Would like to hear from O.D.'s & O.M.D.'s on this one

[chip anderson]

A theory I fail to comprehend: Put add powers on children.

I fail to see how a corected myoptic or hyperoptic child is useing any more accomodation that an emetroptic child. We are not putting bifocals on emetropic children.

Another theory I fail to comprehend: U.V. is destroying us all giving us catracs, macular degeneration, etc. Why are we not insisting that emetropes wear U.V. plano's if this is the case?

Someone please try to convince me these are vivable theories.

Chip

[mowmow]

Chip,

Regarding UV there is certainly enought documented research
to support the premise of adding UV filtratration to lenses. Anyone having to wear specs full time, with UV Block should benefit long term compared their non spec wearing coherts. It would be very interestiing to look at the two groups long term to see if those wearing specs with UV block have a lower incidence of developing cataracts and AMD compared to uncorrected emmetropes. Until such a study proves us wrong I feel that if ya gotta wear glasses you might as well pop for the UV protection.

As for Bifocals & myopic kids; after doing this for 15 years, in my opinion the best explaination I have would simply be greed. Why stigmatise a child with bifocals when the end result is that when they're 20 years old their Rx is -3.50 as opposed to -3.75. What's the point? The bigger joke is when I see these -4.00 12 year olds in Varilux lenses. Hyperopes are a different ball of wax in that it might help with a tropia or other muscle problem.

Hope this shed some light!!!!

[Diane]

Re: Would like to hear from O.D.'s & O.M.D.'s on this one

chip anderson said:
A theory I fail to comprehend: Put add powers on children.

I fail to see how a corected myoptic or hyperoptic child is useing any more accomodation that an emetroptic child. We are not putting bifocals on emetropic children.

Another theory I fail to comprehend: U.V. is destroying us all giving us catracs, macular degeneration, etc. Why are we not insisting that emetropes wear U.V. plano's if this is the case?

Someone please try to convince me these are vivable theories.

Chip

Research has proven that cigarette smoking is harmful to one's health in a number of ways, but people not only continue to smoke, but more and more are starting up.

Sometimes proof isn't enough.

Diane

[p944t]

This is one of my pet peaves. How many of you have checked out how much "uncoated" CR39 blocks UV? Most sources list about 88-92% of the total UV is blocked. How much is that additional 10% worth and are you upfront with the patient as to what they are getting for the dollar? You maybe surpised how much "protection" the demo lenses in all your frames give. Think of std. CR39 being like SPF 15 while coated CR39 is SPF 45. Does your dermatologist tell you need SPF 45? I have heard slaes people (I wouldn't call them opticians) that without the additional UV coating ($) they will get increased UV over wearing nothing. Of course i have also heard people sell additional UV coating on polycard - hey,sure. If you really won't to protect your patients sell them a hat.

Twins: One needs corrective glasses and wears uncoated CR39, the other doesn't need correction. Whom should we be more concern with and educate?

If anyone has data that differs from my please let me know. Most journal articles don't list uncoated CR39 and if they do you need to look at the charts/raw data. I have never seen it in the body of the article.

[harry888]

Bifocals are sometimes needed for kids with a high ACA ratio.

In plain english, some converge too much when accomodating.

Myself, I rarely prescribe bifocals on kids due to the stigma thing, but the straightening of the eyes, fusion/binocular lock, and avoidance of surgery outweighs a little line. Kids can often outgrow the need, but may need the bifocal in the critical early years.

As for the UV thing, I've noticed emmetropes (especially those working outdoors) get cataracts at a younger age. Those that wore glasses most of thier life, at a later age. This I attribute to the 80% UV filter even untreated plastic lenses have.

I recommend good sunglasses for most everyone.

Harry

[Jim Stone]

UV protection to me is kind of like stoping at a stop sign. There may not be anything coming but I'm going to stop. It may prevent problems later.

[Stopper]

Bifocals on children are necessary sometimes. A child with a convergence excess (high ACA) may need this to read comfortably or to keep from troping at near. A child with a large amount of hyperopia who can't handle the full rx for distance but needs it for near work to read comfortably and for good binocularity. This is not an everyday thing but there are a bunch out there and most probably aren't getting the help they need.
My two cents.

[mjh]

I'm not an MD or an OD, but I just wanted to welcome EVERYONE to reply to this thread regardless of your occupation. Our fellow optiboarder from the UK reminded us all recently that this is a public discussion forum, so no one can really be excluded from replying to whatever we want. I found that out the hard way. Michael.

[LENNY]

I am not an OD or MD1
Thats why i just want to ask another question.
Was not glass the material of choice at the time that we are talking about. 60 years old cataract patient, how long was he wearing or not wearing glass lenses with uv in them?

[Joann Raytar]

mjh said:
I'm not an MD or an OD, but I just wanted to welcome EVERYONE to reply to this thread regardless of your occupation. Our fellow optiboarder from the UK reminded us all recently that this is a public discussion forum, so no one can really be excluded from replying to whatever we want. I found that out the hard way. Michael.

I believe that is why Jim and Diane have already replied to this thread - they know these are open forums. I didn't hear a complaint from Chip who started the topic and so far, almost all of the posts have been on the topics he mentioned.

[chip anderson]

I am passing along a reply to the question: "Please tell me how/why a corrected child myope or hyperope uses more accomodation than an emetropic child." This reply is from the most honest ophthalmologist I have ever met. He even insists on paying for his and his families personal spectacles a contact lenses at retail!


Hi Chip,
I hope things are going reasonably well with you. I enjoy the emails
you send; though I may only respond to a few. I can't keep up with
work and family stuff as it is. I am sure that you understand.
Hyperopes whose error is not too great (+1.00 to +2.00 or less) use
native accommodation to see clearly at near. Since infants start out
with about +30.00 diopters of accommodation, meeting this need to see
clearly at distance or near is no problem. It is also the reason you
see some fighter pilots in low hyperopic correction to fly after age
30. They had enough accommodation for distance and near at age 22 when
they passed the flight physical.
Hyperopes who are greater than +3.00 as infants typically get an
esotropia when they use the higher amounts of accommodation needed to
see clearly at distance and near. The reason the esophoria/tropia
shows up is the eye muscle hardwiring in the brainstem. The
neurological response to looking at something close up is called the
"near synkinetic reflex" and it is a reflex. You can't fight it. The
near synkinetic reflex consists of simultaneous ocular convergence,
pupillary miosis, and accommodation. If a hyperope uses too much
accommodation just to maintain distance image clarity, he will
stimulate the near synkinetic reflex resulting in ES or ET. That is
why putting them in a hyperopic correction (usually with a bifocal)
stops the problem. If you don't do this, they may develop amblyopia in
one eye due to the image confusion presented to the brain from the
crossed eyes.

Myopic children have a different problem related to accommodation.
Excessive accommodation (near tasks) is felt to stimulate a worsening
(greater amount of myopia), than if the child avoided them. A myopic
child looking through his distance correction uses more accommodation
to do a near task than a myopic child who takes off his glasses and
holds the object closer to or at his optical far point. By definition,
a myope's uncorrrected far point is closer to him than infinity (the
optical far point of the emmetrope). One theory is that myope's appear
to have a type of defective (more stretchable) collegen fibers that
make up the sclera. The pull of the ciliary muscle on the collegen of
the scleral spur some how causes excessive lengthening of the eye
during growth. This property becomes exaggerated with an increasing
amount of near work, like reading, during childhood.

Hot off the press: A phase 2 trial (meaning the first human work) was
completed recently (Univ of Oklahoma, I think) with a drug called
pirenzepine (Gastrozepin) on near sighted children (174 kids with
myopia from -0.75 to -4.00D) . Kids getting the drug were 10 times
more likely than the control group to see a reduction in their myopic
progression rate, generally 1D or more per year. It works by blocking
the accommodative part of the near synkinetic reflex, so kids can look
at near stuff without so much adverse effect from the ciliary muscle.

[joy niklas]

My O.D. frequently prescribes an add power for children. In fact, when the computer lenses first came out (Readables) we most often used them for kids due to the low amount of add power .75-.87, it worked wonderfully, was not embarrassing for the kids since there was no line, and also kept the price down compared to regular progressives. We use Interview and Access Low now.

I don't agree that it's just due to greed, he even prescribed adds for his own kids ( no money there ) and also for Medicaid recipients, although they are stuck with lined bifocals due to program restrictions. Even moreso now due to all the computer usage among kids, I'm using more Crizal with teens, students, etc.


Chip, the pirenzepene sounds interesting, I hope it works (then I can go do something else with my life !)

[Stopper]

Chip,
Thanks for sharing the OMD reply. I read an article about the pirezinzepina a few weeks ago. looks exciting. Combine that with an early rgp fit and they may be on to something. The convergence with accommodation is what we were referring to with a high aca ratio. It was a good explaination for those who are not familiar with the physiology. Thanks for starting another good thread.

[paw]

We like to use a round bifocal for children (the round bifocal -- an oldie but a goodie). It works like a flat top but it is hard to see the line. So the kids like it and the price is right for the parents.

[Chris Ryser]

Re: Would like to hear from O.D.'s & O.M.D.'s on this one

chip anderson said:
..............................Another theory I fail to comprehend: U.V. is destroying us all giving us catracs, macular degeneration, etc. Why are we not insisting that emetropes wear U.V. plano's if this is the case?

Someone please try to convince me these are vivable theories.

Chip

I am not an MD but I am a UV guy for the last 20 years and can give some comments on the subject.

Knowing what damage UV can do, we also should take steps to protect against UV.

Most lenses made today absorb UV up to 360nm. (at 324nm we get sun burn). UV absorbers were added by the lens manufacturers somewhere around 1980 because plastic lenses used to yellow within a short period of time.

However the longer UV A wavelength's between 360nm and
400nm are the culprits creating long range damage to the visual system. Some of these UV rays are also emitted by elecrtic bulbs (hi- pressure mercury) and fluorescent tubes.

Advising patients to spend a bit more and get fully protected should be the proper everyday procedure. At least the optical practitioner has done his or her duty to to advise the patient.
(just heard the announcement on the radio weather report that the UV factor is 8 = 25 minutes to suburn)

UV lenses
Some CR39 lenses com from the lens manufacturers with UV protection included.

Polycarbonate lenses have UV asborbers added that cover the full range up to 400nm.

Most of the optical laboratories treat lenses themselves in UV solutions because this it is cheaper and often better.

A "properly UV'd" lens will never loose its protective qualities, as a matter of fact they even get better with time.

However if a lens is not properly treated the optical practitioner is selling protection that is NOT there or only partially there.

There must thousands of lenses un-knowingly sold by optical practitioners that do NOT provide the protection they should, and out of of a few reasons I can also explain if anybody is interested.