vision check in 5 year old (long)

#13 04-20-2008, 01:26 AM

On Apr 17, 4:25*pm, janes...[at]gmail.com wrote:
- quote -

> I took my 5 yo DD to a pediatric ophthalmologist. He dilated her eyes
> and checked and came up with a prescription, let's say "x" which was
> rather high (worse) reading. Since we don't have anyone in family that
> had glasses DH wanted a second opinion so I took her to an optometrist
> today. She was very thorough and fully engaged DD and tested for a
> while without dilating and came up with a prescription that pretty
> much identical to "x". Then she said this reading is a bit on the
> higher side and also since I never noted any problems with DD's vision
> at home, she wanted to dilate and check again. She used a stronger
> solution to dilate her pupils and checked again after 45 minutes. This
> new reading "y" turned out to be negligible enough that she doesn't
> need glasses.
> But, DD also has astigmatism. So she gave me 3 choices:
> 1. The biggest problem with DD is that she's unable to relax her eye
> muscles and she's over focusing. So she said we can use a solution to
> dilate her pupils that lets her relax her eye muscles. We can use it a
> few times a week after school. During that time she has to have
> bifocals with reading glasses in the bottom half in case she wants to
> read etc.
> 2. Get prescription glasses that address astigmatism and try to get
> her to relax her eye without dilating or anything.
> 3. Get a 3rd opinion if that makes me more comfortable.
> I felt that the optometrist did a more thorough job than the Ped
> Ophthalmologist but I don't know who knows better. Also, does anyone
> know if there any eye-muscle-relaxation-exercises that I can have my 5
> yo do every day?
> Any comments are appreciated. Thanks.

As others have noted, the prescriptions are more similar than you
think due to being written in different forms.

The missing information for me is unaided and corrected acuity. If
the corrected acuity is not 20/20 in each eye and especially if the
corrected left acuity is less than the corrected right acuity, she
should wear glasses with astigmatism correction so as to prevent
amblopia.

Dr Judy

#12 04-19-2008, 04:40 AM

On 4/18/08 7:34 AM, in article
8e40cd18-accd-43b9-b10d-60a9abc6d456...oglegroups.com,
"janesire[at]gmail.com" <janesire[at]gmail.com> wrote:

- quote -

> On Apr 17, 4:07 pm, Neil Brooks <neil0...[at]yahoo.com> wrote:
> > On Apr 17, 1:25 pm, janes...[at]gmail.com wrote:
> > > > > > I took my 5 yo DD to a pediatric ophthalmologist. He dilated her eyes
> > > and checked and came up with a prescription, let's say "x" which was
> > > rather high (worse) reading. Since we don't have anyone in family that
> > > had glasses DH wanted a second opinion so I took her to an optometrist
> > > today. She was very thorough and fully engaged DD and tested for a
> > > while without dilating and came up with a prescription that pretty
> > > much identical to "x". Then she said this reading is a bit on the
> > > higher side and also since I never noted any problems with DD's vision
> > > at home, she wanted to dilate and check again. She used a stronger
> > > solution to dilate her pupils and checked again after 45 minutes. This
> > > new reading "y" turned out to be negligible enough that she doesn't
> > > need glasses.
> > > > But, DD also has astigmatism. So she gave me 3 choices:
> > > > 1. The biggest problem with DD is that she's unable to relax her eye
> > > muscles and she's over focusing. So she said we can use a solution to
> > > dilate her pupils that lets her relax her eye muscles. We can use it a
> > > few times a week after school. During that time she has to have
> > > bifocals with reading glasses in the bottom half in case she wants to
> > > read etc.
> > > > 2. Get prescription glasses that address astigmatism and try to get
> > > her to relax her eye without dilating or anything.
> > > > 3. Get a 3rd opinion if that makes me more comfortable.
> > > > I felt that the optometrist did a more thorough job than the Ped
> > > Ophthalmologist but I don't know who knows better. Also, does anyone
> > > know if there any eye-muscle-relaxation-exercises that I can have my 5
> > > yo do every day?
> > > > Any comments are appreciated. Thanks.
> > > 1) Can you post all the various prescriptions -- with and without
> > cycloplegia (dilation)?
> First (x) from the Opthalmologist with dilation and optometrist
> without dilation:
> Right: sphere -3.00 Cyl: +1.25 Axis 123
> Left: sphere -3.25 Cyl: +1.25 Axis 080
> Second (y) at optometrist with dilation:
> Right: sphere -0.25 Cyl: -0.75 Axis 021
> Left: sphere 0 Cyl: -1.50 Axis 175
> > > 2) It might help to know if DD has had any history of binocular
> > function disorders (strabismus) or surgeries, and the specifics on
> > that, too -- perhaps including her alignment pre- and post-
> > operatively, if applicable.
> None of the above.
> > > 3) Also, there's nothing to be gained ... and much to be lost ... in
> > paying any attention to Otis Brown.
> > > I'm not an eye doctor, but a very interested patient.

I notice you wrote the prescription "x" from the ophthalmologist was the
same as the optometrist, yet this is a plus-cylinder prescription.

You note the optometrist's dilated prescription, written in minus-cylinder.

Therefore, I wonder if the undilated numbers you got from the optometrist
may LOOK like the numbers from the ophthalmologist, but really are
different.

I suspect that the undilated numbers really are more minus than the dilated
from the ophthalmologist. However, I still cannot explain the difference
between the dilated numbers from the two exams, which should be more equal.
The strenght of the drops , as you said, may have had something to do with
it, and it is not clear which is correct.

A cylinder 1.00 or higher is a relative reason to prescribe glasses at age
6, per the Ophthalmology Academy guidelines. However, some kids see fine
anyway, and do not need glasses, and others see not so fine, and need the
glasses.

This is a quandry here. You have to put your faith I who you believe more,
or get a third opinion to help settle it.

David Robins, MD
Board certified Ophthalmologist
Pediatric ophthalmology and adult strabismus subspecialty

#11 04-18-2008, 10:31 PM

"Zetsu" <absolutelyinvincible[at]hotmail.com> wrote

- quote -

> accommodative spasm, so I was surprised. I am just a layperson, how am
> I to know these things =P

You're supposed to KNOW WHAT YOU DON'T KNOW.

It's how you avoid leaving turds in the swimming pool.

Do you really prefer toilet training in public?

-MT

#10 04-18-2008, 09:22 PM

Zetsu schreef:

- quote -

> Well I didn't know about the difference of convention for writing
> prescriptions with some of them in 'minus cylinder' and others in
> 'plus cylinder', so I didn't know there wasn't really a big difference
> in the two prescriptions, so it just sounded like a huge amount of
> accommodative spasm, so I was surprised. I am just a layperson, how am
> I to know these things =P

By keeping your eyes open and your mouth shut when reading the messages
in this newsgroup.

Jan (normally Dutch spoken)

#9 04-18-2008, 09:04 PM

On 18 Apr, 21:35, Neil Brooks <neil0...[at]yahoo.com> wrote:
- quote -

> On Apr 18, 11:03 am, Zetsu <absolutelyinvinci...[at]hotmail.com> wrote:
> > On 18 Apr, 15:34, janes...[at]gmail.com wrote:
> > > On Apr 17, 4:07 pm, Neil Brooks <neil0...[at]yahoo.com> wrote:
> > > > On Apr 17, 1:25 pm, janes...[at]gmail.com wrote:
> > > > > I took my 5 yo DD to a pediatric ophthalmologist. He dilated her eyes
> > > > > and checked and came up with a prescription, let's say "x" which was
> > > > > rather high (worse) reading. Since we don't have anyone in family that
> > > > > had glasses DH wanted a second opinion so I took her to an optometrist
> > > > > today. She was very thorough and fully engaged DD and tested for a
> > > > > while without dilating and came up with a prescription that pretty
> > > > > much identical to "x". Then she said this reading is a bit on the
> > > > > higher side and also since I never noted any problems with DD's vision
> > > > > at home, she wanted to dilate and check again. She used a stronger
> > > > > solution to dilate her pupils and checked again after 45 minutes. This
> > > > > new reading "y" turned out to be negligible enough that she doesn't
> > > > > need glasses.
> > > > > But, DD also has astigmatism. So she gave me 3 choices:
> > > > > 1. The biggest problem with DD is that she's unable to relax her eye
> > > > > muscles and she's over focusing. So she said we can use a solution to
> > > > > dilate her pupils that lets her relax her eye muscles. We can use it a
> > > > > few times a week after school. During that time she has to have
> > > > > bifocals with reading glasses in the bottom half in case she wants to
> > > > > read etc.
> > > > > 2. Get prescription glasses that address astigmatism and try to get
> > > > > her to relax her eye without dilating or anything.
> > > > > 3. Get a 3rd opinion if that makes me more comfortable.
> > > > > I felt that the optometrist did a more thorough job than the Ped
> > > > > Ophthalmologist but I don't know who knows better. Also, does anyone
> > > > > know if there any eye-muscle-relaxation-exercises that I can have my 5
> > > > > yo do every day?
> > > > > Any comments are appreciated. Thanks.
> > > > 1) Can you post all the various prescriptions -- with and without
> > > > cycloplegia (dilation)?
> > > First (x) from the Opthalmologist with dilation and optometrist
> > > without dilation:
> > > Right: sphere -3.00 Cyl: +1.25 Axis 123
> > > Left: sphere -3.25 Cyl: +1.25 Axis 080
> > > Second (y) at optometrist with dilation:
> > > Right: sphere -0.25 Cyl: -0.75 Axis 021
> > > Left: sphere 0 Cyl: -1.50 Axis 175
> > > > 2) It might help to know if DD has had any history of binocular
> > > > function disorders (strabismus) or surgeries, and the specifics on
> > > > that, too -- perhaps including her alignment pre- and post-
> > > > operatively, if applicable.
> > > None of the above.
> > > > 3) Also, there's nothing to be gained ... and much to be lost ... in
> > > > paying any attention to Otis Brown.
> > > > I'm not an eye doctor, but a very interested patient.
> > Wow, you mean there's a whole 3.25 diopters of tonic accomodation in
> > the left eye? I am quite surprised!
> I'm not surprised.
> I'm not at ALL surprised. This is yet ANOTHER reason why Mike Tyner
> KNOWS that you don't understand how LITTLE YOU know.

Well I didn't know about the difference of convention for writing
prescriptions with some of them in 'minus cylinder' and others in
'plus cylinder', so I didn't know there wasn't really a big difference
in the two prescriptions, so it just sounded like a huge amount of
accommodative spasm, so I was surprised. I am just a layperson, how am
I to know these things =P

#8 04-18-2008, 08:50 PM

On Apr 18, 7:34 am, janes...[at]gmail.com wrote:

- quote -

> First (x) from the Opthalmologist with dilation and optometrist
> without dilation:
> Right: sphere -3.00 Cyl: +1.25 Axis 123
> Left: sphere -3.25 Cyl: +1.25 Axis 080
> Second (y) at optometrist with dilation:
> Right: sphere -0.25 Cyl: -0.75 Axis 021
> Left: sphere 0 Cyl: -1.50 Axis 175

The difference between the two prescriptions is largely accounted for
"convention" in writing prescriptions. One is written in "minus
cylinder." The other, in "plus cylinder."

The latter prescription -- written in the same 'convention' as the
former -- works out to:

RE: -1.00 +.75 x111
LE: -1.50 +1.50 x85

The difference, then, is far less than it first appears. She's
slightly myopic with a bit of astigmatism.

Have they actually /diagnosed/ your DD for "accommodative excess??"
It is an actual clinical condition* that has diagnostic criteria and
for which various treatments DO exist.

It's also a good idea to have a pediatric /strabismus/ ophthalmologist
"intervene" while your DD is young. There is a physiologic link
between accommodation (the eye focusing) and convergence (the eye
turning inward to view near objects). If she truly has accommodative
issues, then a strabismus ophthalmologist (or binocular function
optometrist) is the one to monitor and advise.

The eye drops you referred to are virtually always preserved with a
chemical agent that's /really/ bad for the eyes ... over time. If
this were a temporary use thing, then I might consider it.

If it were "during school" as in ... years ... I would strongly
recommend avoiding it, in lieu of other treatments (glasses and/or
vision therapy ARE options).

Reading glasses or bifocals ARE a treatment for accommodative excess,
but I'd be sure that a 'thorough' dilation (perhaps using cyclogyl, or
stronger agent) is/was performed to be sure.

Young accommodative mechanisms are strong. They need to know exactly
how much accommodative spasm this young one might be hiding before
prescribing.

A really competent strabismus doc will be able to balance all the
factors and prescribe the right glasses, if necessary.

Neil

*http://www.aoa.org/documents/CPG-18.pdf

#7 04-18-2008, 08:35 PM

On Apr 18, 11:03 am, Zetsu <absolutelyinvinci...[at]hotmail.com> wrote:
- quote -

> On 18 Apr, 15:34, janes...[at]gmail.com wrote:
> > On Apr 17, 4:07 pm, Neil Brooks <neil0...[at]yahoo.com> wrote:
> > > On Apr 17, 1:25 pm, janes...[at]gmail.com wrote:
> > > > I took my 5 yo DD to a pediatric ophthalmologist. He dilated her eyes
> > > > and checked and came up with a prescription, let's say "x" which was
> > > > rather high (worse) reading. Since we don't have anyone in family that
> > > > had glasses DH wanted a second opinion so I took her to an optometrist
> > > > today. She was very thorough and fully engaged DD and tested for a
> > > > while without dilating and came up with a prescription that pretty
> > > > much identical to "x". Then she said this reading is a bit on the
> > > > higher side and also since I never noted any problems with DD's vision
> > > > at home, she wanted to dilate and check again. She used a stronger
> > > > solution to dilate her pupils and checked again after 45 minutes. This
> > > > new reading "y" turned out to be negligible enough that she doesn't
> > > > need glasses.
> > > > But, DD also has astigmatism. So she gave me 3 choices:
> > > > 1. The biggest problem with DD is that she's unable to relax her eye
> > > > muscles and she's over focusing. So she said we can use a solution to
> > > > dilate her pupils that lets her relax her eye muscles. We can use it a
> > > > few times a week after school. During that time she has to have
> > > > bifocals with reading glasses in the bottom half in case she wants to
> > > > read etc.
> > > > 2. Get prescription glasses that address astigmatism and try to get
> > > > her to relax her eye without dilating or anything.
> > > > 3. Get a 3rd opinion if that makes me more comfortable.
> > > > I felt that the optometrist did a more thorough job than the Ped
> > > > Ophthalmologist but I don't know who knows better. Also, does anyone
> > > > know if there any eye-muscle-relaxation-exercises that I can have my 5
> > > > yo do every day?
> > > > Any comments are appreciated. Thanks.
> > > 1) Can you post all the various prescriptions -- with and without
> > > cycloplegia (dilation)?
> > First (x) from the Opthalmologist with dilation and optometrist
> > without dilation:
> > Right: sphere -3.00 Cyl: +1.25 Axis 123
> > Left: sphere -3.25 Cyl: +1.25 Axis 080
> > Second (y) at optometrist with dilation:
> > Right: sphere -0.25 Cyl: -0.75 Axis 021
> > Left: sphere 0 Cyl: -1.50 Axis 175
> > > 2) It might help to know if DD has had any history of binocular
> > > function disorders (strabismus) or surgeries, and the specifics on
> > > that, too -- perhaps including her alignment pre- and post-
> > > operatively, if applicable.
> > None of the above.
> > > 3) Also, there's nothing to be gained ... and much to be lost ... in
> > > paying any attention to Otis Brown.
> > > I'm not an eye doctor, but a very interested patient.
> Wow, you mean there's a whole 3.25 diopters of tonic accomodation in
> the left eye? I am quite surprised!

I'm not surprised.

I'm not at ALL surprised. This is yet ANOTHER reason why Mike Tyner
KNOWS that you don't understand how LITTLE YOU know.

#6 04-18-2008, 06:03 PM

On 18 Apr, 15:34, janes...[at]gmail.com wrote:
- quote -

> On Apr 17, 4:07 pm, Neil Brooks <neil0...[at]yahoo.com> wrote:
> > On Apr 17, 1:25 pm, janes...[at]gmail.com wrote:
> > > I took my 5 yo DD to a pediatric ophthalmologist. He dilated her eyes
> > > and checked and came up with a prescription, let's say "x" which was
> > > rather high (worse) reading. Since we don't have anyone in family that
> > > had glasses DH wanted a second opinion so I took her to an optometrist
> > > today. She was very thorough and fully engaged DD and tested for a
> > > while without dilating and came up with a prescription that pretty
> > > much identical to "x". Then she said this reading is a bit on the
> > > higher side and also since I never noted any problems with DD's vision
> > > at home, she wanted to dilate and check again. She used a stronger
> > > solution to dilate her pupils and checked again after 45 minutes. This
> > > new reading "y" turned out to be negligible enough that she doesn't
> > > need glasses.
> > > But, DD also has astigmatism. So she gave me 3 choices:
> > > 1. The biggest problem with DD is that she's unable to relax her eye
> > > muscles and she's over focusing. So she said we can use a solution to
> > > dilate her pupils that lets her relax her eye muscles. We can use it a
> > > few times a week after school. During that time she has to have
> > > bifocals with reading glasses in the bottom half in case she wants to
> > > read etc.
> > > 2. Get prescription glasses that address astigmatism and try to get
> > > her to relax her eye without dilating or anything.
> > > 3. Get a 3rd opinion if that makes me more comfortable.
> > > I felt that the optometrist did a more thorough job than the Ped
> > > Ophthalmologist but I don't know who knows better. Also, does anyone
> > > know if there any eye-muscle-relaxation-exercises that I can have my 5
> > > yo do every day?
> > > Any comments are appreciated. Thanks.
> > 1) Can you post all the various prescriptions -- with and without
> > cycloplegia (dilation)?
> First (x) from the Opthalmologist with dilation and optometrist
> without dilation:
> Right: sphere -3.00 Cyl: +1.25 Axis 123
> Left: sphere -3.25 Cyl: +1.25 Axis 080
> Second (y) at optometrist with dilation:
> Right: sphere -0.25 Cyl: -0.75 Axis 021
> Left: sphere 0 Cyl: -1.50 Axis 175
> > 2) It might help to know if DD has had any history of binocular
> > function disorders (strabismus) or surgeries, and the specifics on
> > that, too -- perhaps including her alignment pre- and post-
> > operatively, if applicable.
> None of the above.
> > 3) Also, there's nothing to be gained ... and much to be lost ... in
> > paying any attention to Otis Brown.
> > I'm not an eye doctor, but a very interested patient.

Wow, you mean there's a whole 3.25 diopters of tonic accomodation in
the left eye? I am quite surprised!

#5 04-18-2008, 02:34 PM

On Apr 17, 4:07 pm, Neil Brooks <neil0...[at]yahoo.com> wrote:
- quote -

> On Apr 17, 1:25 pm, janes...[at]gmail.com wrote:
> > I took my 5 yo DD to a pediatric ophthalmologist. He dilated her eyes
> > and checked and came up with a prescription, let's say "x" which was
> > rather high (worse) reading. Since we don't have anyone in family that
> > had glasses DH wanted a second opinion so I took her to an optometrist
> > today. She was very thorough and fully engaged DD and tested for a
> > while without dilating and came up with a prescription that pretty
> > much identical to "x". Then she said this reading is a bit on the
> > higher side and also since I never noted any problems with DD's vision
> > at home, she wanted to dilate and check again. She used a stronger
> > solution to dilate her pupils and checked again after 45 minutes. This
> > new reading "y" turned out to be negligible enough that she doesn't
> > need glasses.
> > But, DD also has astigmatism. So she gave me 3 choices:
> > 1. The biggest problem with DD is that she's unable to relax her eye
> > muscles and she's over focusing. So she said we can use a solution to
> > dilate her pupils that lets her relax her eye muscles. We can use it a
> > few times a week after school. During that time she has to have
> > bifocals with reading glasses in the bottom half in case she wants to
> > read etc.
> > 2. Get prescription glasses that address astigmatism and try to get
> > her to relax her eye without dilating or anything.
> > 3. Get a 3rd opinion if that makes me more comfortable.
> > I felt that the optometrist did a more thorough job than the Ped
> > Ophthalmologist but I don't know who knows better. Also, does anyone
> > know if there any eye-muscle-relaxation-exercises that I can have my 5
> > yo do every day?
> > Any comments are appreciated. Thanks.
> 1) Can you post all the various prescriptions -- with and without
> cycloplegia (dilation)?

First (x) from the Opthalmologist with dilation and optometrist
without dilation:

Right: sphere -3.00 Cyl: +1.25 Axis 123
Left: sphere -3.25 Cyl: +1.25 Axis 080

Second (y) at optometrist with dilation:

Right: sphere -0.25 Cyl: -0.75 Axis 021
Left: sphere 0 Cyl: -1.50 Axis 175

- quote -

> 2) It might help to know if DD has had any history of binocular
> function disorders (strabismus) or surgeries, and the specifics on
> that, too -- perhaps including her alignment pre- and post-
> operatively, if applicable.

None of the above.

- quote -

> 3) Also, there's nothing to be gained ... and much to be lost ... in
> paying any attention to Otis Brown.
> I'm not an eye doctor, but a very interested patient.

#4 04-18-2008, 02:30 PM

On Apr 17, 5:01 pm, Scott Seidman <namdiestt...[at]mindspring.com> wrote:
- quote -

> janes...[at]gmail.com wrote in news:7bb4b8f0-10f8-4fcb-87bd-
> 43975d28a...[at]x41g2000hsb.googlegroups.com:
> > Any comments are appreciated. Thanks.
> Was there any complaint that brought you to a pediatric
> ophthalmologist in the first place??
> --
> Scott
> Reverse name to reply

She had a vision/hearing test at her preschool (I don't know how they
tested but they didn't dilate her pupils). They said I have to get her
checked by ophthalmologist. That's why we went.

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