Latent Hyperopia - Child age 6 - glasses? (+3.25 script)

#28 09-01-2008, 11:24 PM

- quote -

> 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

--
Message posted via http://www.medkb.com

#27 08-31-2008, 11:56 PM

On Aug 31, 12:02 am, p.clar...[at]gmail.com wrote:
- quote -

> On Aug 29, 1:35 pm, "JWard6971 via MedKB.com" <u45776[at]uwe> 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

- quote -

> > 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

ses yet. regardless, a reasonable course of
- quote -

> 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?

#26 08-31-2008, 04:02 AM

On Aug 29, 1:35*pm, "JWard6971 via MedKB.com" <u45776[at]uwe> wrote:
- quote -

> 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.

- quote -

> Glasses or wait and see?

do you want "wait and see" for your child's development? whats the
downside of using readers part-time?

- quote -

> 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?

#25 08-30-2008, 10:39 PM

On Aug 29, 5:12*pm, Salmon Egg <Salmon...[at]sbcglobal.net> wrote:
- quote -

> In article
> <05130bd0-2d8f-4118-9398-6175bbadc...[at]l42g2000hsc.googlegroups.com> ,
> *Dr Judy <mpac...[at]rogers.com> wrote:
> > On Aug 29, 12:14*am, Salmon Egg <Salmon...[at]sbcglobal.net> wrote:
> > > 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!

- quote -

> > 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.

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.
- quote -

> 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

#24 08-29-2008, 09:35 PM

In article
<16279662-1716-4d03-ae06-32f50c05110b[at]79g2000hsk.googlegroups.com> ,
otisbrown[at]embarqmail.com wrote:

- quote -

> 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

#23 08-29-2008, 09:12 PM

In article
<05130bd0-2d8f-4118-9398-6175bbadc1ca[at]l42g2000hsc.googlegroups.com> ,
Dr Judy <mpace99[at]rogers.com> wrote:

- quote -

> On Aug 29, 12:14*am, Salmon Egg <Salmon...[at]sbcglobal.net> wrote:
> > 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.
> 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.

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.
- quote -

> 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.
- quote -

> 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

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

#22 08-29-2008, 08:16 PM

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

On Aug 29, 4:00 pm, Salmon Egg <Salmon...[at]sbcglobal.net> wrote:
- quote -

> In article
> <10e31b6d-ce91-4cad-80da-0f11bb449...[at]d1g2000hsg.googlegroups.com> ,
> otisbr...[at]embarqmail.com wrote:
> > 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

#21 08-29-2008, 08:00 PM

In article
<10e31b6d-ce91-4cad-80da-0f11bb449cf3[at]d1g2000hsg.googlegroups.com> ,
otisbrown[at]embarqmail.com wrote:

- quote -

> 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

#20 08-29-2008, 06:20 PM

On Aug 29, 12:35*pm, "JWard6971 via MedKB.com" <u45776[at]uwe> wrote:
- quote -

> Neil Brooks wrote:
> > 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 myfirst
> message. *We saw an optometrist not an ophthalmologist. *However, nota
> 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. *Weare
> 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 forme
> 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 myson
> through the eye drops again - they are a battle!)
> If you aren't sick of me yet, your continued feedback is welcome.
> Janice
> --
> 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.

#19 08-29-2008, 05:35 PM

Neil Brooks wrote:
- quote -

> 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

--
Message posted via MedKB.com
http://www.medkb.com/Uwe/Forums.aspx/vision/200808/1

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