Adolescent Hyperopia

[GMadden]

My 13 year old son has worn glasses/contacts since he was 3 years old for hyperopia and astigmatism. He has been undercorrected for several years with the idea that by under correcting his eyes will work harder and hopefully improve. Now at age 13 he's getting headaches and dislikes reading. During his most recent eye exam his new optomotrist recommended true corrections +2.50 and +5.50. Previous correction was +2.00 and +3.00. I'm very confused as to whether under correcting is what should have occured and what should continue to occur or not. I want to do what we can to help him in school and protect his longterm eye health. I can't find very much information regarding under correction. I also don't know if

[John C Hagan III, MD, FACS, FAAO]

Visual therapy as pushed by optometrists had not been shown to be good for anything other than the optometrists' income.  I have had people spend between $5000 and $8000 for visual therapy that didn't help at all. A scientific study in Archives of Ophthalmology did not find any credible studies showing benefit.

Remember this condition runs in families so all other children, nieces, nephews, and eventually grandchildren have a 20% chance of having the same problem. They should be checked by a pediatric ophthalmologist at about age 2.5 to 3  sooner if any thing abnormal is noticed.

If the new RX is +2.50 and +3.50 he might adjust to that.

JCH MD

[John C Hagan III, MD, FACS, FAAO]

If you son's full correction is + 2.50 and + 5.50 there is very little chance that he will be able to wear that correction due to the large difference in the two eye (+ 3.00 diopters  anything over 1.50 diopters difference is usually hard to adjust to). It's also likely that you son has some amblyopia in the +5.50 eye and that when both eyes are used together that the +2.50 eye does all the reading and fine vision.

Because of that the "old" RX of +2.00 in the better eye only under corrected your son by 0.50 diopters.

Some people address this by wearing contacts of different strengths (as long as the glasses RX is not a bifocal).

I do not think your son likely has any detrimental effect from his old RX. I am not a betting person but if I was I would be you son will not be able to wear glasses that are +2.50   and +5.50      

My suggestion is to see another pediatric opthalmologist.

If you stick with the optom ask for a guarentee that if he can't wear the glasses that you can get your money back or at least change the lens to the "Old" RX without any extra cost.

JCH MD

[GMadden]

Thank you so much D. Hagan - I have to tell you that after closer examination of the glasses Rx I believe I what I thougtht was a 5.5 is really a 3.5 on the glasses Rx. The Optomotrist did say he found a "little" differnece since his last exam which if if were a 5.5 "little" would not be accurate. I've not had the  glasses Rx filled but plan on giving the contact Rx a try while I'm arranging a visit with a pedi opthamologist, Doyou have an opinion on the benefits of vision therapy? I noticed that one pedi opthamologist in our area seems to highly recommend a vision exam that looks at more than just the traditional eye exam. Thank you again for your input, I'll try to make this my last post.

[GMadden]

It was the pediatric opthamologist (recently retired) that under corrected. The new optomotrist that I took him to to check his contacts is the one recommending full correction. My fear was that the optomotrist didn't know the benefits of under correction. Now concerned that some of my son's dislike of reading and school in general could have been avoided if the pedi opthomologist had fully corrected him.

[John C Hagan III, MD, FACS, FAAO]

Under-correcting his eyes is NOT going to make his eyes better or less farsighted.

I would suggest you consider seeing a pediatric ophthalmologist. Find one at www.aao.org

The training of an optometrist is so much less thorough and so much shorter that I would only entrust it to a physician Eye MD.

JCH MD