managing pseudomyopia?

[MrG1]

Just wondering what approaches others like to use for managing pseudomyopia. For example, I had a 6 year old Px with subjective refraction of -2.00 R & L. Cycloplegic refraction gave +0.50 R & L.

Some practitioners would suggest using plus lenses at near, others suggest progressive lenses (eg. Sola access) and others may do vision therapy. What is your preferred way of managing cases like this? And what factors would make you chose one method over another? (I think it never hurts to get a range of opinions on case managment, even if you don't necessarily agree with or use some of them.)

[braheem24]

BI prism?

[harry888]

Does the kid want glasses? probably

Will the parents listen that there is just a near problem? Probably not, the kid is complaining about vision which parents assume is distance.

I would probably explain to the parents that it is probably temporary and give the kid -0.75 sph OU and tell the parents the kid will probably grow out of them (get sick of the specs). If there is a further problem later, bifocals.

Lot of probables here, but after 30 years in practice and seeing kids wrap the parents around their fingers, then have the parents badmouth me all over town, it's often easier to give a small rx which will make the kid miraculously better a few months later when the novelty of the specs wears off. Truely corrective lenses.

Harry

On re-reading this post I would like to add that: , I would explain the near point stress that we will treat the symptoms and not the problem. Because kids can focus lots, unlike us old folks.

[pseudonym]

Shows what I know. When I saw the word "pseudomyopia", I thought it meant the kid was faking it.

So, doctors, what DO you do when the kid is faking it? I only recently learned not to inform the mother what scratches on the inside of the lens mean.

[uncut]

Just wondering what approaches others like to use for managing pseudomyopia. For example, I had a 6 year old Px with subjective refraction of -2.00 R & L. Cycloplegic refraction gave +0.50 R & L.

Some practitioners would suggest using plus lenses at near, others suggest progressive lenses (eg. Sola access) and others may do vision therapy. What is your preferred way of managing cases like this? And what factors would make you chose one method over another? (I think it never hurts to get a range of opinions on case managment, even if you don't necessarily agree with or use some of them.)

Schedule an appointment 3 to 6 months hence..........and re-evaluate?

[MikeAurelius]

My son has Down's Syndrome. He's a pretty smart young man, but has absolutely no understanding of the meaning of "is this clear?" "how about this?" "How about now?"

Refracting a child has to be approached in an entirely different manner than that of an adult.

My son (even now at age 22) has cycloplegic refractions done every time. And his vision is spectacular. Don't try to overthink it. I'd suggest continuing the cycloplegic refractions, but don't give up the normal refractions until the two start to garner the same results.

One further point: are the parents in the room at the time of the refraction? If they are, I'd ask them to leave. I'd be willing to bet that the child may be playing up for the parents to get some attention. Conversely, if the parents are not in the room, ask them to come in, to assist in reigning in imagination.

[fjpod]

One current treatment protocol is to treat incipient myopes with cycloplegia.....atropine. Some research supports this method over any of the others mentioned.

Atropine is instilled in the eye daily or a few times per week. The child is fit with a progressive lens, as their accommodation will be inhibited. And they must have a photosensitive and UV protecting lens since the pupil will be dilated. This must be done for several years. (Great for business, huh?)

Although its been proven to work better than any other method, it seems like a drastic approach, doesn't it?

mike, your son may be lucky in that his cycloplegic refraction happens to be his "walking around" refraction. A cycloplegia refraction most often over-pluses people. It makes it easier for the refractionist. But maybe your doctor is compensating his/her findings a bit and taking this into consideration.

[MikeAurelius]

mike, your son may be lucky in that his cycloplegic refraction happens to be his "walking around" refraction. A cycloplegia refraction most often over-pluses people. It makes it easier for the refractionist. But maybe your doctor is compensating his/her findings a bit and taking this into consideration.

He started out with +4.00 with about a -50 cyl OU at age 3. Now at age 22, he's at +1.50 with a -75 cyl OU. He's refracted annually, and the change over the last couple of years has been decreasing about .25 D sphere each year.

His main problem is that he has a reading deficit because of the Down's, and can't reliably read a normal chart. He's good with arrows, pictures and what not (which is what the OD uses), but letter recognition is beyond him. He CAN read, but the format during refraction is not conducive to HIS reading style. The OD has been in the biz a long time and works with a lot of kids and "differently abled" adults.

[OHPNTZ]

Just wondering what approaches others like to use for managing pseudomyopia. For example, I had a 6 year old Px with subjective refraction of -2.00 R & L. Cycloplegic refraction gave +0.50 R & L.

Some practitioners would suggest using plus lenses at near, others suggest progressive lenses (eg. Sola access) and others may do vision therapy. What is your preferred way of managing cases like this? And what factors would make you chose one method over another? (I think it never hurts to get a range of opinions on case managment, even if you don't necessarily agree with or use some of them.)

Lots of unanswered questions...depends on acuities, is this an accommodative problem (excess, infacility,etc?)? What do you find on retinoscopy?