Re: Child needs glasses?

In article <4364BD87.9090905@xxxxxxx>, Dom <dont@xxxxxxx> wrote:

> David Robins, MD wrote:
> > As far as I am concerned, +0.50s is a homeopathic, insignificant refractive
> > error. When it is equal and bilateral, it serves no purpose whatsoever to
> > order it, except to pad the optician's pocket.
> >
> >
> > David Robins, MD
> > Board certified Ophthalmologist
> > Pediatric and adult strabismus subspecialty
> > Member of AAPOS
> > (American Association of Pediatric Ophthalmology and Strabismus)
> >
>
> I beg to differ. Dozens of patients have presented to me over the years
> c/o frontal HAs put down to "sinus", "stress" or idiopathic by their
> doctor but subsequently resolved very quickly and effectively with
> +0.50s once mild hyperopia was detected in the eye exam.
>
> Not every one with a refraction of +050 is symptomatic or requires
> correction, and the child at the start of this thread may well be in
> that group... however it would be irresponsible not to at least offer
> correction to those patients who do experience relevant symptoms (e.g.
> frontal headaches, eye strain, difficulty concentrating, a child falling
> behind in reading or comprehension, etc, etc).
>
> To suggest that +0.50s are prescribed as some sort of misguided
> amblyopia treatment is missing the point entirely.
>
> Dom

IMHO, it is a rarity that +.50 specs would be more than a placebo (but
more on that coming!). But as Dom wrote, when there ARE symptoms for
which you can not identify any pathology, that low plus rx might, for
whatever reason, resolve those symptoms. Is it a spasm in
accomodative-convergance? Is the cause an iris sphincter over reaction
to that itsy bitsy accomodation? Does that +.50 just push the fusion
system to finally lock? And so what if it is a placebo effect? As long
as the parent and child understand that the specs are "therapy or
treatment" that will be discontinued after a short time when the vision
system is "healed", so be it.

Sure, there might be unethical scam-and-rip-off eyeglass sellers willing
to rx +.50s, but consider the ethical and responsible doctor actually
listening to the patient's symptoms and trying something that actually
be of benefit and doing so for that, and only that reason.

I think it is far, far worse for MDs to rx antibiotics for a child with
sniffles and runny nose caused by virus because the parent expects a
pill to fix the symptoms. Or the doc who dispenses sodium sulfacetamide
drops for the associated "pink eye." Eh, David?

--LB, O.D.
.

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