Accommodative spasm - atropine treatment failure

[benvenuto68]

Hello,
I hope you can help me regarding this fairly rare matter.
I have been diagnosed with an accommodative spasm at both eyes. I am 28 years old.
Refraction with cyclopegia (Atropine) : + 0,50 (slight hyperopia)
Refraction WITHOUT cyclopegia : - 4,50 (pseudomyopia)
This constant spasm appeared right after a lasik surgery, 6 month ago.
However, before the surgery, there was no difference found between cyclopegic and non-cyclopegic refraction. I was hyperopic, +3,50 for the right eye and +2,00 for the left one
This situation causes me constant headaches and very blurry vision for targets near AND far.
I have to strain a lot to get images into focus which is exhausting. Of course I cannot hold accommodation all the time with such a big spasm, at rest everything is blurry.
To relieve the symptoms I had atropine for 3 months (1 drop per day in each eye), thanks to these drops my vision was perfect for targets far. During this time I used +3.00 readers for close vision.
My problem is : After 3 months i stopped the drops and when atropine wore off (2 weeks later which is quite long), accommodative spams came back.
My surgeon doesn't know what to do anymore. I have been to other ophtalmologists and unfortunately, they have no further idea.
I have got 2 questions in my mind :
1) Should I try atropine longer (1 year ?). Are there risks for the retina by having a long-term atropinization ?
2) In my case, as the 3-month atropine treatment didn't work, do you think that a clear lens extraction could be a good idea ?
I would be very grateful if you could advise me.
Thank you

[JohnHaganMD]

You are welcome. Let u know later how this turns out

[alexandriamk]

I will
Thank u very much for ur help and guidance
Much appreciated

[JohnHaganMD]

I doubt the eye drops or the glasses are of much help. I would strongly suggest you see either an ophthalmologist that specializes in eye muscle problems (called a strabismus specialist or pediatric specialist most treat adults) or a neuro-ophthalmologist.  If you live in the USA you can go to www.geteyesmart.org and find those types of ophthalmologist near you, most university ophthalmology departments have these types of specialists.

JCH MD

[alexandriamk]

Name of drops: alcon 1% mydriacyl tropicamide 1%(sterile opthalmic preparation). Used at bedtime nit during the day.

Vision:
According to the vision test: no problem in eyes. Glasses needed to correct myopia caused by spasm.glasses of -0.5 for both eyes


In reality:
without glasses: when focusing on close objects for a long time they become blurry. Cant see far objects and ghosty images appear on red and yellow lights. Those two(focusing on near and inability to see far) usually result in headaches

With glasses: difficulty focusing on near objects for a long time they become blurry with headaches. Far objects: seem clearer however ghosty shadows still appear on red and yellow lights.

Headaches begin if i use my eyes for prolonged period of times, focus on tasks such as driving, reading, studying, working on the laptop or cell phone...

Headaches occur with and without glasses when doing the above mentioned tasks

[Cwahl09]

Any updates?

[JohnHaganMD]

=

[JohnHaganMD]

What is the name of the drops. What is your vision distance and near with and without glasses?

[alexandriamk]

After my last visit to the doctor he concluded that im suffering from accommodative spasm because I have neither myopia nor hyperopia post op.

He prescribed an eye drop: Alcon to dilate the pupil. I am using it at night since it is really annoying at day time

He also prescribed glasses for myopia(-0.5) in both eyes because he suggested that muscle spasm is causing myopia.

However, with the glasses and the eye drop nothing is changing. The symptoms are still there

So do You suggest another doctor?
is accommodative spasm my right diagnosis?
In case it is will it ever go away?
Are there any steps I can currently follow to reduce headaches?

Thank You

[JohnHaganMD]

I would start by seeing another corneal/refractive surgeon for a consultation why your distance vision is blurry (you did not post your visual acuity). This should include a corneal topography and a post cycloplegic refraction (glasses check done after pupils dilated and focus muscle relaxed).

What is the eye drop? If its atropine. Is your pupil dilated? If it is atropine (or cyclogyl) and your pupil is dilate you would expect you to have blurred near vision, sensitivity to light, possibly headaches.

JCH MD

[alexandriamk]

Before surgery: +2, +2 in both eyes
after surgery: started with -0.5 in both eyes. Then nothing in both eyes. But still a difficulty seeing far objects, focusing on tasks, and a severe headache.
Currently using glasses: -0.5 in both eyes with an eye drop to relax eye muscles. However, i am stil suffering from the same symptoms and far objects still are blurry with glasses on.
I'm 23 years old. I did the surgery 6 months ago

[JohnHaganMD]

LASIK for farsightedness (hyperopia) is not the same high success that myopic LASIK is.

Please provide your glasses RX your vision with and without the glasses and your age. All are relevant to your problem.

[alexandriamk]

Hello Doctor
Thank You for the reply
I had lasik surgery and have been experiencing difficulty in concentration after it. Far objects are always blurry with headaches. I was hyperopic before surgery. Currently I am not. Im using glasses for distant objects but they still seem blurry with the glasses on. I am also using eye drops to relax the eye muscles but nothing is changing.
Thank you for Your help
Much appreciated

[JohnHaganMD]

There have been no further posts from b-68 since 2013 and I doubt you will get a response. HOWEVER you don't have spasm of accommodation if you have had cataract surgery.  Spasm of accommodation by definition occurs only in an eye with the natural lens in it.  Try a new post and list your post operative glasses refraction and your vision with and without them. there are many many many posts about problems like that.

JCH MD

[alexandriamk]

Hello
I am currently facing the same problem
severe headache and eye fatigue with difficulty seeing near and far objects.
it started 6 months ago after the surgery. Pre Op, i was hyperopic also
i have already visited several doctors and still at this same stage
Could You help me out?
Much appreciated

[benvenuto68]

Thank you for your answers. I will keep seeing specialists and try to make a decision

[achillea]

I am no eye expert, but after reading about bilateral accommodative spasm on the net (just google the term), I would advise against extreme or surgical measures.

It seems that those with this problem may have a history of physical trauma in the fairly recent past, as you do, and there is an emotional component (no s*it, Sherlock?).

This article suggests that tincture of time, and maybe a little psychotherapy can be of help:

http://books.google.com/books?id=ghX1t21RrloC&pg=PA518&lpg=PA518&dq=bilateral+accommodative+spasm&source=bl&ots=-pMI_9ioGX&sig=ud7qqZmCxXaEV7CZ7y7yH3Xvr-A&hl=en&sa=X&ei=DuXDUe6aEomw8QSZ4YDoCg&ved=0CEAQ6AEwBA#v=onepage&q=bilateral%20accommodative%20spasm&f=false

This is not to trivialize your experience, and I know then you are young, six months is an eternity, but try the approach discussed in this and other articles.

[Ray T Oyakawa, MD]

I have never seen a patient like you in over 30 years.  You should also see a neuro-ophthamologist and possibly a pediatric ophthalmologist.

I not recommend a clear lens extraction.

Dr. O.