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Medical Forum / General / Vision / August 2006Atropine questions
I suspect I have some tonic accomodation, probably 1.5 diopters of it. If atropine is tried, wont it blur my vision so my BCVA is 20/100? How will I get an accurate cycloplegic refraction if the best lenses is still blurry and I cant tell the difference between small increments of half diopter when "one or two is better" Also is it true atropine's effects last a week? I want to get this out of the way because my manifast pescription is too strong for seeing clear from near and someone said I may have significent tonic accomodation rather than presbyopia. > I suspect I have some tonic accomodation, probably 1.5 diopters of it. > If atropine is tried, wont it blur my vision so my BCVA is 20/100? How [quoted text clipped - 5 lines] > someone said I may have significent tonic accomodation rather than > presbyopia. People undergo cycloplegic refractions all the time. Ironically, a cycloplegic can sometimes improve the ability to discriminate between two lenses if it eliminates the accommodative fluctuations. Atropine's effects last several days. Maybe cyclopentolate can do the job, and recovery is quicker. DrG > > I suspect I have some tonic accomodation, probably 1.5 diopters of it. > > If atropine is tried, wont it blur my vision so my BCVA is 20/100? How [quoted text clipped - 13 lines] > > DrG I had cyclopentolate which reduced my myopia by just half a diopter but I noticed I still had some accomodation so I feel it was incomplete. My BCVA did not decrease. I understand it may improve discimination because youd be able to tell if your overminused. However if atropine blurs your BCVA to around 20/100 you may not be able to discrimiate well with all that blur. Or am I missing something? I want to try it if it is useful for uncovering all my tonic accomodation and it may help releave some of it too. > because youd be able to tell if your overminused. However if atropine > blurs your BCVA to around 20/100 you may not be able to discrimiate > well with all that blur. Why would atropine blur your BCVA to 20/100? I've never seen it do that. It should be that different from cyclopentolate. They both enlarge the pupil to a comparable degree. -MT > > because youd be able to tell if your overminused. However if atropine > > blurs your BCVA to around 20/100 you may not be able to discrimiate [quoted text clipped - 6 lines] > > -MT http://www.tfn.net/~kate901/amblyopia/atropine.htm more proof: atropine is used to blur vision in the non-amblyopic eye and offers a useful alternative to traditional occlusion therapy with patching, especially in older children who are not compliant with patching. Drops Do as Well as Patches for 'Lazy Eye' Atropine drops given once a day to treat amblyopia, or lazy eye, the most common cause of visual impairment in children, work as well as the standard treatment of patching one eye, according to the March issue of Archives of Ophthalmology. Amblyopia is a condition in which an otherwise healthy eye has poor vision because the brain has learned to favor the other eye. Most eye care professionals treat the condition by putting a patch over the unaffected eye, thereby forcing the child to use the weak eye. Atropine drops blur the vision in the unaffected eye, and parents say it is easier than requiring a young child to wear an eye patch. Are they wrong? I looked it up and they say atropine blurs your vision! > http://www.tfn.net/~kate901/amblyopia/atropine.htm > > more proof: No, one mother's understanding. Technically, what she calls "CV" is only "CV" if the child wears a +250 add in the atropinized eye. This is one of the benefits of atropine patching, for children who already wear glasses. The atropinized eye remains mercifully clear at distance, and functional for school. It's the difference in NEAR VISION that challenges the "bad" eye in that circumstance. So mother Kate was saying that the blur in NEAR vision can't be made more than about 20/100. You are quite right that there are situations where atropine simply wouldn't work. If the atropine eye was -250, they'd _have_ to wear glasses or it wouldn't do anything. Full atropine dilation only reduces Snellen acuity by a line or two. Remember there's still a large percentage of the cornea and lens that have no aberration. As a result, the blur of dilation isn't debilitating blur like out-of-focus. It's a clear image surrounded by haze, blacks are slightly grayer and whites are slightly grayer but the image is still there. And the IRIS isn't the only thing that frames your pupil. Slit your lids and you're 20/15 for vertical lines. > Are they wrong? I looked it up and they say atropine blurs your vision! Not 20/100. 20/25. -MT > It should be that different from cyclopentolate. I shoulda said "should NOT be". The blur, for a myope, comes from wide pupils causing huge increases in aberration, mostly spherical IIRC. The pupils are a little wider with atropine, but not "20/100" worth. Total aniridia wouldn't cause that, by itself. If you use atropine once or twice a day for a week, it will take several days, maybe a week, to fully recover your accommodation. Why are you working so hard? Since you first began posting, we've been telling you your problem is basically excess accommodation. It isn't making anything worse because your prescription is decreasing, not increasing. It will take care of itself. After age 48 you'll probably be rock solid at -200, just where you'd want to be for reading. If you want to "train away" the excess accommodation, stare at small print just beyond your farpoint and learn to control your accommodation. Relaxation would be bery, bery goood, too yoo. Knowing your absolute refractive measurements under total cycloplegia doesn't change anything, except it might tell you when to stop your training (ie when you reach the normal 050 difference between dry and wet refractions.) You could occupy yourself for hours staring at just-blurry print. It would help some, but your accommodation is going to relax eventually, whether you fiddle with it or not. So you could just forget about it. Get glasses or contacts for driving with minimum tolerable minus and if that's blurry at near, get drugstore plus. Or skip contacts - get PALs, or a second pair for reading. And get on with your life. Whatever that's worth. -MT "If you use atropine once or twice a day for a week, it will take several days, maybe a week, to fully recover your accommodation. Why are you working so hard?" sometimes tonic accomodation is stubborn and may take repeated use of atropine to yield it all away. One guy mentioned he had 3 diopters of it and it took 4 days of repeat atropine to unlock it all. "Since you first began posting, we've been telling you your problem is basically excess accommodation. It isn't making anything worse because your prescription is decreasing, not increasing. It will take care of itself. After age 48 you'll probably be rock solid at -200, just where you'd want to be for reading." -2, not -200 lol! I cant even imagine -200 diopters, just not possible *eek!* Well have to see how much tonic accomodation I have. My eye exercises reduced it by a diopter or so but I still have more. I am not gonna wait till im old, I want to do something asap because my accomodative amplitude is reduced due to some of it "locked" and also I just dont want such blurry distance vision. "If you want to "train away" the excess accommodation, stare at small just beyond your farpoint and learn to control your accommodation. Relaxation would be bery, bery goood, too yoo." I have been doing just that, its what one lady did to improve by 1.25 diopers. Atropine will let me know how much more I have to go. "You could occupy yourself for hours staring at just-blurry print. It would help some, but your accommodation is going to relax eventually, whether you fiddle with it or not." again, I am not gonna be more myopic than I really am. I also want to free up accomodation. "This is one of the benefits of atropine patching, for children who already wear glasses. The atropinized eye remains mercifully clear at distance, and functional for school." I guess he must have been a (latent) hyperope because the 20/100 was for distance. no matter, once the amblyopia is cured, atropine can be discountinued and normal vision restored shortly. "As a result, the blur of dilation isn't debilitating blur like out-of-focus. It's a clear image surrounded by haze, blacks are slightly grayer and whites are slightly grayer but the image is still there." also known as loss of contrast. my pupils dilate naturally so they would barely get bigger with atropine but they wont shrink in light so ill need sunglasses or stay away from bright lights. "Slit your lids and you're 20/15 for vertical lines" if your retina is capable and if you dont have lots of aberrations in the center of your cornea. "Not 20/100. 20/25." I already cant correct to 20/20 so I guess I wont experience additional distance blur with atropine unless I happen to be hyperopic which is highly unlikley with my manifast -4.5 probably my cycloplegic would be like -3 or so but the lower, the better and perhaps once the atropine wears off, not all my tonic accomodation will return > I suspect I have some tonic accomodation, probably 1.5 diopters of it. > If atropine is tried, wont it blur my vision so my BCVA is 20/100? why do you think that? if you are properly refracted you should reach your maximal acuity while cyclopleged-- probably 20/20 or better. the lenses that are required to achieve that acuity will represent your true myopia (=anatomical myopia) without any tonic accommodation. it will represent the lowest prescription you would be able to achieve by using any of your NVI relaxation schemes. > Also is it true atropine's > effects last a week? no > I want to get this out of the way because my > manifast pescription is too strong for seeing clear from near and > someone said I may have significent tonic accomodation rather than > presbyopia. people have been telling you that for ages. are you finally catching on? no one your age is presbyopic. perhaps you're finally getting it. > > I suspect I have some tonic accomodation, probably 1.5 diopters of it. > > If atropine is tried, wont it blur my vision so my BCVA is 20/100? [quoted text clipped - 18 lines] > people have been telling you that for ages. are you finally catching > on? no one your age is presbyopic. perhaps you're finally getting it. Thanks for your reply. Ive been thinking why atropine blurs vision and maybe its because when its used in the dormant better eye in young children with amblyopia, they lose their accomodation in that eye and experience hyperopic blur. Their nondormant eye now becomes the better eye and gets exercised, thereby hopefully correcting amblyopia. Atropine would NOT work in myopic amblyopic children. Whoever said atropine blurs must have meant only if you are hyperopic because you can no longer accomodate around it. Does atropine always result in a complete cycloplegia? I may need like a week of atropine treatment to really be sure I unlock all my tonic accomodation. How long does atropine last? Ive read it lasts a week on average. If I cant see well from near with -4.5 glasses, I could have significent tonic accomodation and if I dont, what other explanation is there? > Thanks for your reply. Ive been thinking why atropine blurs vision and > maybe its because when its used in the dormant better eye in young > children with amblyopia, they lose their accomodation in that eye and > experience hyperopic blur. Their nondormant eye now becomes the better > eye and gets exercised, thereby hopefully correcting amblyopia. not sure what you mean here. anyway, atropine blurs hyperopes because they can't accommodate and clear their vision. its blurs more for higher hyperopes of course. but atropine also blurs anyone because of the profound dilation it causes. > Atropine would NOT work in myopic amblyopic children. they are also blurred due to dilation. and of course they can only see at distance with the proper eyeglass Rx on and they can only see at near at a working distance equal to their true myopic state. > Whoever said > atropine blurs must have meant only if you are hyperopic because you > can no longer accomodate around it. you are right in that atropine blurs hyperopes more but it also causes significant visual blur in myopes. > Does atropine always result in a complete cycloplegia? I may need like > a week of atropine treatment to really be sure I unlock all my tonic > accomodation. How long does atropine last? Ive read it lasts a week on > average. there is a lot of variability in peoples response to atropine. mydriasis (=dilation) lasts much longer than the cycloplegia (=paraplysis of accommodation) so the complete effects of atropine may take 1-2 weeks to wear off because the dilation is slow to go away completely. in cases of profound ciliary spasm atropine can be given up to twice daily for multiple days. one drop may not completely relax accommodation especially in children. its effects in adults is usually more complete. using atropine is not fun. > not sure what you mean here. > anyway, atropine blurs hyperopes because they can't accommodate and > clear their vision. its blurs more for higher hyperopes of course. > but atropine also blurs anyone because of the profound dilation it > causes. Thats what I was thinking. For latent hyperopes, they will experience worse uncorrected vision. For pseudomyopes, their uncorrected vision will improve > you are right in that atropine blurs hyperopes more but it also causes > significant visual blur in myopes. Should I expect the blur of atropine to be equal to cyclopentolate? My BCVA with glasses wasnt really effected and my uncorrected vision was about the same indoors, its outside in bright light that everything was all washed out and looked like a watercolor because my pupils were huge. Normally they shrink, resulting in a pinhole effect and giving much improved visual accuracy. This is also why eye exams should be done in a dimly lit room with an illuminated eyechart. > there is a lot of variability in peoples response to atropine. > mydriasis (=dilation) lasts much longer than the cycloplegia [quoted text clipped - 4 lines] > accommodation especially in children. its effects in adults is usually > more complete. How long does cyclopegia last? I want to make sure I get to the optometrist or ophthamologist asap after inserting drops of atropine. I may need 5 to 7 days for a complete cyclopelgic. I had cyclogyl before and only got a drop and only one season and I could tell it was incomplete as I could still accomodate but not as well. > using atropine is not fun. But its educational and important for me to know my true myopia. Would I stand correct in saying ill experience the same blur and dilation as cyclogyl except a longer duration and complete cycloplegia. bump, need a few more answers. I am going to schedule an appointment very soon with an opthamologist for atropine to see how much pseudomyopia, tonic accomodation I have > bump, need a few more answers. I am going to schedule an appointment > very soon with an opthamologist for atropine to see how much > pseudomyopia, tonic accomodation I have Like a good obsessive nut, yes, waste a doctor's time. > > bump, need a few more answers. I am going to schedule an appointment > > very soon with an opthamologist for atropine to see how much > > pseudomyopia, tonic accomodation I have > > Like a good obsessive nut, yes, waste a doctor's time. He doesnt care as hes getting paid. Besides my complaint is legitimate. My accomodation is nowhere near normal for a person in his mid 20s. Some of the optometrists here have been telling me I have accomodative excess, tonic accomodation, pseudomyopia. The fact my vision improved in the last 18 months due to eye exercises and wearing weaker minus is proof I have tonic accomodation. I feel I may have quite a bit left still. I may even get vision theraphy to much more rapidly eliminate the rest of my tonic accomodation. Ive been told my true structual or axial myopia could be -3 or even -2 based on the info ive given out. http://groups.google.com/group/sci.med.vision/browse_thread/thread/5d3174a81751e 90a/0c94fbbb782d39f6#0c94fbbb782d39f6 read this thread Dear AceMan, Subject: Work for true-prevention. If you had put this much effort into it -- when your Snellen was 20/60 (about -1.25 diopters) -- I believe you would have cleared to pass the DMV -- in about 4 months -- as others have done. No one, repeat no one, wants you to get stair-case myoipia from an over-prescribed minus. But often the OD has NO CHOICE because the person concerned with it -- WILL REFUSE THE USE OF A STRONG PLUS FOR PREVENTION. But that becomes "our fault" if we are offered plus-prevention (as the second-opinion) and turn it down cold -- in favor of that impressive minus lens. But maybe, the next generation (your children) will lean from the struggle you are going though with this work. That is a true "learning process". Best of luck, Otis > > > bump, need a few more answers. I am going to schedule an appointment > > > very soon with an opthamologist for atropine to see how much [quoted text clipped - 15 lines] > > read this thread I will share the news how much my vision improves after atropine! I hope my cycloplegic refraction is low! I am also looking to get soft contact lens orthoK to further reduce my myopia. I will be very happy if I get down to -2 then I can see the computer monitor without glasses. I wont need glasses for most things. Good luck, AceMan! Otis > I will share the news how much my vision improves after atropine! I > hope my cycloplegic refraction is low! I am also looking to get soft > contact lens orthoK to further reduce my myopia. I will be very happy > if I get down to -2 then I can see the computer monitor without > glasses. I wont need glasses for most things. > Good luck, AceMan! > [quoted text clipped - 5 lines] > > if I get down to -2 then I can see the computer monitor without > > glasses. I wont need glasses for most things. Whatever improvements I get, I am getting soft contact lens orthoK to further improve my vision. I expect a reduction of -1 to -1.5 diopters, maybe even -2 if I get really lucky. RGP orthoK can improve from more than twice to three times as much but its much more expensive. I see no reason to first try soft contact orthoK for a tiny fraction of the cost to see how well it works for me. I can always "upgrade" to RGP orthoK when and if I feel like it and have the money. Hopefully atropine, natural vision improvement and orthoK get me to the point I dont need glasses for the computer and if I get there, I wont need glasses much at all! I would need to get down to -2 for that to be possible. Ok everyone, this is interesting! At 9am I went to the ophthalmologist clinic. The tech/assisant first measured me "objectivately" with autorefractor then a peripheral vision test. He then refracted me with a phoropter, first with my distance glasses then with phoropter using different lenses. My distance glasses were -4.5(left) -4(right) and I looked at the mirror which had snellen letters projected from behind and bounced off another mirror. The tech said I was 20/25 in this eye and 20/30 in that eye. I thought to myself "strange" as those glasses undercorrected me by half diopter and that 20/25 and 20/30 was my BCVA with *full* power glasses. Maybe my vision improved. The tech then took out a small bottle of tropicamide. I was like wait, am I getting atropine? He said the optometrist said no. I got tropicamide instead. The female(tall blond nice looking) optometrist refracted me to confirm the tech's results. BCVA was 20/20(left) 20/25(right) which I thought was impossible. I got every single of the 4 letters right on the 20/20 line! That eyechart must not be calibrated right and not the approperate distance. My BCVA is 20/25 and 20/30 in a proper 20 feet eyechart which this one wasnt. There is an ophthalmologist and lasik surgeon in that clinic. Now I see why so many people get "20/20" they are only "20/20" on their eyechart, but on a proper eyechart, they arent. Not only did I see 100% 4 out of 4 of the 20/20 line, that was with minification of -5 lens! Youd need some special eyes to see better than 20/20 or 20/20 with lots of minus which makes everything smaller and further away. She then inserted strange yellow eyedrops to numb my eyes then give me a glucoma or eye pressure test. I felt nothing. She also looked into my dilated pupils which tropicamide a few minutes ago caused. My retina is fine, my eye is perfectly healthy. I just have plain old myopia and she didnt believe I had pseudomyopia. Only a few children do and they get atropine for months, sometimes even years, she said. I did not need atropine, she said. I thought to myself theres no way im bothering with something(atropine) that takes months when I can improve my vision naturally, and do away with whatever little pseudomyopia I had left. I did ask her why are things a little blurry from near with my distance glasses and that I see much clearer and closer without. She said its normal because you have to accomodate and thats a strain. You can and should take your glasses off to read if nearsighted. Thats what I do already, glasses are worse than useless for near. The optometrist then handed me my autorefraction results and prescription papers. I questioned the accuracy of the autorefractor, it gave me different results and overcorrected me. The prescription papers said -5.00 +.50 x90(right) -5.50 +.50 x85(left) which is confusing and should be written as -4.50 -.50 x180(right) -5.00 -.50 x175(left) I question the astigmatism in the right as the astigmatic wheel shows it to be oblique but my topographies I got 2 years ago show asymetric irregular astigmatism in that right eye. It cant be corrected with todays technology and is costing me a line of BCVA. As far as regular astigmatism goes, the amount I have is neglecable and accounts for only a -.25 spherical equivalent. Therefore my S.E is -5.25 and -4.75 which is a -.25 diopter overcorrection. When two lenses were shown that appeared the same, the lower power should have been given. I got the -.25 higher one. Another indicator of overcorrection is I measured 20/25 and 20/30 with my -4.5 and -4 glasses, yet they give me -.75 diopters more minus for 20/20 and 20/25! Doing the nearpoint measure, I achieve 21cm which corresponds to -4.75! My -5 and -4.5 glasses I have correct me fully and the -4.5 and -4 undercorrect me by half diopter, costing me just a single line. So it looks like I will keep on doing NVI to improve a little further and will be getting soft contact lens orthoK to chop off another 1 to 1.5 diopters off. The orthoK is instant gratification, the NVI will take some time for gradual improvements. My UCVA will greatly improve, ill be alot less "blind" without glasses and ill be able to read from a comfortable distance instead of so close. Once I get the soft contact orthoK, I will let you know how it goes and how much improvement I get! Ace, in order for your narrative to have any meaning, we need to have some confidence that the reporting is objective. Unfortunately, it is permeated with your own biases and editorial comments and has no utility whatsoever. In fact, you very well might have made up the entire incident. DrG > Ok everyone, this is interesting! At 9am I went to the ophthalmologist > clinic. The tech/assisant first measured me "objectivately" with [quoted text clipped - 65 lines] > comfortable distance instead of so close. Once I get the soft contact > orthoK, I will let you know how it goes and how much improvement I get! > Ace, in order for your narrative to have any meaning, we need to have > some confidence that the reporting is objective. Unfortunately, it is [quoted text clipped - 3 lines] > > DrG The retard does make things up as he goes along. I like the "eyechart wasn't calibrated right". > > Ace, in order for your narrative to have any meaning, we need to have > > some confidence that the reporting is objective. Unfortunately, it is [quoted text clipped - 6 lines] > The retard does make things up as he goes along. I like the "eyechart > wasn't calibrated right". I speak for others when they were told they had "20/20" vision when tested in a clinic that does lasik or is affiliated with lasik. The clinic I went to has a lasik surgeon and there was pictures of 100+ people who had lasik on the wall in the waiting room. People also go there for eye exams and to assert the health of the eye. Those guys who were told they had "20/20" admit the testing was faulty and too generous and consider themselves closer to 20/30. It explains why so many people are told they have 20/20 and in some cases, 20/15 after lasik. If they were tested on a proper eyechart, they would be a line to a line and a half worse. There is an optometrist here who claims half the people he tests are 20/15. I pointed out his eyechart isnt the proper distance and those 20/15 guys would be 20/20 on a correctly distanced eyechart. Every correctly distanced eyechart has put me at 20/25 to 20/25- BCVA except this one which I passed 4 out of 4 on the 20/20 line. I know the truth now, had my suspicious but they have been confirmed. Thats lasik "20/20" for ya which isnt as good as real 20/20 in quantity, acuity and quality. I dont correct to 20/20 because my glasses minify and make that line too small and also because my eyes are quite myopic as well as having high order aberrations. Alot of people actually fall closer to 20/25 BCVA, 20/20 BCVA is above average and 20/15 BCVA is outstanding and uncommon. >> > Ace, in order for your narrative to have any meaning, we need to have >> > some confidence that the reporting is objective. Unfortunately, it is [quoted text clipped - 28 lines] >people actually fall closer to 20/25 BCVA, 20/20 BCVA is above average >and 20/15 BCVA is outstanding and uncommon. I can read every letter on the chart with corrected myopia of -6.5 and some astigmatism. And that's using a chart at the hospital set the proper distance without using mirrors. So maybe the chart isn't wrong. Maybe your ideas are wrong instead. Ann > I can read every letter on the chart with corrected myopia of -6.5 and > some astigmatism. And that's using a chart at the hospital set the > proper distance without using mirrors. So maybe the chart isn't > wrong. Maybe your ideas are wrong instead. > > Ann If you still see all of 20/20 with your prescription glasses then you be (halfway)between 20/20 and 20/15 with soft contacts and possibily 20/15 with proper RGP contacts. Have you looked at other eyecharts for consistity? I have seen dozens of eyecharts and this is the only eyechart where I was able to see all of the 20/20 line. Not only that, but I read 20/25 with my slightly weaker glasses when on other eyecharts I can only read 20/30 to 20/40. If this is the type of 20/20 people get after lasik, its lasik "20/20" and would be 20/25 to 20/30 in reality and may be worse in real world. I know a bunch of "20/20" lasik patients passing that line in an improperly distanced mirror eyechart, they would be no better than 20/25 in a proper eyechart and in the real world they are like 20/40, they cant see license plates nor street signs from anywhere near the distance they could with glasses before lasik! > I will share the news how much my vision improves after atropine! I > hope my cycloplegic refraction is low! I am also looking to get soft > contact lens orthoK to further reduce my myopia. I will be very happy > if I get down to -2 then I can see the computer monitor without > glasses. I wont need glasses for most things. w00t indeed. Please see http://en.wikipedia.org/wiki/W00t for a definition. ;-) |
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