmett. If he had, the there would be no problem. The failure was to explain Emmett's right-of-choice, the fact that the kid had (20/20 -- best guess) and there was no overt reason for "prescribing" those 1/2 diopter lenses. Best, Otis fyi, this is standard-of-care, or as you would say "the majority opinion". this topic has nothing to do with myopia prevention. you know even less than normal about this topic. just go away. go post in alt.med.vision.improve At discussion is the principle of whether or not there is ever sufficient reason to prescribe +0.50D eyeglasses for a 6 year/old child. Nothing at all was mentioned about the price of them. Otis, of all people, should not be lecturing others on the ethics of prescribing lenses. Otis wouldn't hesitate to recommend plus lenses to Emmett, but only on the condition that he would not purchase them from an O.D. DrG > Clar> otis, does your term "the second opinion" refer to wearing plus > lenses [quoted text clipped - 56 lines] > less than normal about this topic. just go away. go post in > alt.med.vision.improve Dear Dr. G., No, I would NOT put a child with 20/20 into a +1/2 diopter lens (even IF I though it was wise) UNLESS the parent had full information as to the REASONS WHY. If Emmett does not understand those reasons, then (providing the child has eye-chart 20/20) you should not do it. Equally, if Emmett were given the resaons -- and evaluated them completely, then there would be a role for the use of the plus. Only AFTER Emmett agreed, and understood, should a "plus" be used. And in THAT case, I would suggest that a "plus one" should be used. (But that WHOULD require and "educated parent". The "price" I don't care about. I would rather pay $300 for the education about this issue (supported by prevention advocacy websites) and pay the going rate for over-the-counter plus lenses. The real "price" is in the educational process, and not in the lens. Best, Otis Coming back on the question as to why the optician was suggesting that glasses were needed. My son is doing well at school and socially and he is generally very happy in himself. He does well in ball games. He doesn't watch much television or spend a lot of time on a computer ~ maybe half an hour a day in total. He doesn't complain of 'constant' headaches or sore eyes. However, when he is tired he sometimes goes into eye-blink mode for a few seconds. The rate of blinking is maybe once a second. Occasionally he complains of having a mild headache. Both typically occur within an hour of his bedtime. The blinking occurs maybe once a week, the headaches maybe once a month. Both seem to be decreasing in frequency. We have seen the rapid eye blinking with his friends and cousins of the same age so we weren't particularily worried but we decided to take him to the optician just to check that everything was OK. The optician argued that he should have glasses because they 'might' help with the blinking. Her argument was that if we got the glasses and they didn't help then no harm was done. Of course, in the meantime she had sold us glasses without the ability to return them. I got the strong sense of end-of-month quotas. Regards Emmett |
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