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Medical Forum / General / Vision / March 2006follow up of posting 20/60 with -11.50 retinoscope please help
my daughter went to a local optometrist with my wife today. the optometrist had just graduated from school. i would usually prefer a doctor with more experience but she was willing to see my daughter. today my daughter sat in the chair and did some tests. on the vision chart she only got down to 20/200 whith a letter chart. i dont understand how she got 20/60(picture chart) and 20/80(letter chart) just a week ago with antropine drops. then my wife thought that maybe she did not like looking in the mirror so she brought my daughter to the other side of the room to look at the reflection which the doctor said is half the distance of looking in the mirror. now for some reason my daughter goes to the 20/60 line which would be 20/120 because it is half the distance. the letters were limited because the only letters that could be used were letters that looked the same when flipped. when my daughter sat in the chair the doctor put different lenses from -2.00 to -8. 00 and she did not read any further. it appeared that she did not want to do it and would guess. how is there this difference in just one week. i try to tell myself that she is 2 and sometimes she wants to do her own thing. my daughter was in the room for a half hour before the distance vision test and my wife felt like she had enough. even 20/200 is better than a -11.50. if the glasses are too strong could she be seeing worse because we put the glasses on her for a couple of hours last week. does anyone have any opinions? if she saw 20/60 and 20/80 last week was this just luck? or was today just a bad day. > my daughter went to a local optometrist with my wife today. the > optometrist had just graduated from school. i would usually prefer a [quoted text clipped - 20 lines] > opinions? if she saw 20/60 and 20/80 last week was this just luck? or > was today just a bad day. I'm not a doctor by any stretch of the imagination, but from the history of your last thread, and this recent addition, I'd suggest that your daughter's case seems somewhat complex, and that a recent graduate of optometry isn't necessarily the doctor your daughter needs to see. Generally, one works their way UP the expertise ladder, and not DOWN. In the last thread, you got some excellent advice on how to find a doctor with some knowledge in pediatric optometry and development. Find the expert, make an appointment, and make sure you request and bring the charts (that is, the doctors' notes, not the eye charts) from the first two exams with you to the visit.  SignatureScott Reverse name to reply > tell myself that she is 2 and sometimes she wants to do her own thing. my Kind of the definition of that age, isn't it? :-) > on her for a couple of hours last week. does anyone have any opinions? if she My opinion is that this bears careful watching, but not necessarily much action. If she is getting around in life OK, then I think her vision is OK too. If she is having problems, then something needs to be done. I'm posting as a parent, not someone who knows anything. SignatureDan Abel dabel@sonic.net Petaluma, California, USA Dear Concerned Parent, You will get a lot of advice -- much of it profoundly contradictory. In this post -- you failed to mention if a minus lens (of any power) could clear the 20/40 line (at least). If that is not possible, then you truly have a profound problem. The terminology is that if you can not obtain 20/40 or better with a minus lens, then she has "lazy eye". But that term was not used. So, could your child vision be cleared with a minus lens or not? That is the "open" question. I AM NOT A DOCTOR. Best, Otis If a minus lens does not help her vision, have her screened for ambylopia and other diseases. Glasses may just strain the eyes if they are too strong and not helping her see better. > If a minus lens does not help her vision, have her screened for > ambylopia and other diseases. Glasses may just strain the eyes if they > are too strong and not helping her see better. Amblyopia is not a disease. There is no reason to prescribe more power than neccesary, if done it is by mistake (we are all human) Ace, give mom an dad a kiss and go to bed, hands above the sheets. SignatureFree to Marcus Porcius Cato: ''Ceterum censeo Carthaginem esse delendam" In conclusion, I think that the "Otis therapy" should be destroyed Jan (normally Dutch spoken) ROFLMAO Jan. I like your style.\ grant > Dear Concerned Parent, > > You will get a lot of advice -- much of > it profoundly contradictory. And answers of laymen such as Otis. > In this post -- you failed to mention > if a minus lens (of any power) could [quoted text clipped - 7 lines] > with a minus lens, then > she has "lazy eye". Your terminology Otis ! There are several other reasons why this child can not obtain a, for the child age, normal vision. One of them is already explained by the father, it is possible the child simply behaves against the grain. Other possible reasons are explained by the real eyecare specialists in this newsgroup Further more, a so cald ''lazy eye'' or amblyopia most of the time is just the outcome of an untreaded problem in the eye. One of the problems could be an optical mismatch such as an refraction error. This is one reason why carefull parents have to avoid your therapy. You recomment to avoid the minus correction and you are not aware of the possible damage by just causing that ''lazy eye'' by following this evil and horrible therapy of yours. SignatureFree to Marcus Porcius Cato: ''Ceterum censeo Carthaginem esse delendam" In conclusion, I think that the "Otis therapy" should be destroyed Jan (normally Dutch spoken) wrote: >> Dear Concerned Parent, >> [quoted text clipped - 25 lines] >possible damage by just causing that ''lazy eye'' by following this evil >and horrible therapy of yours. > The terminology is that if > you can not obtain 20/40 or better > with a minus lens, then > she has "lazy eye". But that > term was not used. It's obvious you don't know what to expect from a 3-year-old. -MT tonight we attempted to put her glasses on and she refused. we then decided to see if she would wear my wife's glasses at which she gladly did. like i said before my wife is a -2.00. when we tested her she saw the letters that we use(height is about 2.5 inches and width is about 1.75 inches) from about 33 feet away. normally she sees them from maybe about 25 feet at the most. so then i felt that even though the glasses do not have atigmatism built in i felt she saw well. but then i got her to put her glasses on and she saw from the same location. we then tested with letters that are about one inch by one inch and she saw exactly the same again. can i please get some opinions on how we are getting the same results from to totally different lenses? >> The terminology is that if >> you can not obtain 20/40 or better [quoted text clipped - 5 lines] > >-MT > tonight we attempted to put her glasses on and she refused. we then decided > to see if she would wear my wife's glasses at which she gladly did. like i [quoted text clipped - 6 lines] > inch and she saw exactly the same again. can i please get some opinions on > how we are getting the same results from to totally different lenses? I'm sorry, but I don't remember what prompted you to take her to have her eyes checked in the first place? Was it because you suspected she couldn't see? My first inclination would be, if it ain't broke, don't fix it. As a concerned parent myself, I wouldn't rely on any answers you'll get here but do find a pediatric ophthalmologist. Is she your first child? At age 2 I wouldn't put much stock on her making any decisions whether or not she wants to wear her glasses. I'd worry with all this "testing" and her choosing to wear her glasses or your wife's glasses that soon it's going to turn into a power struggle and it's not going to do anybody any good. Signature~RT we originally went because my wife thought she was crossed eyed. we found out this was not so and it just appeared like it do to a wide bridge of her nose. i have no problems making her wear the glasses but i just dont understand how she sees so much better than her perscription suggests. even though she did not do as well today with the doctor it still is a world of difference from 20/120 to about 20/1500. another question i have is that if we find out she is this bad does laser surgery ever become an option due to quality of life issues?i know that at her age until about 18 they continually change but if she would become a -6.00 worse i would rather her be a -6.00 than a -18.00. two doctors told us due to her high myopia she could level off at an early age. is this possible or are they trying to make us feel better? >> tonight we attempted to put her glasses on and she refused. we then decided >> to see if she would wear my wife's glasses at which she gladly did. like i [quoted text clipped - 15 lines] >your wife's glasses that soon it's going to turn into a power struggle >and it's not going to do anybody any good. Look up www.covd.org and find a fellow in your area. What you need is someone experienced in kids vision. grant we are going for one more opinion which the name was obtained from that website that you suggested. my wife spoke to the doctor and he sounded interested. i have noticed there is many opinions on how to handle myopia. on the phone the doctor said that the doctor who gave us the perscription for - 10.50(he subtracted 1 from the -11.50) should have gave us a much weaker perscription to start. another doctor we talked to said you he should have gave the whole amount. who is right and who is wrong? >Look up www.covd.org and find a fellow in your area. What you need is >someone experienced in kids vision. > >grant i forgot to add this to the previous post. a doctor mentioned that it sounded if my daughter could have lenticonus because of what she sees compared to the retinoscope. a doctor that we talked to said that some kind of microscope has to be used and that a retinoscope does not always see it even with the eyes dilated. is this true? i can not find much information about this. if this was the case could anything be done about it. >we are going for one more opinion which the name was obtained from that >website that you suggested. my wife spoke to the doctor and he sounded [quoted text clipped - 8 lines] >> >>grant Lenticonus can be observed with the retinoscope, almost by definition. That is because the "cone" is confined to only the central portion of the lens. This would make the center of the retinoscopic reflex behave much differently than the peripheral, causing a "scissor-like" movement of the streak. It is this non-uniform wavefront which makes it possible for the child to have such good acuity in relation to the amount of myopia. DrG thank you for your reply. my wife spoke today to the doctor who prescribed the glasses. he has another autorefractor and two more machines he would like to try. he said her myopia was lenticular and thinks there could be a problem with the lens. what does that mean that the myopia is lenticular? >Lenticonus can be observed with the retinoscope, almost by definition. >That is because the "cone" is confined to only the central portion of [quoted text clipped - 5 lines] > >DrG > thank you for your reply. my wife spoke today to the doctor who prescribed > the glasses. he has another autorefractor and two more machines he would > like > to try. he said her myopia was lenticular and thinks there could be a > problem > with the lens. what does that mean that the myopia is lenticular? Lens, lenticular, lenticonus and lentiglobus all refer to the same structure - the "crystalline lens" behind the pupil. You can get good images from the Google Images link: http://images.google.com/images?q=crystalline+lens&hl=en and http://images.google.com/images?svnum=10&hl=en&lr=&q=lenticonus. Most ordinary myopia is "axial" or caused by increase in eyeball length. But that's rare at age 3. "Lenticular" myopia would result when the crystalline lens is too curved, while the eye is normal in length. "Lenticonus" refers to a bulge or outpouching, usually in the center of the lens. It could occur in the front surface or the back of the lens. It is often associated with a cataract in the region of the bulge, but you can presume there is no cataract so far. "Lentiglobus" implies that the bulge involves the entire lens, rather than a distinct pouch. When the bulge is distinct and well-defined, it's hard to miss in retinoscopy, as you might see from the images. Especially when dilated with atropine. If the vision is acceptable, treatment isn't urgent. If the vision is significantly impaired, ordinary cataract surgery would completely solve the problem, although reading glasses would become necessary. If there is evidence of anterior lenticonus, it might signify Alport's syndrome, making it important to test hearing and kidney function. -MT why jump to lasik? You are counting chickens way in the future. The optometrists here believe the myopia is due to a central bulging of the lens and she sees well by looking from the flatter sides of the lens. If I had to guess how she sees, her world is very blurry in the center of her vision and much clearer off to the sides. Its like wearing a high plus contact lens that has a tiny circle potion with the plus power and the rest of the contact is near plano. If her lenticular myopia and deformities is whats holding back both her UCVA and BCVA, then maybe talk to the ophthamologists about having it removed. I would not do anything till shes older and better testing can be done. > why jump to lasik? Who's talking about lasik, psychedelic toadstool glutton. > If I had to guess how she sees, her world is very blurry in the center > of her vision and much clearer off to the sides. Again it shows you know nothing about these matters, keep guessing nitwit. Simple tric to get the picture is placing a very small, powerfull positive, lens in front/on top off a reflexcamera- lens and see what happens when you take a picture. (no Otis I am not talking about a fixed boxcamera) Blurried in the center or just a little ''soft'' in the whole picture? Then cover the surronding area of the very small lens and try to get the same picture again without changing the distance and aperture adjustment. Blurried in the center or just a total blurry picture? > If her lenticular > myopia and deformities is whats holding back both her UCVA and BCVA, > then maybe talk to the ophthamologists about having it removed. I would > not do anything till shes older and better testing can be done. Ace, try to think on your own instead of babbeling like a parrot, knowing the words but absolutly not knowing what you'r talking about. And, as always, give mom an dad a kiss and go to bed, hands above the sheets. SignatureFree to Marcus Porcius Cato: ''Ceterum censeo Carthaginem esse delendam" In conclusion, I think that the "Otis therapy" should be destroyed Jan (normally Dutch spoken) > If I had to guess how she sees, her world is very blurry in the center > of her vision and much clearer off to the sides. Your guess is wrong. So why guess? -MT I am repeating the advice the optometrists said here and adding in my opinion and comments. Theres alot I can learn from an unusual case like hers. Like what? Like you are a pathetic loser that trolls the net? That's about it. dr grant to Dr.Leukoma the doctor called us this morning and advised us that he really thinks that lenticonus is a real possiblity. he said he believes that it could be the type that is under the lens. if this is so he had a specialist(who will be there tomorrow) that could do the lens replacement. even though we dont no for sure yet if she has it, i can not thank you enough for the information you provided. i dont think we would have ever have found out(at least the possibility of) what was wrong. even if it is not lenticonus we will investigate further into other areas. i have a couple of questions. the dr. said that he would under correct her due to age, what does this mean? does the lens they put on have a perscription in it. i have read that people are often farsighted afterwards. the next question is that later on could she possibly wear contacts? and the last is there any important questions i should ask? again thank you very much for at least giving us an idea of what is wrong. but it sounds like it could be the answer. >Lenticonus can be observed with the retinoscope, almost by definition. >That is because the "cone" is confined to only the central portion of [quoted text clipped - 5 lines] > >DrG > to Dr.Leukoma > the doctor called us this morning and advised us that he really thinks that [quoted text clipped - 11 lines] > should ask? again thank you very much for at least giving us an idea of what > is wrong. but it sounds like it could be the answer. Glad to be of help. The removal of the crystalline lens does indeed make the eye very hypermetropic(farsighted). However, replacing the natural lens with an implant will take care of the bulk of the hypermetropia. I surmise that "undercorrection due to age" means that the child will be expected to outgrow some of the hyperopia through natural growth of the eyeball. Children who have undergone lens extraction with replacement IOL's typically show a myopic shift. Any discrepancy in prescription can be handled with spectacles or contact lenses. Please remember that accommodation will no longer be possible after this kind of surgery, and so reading glasses will be necessary. DrG http://www.coppellfamilyeyecare.com Before you jump to any lens removal, be sure her 20/60 vision is due to an irregular lens. This might not be the factor or the only factor. Discuss with your doctors what age she should be before this surgury is done. Maybe she can give a better manifast refraction when she gets a little older and more accurately describe what shes seeing. > Before you jump to any lens removal, be sure her 20/60 vision is due to > an irregular lens. This might not be the factor or the only factor. > Discuss with your doctors what age she should be before this surgury is > done. Maybe she can give a better manifast refraction when she gets a > little older and more accurately describe what shes seeing. I was waiting for Ace to make his usual contribution. Heck, he might just as well examine this girl so we can all just quit beating around the bush. At the very least Ace should be present to insure that the doctors are doing their job correctly. DrG i just got back from the appointment. the dr used an ultrasound machine on her eye, a machine to measure it, and another autorefractor(my daughter would not sit for today).the dr also used a retinoscope but did not dialate the eyes. he said he believes she has posterior lenticonus but does not know why he does not see it. he advised everything points to it but he still sees a "nice cone" in the eye. is it possible that she has it but can not be seen yet? again he thinks she has it but cant see it in her eye. again she saw basically the same on the eye chart with and without the glasses which makes him believe she has amblyopia in both eyes. from what i understand she could be seeing the 20/1500 or so through the middle but seeing 20/60 on the outer edge of her eye. this would make me a little nervous to put the glasses on her but he still thinks i should witout a doubt. would it be very uncommon to have lenticonus in both eyes? he said that even without the lenticonus he would think about lens replacement due to the high lenticular myopia. any help on this would be greatly appreciated. >> Before you jump to any lens removal, be sure her 20/60 vision is due to >> an irregular lens. This might not be the factor or the only factor. [quoted text clipped - 8 lines] > >DrG i have one more question. if it was lenticonus would she actually be -11.50 in the middle or would it just appear to be that high with the retinoscope because of the lenticonus? in other words is it possible that she sees 20/60 or so with the whole eye but the retinoscope is giving the false illusion of high myopia. i still do not know why he thinks she has it but can not see it. >i just got back from the appointment. the dr used an ultrasound machine on >her eye, a machine to measure it, and another autorefractor(my daughter would [quoted text clipped - 17 lines] >> >>DrG > i have one more question. if it was lenticonus would she actually be -11.50 > in the middle or would it just appear to be that high with the retinoscope > because of the lenticonus? in other words is it possible that she sees 20/60 > or so with the whole eye but the retinoscope is giving the false illusion of > high myopia. i still do not know why he thinks she has it but can not see it. That would be the correct conclusion. Usually the lenticonus is confined to the central part of the lens. The shape of the lens can be visualized with high frequency ultrasound, or a number of other imaging devices such as an OCT, Oculus Pentacam, etc. DrG in your opinion is it possible for the posterior lenticonus to be there but can not be seen yet? until i find out for sure i am afraid to put the glasses on her especially since she does not want to wear them now. >> i have one more question. if it was lenticonus would she actually be -11.50 >> in the middle or would it just appear to be that high with the retinoscope [quoted text clipped - 8 lines] > >DrG > in your opinion is it possible for the posterior lenticonus to be there but > can not be seen yet? until i find out for sure i am afraid to put the glasses > on her especially since she does not want to wear them now. Any practitioner who is skilled in retinoscopy should be able to appreciate lenticonus through a dilated pupil. Since there is a high index of suspicion for posterior lenticonus, it would be reasonable to have your daughter seen by a pediatric ophthalmologist. DrG the doctor is a pediatric ophthalmologist. like i said he thinks it is there but he is not seeing it. i talked to another dr. who also said it should be obvious. i was wondering if its possible that it just cant be seen yet but is still making the effects and will show up later. we are getting another opinion from a pediatic ophthalmologist on tuesday. i have tried to find more info on the subject but i have not had much luck. when my wife talked the other day on the phone with the dr. and mentioned the lenticonus he went and researched it and the next day called to say that it was strongly possible. we just felt that maybe he does not have much experience with lenticonus and we feel that just maybe he is missing it. >> in your opinion is it possible for the posterior lenticonus to be there but >> can not be seen yet? until i find out for sure i am afraid to put the glasses [quoted text clipped - 6 lines] > >DrG "concerned parent via MedKB.com" <u18668@uwe> wrote\ > we just felt that maybe he does not have much experience with lenticonus > and > we feel that just maybe he is missing it. Lentiglobus shows a classic "oil droplet" dimple in retinoscopy that is hard to miss. Lenticonus OTOH isn't so dramatic because the posterior surface is smoothly conical without a pronounced "oil droplet." We must presume in your daughter's case that the outpouching is more conical, less well-defined and perhaps broader. That would make it more difficult to distinguish in retinoscopy but quite easy to see with ultrasound. In lenticonus, the "cone" is steepest at its center, so you might expect your daughter to need strong glasses more when lights are bright and the pupils are small. In dim light, with larger pupils (and during atropine dilation), the necessity for glasses would diminish and uncorrected acuity would increase dramatically as she uses more of the peripheral lens. For what it's worth, I disagree with the ophthalmologist about wearing the glasses full-time. Her neurological system doesn't care which parts of the lens focus the image. If the condition is bilateral and she gets any reasonable focus, she avoids amblyopia. -MT, OD thank you for your reply. it has been alot of help talking to people and gettingh ther ideas. he did do an ultrasound but never went over it with us (he put a "jelly" type substance on a stick and placed it over her closed eye) . if it showed positive or negative for the lenticonus i would think he would have went over it. i am starting to wonder if he knows what he is looking for. i think the only thing he said about the ultrasound was to measure the size of the eye which he said was normal. he said the only way to see it would be with the retinoscope or slit lamp at which he could not see it but felt it was there. >"concerned parent via MedKB.com" <u18668@uwe> wrote\ > [quoted text clipped - 27 lines] > >-MT, OD to mike turner i would also like to thank you for the information you have provided. >"concerned parent via MedKB.com" <u18668@uwe> wrote\ > [quoted text clipped - 27 lines] > >-MT, OD I'm not pretending to be a "know-it-all" here. Retinoscopy is an interpretive test, and there are varying degrees of presentation. At least you are pointed in the right direction, and other tests will be needed to confirm the diagnosis. DrG like i said before dr.leukoma you have been very helpful. i can not thank you enough for your input. without you i think we would have no idea what to do. >I'm not pretending to be a "know-it-all" here. Retinoscopy is an >interpretive test, and there are varying degrees of presentation. At >least you are pointed in the right direction, and other tests will be >needed to confirm the diagnosis. > >DrG i was also wondering with taking my daughter to get other opinions should i have concerns with the retinoscope hurting my daughter's eyes? the reason i say this is because a light is being shined into her eyes and you know how they always say not to look at bright lights. my dayghter has had the retinoscope used on her five times in the past couple of weeks. we plan on getting two more opinions. should i also be concerned about getting her eyes dilated again? >I'm not pretending to be a "know-it-all" here. Retinoscopy is an >interpretive test, and there are varying degrees of presentation. At >least you are pointed in the right direction, and other tests will be >needed to confirm the diagnosis. > >DrG >i was also wondering with taking my daughter to get other opinions should i > have concerns with the retinoscope hurting my daughter's eyes? the reason > i > say this is because a light is being shined into her eyes and you know how > they always say not to look at bright lights. my dayghter has had the > retinoscope used on her five times in the past couple of weeks. Retinoscopy is negligible compared to an hour playing in a sandbox. > getting two more opinions. should i also be concerned about getting her > eyes > dilated again? No. -MT i was reading a past reply from dr.leukoma saying that with the lenticonus it would not be completely correctable with spectacles. i am starting to wonder if maybe that is why my daughter does not see much better with glasses and maybe she does not have the start of amblyopia. could that be possible? i was also wondering since the lenticonus has to deal with the bulge of the lens if the dr. is showing a high astigmatim(he did not know if the atigmatism was on the cornea or lens) due to this bulge and getting an inaccurate reading? >>i was also wondering with taking my daughter to get other opinions should i >> have concerns with the retinoscope hurting my daughter's eyes? the reason [quoted text clipped - 12 lines] > >-MT >i was reading a past reply from dr.leukoma saying that with the lenticonus >it > would not be completely correctable with spectacles. i am starting to > wonder > if maybe that is why my daughter does not see much better with glasses and > maybe she does not have the start of amblyopia. Amblyopia is failure to develop normal connections in the brain. It can result from poor optics, but usually it's one eye only, because one eye is disadvantaged compared to the other. A more subtle form of amblyopia can develop when both eyes have a lot of astigmatism. > also wondering since the lenticonus has to deal with the bulge of the lens > if > the dr. is showing a high astigmatim(he did not know if the atigmatism was > on > the cornea or lens) due to this bulge and getting an inaccurate reading? If the bulge were perfectly centered, presumably it would cause no astigmatism. But perfection seldom occurs in anatomical abnormalities, and a little off-center displacement would cause a lot of astigmatism. -MT we have noticed that sometimes she looks at a book she will keep it on her lap and look at the pictures. and other times she(same size pictures) will put it about 5 inches from her face. that is the only thing that makes me think she is nearsighted. i was wondering that if maybe with the closer the object is the more center of her eye she is using and that is why she sometimes put it close? i actually read an article though that says it is common for a child(without vision problems) her age to put things close to there face. what do you think about that? we have an appointment tomorrow with bascom palmer eye institute in miami. >>i was reading a past reply from dr.leukoma saying that with the lenticonus >>it [quoted text clipped - 19 lines] > >-MT > common for a child(without vision problems) her age to put things close to > there face. what do you think about that? There are studies that indicate a very close reading distance stimulates myopia, but that's a different sort of myopia that doesn't usually start before age 6 or 9. I don't think you should interfere with her habits for now. > We have an appointment tomorrow > with bascom palmer eye institute in miami. They have an excellent reputation. I believe you'll get some authoritative answers. -MT we were at the office for 8-3. the first couple of hours was arguing with the insurance company. the dr. advised she has some(what you described before) anatomical anomaly with her lens. he does not think it is lenticonus but he can see high myopia in the middle and not so bad on the periph(she saw about 20/80 in one eye and about 20/100 in the other). he had other doctors look at her who also have never seen it before. he suggested a little lighter perscription then our other doctor. she was a -10.00 and a -8.50 and gave us - 8.00 and -6.50. he advised that her lens is so out of line that depending on how dialated her eye is would change the perscription. we dont know what to do with the glasses. should we change them or not. one thinks they can be to strong the other thinks(when we called him) the perscription is to light and will not help with amblyopia. what scares us is the dr. today does not think she will ever get to 20/20 but maybe 20/30. the dr. today is totally against surgery and does not like doing it unless he has to. both doctors are friends and both well respected. our regular doctor thinks that in the near future(a year or so) that surgery would be good because all problems are from these lenses and thinks it would be a better quality of life. i still wonder if instead of amblyopia if the lens itself will not get better with glasses due to this anomaly just like lenticonus. any thoughts out there about this? >> common for a child(without vision problems) her age to put things close to >> there face. what do you think about that? [quoted text clipped - 11 lines] > >-MT Dear Concerned, There are scientists who believe that a child consistently reading at 4 or 5 inches (about -10 diopters) and a very young age, of 2 or 3, can induce a negative refractive state in their young eyes. This is the "second opinion" so you can judge this statement in that context. How long has she been doing this? Best, Otis we have noticed that sometimes she looks at a book she will keep it on her lap and look at the pictures. and other times she(same size pictures) will put it about 5 inches from her face. that is the only thing that makes me think she is nearsighted. i was wondering that if maybe with the closer the object is the more center of her eye she is using and that is why she sometimes put it close? i actually read an article though that says it is common for a child(without vision problems) her age to put things close to there face. what do you think about that? we have an appointment tomorrow with bascom palmer eye institute in miami. > There are scientists who believe that a child consistently > reading at 4 or 5 inches (about -10 diopters) and a [quoted text clipped - 3 lines] > This is the "second opinion" so you can judge > this statement in that context. The "third opinion" is that people don't do this to irritate you and ruin their eyes. They do it to see better. SignatureDan Abel dabel@sonic.net Petaluma, California, USA Dear Dan, Subject: The "conditions" of an office. It is very easy to have a person read an eye chart at say 20/50, and say -- that bad. Then it is very easy to pus a -1.0 diopter lens, that sharpens vision incredibly -- and say that is good. And then in 15 minutes you have "solved" the problem -- and that is the end of that. Or is it? That is the nature of the second-opinion question. Best, Otis > Dear Dan, > [quoted text clipped - 11 lines] > > Or is it? Alternatively you can tell them that you're going to put glasses on them that will make them see even worse and after a number of years they *may* (even though there is NO evidence of this) see less worse than they do now? -Quick >i have one more question. if it was lenticonus would she actually be -11.50 > in the middle or would it just appear to be that high with the retinoscope [quoted text clipped - 11 lines] >>not sit for today).the dr also used a retinoscope but did not dialate the >>eyes. May I "enlighten", with an example in photography, the optical part of your question? Place a very small, powerfull positive, lens (like a RGP contactlens about 9 mm diameter) in front/on top off a reflexcamera- lens Then adjust through your vieuwfinder to get a as sharp as possible picture. Then cover (black) the surronding area of the very small lens and try to get the same picture again without changing the distance and aperture adjustment. What you see now through your vieuwfinder is a totally unsharp image.(and indeed more dark) Why does this happens? In the first situation, the surface of the surrounding area is much larger than the surface of the small on top placed (contact) lens. The image seen through your vieuwfinder depends for the most on this larger surrounding area which has a lesser optical power, however when you cover this surrounding area and let only the lens on top uncovered, you have to deal with another power (the lens on top plus the basic power of the camera lens) To get the ''picture'' sharp in this situation (surrounding covered) you have to adjust according to the other (stronger) power, otherwise the picture stays unsharp and out of focus. Exchange in the excample above the very small but powerfull lens on top with the lenticonus part of your daughters lenscrystallina and take the whole diameter of your daughters lenscrystallina as the basic cameralens. When she is walking around in daylight her pupil is more constricted and almost similiair with the ''covered'' camera lens situation, so the power off the correction needed is depending on the basic lenscrystallina power plus its lenticonus part in the center. When she is placed in a more darker situation and her pupils are more dilated (more open or larger) the eye has to deal with a similar sutuation as found in the first excample of the photocamera.(surrounding area is used because of its larger surface) You explained that the opthalmologist has NOT dilated the pupils, the chance pupils constricted to a very small diameter is high this way because you just use a light beam to excamen the eyepower by using a ''skiascoop'' or, as you in the Angel Saxon countries are used to say , ''retinascope'' Discovery off an posterior lenticonus might be difficult in such a situation, but Dr. Leukoma already made clear there are other ways to discover what is the matter. PS, for the optical engineers, I smuggeled a bit in my explanation (small lens on top (anterior) and lenticonus posterior plus the differend placed aperture) but I want to keep the explanation as simple as possible, my apologies for this behaviour SignatureHope this helps, Jan (normally Dutch spoken) > > Before you jump to any lens removal, be sure her 20/60 vision > I was waiting for Ace to make his usual contribution. Heck, he might > just as well examine this girl You just don't understand, do you? You don't have a clue. Ace doesn't have to examine anyone, he can recommend a pescription without any information whatsoever. Just give him a Snellen test result, and he can convert that to a pescription. Tell him the prescription that your OD issued, and he'll tell you what pescription you *really* need. This guy is good. SignatureDan Abel dabel@sonic.net Petaluma, California, USA >> > Before you jump to any lens removal, be sure her 20/60 vision >> I was waiting for Ace to make his usual contribution. Heck, he might [quoted text clipped - 6 lines] >issued, and he'll tell you what pescription you *really* need. This guy >is good. I'm hearing that whistling theme from _The Good, the Bad, and the Ugly_.... SignatureLive simply so that others may simply live > on > the phone the doctor said that the doctor who gave us the perscription > for - 10.50(he subtracted 1 from the -11.50) should have gave us a > much weaker perscription to start. another doctor we talked to said > you he should have gave the whole amount. who is right and who is > wrong? Why don't you wait and talk to this new doctor, and see what he or she has to say AFTER actually examining your child? SignatureScott Reverse name to reply Dear Concerned Parent, It is always good to do your own visual acuity testing. The child is more relaxed, and you might get a better understanding of what she actually DOES SEE. You gave some rough numbers -- of 1 inchs by 1 inch at 25 feet or so. For comparision, 20/40, is a matter of reading 3/4 inch letters at 20 feet. 20/80 would be reading 1.5 inches at 20 feet. Best, Otis > I AM NOT A DOCTOR. Damn Otis, you finally said something I can agree with!!! Now, stop providing medical advice!!! Allen |
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