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Medical Forum / General / Vision / July 2006Using the near point test and a ruler, I measured my manifast refraction!
Did you know you can get an accurate measure right here at home or anywhere with just a ruler and some lines and/or text? What I did was measure the point where a long line becomes in perfect focus, not any closer or further. Since I have cylindar, I need to use a line. I measure how far the line is in focus at two points opposite from each other, the further point is how myopic I am and the nearer point is my myopia plus the cylindar causing blur in that particular direction. In my right eye(OD) I measured 27cm in one direction(opposite to my cylindar axis) and 20cm in the direction that blurs the most which is my axis of cylindar. The left eye(OS) measured at 22.5cm and 20cm. Using the astigmatic wheel confirms oblique cylindar, considerably worse in the right eye. Therefore I am -3.75-1.25 OD and -4.5-.5 OS. This is just an estimate and not an official pescription. To obtain an offical pescription, see a licenced optometrist/opthamologist. The near point test is useful for monitoring the prograss of vision improvement which I have and its improved considerably. I will be getting a regime of atropine to unmask the rest of my tonic accomodation and reveal my structual axial myopia. Hopefully it improves alot and doesnt regress once the atropine wears off. I will do eye exercises and forgo the minus lens whenever I can do keep my vision sharp and reduce dependancy on glasses. right eye(OD)-3.75-1.25 Left eye(OS)-4.5-.5 http://groups.google.com/group/sci.med.vision/browse_thread/thread/e18f478f3432c f65/de509627d1cad4e7?lnk=raot& the above thread talks of me planning to get a regime of atropine to ummask all my tonic accomodation. Its highly likley I have at least a full diopter of it and quite possible a couple diopters. If all my astigmastim is on my cornea, there shouldnt be any changes in the cylindar. Hopefully my cylindar goes away with natural vision improvement as I heard straining your eyes causes your corneas to physically distort. My cylindar has never been truly stable, changing from time to time in diopter(s) and axis. I can do something to exercise it away. Whatever myopia I have under cycloplegia, I should get down to that for my manifast refraction with eye exercises. I could be looking at a major reduction in glasses dependancy depending how things go! :) :) :) Dear AceMan, I would not use atropine (bella-donna). I personally dislike the effect, and it a drug that should be used with discretion. I think you will find it difficult to find an ophthamologist to "prescribe" it for you. Also, be aware that "vision clearing" (change of refractive state in a positive direction) is a very slow process. My estimate is no greater that +1/2 diopter per year. Transient clearing has been done by a few (from 20/70 to 20/40 or better -- pass the DMV) but to be truly effective, the "plus" must be continued through the school years. One item I wish you did have (for your measurements and experiments) is a low-cost trial lens kit. This would include minus lenses in 1/2 diopter steps, and a trial-frame. Thus, using a Snellen, and the trial-frame you could come close to duplicating the standard-measurement methods using the phoropter. Good luck, Otis ++++++++++++ > http://groups.google.com/group/sci.med.vision/browse_thread/thread/e18f478f3432c f65/de509627d1cad4e7?lnk=raot& > [quoted text clipped - 10 lines] > be looking at a major reduction in glasses dependancy depending how > things go! :) :) :) > One item I wish you did have (for your measurements and experiments) is > a [quoted text clipped - 4 lines] > come close to duplicating the standard-measurement methods > using the phoropter. How will that help him train his accommodation? Can't he just take his glasses off and read beyond his nearpoint? It's an idiotic suggestion, but I do have a small antique trial set I'd sell for $300, ground shipping included. -MT Mike> How will that help him train his accommodation? Can't he just take his glasses off and read beyond his nearpoint? Otis> That is about his only option. I truly WISH that AceMan had been offered the option to ACCEPT support for plus-prevention at the threshold. And, perhaps would have TURNED IT DOWN. But then, had he done that -- there would be no doubt at all concerning who was responsible. If that were "standard practice", the AceMan would not be posting about this issue now -- because he would know the consequence of negtlect of the preventive-plus. It is clear that the preventive-plus is "difficult" -- but it is possible and wise. Only the future (and OD parents) will determine when and how it is used. Mike> It's an idiotic suggestion, but I do have a small antique trial set I'd sell for $300, ground shipping included. Otis> AceMan wants to "make the measurements". The "ruler" method is crude and approximate. A "better organized" method would be with a simple trial-frame and a "reduced" set of minus lenses. That way he could check (same as you) any vision-clearing he might experience. That way he could "trust" himself -- with some supporting training -- and double-check any "prescription" he might receive. Otis> I think that a "simplified" trial-lens kit could be developed for less-than $100 -- if there were interest in doing so. Best, Otis > > One item I wish you did have (for your measurements and experiments) is > > a [quoted text clipped - 12 lines] > > -MT > Otis> That is about his only option. I truly WISH that AceMan had > been offered the option to ACCEPT support for plus-prevention at the > threshold. If wishes were fishes... you know we ALL wish you'd tell us how you can be so certain your therapy works. -MT Dear Mike, You keep on jumping to CONCLUSIONS -- about many issues. I NEVER use the word "cure" -- as you do. I do ACCEPT that you can not deliver "prevention" -- and that PREVENTION will depend on the person himself -- making a CHOICE in this matter. This is the same issue of Steve Leung OD making a CHOICE for his own children when there refractive STATE is zero diopters. That issue is critical. Steve has his CHILDREN faithfully putting on a +2 or so lens -- for all reading. The effect of this can be PREVENTION for them, through the grade school, high school, college and graduate school. But only his kids will gain the benifit of it. This is a hard choice that ONLY a parent could make. And he has made it that way. Others MIGHT LEARN FROM IT -- but the more probably course of action will come from engineer-parents who learn how to NOT repeat the mistakes of the past -- and insist that their children wear the low-cost plus -- when their refractive STATE is close to zero. This is completly consistent with the Oakley-Young study which shows that a plus -- used early -- can have the effect of PREVENTION. But it also suggests that the use of the plus in this manner MUST BE UNDER CONTROL OF THE PERSON WHO MAKES THIS TYPE OF WISE CHOICE. Maybe AceMan will be making this type of "choice" for his children, as their refractive STATE moves from a positive to negative value. By then I hope that MORE prevention-minded optometrists will be SUPPORTIVE of this PREVENTIVE method. I know how EASY that minus lens is -- how impressive -- how it "works" in 5 minutes. And that is a major "selling" point. And the plus can NEVER do that. It will take the person himself to figure that out. Maybe AceMan will eventually do that -- for his own children. But that will be about 15 years from now. As you know, the person who figures out how to CLEAR his vision, and pass all legal visual-acuity tests -- NEVER FALLS UNDER YOUR CONTROL. And this type of issue places the solution beyond your control. Best, Otis > > Otis> That is about his only option. I truly WISH that AceMan had > > been offered the option to ACCEPT support for plus-prevention at the [quoted text clipped - 6 lines] > > -MT Otis, as ive already said, no one told me about the plus lens at the treshold. I dont care if optometrist think it wont work, I have the right to make the choice that I was never even informed about. I cant turn time back and cant do much now except reduce my myopia. The good side is ill never need reading glasses. I will be sure to take my family's relatives to a second opinion optometrist >http://groups.google.com/group/sci.med.vision/browse_thread/thread/e18f478f3432c f65/de509627d1cad4e7?lnk=raot& > [quoted text clipped - 10 lines] >be looking at a major reduction in glasses dependancy depending how >things go! :) :) :) I know you wrote you tried cyclopentolate in the above mentioned thread, but you may want to have your doctor try it again in the following regimen: 1 drop of 1%* cyclopentolate with punctal occlusion, wait 5 min. 1 drop of 1% tropicamide with punctal occlusion, wait 5 min. 1 drop of 2.5% phenylephrine with punctal occlusion, wait 5 min. 1 drop of 1% cyclopentolate with punctal occlusion, wait 5 min. Begin refraction 60 minutes after 1st drop. And test NRA/PRA with +2.50D Add at 40cm. Retinoscopy can detect fluctuating or lingering accommodation also. 24 hours of near blur is a lot better than a week of it. I almost never use atropine to refract patients. First of all, it typically needs to be used for 3-4 days prior to refracting for full effect. It can dilate pupils for two weeks. Plus, I normally get what I consider to be "reasonable cycloplegia" with the above cyclopentolate regimen. For blue eyed, Caucasian patients, the cyclopentolate regimen is almost always adequate. For dark skin, darkly pigmented irides, sometimes only atropine will do. I will use atropine for amblyopia penalization therapy, severe uveitis/hyphema, accommodative esotropia refraction, prior to referral for strabismus surgery, etc. Nevertheless, if you came into my office insisting on an atropine refraction, I "see" no reason why I wouldn't "accommodate" you (pun intended). * I don't use 2% cyclopentolate ever. > >http://groups.google.com/group/sci.med.vision/browse_thread/thread/e18f478f3432c f65/de509627d1cad4e7?lnk=raot& > > [quoted text clipped - 45 lines] > > * I don't use 2% cyclopentolate ever. Good advice. Is this as good as a week long regime of atropine? I dont think id like the idea of punctal occlusion or having plugs inserted in my tear ducts. Also with atropine, this will be the most complete cycloplegia and while my mydrisis will last 2 weeks, ill deal with it, I stay home most of the time anyway. My vision is already blurry from near with glasses and if atropine unmaks enough tonic accomodation, then great I wont need distance glasses! In fact the more tonic accomodation I have, the better because I can exercise it away and ill be less myopic for real! If atropine takes 4 days to fully work, ill get a 5-7 day regime and at the end, see him again for another refraction. I have tried cyclopentolate and it was incomplete so I am going with a regime of atropine. [snip] >Good advice. Is this as good as a week long regime of atropine? No, but it is "good enough" in nearly all cases like yours. A 4 day regimen of atropine prior to refraction is the "gold standard" for cycloplegia, and as I wrote, there are times when only that will do (e.g., accommodative esotropia in a young child). In my experience, it does not uncover significantly more plus in the vast majority of adults. >I dont think id like the idea of punctal occlusion or having plugs >inserted in my tear ducts. As far as punctal occlusion, I meant this: <http://tinyurl.com/em32s> >My vision is already blurry from near with glasses and if atropine >unmaks enough tonic accomodation, then great I wont need distance >glasses! Wishful thinking. >I have tried cyclopentolate and it was incomplete so I am going with a >regime of atropine. Remember, the full atropine routine is 1 drop of 1% atropine sulfate twice a day for 4 days prior to the refraction. I am going to schedule an appointment with an ophthamologist. Well see what he says, but ill be sure to mention my tonic accomodation and at least 4 day atropine regime to make sure to unlock every bit of tonic accomodation. Would more than 4 days make a difference? If not 4 days is enough and on the 4th day ill visit him for my cycloplegic refraction, hopefully much lower than my manifast. Would it be possible that maybe the tonic accomodation wont return? Dear AceMan, I personally DISLIKE the effect of a myadric. Even the mild cyclogel -- that lasts about 3 to 6 hours. I personally doubt that you will accomplish very much by your 4 day '"test". Your "manifest" is good -- so far. If you are going to spend money -- I would suggest obtain a trial lens kit (or make one us from Zenni-optical lenses. That way you can read your Snellen, and find out the minimum strength minus needed to bring you up to 20/20 -- in day light. And further, the MINIMUM minus lens required to clear the 20/40 line -- again in day light. The Zenni-opical lenses sell for $20 for two -- if you wish to do this. I think it would be a better "learning" path that to attempt anything with atropine-sulfate. Further, some people have a "reaction" to that drug -- and I think and ophthamologist would warn you about these "secondary" effects. Again, I wish there were a low-cost trial-frame and lenes on the market so you could do these "experiments" wisely and effectively. Good luck, Otis ++++++++ > I am going to schedule an appointment with an ophthamologist. Well see > what he says, but ill be sure to mention my tonic accomodation and at [quoted text clipped - 3 lines] > refraction, hopefully much lower than my manifast. Would it be possible > that maybe the tonic accomodation wont return? > Dear AceMan, > [quoted text clipped - 10 lines] > can read your Snellen, and find out the minimum strength > minus needed to bring you up to 20/20 -- in day light. do you think that getting a simple trial lens set and sitting in front of an acuity chart under bright light will give you a good refraction? do you think that there are any other refractive problems aside from simple myopia? don't you think that ciliary muscle contraction and pseudomyopia have any influence in a persons day-to-day visual acuity? > And further, the MINIMUM minus lens required to clear the > 20/40 line -- again in day light. who cares about meeting this minimum visual acuity requirement. somehow you think this BMV-derived standard is the only level of acuity that we should attempt to attain. seeing 20/40 sucks, especially when you're driving on a winding two-lane road at night in the rain. > I think it would be a better "learning" path that to attempt > anything with atropine-sulfate. who cares what you think? > Further, some people have a "reaction" to that drug -- and I think > and ophthamologist would warn you about these "secondary" effects. and plus lenses induce diplopia in some people too. > do you think that getting a simple trial lens set and sitting in front > of an acuity chart under bright light will give you a good refraction? > do you think that there are any other refractive problems aside from > simple myopia? don't you think that ciliary muscle contraction and > pseudomyopia have any influence in a persons day-to-day visual acuity? A trial lens set will give you an estimate. So will measuring how far away you can see clearly. A professional eye doctor will give me an exact manifast and cycloplegic refraction using his phororaptor. By the way, a proper refraction should be taken in a dimly lit room because bright light can skew the results due to pinhole effect. my pseudomyopia is the main reason why I want atropine cycloplegia. > who cares about meeting this minimum visual acuity requirement. > somehow you think this BMV-derived standard is the only level of acuity > that we should attempt to attain. seeing 20/40 sucks, especially when > you're driving on a winding two-lane road at night in the rain. In Otis' defense, I think he means that WITHOUT correction. If your eyes are that bad for full time correction then it makes sense to correct you best as possible, but an undercorrection is a good idea for close work like reading, eating, computer or to relieve tonic accomodation. But if your eyes arent bad, why bother with the wretched minus lens which will just make your eyes worse and cause tonic accomodation? > > I think it would be a better "learning" path that to attempt > > anything with atropine-sulfate. [quoted text clipped - 5 lines] > > and plus lenses induce diplopia in some people too. Ill take my chances with cycloplegia in order to improve my vision and do away with tonic accomodation which is a real problem for me as I cant see well from near with glasses. Its either that or presbyopia and I sure hope I am not presbyopic at 24! Anon, then ill just use a 4 day regime. Am I supposed to return to the doctors office immediately after the final dosage on the 4th day? How long does it take for cycloplegia to start wearing off? If any tonic accomodation returns after my atropine wears off, ill just exercise it away. Ill be wearing glasses that correct my true axial myopia. > If any tonic accomodation returns after my > atropine wears off, ill just exercise it > away. Ill be wearing glasses that correct > my true axial myopia. And missing exits on the interstate. -MT >I am going to schedule an appointment with an ophthamologist. Well see >what he says, but ill be sure to mention my tonic accomodation and at >least 4 day atropine regime to make sure to unlock every bit of tonic >accomodation. Would more than 4 days make a difference? No. [snip] >Would it be possible that maybe the tonic accomodation wont return? Sure, as long as you don't continue using atropine drops twice a day. |
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