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Medical Forum / General / Vision / September 2008Latent Hyperopia - Child age 6 - glasses? (+3.25 script)
I'm a confused mom at the moment. A year ago, my then 5 year old child had his eyes tested (by a clinical ophthalmologist who I feel did a thorough exam) and I was told he was borderline for needing glasses, but if he wasn't manifesting any problems then we should just recheck in a year because he might outgrow and be fine. No particular problems were noticed, although he has never really been interested in the "school work" portion of his Kindergarten program and is a part of the Title I program to help him with the needed pre-reading/reading skills. He was rechecked this week (same doc), now age 6, and the problem was explained in a bit more depth as latent hyperopia. His pre-"eye drops" sight had a correction of +.25/+.37, so he is correcting well. With the drops, he would need a +3.25 in both eyes - the same as last year. The eye doctor is basically telling me it is our choice at this point with glasses and whether or not we think he needs them. Again, apparently this is right on the fence. (?) He will get rechecked again in a year - or sooner if we request it. The doc gave me the script, but said we could 'wait and see' how he does. It was our call. He said if we get them, he wouldn't need to wear them all the time so he could still work on adjusting himself if he is going to outgrow it. I don't want him to use them if he will then never be able to out grown it, but if it would help him with school work, I'm all for it. He doesn't seem to care one way or another about getting them. I am have no idea what to do. He doesn't complain of problems, but at his age (and personality) he probably wouldn't anyway. I'm concerned it may be difficult to tell with him if he is having a problem. I don't know if his pre-reading/reading skills are related to eye sight at all, or just a lag in learning/personality (his temperament is strong willed to say the least). Getting him to do any kind of seat work to observe his behavior is challenging anyway. So - what is common practice for this? What will happen if he does use glasses (even part time) - will he ever have the chance to outgrow the latent hyperopia? Is it even likely he will outgrow it with the +3.25? Any information on how to handle this or what to "watch for" will be appreciated.. ..I just have no idea what the best course of action is with my little guy. Thank you in advance. Confused Mommy Janice :) > So - what is common practice for this? There is NO long-term benefit in avoiding the glasses. No harm will be done by wearing them. A conscientious doctor would recommend glasses if there were symptoms (headaches, avoiding close work) or objective findings like esotropia or reduced stereo vision. Since they did not recommend glasses outright, we assume there were no such findings. Some doctors would be appalled at NOT recommending glasses in this case. But in the absence of symptoms or objective findings, there's no compelling reason to make him wear glasses. Hyperopia is the normal condition for young people and they have enormous reserves for coping with it. As age and the quantity of near work increases, he might tolerate the hyperopia without symptoms until his third decade. Or he may need glasses for symptoms that crop up. Or he may be one of the 25% of (caucasians?) who start turning nearsighted about age 10, and that would reverse the condition. What you do now is not likely to influence any of these outcomes. Suggestion - get him a "cool" pair of drugstore +2.00 glasses and see if he likes to wear them when he reads. (The +3.25 was measured in artificial conditions and "full" correction is not always used.) -MT, OD > I'm a confused mom at the moment. > [quoted text clipped - 39 lines] > > Confused Mommy Janice :) Janice, I strongly recommend that you do a literature search on hyperopia. Jerome Rosner of the University of Houston College of Optometry has published many studies showing the strong correlation between uncorrected moderate hyperopia and poor academic achievement. Even the official Clinical Practice Guidelines of the American Optometric Association includes "aversion to reading" as a symptom of hyperopia. If it were me, I would weigh the risk (?) of wearing a spectacle correction with the possibility of a lifetime of academic difficulties. If it were me, I would also get a second opinion from a pediatric optometrist. Please bear in mind that there is huge disagreement among professionals concerning when and how much plus to prescribe a young hyperope, especially when neither amblyopia or strabismus are present. >Please bear in mind that there is huge >disagreement among professionals concerning when and how much plus to >prescribe a young hyperope, especially when neither amblyopia or >strabismus are present. I'm very grateful for the responses thus far. I have been doing searching and have encountered some of the literature in this category. One question that I have as a layperson is when the literature discusses the implications, etc. for hyperopia, do those findings apply to a child like my son who was diagnosed with latent hyperopia, and is - apparently - self-correcting at this point? I've read several items, but I am uncertain if the findings also apply in the case of latent hyperopia. At this point, we have informed his teachers (he starts 1st grade next week) and if they sense any sign at all, we will immediately proceed with the glasses. In the meantime, I am continuing to try and figure this out and see if I can feel more certain of what decision to make. Additional advice and opinions is still welcome! Thank you, Janice "Latent" means real hyperopia. It's latent because it's hidden. It's hidden because he compensates for it by accommodating, exerting constant effort to focus. Compensating is very easy in the young, very hard by age 40-50. Kids do not usually grow out of hyperopia, except as I mentioned, some percentage will experience genetic nearsightedness starting around age 9-12. Generally, the rest get gradually worse. In kids, the hyperopia measured after cycloplegic drops ("wet" refraction) stays pretty stable or increases gradually. Between ages 30-60 it's more likely to increase than decrease. From an early age, the hyperopia we measure _without_ drops always increases gradually to match the refraction _with_ cycloplegic drops. That's consistent with the decrease in accommodation that causes most people to have near problems at 40. Most farsighted people have been that way all their lives. Often they didn't "need" glasses til they started school, or college, etc. If your son has symptoms, there's no question. A cycloplegic refraction of +3.25 justifies glasses unless a kid is behaviorally and academically "normal." If there's any question of reading difficulty, avoiding near work, headaches with close work then those are symptoms deserving treatment. Does he color, read, write, use a computer, gameboy or psp? Does he resist or avoid any of these? Again, glasses will not do any harm. The cycloplegic refraction is not likely to increase just because you get him glasses. If the "dry" refraction seems to increase, it's just because they get used to exerting less effort. -MT, OD > >Please bear in mind that there is huge >>disagreement among professionals concerning when and how much plus to [quoted text clipped - 23 lines] > Thank you, > Janice Dear Mike, Just to clarify. You can measure hyperopia with a trial-lens kit or a phoropter. You call this regular or normal hyperopia. To measure "latent" hyperopia you MUST use "drops", like cyclogel. From what this mother reported, the child's cyclogel refractive STATE was +3.25 diopters, and the trial-lens measurement was +1/2 diopter. It would help her to understand the difference between "latent" and "regular" correctly. Thanks, Otis > "Latent" means real hyperopia. It's latent because it's hidden. It's hidden > because he compensates for it by accommodating, exerting constant effort to [quoted text clipped - 64 lines] > > - Show quoted text - On Aug 28, 6:15 pm, otisbr...@embarqmail.com wrote: > It would help her to understand the difference between "latent" > and "regular" correctly. Generally speaking, Janice, it would help you to ignore /anything/ Otis Brown posts. Trust me. On 8/28/08 6:01 PM, in article t8KdnRZRXtPk1yrVnZ2dnUVZ_hednZ2d@giganews.com, "Mike Tyner" <mtyner@mindspring.com> wrote: > Kids do not usually grow out of hyperopia, except as I mentioned, some > percentage will experience genetic nearsightedness starting around age 9-12. > Generally, the rest get gradually worse. My experience does not seem to mirror yours, Mike. I find many (not all) kids become less hyperopic gradually over time from age 6 months to about 8 years or so. Most of the change is before age 5-6 or so. Less change after that time. The occasional child gets more hyperopic, but it is the exception rather than the rule. Sometimes seems to make a jump up after the first glasses, probably because the chronic accommodation is hard to overcome on the first cycloplegic, and more hyperopia is picked up once they are not overaccommodating. David Robins, MD Board certified Ophthalmologist Pediatric ophthalmology and adult strabismus subspecialty >> Kids do not usually grow out of hyperopia, except as I mentioned, some >> percentage will experience genetic nearsightedness starting around age [quoted text clipped - 6 lines] > years or so. Most of the change is before age 5-6 or so. Less change after > that time. Well, we agree there's a tendency to normalize at very early ages and it's a good reason to be conservative using glasses. But the OP has a child age 6, and that ship has sailed. It's reasonable to say spontaneous "improvement" is only likely if he inherits myopia. > The occasional child gets more hyperopic, but it is the exception rather > than the rule. As a child, sure. I don't expect much increase in the cycloplegic refraction. But I was thinking more long-term, and it's a good bet that hyperopia will increase in mid-life. > Sometimes seems to make a jump up after the first glasses, > probably because the chronic accommodation is hard to overcome on the > first > cycloplegic, and more hyperopia is picked up once they are not > overaccommodating. Agreed. I never assume we've uncovered all of it, nor that we have to. -MT > >Please bear in mind that there is huge > >disagreement among professionals concerning when and how much plus to [quoted text clipped - 21 lines] > -- > Message posted viahttp://www.medkb.com can I ask why you wouldn't simply try to introduce the idea of using readers to your child and just observe for yourself their effect on his attention span and willingness to engage in prolonged near work? kids who are straining to see at near do not always clearly behave in a predictable manner. some may complain of headaches or eyestrain but many just simple avoid near tasks and never complain about anything. being a +3.25 hyperope (latent or not) is almost certainly a strain on your son and using part-time reading glasses isn't that difficult or scary. if he were my child I wouldn't take the chance that farsightedness might be slowing his academic development-- I would just get him a cheap pair of readers and encourage him to use them and see what happens. why not? and your question about the long-tern ramifications of being hyperopic-- its pretty simple really. when you are young you will use reading glasses occasionally but when get older you will likely be wearing glasses all the time. Suppose it is true that corrective negative lenses to compensate for myopia myopia does indeed lead to progressive myopia. (Don't jump on me yet.) How could such putative knowledge be used to cure hyperopia? Suppose enough positive power is used to correct a young child's hyperopia so that reading distance is moved in to be closer than typical reading distance. That is, the far point is brought into where the normal near point would be. Then I would expect that all the visual behavior with such positive lenses would be pretty much the same as that of a myope. Would that cause the eyeball to lengthen? I sure do not know. Such technique is probably testable on animal models. Other strategies might hold even more promise. Bill Bill, If you put a +3 diopter on a primate, his refractive STATE will simply "move more positive". Click here watch the blue-tint model of the natural eye. http://vision.berkeley.edu/wildsoet/myopiaprimer.html So the effect on the primate eye is proven as fundamental science. But for a child ...? Science is clear. Mose people are not. Otis > Suppose it is true that corrective negative lenses to compensate for > myopia myopia does indeed lead to progressive myopia. (Don't jump on me [quoted text clipped - 11 lines] > > Bill On Aug 28, 9:24 pm, otisbr...@embarqmail.com wrote: > Bill, > > If you put a +3 diopter on a primate, his refractive STATE will > simply "move more positive". a) But, but, but ... only a particular species of macaque behaves this way; b) But, but, but ... the macaque was 20/20, so ... the eye simply adapted. What if the macaque had a prescription OF +3d? c) But, but, but ... it only happened TO this particular species of macaque ... who didn't NEED glasses ... when the lenses were left on 24 hours a day, 7 days a week. Breaks eliminated even THIS effect. But ... since I've shown you the science behind these facts ... over and over and over .... you're simply lying by omission. Janice: THIS (among myriad other reasons) is why Otis is to be ignored. He's medically dangerous. Literally. In article <10e31b6d-ce91-4cad-80da-0f11bb449cf3@d1g2000hsg.googlegroups.com>, > If you put a +3 diopter on a primate, his refractive STATE will > simply "move more positive". <snip> I understand all that. Let me try to explain my thinking a bit more. I think we both believe that the body is able to respond to close work by permanent changes thagt make the body handle close work well. If a young hyperope cannot see close items well enough, he will not be able to do close work, reading, without the aid of positive external lenses. The chain of progressive myopia never starts. Is it possible to reach a visual state which replicates the starting point for progressive myopia. This means that an external positive lens takes the image from a close object that would form behind the retina and bring it close to the retina. That way, close work can be performed with the aid of intrinsic accommodation. With the right incentives, the youngster may be encouraged to do close work in a way to lengthen the eyeball. In my case, I would read stretched out with the book, often a comic book, closer than normal reading distance. Perhaps a truly interesting book such as in the Harry Potter series printed in small type might encourage such behavior. As the eyeball lengthens, the power of the external lens can be reduced. This hypothesis of mine is proposed with absolutely no proof. Once this behavior is started, can it prove difficult to stop after the eyeball reaches proper length? I have no idea. Bill Dear Bill, Yes, there are two opinions concerning the natural eye's dynamic behavior. The "accepted" one is the Donders-Helmholtz theory that is more "shop-practice" than anything else. It does create a nice impression that the only answer is a minus lens. But, with some insight and judgment, it is possible to prove that the shop-practice "model" of the natural eye's behavior is "flawed". So I think that blue-tint model is accurate science (but never "medicine"). But, it is because I would expect a sophisticated control system to behave that way -- in the first place. In fact Bates "sense" was along those lines. That, while the "minus" creates an impressive sharpness in a few minutes, the "later" or secondary effect is the "adaptation" as shown by the blue-tint model. That these ideas are disputed -- is the essense of a scientific argument. To understand this issue more clearly I would suggest reading Thomas Kuhn's broad-based book on the subject, "The Structure of Scientific Revolutions". The nature of these arguments often turns on "accepted" definitions -- that were wrong to start with. In fact, the theory of Relativity requires that meter-sticks shrink in the direction of travel -- inorder to make the speed of light a constant. That truly could not happen in a "Newton" world. Otis > In article > <10e31b6d-ce91-4cad-80da-0f11bb449...@d1g2000hsg.googlegroups.com>, [quoted text clipped - 31 lines] > > Bill In article <16279662-1716-4d03-ae06-32f50c05110b@79g2000hsk.googlegroups.com>, > In fact, the theory of Relativity requires that meter-sticks > shrink in the direction of travel -- inorder to make the > speed of light a constant. > > That truly could not happen in a "Newton" world. I think you have it backwards. The physical universe require that the theory of relativity be discovered by physicists sooner or later. Observing that the speed of light requires that the meter stick shrinks. While this is not a good forum to discuss it, it is easy to show that in an almost Newtonian environment. Consider a clock consisting of light bouncing between two mirrors separated by a meter stick. Calculate the period of the ticks with the clock's length oriented perpendicular to the direction of travel and compare it to what happens with it oriented along the direction of travel. Do this in the Newtonian way. This will show that a moving clock slows compared to a stationary clock. For the two clocks, perpendicular and along the direction of motion to keep the same time, separation of the two mirrors for the longitudinal clock has to become smaller. All this can be derived using simple geometry (Pythagorean theorem) and algebra. Dr. Bill > Suppose it is true that corrective negative lenses to compensate for > myopia myopia does indeed lead to progressive myopia. (Don't jump on me [quoted text clipped - 9 lines] > Such technique is probably testable on animal models. Other strategies > might hold even more promise. Using high plus would be equivalent to uncorrected myopia, not to wearing minus lenses. Emmetropization is a process that controls eye growth so as guide the eye towards having no refractive error. Uncorrected myopia is due to the eye being too long for its refracting power, so emmetropization would stimulate a slowing of axial growth so as to decrease eye length. This has been done with animals. Positive lenses create "myopic blur", stimulate a slowing of eye growth or shortening of the eye. This would make the eye more hyperopic, not less. Using minus lenses which create hyperopic blur could, in theory, cause axial enlongation but this has not been observed in humans. In this case, leaving the child uncorrected leaves the child with hyperopic blur. If emmetropization is going to happen, it will happen if lenses are not prescribed. As we can tell from the history, it has not happened: the child was hyperopic at age 5, left uncorrected for one year, and is the same amount hyperopic at age 6. Emmetropization is either finished or not happening with this child. Adding minus lenses to make him even more hyperopic would likely have no effect. Dr Judy In article <05130bd0-2d8f-4118-9398-6175bbadc1ca@l42g2000hsc.googlegroups.com>, > > Suppose it is true that corrective negative lenses to compensate for > > myopia myopia does indeed lead to progressive myopia. (Don't jump on me [quoted text clipped - 16 lines] > power, so emmetropization would stimulate a slowing of axial growth so > as to decrease eye length. As you well know, positive lenses are available in a range of power. My suggestion is to use the power that simulates the degree of focusing that leads to progressive myopia, if indeed that process exists. Presumably, that would lead to a longer eyeball. > This has been done with animals. Positive lenses create "myopic > blur", stimulate a slowing of eye growth or shortening of the eye. > This would make the eye more hyperopic, not less. Using minus lenses > which create hyperopic blur could, in theory, cause axial enlongation > but this has not been observed in humans. Following this logic, there should be no such thing as progressive myopia. > In this case, leaving the child uncorrected leaves the child with > hyperopic blur. If emmetropization is going to happen, it will happen [quoted text clipped - 5 lines] > > Dr Judy I am not a health professional. I do understand optics well although short of being a lens designer. The biological principle driving my thought is similar to that of homeostasis or Le Chatelier's principle. Dr. Bill > In article > <05130bd0-2d8f-4118-9398-6175bbadc...@l42g2000hsc.googlegroups.com>, > > > > Suppose it is true that corrective negative lenses to compensate for > > > myopia myopia does indeed lead to progressive myopia. (Don't jump on me > > > yet.) How could such putative knowledge be used to cure hyperopia? > As you well know, positive lenses are available in a range of power. My > suggestion is to use the power that simulates the degree of focusing > that leads to progressive myopia, if indeed that process exists. > Presumably, that would lead to a longer eyeball. I think you are misunderstanding the effects of a plus lens and the nature of hyperopia. Those who argue that minus lenses cause progressive myopia (BTW, there is no evidence for this) suggest it works like this: An uncorrected 3D myope does not need to accommodate at near as their far point is at near, near print at 33cm is clear without any effort. When the myope wears a minus lens, the far point moves back out to infinity and the myope then must accommodate at near, The accommodation needed at near is about 2.5D for 40cm/16 inches, the standard distance. Somehow this accommodation causes the myopia to progress. Our uncorrected 3D hyperopic child is accommodating 3D when viewing at far and 5.5D when reading at 40cm. He is accommodating more at far than the corrected myope does at near and twice as much at near as the corrected myope ! So if accommodation is causing progressive myopia, then leaving the child uncorrected should make him more myopic and his hyperopia will disappear. Obviously it didn't work, this child had no change in his refractive error between age 5 and 6 despite all that accommodation. Now suppose you correct him with plus as you suggest. Any amount of plus correction will reduce the amount of accommodation the child does and thus provide even less a stimulus to myopia. The amount of plus that "that simulates the degree of focusing that leads to progressive myopia" is no plus at all! > > This has been done with animals. Positive lenses create "myopic > > blur", stimulate a slowing of eye growth or shortening of the eye. [quoted text clipped - 4 lines] > Following this logic, there should be no such thing as progressive > myopia. Yes, if human eyes behaved like experimental animal eyes, there would be no myopia. But myopia exists. So maybe human eyes do not behave like animal eyes. > I am not a health professional. I do understand optics well although > short of being a lens designer. The biological principle driving my > thought is similar to that of homeostasis or Le Chatelier's principle. If refractive error development followed that principle, there would be no refractive error, it would self correct. And, to a degree it does. Refractive error is common at birth and is largely eliminated by age 2 during normal growth. Some remains and some develops in later childhood. This remaining error and later developing error does not seem to follow homeostasis. Dr Judy > >Please bear in mind that there is huge > >disagreement among professionals concerning when and how much plus to [quoted text clipped - 21 lines] > -- > Message posted viahttp://www.medkb.com Janice, Hyperopia is hyperopia. You can consider that the true magnitude of the hyperopia is revealed by the cycloplegic refraction. There are ways of helping the child to adapt to the prescription. Cycloplegic drops is one way. A bifocal prescription is another. However, such drastic steps are seldom taken when amblyopia or strabismus are not present. I think that the steps you have taken are prudent, since you are now aware of the behavioral and cognitive ramifications of uncorrected hyperopia. One of the risks of prescribing amounts of plus that are higher than the manifest refraction is that the child remains blurred at far. The nearpoint, however, will still be quite clear. The natural equivalent of having too much plus at far is called myopia. Myopia has not been implicated in reading-related learning disorders. A successful strategy I have employed in getting the parents to accept this treatment for their child is to say that the need for eyeglasses may only be temporary. In fact, prescribing only a partial amount of the cyloplegic refraction can still be beneficial from a functional standpoint, while also requiring accommodative effort on the part of the child, permitting the emmetropization process to continue. However, at the end of the day, compliance will be a major issue if the child does not perceive a positive difference with the spectacles. One way to determine this is by trying it. > A successful strategy I have employed in getting the parents to accept > this treatment for their child is to say that the need for eyeglasses > may only be temporary. In fact, prescribing only a partial amount of > the cyloplegic refraction can still be beneficial from a functional > standpoint, while also requiring accommodative effort on the part of > the child, permitting the emmetropization process to continue. I think I should clarify that I do not believe that excessive accommodation drives the emmtropization process. What I should have said was that a partial correction will still leave the child with some hyperopic defocus, which may be helpful in driving the child towards emmetropia. What part of the world are you in, Janice -- if you don't mind saying?? I'm a layperson, but a high hyperope who's learned a thing or two along his 4+ decades of being in the patient's side of the chair. I think you should get your son evaluated by the best pediatric strabismus opthalmologist that you can -- much as Dr. Leukoma recommends. I know a name or two, in a couple of parts of the country. Others on this forum may know additional eye docs. In a painfully obvious fashion, I think this could go one of two ways: he could be fine for years and years -- even decades -- and then need glasses ... or.... The "or" is that his eyes (and the neurologic components of vision) could be overtaxed by all of the accommodation that he'll surely need to use, to get through school and life. This could cause eye-turn (strabismus), double vision, accommodative difficulties, etc., etc. Trust me when I say ... you don't want the "or." A thorough exam by a truly excellent pediatric ophthalmologist will help to understand if there are ANY deficits or problems with his accommodative or binocular function that COULD make all of that accommodation problematic. Along with you and his teachers watching for any and all the usual symptoms of vision trouble, I'd probably have him checked by a good OD or ophthalmologist more frequently than the standard annual visit. As with so many things, early intervention offers the best possible outcome. Neil Neil, the child has about +3 diopters (measured). There are two opinions: 1. Don't wear a plus. 2. Get a plus lens that "matches" the child's refractive status -- for full time wear. Which of these two choices would you recommend. You have experience with an identical situation, were your eyes were protected by that plus lens that you were prescribed. What you you recommend? You have been very vocal on the subject. Majority/Second Opinion best, > What part of the world are you in, Janice -- if you don't mind > saying?? [quoted text clipped - 32 lines] > > Neil > What part of the world are you in, Janice -- if you don't mind > saying?? [quoted text clipped - 32 lines] > > Neil Neil, I specifically said "pediatric optometrist," not pediatric ophthalmologist. Of course, I would not object to a third opinion by a pediatric ophthalmologist if strabismus was involved. > Neil, > > I specifically said "pediatric optometrist," not pediatric > ophthalmologist. Of course, I would not object to a third opinion by > a pediatric ophthalmologist if strabismus was involved. Sorry, Doc. Didn't mean to mis-quote. From my perspective, I'd advocate either -- provided he/she are experienced in thoroughly evaluating binocular and accommodative status. >What part of the world are you in, Janice -- if you don't mind >saying?? I'm in West Central Wisconsin. This is interesting conversation! And I should correct a mistake in my first message. We saw an optometrist not an ophthalmologist. However, not a pediatric one. Within our regional medical system, I cannot seem to locate any optometrist with a "pediatric optometrist" specialty, although a few list it as an interest in their medical profiles. (Not the same - I know.) Couple of extra pieces of information in response to comments here. We are Caucasian, there is no family history on either side of hereditary myopia. Typical hyperopia in later years (mid-40s for my side, I believe similar for my husband). However, I do have some of my own eye "fun". I do not require reading glasses yet (I'm 37), but my whole life (I will explain in layman's terms as I'm afraid to mess up the medical terminology I'm learning!) I have had a slight intermittent turning inward of my left eye - only when fatigued, but it has not resulted in a lazy eye. I was seen by a specialist for many years to track this, and have never developed a lazy eye. Both eyes are similar in strength (at worst a +1.00 currently (when using the eye drops)). I, however, do not have good stereo/binocular (?) vision. Since I do not know the terminology, I always describe it as the fact that I do not see one picture when I look in a ViewMaster - I see two - unless I manipulate my eyes to compensate. If I take an eye exam in one of those devices like at a driver license station, I look one way first and then the other as I do not see one picture. However, it seems to have no noticeable affect on my depth perception or day to day life. (Those cute little eye puzzle pictures where something is supposed to appear when you stare long enough don't work for me either.) I only mention this in case it matters to my son - so far he shows no eye turning at all. As far as my son is concerned, he has a GameBoy, but it is not something he uses a lot. He has never been a "coloring book" kid and his seat work requirements have been limited in Kindergarten. More will come this year. His academic skills are behind, but I don't have any clear picture if vision is a related cause. I think I could talk myself into lots of things that seem to avoid close up work if I tried! Seems like the case has boiled down to a few items. Glasses or wait and see? While I won't say I've seen a hard, clear recommendation there seems to be a leaning towards the glasses. The second issue seems to be a lot of recommendation for a lower prescription than the full 3.25 we were given. Not sure there what to do there? I'm also wondering about the OTC readers - how will I know if they make a difference with a child this age (and temperament - he is a stubborn one and not likely to tell me it's better). (Side question - do they make child sized OTC readers?) I think a second opinion is a good idea, but I'm not sure how to pick a good doctor to do that. (And honestly, there is some dread about putting my son through the eye drops again - they are a battle!) If you aren't sick of me yet, your continued feedback is welcome. Janice > >What part of the world are you in, Janice -- if you don't mind > >saying?? [quoted text clipped - 54 lines] > -- > Message posted via MedKB.comhttp://www.medkb.com/Uwe/Forums.aspx/vision/200808/1 Janice, You say your son's academic development is delayed but haven't a clear picture of the cause. As a layperson, what evidence will suffice in that regard? With respect to making a decision about whether or not to give him correction at this stage, I would ask myself this: Is the risk on the side of doing something or doing nothing? If you do nothing and the development continues to lag further, would you feel better than if you had "wasted" money on eyeglasses that didn't work now? I think that's a decision only you can make (a pound of prevention and all that). With respect to the power of the glasses, anything between the manifest and the cycloplegic is fair game, with ease of adaptation favoring the lower prescription. I know what I would probably do, but it's not my place to tell you. Perhaps you should get a second opinion from a pediatric ophthalmologist if you cannot find a pediatric optometrist. > His academic skills are behind, but I don't have any clear picture if vision > is a related cause. what kind of clear picture do you expect to see? whats clear to me from what you've written is: 1) that your child's academic skills are behind, 2) his refraction is +3.25D indicating that he is significantly farsighted, and 3) farsightedness is clearly associated with inhibition of academic development and performance. The path forward is pretty clear from what my experience is, and I think that you know it. But for some reason you seem to be averse to the idea of your son wearing glasses. > Glasses or wait and see? do you want "wait and see" for your child's development? whats the downside of using readers part-time? > Janice your child's young age allows you to be a little "sloppy" in your decision-making now because he hasn't started into any prolonged reading and writing exercises yet. regardless, a reasonable course of action for you would be to simply get a weak pair of readers, say +1.50, and have him use those to read along with you or color or whatever. he's not going to tell you that he sees better, or that he feels better-- the only proof that you would get that they are benefiting him is if he improves his academic development. kids notoriously give poor clinical feedback. its not the clear evidence that you seem to be looking for but visualize the alternative-- do nothing and ignor the likely cause of my son's slow academic development. i guess i'm not sure why you don't just jump at this as a real possibility to improve your sons situation? On Aug 31, 12:02 am, p.clar...@gmail.com wrote: Is this true: The child's manifest (Snellen and trial lens) refractive STATE is +1/2 diopter. (That means that more plus will blur the Snellen -- significantly, say by about 20/100 through an additional +3 diopters.) Thus, while the +3 diotpers might be "good" for near, the child's distant vision will be seriously bad -- as I described it. Have you explained this to the mother? Enjoy, Otis > > His academic skills are behind, but I don't have any clear picture if vision > > is a related cause. [quoted text clipped - 19 lines] > decision-making now because he hasn't started into any prolonged > reading and writing ses yet. regardless, a reasonable course of > action for you would be to simply get a weak pair of readers, say > +1.50, and have him use those to read along with you or color or [quoted text clipped - 8 lines] > i guess i'm not sure why you don't just jump at this as a real > possibility to improve your sons situation? >But for some reason you seem to be averse to >the idea of your son wearing glasses. Well, I think it's time to take what I've learned and move on from this discussion. To those that educated me, even if it was with more questions or options -- thank you. But, I resent the comment above and the rest of the message's implication that somehow I know what to do and just didn't want to do it. To clarify - I have NO problem getting my child glasses - I've considered every day walking right in and getting them ordered, but keep in mind that even here a variety of opinions abound on even what strength of glasses he should have. My reputable optometrist associated with my medical clinical gave me no clear direction on which option to take (pretty much that either was equally acceptable), and left me with questions. Questions any reasonable mother would want answered before potentially doing something that could slow his own natural eventual correction of the problem or cause problems (maybe +3 is too strong right away) if no were currently manifesting. (The local opinion was that any natural "growing out of it" wouldn't occur until 7-9 years of age. And correction could slow that process.) I now have more information, and more options to discuss with a second opinion which I intend to now seek. To say that I somehow just didn't want to do this and statement that I am now making "sloppy" decisions as a result of wanting to learn more is uncalled for and a little egotistical. Taking the advice of a bunch of strangers on the internet as anything more than educational material to consult with a credientialed optometrist face to face is not the kind of person I am. I am thankful for the education on options that exist so I can have a better conversation with my own optometrist and the second opinion. I have a better understanding of some of the published literature on the subject as a result as well. I am about as unsloppy as it gets on this one considering its only been a week since my appointment and school hasn't even started yet. So thank you and good bye. Janice |
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