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Medical Forum / General / Vision / April 2007accommodative spasm
Are ophthalmologists and optometrists trained to recognize accommodative spasm, lengthening of the eyeball, and pseudomyopia? What do they do about it and how do they inform the patient about it? Are they supposed to tell the patient what is going on? If they need to adjust the distance prescription so the doctor can sell them progressive lenses, do they tell the patient? On Apr 21, 9:49 am, cda...@directflatscreen.tv wrote: > Are ophthalmologists and optometrists trained to recognize > accommodative spasm, lengthening of the eyeball, and pseudomyopia? > What do they do about it and how do they inform the patient about it? > Are they supposed to tell the patient what is going on? If they need > to adjust the distance prescription so the doctor can sell them > progressive lenses, do they tell the patient? I don't know anything about the 3 items you mentioned, nor do I know whether ophthalmologists or optometrists are trained to recognize them. However, I do know how hard it is to convince them that you deserve being informed. Most simply consider it a waste of time since they presume the patient is incapable of understanding their specialized diagnosis and the complexity of all the issues involved. For them the patient is not smart or educated enough to provide a second opinion, and usually they don't like a second opinion. Also, since medicine nowadays is so specialized, they don't seem to realize that there is person attached to the eye. Most relate to the portion of the eye that they are specilaized in, forget the person. IMO this stems from the status of healthcare in the U.S. as business, and consequently money is the main factor in running the business. MDs' time is worth gold, insurance pays by the visit and less time spent with the patient means more profit. One doc sent me to the Internet when I asked some basic questions. This is a shame. "Ms.Brainy" <mikabrainy@gmail.com> wrote in message > them. However, I do know how hard it is to convince them that you > deserve being informed. OK here's a problem. Every young person alive maintains some resting level of accommodation yielding pseudomyopia. Farsighted kids have it in spades, even nearsighted kids do. Do we draw some arbitrary line and say "ok everything over 1 diopter is 'pseudomyopia' and must be spelled out and lost sleep over, when it's just muscle tone? No you don't. If it's causing problems, you treat it. If not, you give the binocular system what it wants and prescribe -1.00 instead of -0.50. The highstrung people who tend to have pseudomyopia are the same ones who will come back and complain if roadsigns aren't crisp and clear and "bold" at night. > Most simply consider it a waste of time since > they presume the patient is incapable of understanding their > specialized diagnosis and the complexity of all the issues involved. What does capability have to do with it? When you get a pipe fixed, does the plumber explain the chemistry of solder alloys? If you want education, do some homework. > IMO this stems from the status of healthcare in the U.S. as business, > and consequently money is the main factor in running the business. Like the British NHS is better? > One doc sent me to the > Internet when I asked some basic questions. This is a shame. So is homework, but it's a necessary evil. :) -MT > ...Do we draw some arbitrary line and say "ok > everything over 1 diopter is 'pseudomyopia' and must be spelled out and lost > sleep over, when it's just muscle tone? > > No you don't. If it's causing problems, you treat it. If not, you give the > binocular system what it wants and prescribe -1.00 instead of -0.50. And you maintain that the patient should not even know what you have diagnosed? > What does capability have to do with it? When you get a pipe fixed, does the > plumber explain the chemistry of solder alloys? No, but he would explain that he has soldered the pipe so it won't leak. >If you want education, do some homework. Sure. Is this what you would tell a 75 yr old with a retinal detachment? "Go to the library, grandma, and find out what it is. Or better ask your grandson to do some research for you on the Internet. It will take you a couple of weeks, but by then your macula will detach and you you may be blind beyond repair. What? You don't know what is macula?" Or look at our own "cda", with a computer and a determination to figure out what's going on with him (even suggesting that they might have removed his cloudy lens but didn't replace it with an IOL), who is totally lost in his desparate "homework". I believe that both can get the necessary basic "education" in a few minutes by a physician who is willing to give them those few minutes before he cut their eyes. > > IMO this stems from the status of healthcare in the U.S. as business, > > and consequently money is the main factor in running the business. > > Like the British NHS is better? Ask the Brits if it's better or not. > Sure. Is this what you would tell a 75 yr old with a retinal > detachment? "Go to the library, grandma, and find out what it is. Or > better ask your grandson to do some research for you on the Internet. > It will take you a couple of weeks, but by then your macula will > detach and you you may be blind beyond repair. What? You don't know > what is macula?" Accommodative spasm isn't retinal detachment. It's muscle tone. It doesn't cause blindness. It goes away eventually, on its own. >> Like the British NHS is better? > > Ask the Brits if it's better or not. I have. It resembles the VA medical system on sedatives. -MT >> Sure. Is this what you would tell a 75 yr old with a retinal >> detachment? "Go to the library, grandma, and find out what it is. Or [quoted text clipped - 13 lines] > >-MT I'm not in a position to compare the NHS with anything else, but I will comment that the NHS doesn't cover everything these days. As I have what they define as a complex prescription (in my case 18D myopia or so with about 2D of astigmatism on top) I get one free eye test a year and an allowance of about £30 for my glasses. The provision of glasses is private and my glasses cost about £400 with the allowance taken off. I'm not very happy with their quality either (I suspect my prescription has got to the point where it is too different from them to run through the same routine as with all their other pairs) but I guess that's a separate point. Similarly, there is supposedly an NHS dental service but the government fell out with the dentists over rates some years ago and never made up, which means that it is almost impossible to register as an NHS patient with a dentist. I have found UK opticians uniformly pleasant and helpful, but then again I don't detain them by asking them questions, apart from "is it safe for me to drive a car?"  SignatureA.G.McDowell [snip] >>If you want education, do some homework. > >Sure. Is this what you would tell a 75 yr old with a retinal >detachment? Perhaps you think we (as primary care practitioners) are advocating no explanation at all and we think you are advocating a 30 minutes explanation. Maybe this will clear things up: As a primary care eye practitioner and not a retinal surgeon what I would tell such a patient would be limited. Limited not because I am incapable of giving a verbose explanation, but limited because the retinal surgeon will be seeing her and therefore a detailed explanation is a waste of time. The medicolegal standard of care is something like this: The patient just needs a brief explanation in layman's terms of what is going on ("the inner layer of the inside of the eye has peeled off the back of the eye like wallpaper coming off of the wall"), the timeframe the patient needs to be evaluated (e.g., macula-off detachment -- within the next couple days; threatening the macula -- immediate), and the risks of ignoring your recommendations ("permanent, total and irreversible blindness"). I would also make the patient aware that surgery would be necessary. Such an explanation should take less than five minute, tops. Normally, it's less than a minute. Also -- the greater the risk to life and limb associated with the condition, the greater the explanation should be. Bacterial conjuncitivitis being treated by me does not need the detailed explanation that a person undergoing treatment for a grade 4 astrocytoma of the brain requires from a neurosurgeon. > Perhaps you think we (as primary care practitioners) are advocating no > explanation at all and we think you are advocating a 30 minutes [quoted text clipped - 26 lines] > explanation that a person undergoing treatment for a grade 4 > astrocytoma of the brain requires from a neurosurgeon. I agree with you. Whatever I wrote was not specifically directed to you or any particular eyecare professional who writes here. My comments were general. I don't even know what your specialty is, although I gather that most of the professionals here are optometrists who specialize in writing prescriptions and detecting problems that require referral to a specialist care. In fact I appreciate tremendously you and your colleagues willingness to give advice here to people who need it and can't find it elsewhere -- all this for free, no $300/hr charge :-) >From my limited experience I presume that most patients don't require much information. My next door neighbor, who has had 2 retinal detachments (which I detected by her droopy eyelid) has no idea whether she has had a vitrectomy or a scleral buckle, nor the location of her detachments. Furthermore, she has no clue of her eyeglasses Rx -- and she was a nurse! Apparently most people come to the doctor, tell what bother them and say: Fix me! When I faced a decision of whether to operate on my mac hole, I needed information to enable me to make a rational and educated decision. Unfortunately, I had no idea of the risk of retinal detachment, nor did I know (and still don't know) how often it happens. What I do know is that my condition today is worse than it could have been without the original surgery, but maybe nobody could have predicted it. After my retina surgeon left town I requested and received my medical record, and found many interesting things there. Among them I found a note (dated 3 months after my retinal detachment) about a macular pucker. Macular pucker? Nobody told me anything about it. Do I have a macular pucker? I still don't know. I asked the next retinologist who checked me thoroughly, and he said that I have some wrinkling of the retina. What does it mean? I don't know. I only know that my vision in the bad eye is distorted, besides being blurry from increased myopia and a thick cataract. Will a cat surgery correct it? I don't know. How correctable my vision is? I don't know. And if my vision is improved, how would my brain process it? I don't know, and I am worried about it. Maybe I am better off leaving the cataract in place, thereby causing my brain to ignore the bad eye, instead of ending up with a smaller disparity and confusing my brain? I don't know, and have no idea how I can educate myself and find out. If there are answers to these questions, only my ophthalmologists can tell me. And if there are no answers, they should also tell me. I need to make decisions and I don't have the information on which I can base these decisions, and nobody gives me this information. As a side note, I have found much false information on the Internet (on professional websites) about issues that I do know, together with lots of accurate and very helpful information. [snip] >I agree with you. Whatever I wrote was not specifically directed to >you or any particular eyecare professional who writes here. My >comments were general. I don't even know what your specialty is, >although I gather that most of the professionals here are optometrists >who specialize in writing prescriptions and detecting problems that >require referral to a specialist care. Some problems require referral, while other problems are treated. >In fact I appreciate tremendously you and your colleagues willingness >to give advice here to people who need it and can't find it elsewhere >-- all this for free, no $300/hr charge :-) Remember, this is just general theoretical advice, not specific "medical advice" to you or any particular patient. Medical advice can only be given after a face-to-face, "hands on" session between doctor and patient. [snip] >When I faced a decision of whether to operate on my mac hole, I needed >information to enable me to make a rational and educated decision. [quoted text clipped - 23 lines] >need to make decisions and I don't have the information on which I can >base these decisions, and nobody gives me this information. I think the above are valid and fair questions that your retinal surgeon should answer for you. Basically, the questions that should be answered are those that are the minimum required for you to make an intelligent, informed decision. Ones that allow you to understand the basics of what is going on, the risks/benefits of the possible treatments (including no treatment), and the doctor's recommendation (if any). Dear Brainy, You are correct. And if you complain they will look down there nose at you and tell you that, "...you will get used to it". And where is your medical degree that you have the right to ask any questions. It would be of value if you were offered a choice (second-opinion) and sent to the internet to research that choice. Best, Otis > On Apr 21, 9:49 am, cda...@directflatscreen.tv wrote: > [quoted text clipped - 23 lines] > spent with the patient means more profit. One doc sent me to the > Internet when I asked some basic questions. This is a shame. > On Apr 21, 9:49 am, cda...@directflatscreen.tv wrote: > IMO this stems from the status of healthcare in the U.S. as business, > and consequently money is the main factor in running the business. > MDs' time is worth gold, insurance pays by the visit and less time > spent with the patient means more profit. One doc sent me to the > Internet when I asked some basic questions. This is a shame. Don't know about US insurance, but in Canada the fee for an eye exam doesn't cover a lot of time. If you are asking questions beyond your immediate care, ie asking questions about how the eye works, visual system functions etc, it is not unreasonable for your doctor to refer you to the Internet for detail. Dr Judy >However, I do know how hard it is to convince them that you deserve >being informed. Most simply consider it a waste of time since they >presume the patient is incapable of understanding their specialized >diagnosis and the complexity of all the issues involved. It's a waste of time, not because the patient is incapable of understanding, but rather because the standard eye examination fee (especially if via a third party/insurance is involved) does not reimburse doctors for that (detailed, complex and comprehensive explanations) and patients (99.999% of the time) are unwilling to pay out of pocket for the time needed to explain that. For example, if you have glaucoma, then: (1) you'll be educated that your eye pressure is too high and that you need to be on drops to lower the intraocular tensions, but you won't typically get a detailed explanation on the vascular versus mechanical theory of glaucoma; (2) you'll be given a visual field examination and briefly shown the results, but you won't get a detailed explanation on the pros/cons of the Octopus G1x versus Humphrey Field Analyzer's 30-2 point layouts or white-on-white versus frequency doubling technology versus short wavelength automated perimetry versus flicker perimetry; or (3) you may have objective retinal nerve fiber layer analysis performed by a GDx/VCC, but won't get an detailed explanation on the technical differences between and how the HRT3, OCT and the GDx work. [It's the same as those patients who want me to be their insurance agent (i.e., answer *detailed* questions regarding how their routine vision insurance works/covers). I politely, *but bluntly*, tell them I am their doctor and not their insurance agent. Or it's like those patients whose chief complaint is a medical in nature (e.g., acute eye trauma) who make an appointment and when asked how they are going to pay for the visit state the name of their routine vision insurance (Uhh... You are aware your routine vision insurance will not pay for anything other than V72.0, 367.0, 367.1, 367.2 and 367.4???)] Clue: When eye doctors are on insurance panels, they always get paid a *reduced fee* (gasp!) from what cash patients pay. And the contract between the doctor and the insurance company (not between you and the doctor!) spells out exactly what they have to do. I will tell you, because doctors are getting paid pennies on the dollars rather than their usual & customary fees, most of us do not want to do more than what we have to to satisfy the terms of the contract (e.g., if the vision insurance plan doesn't pay for a glasses case when you only order lenses and not a new frame, then don't act like we're cheap because we tell you it'll be $5.00 for a case). If we did it for free, we would bleed/lose money -- going in "the red" so to speak. If you want a detailed explanation or general eye knowledge, I am sure most doctors would be willing to take as much time as you need as long as you are willing to pay for their time. A real life example: I referred a patient to a retinal specialist for treatment of exudative age-related macular degeneration. After her retinal consultation, she went to the internet and grabbed articles regarding various treatment modalities (LUCENTIS, MACUGEN, PHOTODYNAMIC THERAPY etc.), printed them out (dozens of pages), wanted me to read through them and give her my opinion on them. While I was flattered she valued my opinion, I told her the retinal specialist was most knowledgable about the various modalities than I was. Still, she said because she was so worried about the profound loss of vision she was experiencing, she wanted me to read them over and give her my opinion on what she should do. Most people, including her, don't want to pay the $300/hour (minimum: one hour -- which filters out all but the truly serious) I routinely would charge for such a service. So in the end, it's not a matter of you don't deserve to be informed or you could not grasp the complexities. Rather, I suspect, it's that the fee you got charged for your exam didn't include that and the doctor "acted" like it was a waste of time rather than bluntly say, "I can answer all of these detailed questions for a fee of 'X'$/hour." Next time, try something along the lines of -- "Hey doc, I have a few questions about eyes that I'd like answered in great detail and I'd obviously be willing to pay whatever you normally charge for that extra time it's gonna take beyond what's alloted or included in a normal eye examination." > If you want a detailed explanation or general eye knowledge, I am sure > most doctors would be willing to take as much time as you need as long [quoted text clipped - 17 lines] > one hour -- which filters out all but the truly serious) I routinely > would charge for such a service. $300/hour????? You must be kidding! But this explains everything. > So in the end, it's not a matter of you don't deserve to be informed > or you could not grasp the complexities. Rather, I suspect, it's that > the fee you got charged for your exam didn't include that and the > doctor "acted" like it was a waste of time rather than bluntly say, "I > can answer all of these detailed questions for a fee of 'X'$/hour." So why do they say in those TV commercials -- "Talk to your doctor"? > > If you want a detailed explanation or general eye knowledge, I am sure > > most doctors would be willing to take as much time as you need as long [quoted text clipped - 27 lines] > > So why do they say in those TV commercials -- "Talk to your doctor"? If you are referring to drug ads, its because the drug companies cannot legally advertise what a drug does. They want you to go to your doctor demanding the drug. Dr Judy - Hide quoted text - > - Show quoted text - > $300/hour????? You must be kidding! But this explains everything. Your reaction is typical of those who have never owned a business. Wow, he must be making $$$$ hand over fist. The reality is that an optometrist billing $300/ hr takes home $50 to $100 of that. The rest goes to staff, rent, equipment purchases, paper towels, cleaning service, insurance ...... And, as a self employed person, he must pay his own disability insurance, health insurance, pension plan. And he gets no paid vacation, no paid statutory holidays, no paid sick leave, no paid snow days. And the expenses (staff, rent, bank loans) continue whether he works or not, whether there is a patient booked or not. Dr Judy Dear M. Brainy, Subject: The second-opinion, and how it develops. It is clear (from the conversations by M.O. ODs on sci.med.vision) that they believe that a strong minus (prescribed for "Best Visual Acuity) is the ONLY answer to Snellens on the order of 20/40 (if you would ever check). That is fine, they believe so totally that they put their own children into a strong minus -- the best and final ethical verification for doing so. But there is a second-opinion. And that is of course prevention (by various methods). If you are unhappy with your prescription, and want better suggestions, perhaps to clear your Snellen, they I would suggest that you MIGHT have accommodation "spasm", where your Snellen is 20/50, but with some work you could clear the muscle spasm, and pass the 20/20 line -- as some pilots have done it. But of course if you don't value your distant vision, then just wear your minus and don't worry about it. Otis > > If you want a detailed explanation or general eye knowledge, I am sure > > most doctors would be willing to take as much time as you need as long [quoted text clipped - 29 lines] > > - Show quoted text - > It is clear (from the conversations by M.O. ODs on sci.med.vision) > that they believe that a strong minus (prescribed for "Best > Visual Acuity) is the ONLY answer to Snellens on the order > of 20/40 (if you would ever check). Fraudulent misrepresentation. Most of us do not prescribe until there are justifying symptoms. > That is fine, they believe so totally that they put their > own children into a strong minus -- the best and > final ethical verification for doing so. Fraudulent misrepresentation. Most of us do not prescribe until there are justifying symptoms. > But there is a second-opinion. And that is of course > prevention (by various methods). If you are unhappy [quoted text clipped - 4 lines] > the muscle spasm, and pass the 20/20 line -- as > some pilots have done it. Fraudulent misrepresentation. We have always said that accommodative spasm is self limiting. > But of course if you don't value your distant > vision, then just wear your minus and don't worry > about it. Fraudulent misrepresentation, and fearmongering. What possible benefit do you see from depriving people of clear vision when they want it? -MT On Apr 23, 12:10 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > Dear M. Brainy, > [quoted text clipped - 23 lines] > > Otis Dear Otis, This is not the kind of second opinion I mentioned. This is rather a suggestion of an alternative method of treating the symptom. About 15 years ago a friend of mine died from breast cancer, 2 days before her 30th birthday. When she first noticed a lump in her breast she went to one of those "wholistic" healers, who diagnosed it as a cyst. He sold her some tea herbs, ordered her to quit coffee and some other stuff, and to come back for a followup within 2 months. Needless to say, the lump continued to grow, and when it became a size of a tennis ball I forced her to go to a real physician for a second opinion. Unfortunately, it was too late. A few years ago I went to see an ENT doc for a sinus problem. As he entered the room, and before even checking me, he already told me that I would need a special surgery. I didn't like his attitude and went for a second opinion. The other ENT doc laughed at the findings of the first doc and told me that I did not need any surgery, and gave me something to clear my sinus inflamation. It worked fine. Ever since, I became suspicious of those who rush to propose surgery. THERE IS MONEY IN SURGERIES, much more than in office visits. With this in mind, I went for second opinion when I was first diagnosed with a macular hole and was advised that I needed an eye surgery, although I had an OCT that showed the hole very clearly. How could I know that the OCT was really of MY eye? I was convinced only when I received an identical OCT from the second-opinion ophthalmologist, but before subjecting my eye to the knives I did an extensive reasearch on possible alternatives to surgery, risks involved, chances of success, etc.. Statistical data played a central role in my considerations, but they were not satisfactory to me. But I found out that high myopes were more prone to suffer macular holes. I concentrated in my research on macular holes, and still knew nothing about retinal detachment, which happened to my same eye 2 months after the mac hole was repaired, and started to collect info about it only AFTER my emergency RD surgery. Dear Otis, I was not a "high" myope according to the "official" definition, however, even my moderate myopia increased my risk of the affliction. Could any of your methods have spared me? Did it spare YOU from having a retinal detachment? Being curious, I checked your website with the hope to find out what you are advocating. I read your autobiography, but found nothing about your experience, only about your mental development. I checked a few of your links but couldn't find any explanation of the "plus method" and how it works. Maybe it's somewhere there, but I gave up. By repeating your "plus" and "second opinion" mantra you are not making any point. I think I have some idea of your suggested method of curing myopia, but it does not make much sense to me. For one, I don't think there is any evidence that any activity of the eye changes the SHAPE of the eye, that seems to be hereditory. You are playing ("accommodating") with the lens, but the lens is not the cause of myopia. Your "second opinion" is of no help to me and I don't believe it could have been when I was 13 and got my first pair of glasses that enabled me to see what the teacher wrote on the blackboard. If you take me as a potential convert or supporter, you are mistaken. >> If you want a detailed explanation or general eye knowledge, I am sure >> most doctors would be willing to take as much time as you need as long [quoted text clipped - 19 lines] > >$300/hour????? You must be kidding! No. That one hour that I would be taking reviewing her materials and educating her is an hour I won't be seeing other patients. And guess how much our practice nets before expenses per hour? About $300.00. The patients/clients who seek out this consultation aren't a captive audience. There is competition (A LOT of competition in the region of the country I practice in) and they are certainly free to go elsewhere if my fees are too high for them. Additionally, I am not a big fan of doing this type of research and education. I have no problem justifying that rate. >> So in the end, it's not a matter of you don't deserve to be informed >> or you could not grasp the complexities. Rather, I suspect, it's that [quoted text clipped - 3 lines] > >So why do they say in those TV commercials -- "Talk to your doctor"? Because those ads are from companies that want you to talk your doctor so he will prescribe their particular ware for you? "Ms.Brainy" <mikabrainy@gmail.com> wrote in news:1177199763.324343.264160 @b75g2000hsg.googlegroups.com: > Most simply consider it a waste of time since > they presume the patient is incapable of understanding their > specialized diagnosis and the complexity of all the issues involved. Let's say you go to a doctor with a headache, and the doctor thoroughly examines you, finds no health issues that pose a danger. The doc recommends you try an aspirin. You do, and the headache goes away. Further, every headache of this type responds the same way to aspirin, and the headaches no longer bother you. How much imaging should you go through to try to find a cause of this headache? Indeed, in the case brought up here, many patients would end up with corrective lenses, with or without the most accurate of "diagnoses" SignatureScott Reverse name to reply On Apr 21, 12:49 pm, cda...@directflatscreen.tv wrote: > Are ophthalmologists and optometrists trained to recognize > accommodative spasm, lengthening of the eyeball, and pseudomyopia? Yes. Accommodative spasm and pseudomyopia, when present in significant amounts, are usually detected as poor best corrected acuity during routine eye examinations. Follow up assessment to establish the diagnosis might include cylcloplegic refraction and electro diagnostic testing to rule out retinal or optic nerve disease. A small amount of accommodative tone, 0.50 to 0.75 is normal in people under 40; that amount would not be called spasm or pseudomyopia. Lengthening of the eyeball can only be detected by successive ultrasound scans or other imaging. These are not done routinely. Lengthening of the eye can be inferred if there is increasing myopia in young people. > What do they do about it and how do they inform the patient about it? > Are they supposed to tell the patient what is going on? If spasm is present (it is rare), treatment is difficult. Often spasm is related to temporary stress, hormonal changes or mental illness, is unstable and will resolve when the stress is removed, hormores stabilize or mental illness is treated. Patients would be told about the reasons for their reduced vision and the reasons why further testing is required. > If they need to adjust the distance prescription so the doctor can sell them > progressive lenses, do they tell the patient? I don't understand this last statement. Patients are usually informed of why progressives are recommended. Dr Judy > On Apr 21, 12:49 pm, cda...@directflatscreen.tv wrote: > [quoted text clipped - 32 lines] > > Dr Judy I'm sorry, that sure didn't come out right. What I meant was: If the doctor feels the need to adjust the distance prescription to less than optimal strength, would he have the obligation to discuss this with the patient? For instance, my eyes need a different correction (in each eye) for reading but the optometrists I have seen seem intent on keeping the add power the same for each eye and then giving me less than optimal distance correction. Maybe they don't want to use prism or slab-off? > the patient? For instance, my eyes need a different correction (in > each eye) for reading but the optometrists I have seen seem intent on > keeping the add power the same for each eye and then giving me less > than optimal distance correction. What is your idea of "optimal?" Your second Rx looked pretty "optimal". And why does it matter when you're only wearing near correction? Tell them you don't want progressives, you want balanced and comfortable reading glasses. Both eyes should focus at the same plane, give or take an inch in dim light. If you get that, it doesn't matter what the actual numbers are. -MT cdavis@directflatscreen.tv schreef: > Are ophthalmologists and optometrists trained to recognize > accommodative spasm, lengthening of the eyeball, and pseudomyopia? > What do they do about it and how do they inform the patient about it? > Are they supposed to tell the patient what is going on? If they need > to adjust the distance prescription so the doctor can sell them > progressive lenses, do they tell the patient? Again you are asking here whit out providing the necessary data about your own situation. In earlier postings here you give the impression in one eye your inner lens (lens crystallina) was removed. If you want a useful answer on your question than give the necessary data. Then it is possible for the real specialists here to give a good answer. Again and again you are suggesting eyecare professionals as a group are only interested in how to get money out of your pocket and meanwhile you want answers from the same people who earn there money as an eyecare specialist here on Internet. What is your real goal mister flatscreen? Jan (normally Dutch spoken) > cda...@directflatscreen.tv schreef: > [quoted text clipped - 23 lines] > > Jan (normally Dutch spoken) My real goal here is to find out why it is difficult to acquire a good prescription from an optometrist and also find some answers as to whether there is something I can do to retain whatever health I have in my eyes. I went to another optometrist in the Portland area (not where I live) and some of the results were as I suspected. For distance I need: Plano +1.25 which leaves me wondering about the doctors saying I needed -.50 +.50. I do indeed have IOL's in both eyes but he did not know this until after the refraction, when he did the dilated exam. He also said another YAG would not do any good and the haze was from the IOL itself. I guess that nobody here can tell me whether I really had cataracts before the surgery. These were supposedly cortical cataracts of grade 2 in the right and grade 1 in the left. I would go in every year or two complaining of not being able to see well in the distance (I could see myself in the mirror and read just fine) and they would give me a new prescription and when I said I still couldn't see and couldn't even read well with the glasses on, they said that was the best they could do and that my eyes were healthy. Making it seem as if it were somehow my fault. They sent me for thyroid workups and MRI. They sent me for diabetic workups also. All tests were normal. So now I wonder if it was just too complicated for them to grind the lenses so they told me I needed cataract surgery. This might have been fine but during my latest refraction I realized that, contrary to what I had been told, I do have accommodation. This is less strong in my left eye but now I will exercise that eye more. My right eye only needs +1.50 to read and a stronger prescription leaves me feeling like the lens is too close to my eye. This type of accommodation might make an exam less than accurate because it takes me a little bit longer than before to focus up close. I began reading about accommodative spasm. For me, I don't know if spasm is the correct word. I have been doing the same things with my eye muscles since before I started school. What is the difference between progressive myopia and accommodative spasm? They both seem to lengthen the eye and compromise the vitreous. Over this many years shouldn't doctors be able to tell and inform the patient of this condition? Now that I have an IOL and still over- accommodate will my eye continue to lengthen and compromise the vitreous? Maybe I will become nearsighted in that eye again but I will be given a reading add based on my age and what I "should" need. What does the chart say for a person 55 years old? These are the questions brushed aside by OD's and OMD's alike. I still have many productive years left but I have not driven on the freeway since 1995 because I could not see far enough into the distance. Now, trying to get a good pair of reading glasses or bifocals seems impossible. Yet nobody has mentioned any diagnosis or prognosis. How do I find a skilled doctor who will take the time to listen and help me work with my eyes for the long term, not just until next week. I am private pay and have paid. cdavis@directflatscreen.tv schreef: >> cda...@directflatscreen.tv schreef: >> [quoted text clipped - 22 lines] >> >> Jan (normally Dutch spoken) > My real goal here is to find out why it is difficult to acquire a good > prescription from an optometrist and also find some answers as to [quoted text clipped - 4 lines] > Plano > +1.25 More details please about which one is for the left or for the right eye and please give the best corrected vision acuity numbers > which leaves me wondering about the doctors saying I needed > -.50 > +.50. And what best corrected vision acuity did you get with this prescription? > I do indeed have IOL's in both eyes but he did not know this until > after the refraction, when he did the dilated exam. Strange, it is quite common to ask you several things (the anamnese). Maybe you forgot to tell these important issues when the optometrist asked you about your eyehealth history? Reminds of the man who came to the general doctor. man: I'm ill doctor: what's the problem? man: don't know, you'r the doctor. He also said > another YAG would not do any good and the haze was from the IOL > itself. I guess that nobody here can tell me whether I really had > cataracts before the surgery. These were supposedly cortical cataracts > of grade 2 in the right and grade 1 in the left. You give the answer yourself. I would go in every > year or two complaining of not being able to see well in the distance > (I could see myself in the mirror and read just fine) If you can read without spectacles I suppose you are myopic in one or both eyes, so your prescription S-0.5 S+0,5 might be more correct as your latest is. and they would > give me a new prescription and when I said I still couldn't see and > couldn't even read well with the glasses on, they said that was the > best they could do and that my eyes were healthy. Making it seem as if > it were somehow my fault. Again your information is too less, what are the numbers of this prescription and where they meant for distance or reading or both? More details please. They sent me for thyroid workups and MRI. > They sent me for diabetic workups also. All tests were normal. So now > I wonder if it was just too complicated for them to grind the lenses > so they told me I needed cataract surgery. Here you go again, you change from history to nowadays and backwards and that is quit confusing. It is hard to follow where to place the different subjects in (time)place. This might have been fine > but during my latest refraction I realized that, contrary to what I > had been told, I do have accommodation. If your inner lenses are removed and replaced by stiff IOL's you have NO accommodation possibilities. This is less strong in my left > eye but now I will exercise that eye more. My right eye only needs > +1.50 to read That's corresponding with the prescription you got before the last one. You also should noticed your vision acuity (uncorrected) for distance is less with the same eye. Your reading distance could be calculated to refraction error 0.5 dpt plus the 1.50 = 2.00 dpts what results in a 50 cm work distance. and a stronger prescription leaves me feeling like the > lens is too close to my eye. This type of accommodation might make an > exam less than accurate because it takes me a little bit longer than > before to focus up close. Again, you have NO possibilities to accommodate. I began reading about accommodative spasm. For you, no need to. > For me, I don't know if spasm is the correct word. I have been doing > the same things with my eye muscles since before I started school. > What is the difference between progressive myopia and accommodative > spasm? They both seem to lengthen the eye and compromise the vitreous. > Over this many years shouldn't doctors be able to tell and inform the > patient of this condition? Now that I have an IOL Here we go again, one or two IOL's? and still over- > accommodate will my eye continue to lengthen and compromise the > vitreous? Maybe I will become nearsighted in that eye again but I will > be given a reading add based on my age and what I "should" need. What > does the chart say for a person 55 years old? If you still have your own inner lenses it's possible to have a bit of accommodation left, not much however. These are the questions > brushed aside by OD's and OMD's alike. I refuse to accept that none of these eyecare professionals informed you about your problem and told you more than you are telling us now. I still have many productive > years left but I have not driven on the freeway since 1995 because I > could not see far enough into the distance. Now, trying to get a good > pair of reading glasses or bifocals seems impossible. Yet nobody has > mentioned any diagnosis or prognosis. How do I find a skilled doctor > who will take the time to listen and help me work with my eyes for the > long term, not just until next week. I am private pay and have paid. For a start, try to write down your history with your eyes in a logical way. Be precise about the date and the findings on that particular date. Most of all, do not keep your mouth shut when a professional is asking. Jan (normally Dutch spoken) On Apr 22, 11:18 am, cda...@directflatscreen.tv wrote: > My real goal here is to find out why it is difficult to acquire a good > prescription from an optometrist and also find some answers as to [quoted text clipped - 7 lines] > -.50 > +.50. In previous posts you have said you also have astigmatism. Are you leaving the cyl part out? Those two Rxs are not much difference, basically +0.50 to +0.75 one over the other. If you did leave the cyl out and one was written in +cyl form, the other in -cyl form, there may be no difference. If you do have some haziness of the IOL or small pupils, that may explain the difference. > I guess that nobody here can tell me whether I really had > cataracts before the surgery. These were supposedly cortical cataracts [quoted text clipped - 6 lines] > it were somehow my fault. They sent me for thyroid workups and MRI. > They sent me for diabetic workups also. All tests were normal. Well you certainly got a thorough work up. If all was otherwise healthy and you were complaining of not seeing well, then the logical next step is to treat the only remaining condition --- the cataract. > during my latest refraction I realized that, contrary to what I > had been told, I do have accommodation. This is less strong in my left > eye but now I will exercise that eye more. My right eye only needs > +1.50 to read and a stronger prescription leaves me feeling like the > lens is too close to my eye. Unless you got a multifocal IOL or accommodating IOL, you do not have accommodation. Pupil size effects may allow for reading large print without glasses. If you find +1.50 works at near for the right eye, then the R -0.50, L +0.50 Rx is likely more accurate -- +1.50 would be the near Rx of -0.50 with a +2.00 add. > What is the difference between progressive myopia and accommodative > spasm? They both seem to lengthen the eye and compromise the vitreous. Progressive myopia is increasing myopia, usually due to lenghtening of the eyeball. It is not reversable. Myopia can also increase due to changes in corneal curvature in some corneal diseases and due to increased curvature/increased density of the lens as cataract develops. Accommodative spasm is a spasm of the ciliary muscle causing accommodation when it is not needed. It is reversable, unstable and does not cause lengthening of the eyeball. > Over this many years shouldn't doctors be able to tell and inform the > patient of this condition? Doctors seldom will tell you that you have progressive myopia, since progression during the teens and early twenties is the normal course of myopia. So your doctor will simply tell you that you have myopia. Accommodative spasm is rare, likely your doctor would discuss this with you. > Now that I have an IOL and still over-accommodate will my eye continue to lengthen and compromise the vitreous? You are not over accommodating if you have IOL. If you have one of the genetic pathological myopias in which the eye continues to lengthen all through life, then it will do so. > Will I be given a reading add based on my age and what I "should" need? What > does the chart say for a person 55 years old? Usually the add is prescribed based on measuring your eye, not on a chart. Fifty five year olds and people with IOL usually need between +1.75 and +2.50 add, depending on where they hold print, BCVA and type of work done. These are the adds mentioned in previous posts. > Now, trying to get a good pair of reading glasses or bifocals seems impossible. Yet nobody > has mentioned any diagnosis or prognosis. What has been wrong the glasses you have tried to date? Did you take them back? You have had at least one diagnosis -- cataract. Refractive error is not consided a disease and you would not expect to have a diagnosis or prognosis is there is no disease. Dr Judy > On Apr 22, 11:18 am, cda...@directflatscreen.tv wrote: > [quoted text clipped - 91 lines] > > Dr Judy Thank you. I will get my long history together along with all prescriptions and measurements that I have. I don't have records from before 1995, only what I had been told were the needed corrections. Where I said that I could not see, I meant nothing well with the glasses on but I could see in the mirror and read with them off. I did go back, several times, but he would not remake them unless I paid more money because a new slab-off was time consuming and expensive. He did not do any remakes. On Apr 22, 2:13 pm, cda...@directflatscreen.tv wrote: > > On Apr 22, 11:18 am, cda...@directflatscreen.tv wrote: > [quoted text clipped - 100 lines] > more money because a new slab-off was time consuming and expensive. He > did not do any remakes.- If you want any opinions, please just post you post surgery Rx's and the problems you found with them when filled. The pre surgery scripts aren't of much relevance now. Dr Judy > On Apr 22, 2:13 pm, cda...@directflatscreen.tv wrote: > [quoted text clipped - 110 lines] > > - Show quoted text - Thank you again. As soon as I get back from Portland I will look them all up and post them. If they were written in +cylinder form should I post them that way or convert them to minus cylinder? |
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