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Medical Forum / General / Vision / December 2005

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Ok dad will take me to an optometrist or ophthamologist for an exam IF....

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acemanvx@yahoo.com - 07 Dec 2005 02:46 GMT
Ok dad will take me to an optometrist or ophthamologist for an exam IF
the following questions can be answered to convinence him WHY he should
take me.

1. Please educate dad on the difference between an optometrist and an
ophthamologist. He says optometrists arent allowed to pescribe any
medicines or even insert eye drops. All they can do is "look" at your
eyes and give you a refraction and pescribe glasses. I told dad an
optometrist can do whatever he pleases except for surgury and treating
the more serious diseases. Clarify.

2. Dad wants to know why would it matter if I get tested for presbyopia
or accomodative dysfunction if nothing can be done about it. Whats the
best cycoplegic agents in order to be used? he may have more than one
type and I want the best to uncover the most pseudomyopia.

3. Dad also wants to know the point of a cycoplegic refraction. I told
him I probably have pseudomyopia and by knowing, I can better take the
approperate action.

4. Ill also ask to be tested for BCVA and find out why its "only" 20/30

5. what else should I ask to get tested for?

6. should I see an optometrist or an ophthamologist?
Dr. Leukoma - 07 Dec 2005 03:16 GMT
> Ok dad will take me to an optometrist or ophthamologist for an exam IF
> the following questions can be answered to convinence him WHY he should
[quoted text clipped - 21 lines]
>
> 6. should I see an optometrist or an ophthamologist?

You should see an optometrist.  Your problems are clearly functional
and not related to any eye disease.  Optometrists are better trained in
refraction, and in prescribing lenses and eye exercises for the
remediation of accommodative problems.  There is no surgical solution
for your problem.  In all states, optometrists can prescribe medication
for the treatment of some eye diseases.

By definition, you cannot have presbyopia because you are only in your
twenties.  Accommodative dysfunction can be treated with lenses, and/or
eye exercises.  The strongest practical cycloplegic agent is
cyclopentolate, which has a duration of action of from 6 to 12 hours.
Atropine is stronger, but lasts several days.  The point of a
cylcloplegic refraction is to paralyze the ciliary muscle and to relax
accommodation in order to measure the amount of axial myopia as well as
the amount of accommodative myopia.

You should also be tested for glaucoma, cataracts, and macular disease.
All of those would be discovered during a comprehensive eye
examination by an optometrist.  Given the fact that your topographies
contain a central corneal irregularity, I would also request of the
doctor that s/he place a rigid contact lens on the eye to see if the
vision could be improved beyond 20/20.  This is another reason to see
an optometrist -- because of their training in contact lenses.

DrG
acemanvx@yahoo.com - 07 Dec 2005 09:31 GMT
thanks for your reply. I searched the net and heres what I found:

Why is there a need to dilate my child’s eyes to check for
refractive errors?  Won’t the cycloplegic drops have harmful side
effects?

Children have great accommodative amplitudes and they can change the
measurement of refraction.  In a child who has no error of refraction
(emmetropic), a significant myopia, and sometimes astigmatism, may be
picked up if he or she accommodates.  The only way to get an accurate
measurement of error of refraction in children is to inhibit
accommodation with the use of cycloplegic agents.

There are several agents commonly used in practice and these include
tropicamide, cyclopentolate, and atropine.  The first two agents have
rapid onset of accommodation, short duration and few side effects.  The
last one has a longer onset, requiring three days of drug application,
and longer duration, but provides the greatest amount of cycloplegia.
Most children may be refracted using the first two.  However, children
with dark irides like Asians are not as responsive as Caucasian
children to the cycloplegic action of the first two agents.  Atropine
refraction is therefore recommended for this set of children.

Minor side effects of cycloplegic agents include transient stinging,
blurring of vision, and photophobia.  The stinging sensation is
diminished by the application of a drop of anesthetic prior to the
application of the cycloplegic agent.  Photophobia may be addressed by
wearing wrap-around sunglasses or hats.  The duration of photophobia
and blurring of vision is related to the duration of the drug’s
mydriatic effect.  The shorter-acting agents provide faster recovery of
accommodation and of resolution of symptoms.  Atropine is associated
with relatively more adverse effects such as dry mouth, flushing of the
face, fever, allergic reaction, irritability, tachycardia, and
hallucinations.  Therefore, the child’s weight and age are
important considerations in the choice of atropine concentration or
dose for cycloplegic refraction.  Punctal occlusion during drug
administration of atropine helps in decreasing the systemic absorption
of atropine and greatly diminishes the occurrence of severe adverse
drug reactions.  Any child with severe adverse drug reaction should be
brought to the hospital for immediate treatment.

How does it work?

Atropine belongs to the group of medicines called anti-muscarinics.
Atropine blocks the receptors in the muscles of the eye (muscarinic
receptors). These receptors are involved in controlling the pupil size
and the shape of the lens.

By blocking these receptors, atropine produces dilatation of the pupil
(mydriasis) and prevents the eye from accommodating for near vision
(cycloplegia).

Atropine is given as eye drops to dilate the pupil and relax the lens
so that eye examinations can be carried out thoroughly. It is often
used to aid eye examinations in young children. It is also used to
relax the muscles that inflame and over-contract in the eye in
conditions such as uveitus.

comments:

I read that atropine is used for amblyombia by blurring the good eye. I
also read atropine can last 2 weeks! It does fully cycoplegize you but
at the expense of making your vision blurry, especially from near. I
also read you need to take it twice a day for 4-7 days then again half
an hour before your cycoplegic eye exam! I read that its known for
risks of side effects, especially long term. tropicamide is not
normally used for cycloplegic refraction as the cycloplegia obtained
with this drug is incomplete. The drugs most frequently used in
cycloplegic refraction are atropine and cyclopentolate, as there is
significant residual accommodation with other drugs.

I have found useful instructions:

http://www.eyetec.net/ce/M4S1.htm

They say cyclopentolate is the best option and works very well and
atropine isnt really needed unless your a little kid with high
accomodation. Half hour is needed for the drops to take effect. The
optometrist can work on other patients in the meantime. Is
cyclopentolate known for blurrying distance vision like atropine does?
Dr. Leukoma - 07 Dec 2005 14:01 GMT
All of the cycloplegic agents have similar side-effects, as they are
all anticholinergic agents.  Those effects are dose-dependent.
However, tropicamide and cyclopentolate have a greater therapeutic
index, i.e. fewer side effects at the recommended dose.  Also, the
systemic side-effects are dependent upon the person's weight.

DrG
Dan Abel - 09 Dec 2005 10:12 GMT
> Ok dad will take me to an optometrist or ophthalmologist for an exam IF
> the following questions can be answered to convinence him WHY he should
> take me.

Because you have vision problems?

> 1. Please educate dad on the difference between an optometrist and an
> ophthalmologist. He says optometrists arent allowed to pescribe any
> medicines or even insert eye drops. All they can do is "look" at your
> eyes and give you a refraction and pescribe glasses. I told dad an
> optometrist can do whatever he pleases except for surgury and treating
> the more serious diseases. Clarify.

Laws vary by state.  What an optometrist can do depends on the state and
what kind of license they have.  They all insert eye drops.  They can't
do their job without it.  What kind might vary.  

> 2. Dad wants to know why would it matter if I get tested for presbyopia
> or accomodative dysfunction if nothing can be done about it. Whats the
> best cycoplegic agents in order to be used? he may have more than one
> type and I want the best to uncover the most pseudomyopia.

It's important to talk to the doctor to agree on what to do.  Telling
them how to do it isn't a good idea.  

> 6. should I see an optometrist or an ophthamologist?

An optometrist.  I don't know your money or insurance situation.  In my
case, you can't just make an appointment with the ophthamologist.  They
are seen by referral only.  The optometrist will check you out and do a
diagnosis.  If you need to see an MD, they will refer you.

Signature

Dan Abel
dabel@sonic.net
Petaluma, California, USA

acemanvx@yahoo.com - 10 Dec 2005 04:09 GMT
"Because you have vision problems?"

dad says I already have glasses so what does it matter? I told him
myopia isnt my only problem!

"They all insert eye drops."

I told dad this! They have to be able to insert drops for things like
cycoplegia.

"It's important to talk to the doctor to agree on what to do.  Telling
them how to do it isn't a good idea."

Of course. hes the expert, maybe he thinks what to do is best for me. I
will discuss my options and let him be the judge of what action to take
with the given infomation ive provided.

"In my
case, you can't just make an appointment with the ophthamologist."

Over here I can.

"The optometrist will check you out and do a
diagnosis."

Then ill see one.

Thanks for your replies. I will have dad schedule me an appointment and
I am going to get a cycoplegic refraction among other things. Exactly
what should I ask to be tested for, clarify the above mentioned
Mike Tyner - 10 Dec 2005 04:45 GMT
> Thanks for your replies. I will have dad schedule me an appointment and
> I am going to get a cycoplegic refraction among other things. Exactly
> what should I ask to be tested for, clarify the above mentioned

Focus on your symptoms. What bothers you most? What's most important to fix?

Try not to decide in advance how you should go about fixing it.

-MT
 
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