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Medical Forum / General / Vision / November 2006Internal debate about providing 11 year old with full presription lens
My wife believes that a full prescription for my two boys (11 & 8) will increase their rate of near sightedness (300 - 100) over time. Therefore, she requests that prescription is written 25 -50 less than what was recommended for the boys. Is there any basis for such a view point? Our eye doctor has been willing to make these changes but I wonder whether there is any type of scientific support for such a view point? If not, I would like to hear from someone on why it's preferred to provide full prescription lens to children to enable them to have as close to 20/20 vision as possible. Any studies or articles which can be referenced would also be welcomed. Thanks. > Our eye doctor has been willing to make these changes but I wonder whether > there is any type of scientific support for such a view point? If not, I > would like to hear from someone on why it's preferred to provide full > prescription lens to children to enable them to have as close to 20/20 > vision > as possible. It's pretty clear that undercorrection doesn't help, and overcorrection doesn't hurt, but you owe it to yourself to check out this article: http://www.newscientisttech.com/article/dn3082 -MT Mike, Amazing...this was exactly the type of article and study which I was looking for to try to debunk my wife's theory that undercorrecting would provide long term benefit. My wife is from Taiwan and I didn't realize that she was probably familiar with earlier Japanese studies or at least word of mouth based on these studies. I'm very hopeful that this article and some additional discussion willl finally enable my two boys to see more clearly in school. Gus >> Our eye doctor has been willing to make these changes but I wonder whether >> there is any type of scientific support for such a view point? If not, I [quoted text clipped - 9 lines] > >-MT > Amazing...this was exactly the type of article and study > which I was looking for to try to debunk my wife's theory > that undercorrecting would provide long term benefit. I wouldn't argue that undercorrection is so dramatically harmful - I'm not aware of any new campaign to "keep your glasses up to date." But the take-home point is that it isn't _helpful_. The majority of studies (in English) show no effect either way. -MT Contact lenses have a risk. I would never let such young children wear them. First of all, how myopic are your children? If only slightly, they can put off wearing glasses unless explictly needed such as reading the board in school and watching movies. Make sure your children never, ever, ever read or do near work with glasses on! Also have them read holding the book away from them because near work excerbates nearsightness. > Contact lenses have a risk. I would never let such young children wear > them. First of all, how myopic are your children? If only slightly, [quoted text clipped - 3 lines] > have them read holding the book away from them because near work > excerbates nearsightness. Exerbates. Good one there, champ. Sorry we will likely never meet. > Contact lenses have a risk. I would never let such young children wear > them. First of all, how myopic are your children? If only slightly, [quoted text clipped - 3 lines] > have them read holding the book away from them because near work > excerbates nearsightness. As if anybody really believes Ace anyway but, just in case, I submit the following: The majority of studies show that the risk of ulcerative keratitis in a daily soft lens wearer is approximately 1/5000 per year. Only 13% of those are bad enough to cause loss of vision. In more than 20 years of a very high volume contact lens practice, I have seen only one (1) patient who lost two lines of vision from wearing a contact lens, and this was a person who slept in their OK lens. The patient subsequently regained most of that within two years. I consider that contact lenses so safe that I allowed my son to begin wearing them at age 11 years. If children never do near work with their glasses on, they gradually lose the ability to accommodate if they are myopes. Is that a fair trade-off, Ace? In return, what is gained by a child not wearing their minus lenses at near? There is no credible evidence, anywhere, under any rock, that suggests there is anything wrong with wearing glasses full-time, unless that correction causes nearpoint esophoria. DrG > As if anybody really believes Ace anyway but, just in case, I submit > the following: [quoted text clipped - 18 lines] > > DrG Not everyone thinks contacts are so safe. Glenn posted an article stating lasik is safer than contacts which I personally find absurd but ill link you. Theres something wrong with google search not returning results newer than June, ill retry tomorrow. Loss of accomodation is called presbyopia. Not wearing glasses has nothing to do with accomodation. There are emmetropes who hate reading and led an active outdoor life and rarely use their accomodation. Glasses are completely useless at near, they wont sharpen up anything(unless you have lots of cylindar) and in my case, I find glasses worse than useless for near. It results in blur and eyestrain. Theres a reason minus glasses are called "distance" glasses. > Not everyone thinks contacts are so safe. Glenn posted an article > stating lasik is safer than contacts which I personally find absurd but > ill link you. Theres something wrong with google search not returning > results newer than June, ill retry tomorrow. The issue is not what other people "think," Ace. I'm interested in the facts. Scientific fact transcends individual opinion. Also, don't bother linking me the article, because I have the entire article. It isn't even an article but a commentary, i.e. an "opinion." The author of that article is speculating on what might be found to be the case "IF" a real study was done. Naturally, the press reported the commentary as if it was fact. DrG > > Not everyone thinks contacts are so safe. Glenn posted an article > > stating lasik is safer than contacts which I personally find absurd but [quoted text clipped - 10 lines] > > DrG Is that the one? http://groups.google.com/group/alt.lasik-eyes/browse_thread/thread/8cee187dd3bd7 10c/325e14cea66ad7f7?lnk=gst&q=glenn+contacts&rnum=1#325e14cea66ad7f7 I corrected Glenn here: http://groups.google.com/group/sci.med.vision/browse_thread/thread/6c5083cb83dd4 f6/c7742f2f1fa90c97?lnk=st&q=glenn+safer&rnum=1#c7742f2f1fa90c97 Ace schreef: > Contact lenses have a risk. I would never let such young children wear > them. You know why, don't you Ace? A megalomaniac layman, that's what you are Ace. As always Ace, give mom and dad a kiss and go to bed, remeber hands above the sheets to avoid getting more shortsighted as you are already. Jan (normally Dutch spoken) | Ace schreef: | | Contact lenses have a risk. I would never let such young children [quoted text clipped - 7 lines] | above the sheets to avoid getting more shortsighted as you are | already. de gedachte, zoals de persoon, is afschuwelijk!  SignatureGrtz, Nicolaas Dan O'Leary's work showed quite categorically that undercorrection would increase the correction over time. The options I look at are hard C/L's, which although recent reports show not to have any ben efit over glasses, I have personally found have made notable reductions in increase in myopia over the years (while undercorrection has NEVER made any improvement), bifocals (when given to the right child) and orthokeratology, which has a slow-down rate similar to hard C/L's. The important thing here is a proper evaluation to know what is going on with your kids. dr grant > My wife believes that a full prescription for my two boys (11 & 8) will > increase their rate of near sightedness (300 - 100) over time. Therefore, > she requests that prescription is written 25 -50 less than what was > recommended for the boys. Is there any basis for such a view point? No, and in fact the opposite may be true. You will no doubt here from the two resident zealots (that's being polite) here on sci.med.vision who will try to convince you to use plus lenses on your children. Their theory of myopia prevention has been thoroughly and repeatedly be proven wrong. > Our eye doctor has been willing to make these changes but I wonder whether > there is any type of scientific support for such a view point? If not, I > would like to hear from someone on why it's preferred to provide full > prescription lens to children to enable them to have as close to 20/20 vision > as possible. There are a number of reasons. First, there is absolutely no scientific evidence to suggest that undercorrection has any affect upon the rate of nearsightness increase or decrease. We thought that might be the case a few decades ago but numerous studies have been unable to substantiate a cause and effect relationship. Further, one of the theories as to why nearsightness progresses is in fact the presence of a blurred retinal image. So, it is actually more likely that, in theory, undercorrection will cause increase myopia than the opposite. The reality is that a small under or over correction will have no real effect and if any, certainly not positive. The clear downside to undercorrection is the the child might not be able to see the chalk/whiteboard and have learning and attention issues. I'd shoot for the correct correction. The only possible basis for undercorrection is when the full correction results in significant esophoria (eyes crossing) and the specific undercorrection eliminates that neuro-motor result, in which case we recommend the child sits closer to the front of the room until such time the correction reduces by itself, vision therapy exercises addresses the problem, or full correction no longer causes the esophoria. Something you might want to consider is contact lenses. I'm a proponent of contact lens correction for children as that form of vision correction provides a more "normal" retinal image and eliminates the prismatic and distortion effects of off-center viewing through spectacle lenses. There is some theory that suggests that contacts might affect the rate of myopia change. Personally, I'm not convinced, but I the theory looks nice----and is far more science-based than what you'll get from Otis and Ace. I've got dozens of children in contact lenses and half of them appear to be Rx stable and the other half continue to increase. By the way, the children are far more compliant with contact lens handling and care than the adults! They almost never invent ways to circumvent the protocols but adults seem to think that they know better and change solutions, over wear lenses, leave in lenses that hurt, etc. Perhaps one of my colleagues might post some literature citations for a scientific understanding. I'm away from my computer that has that info right now. LB, O.D. |
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