Severe spasm of accommodation - Neurologist or Ophtalmologist ???
My current diagnosis are Asthenopia, Spasm of accommodation and Insomnia. I will try to point out the main facts in order to find any helpful advise because I think this condition in which I am is unbearable and impossible to live with This question Im going to post in both neurology and eye care sections because it is related.
After often prolonged time of reading I noticed that i cant see distance objects and first glasses (-0.5) were prescribed to me. But the problem was that every time i should have worn them I felt strong pain in my eyes and headache, especially it was hard to watch close objects with glasses so I decided not to wear them except in situations when i had to. However as time was passing I felt worse and worse and doctors prescribed me stronger glasses what resulted in more severe problems. (-1)
Doctors decided to send me on binocular tests and found that I have very low fusion of eyes and told me that in order to improve it I have to wear the glasses (even stronger -1.75) with theory that better individual pictures would improve binocular vision) all the time despite the strong pain and prescribed exercises.
However, this made my condition even more worse. Binocular exercises haven't helped at all Since then I have CONSTANT pain in my eyes and headache which is so strong that I am NOT ABLE TO SLEEP. Then the other ophthalmologist found that I have severe CILIARY SPASM and decided to send me to neurologist who prescribed to me Lorazepam which didn't help and then Flormidal (both before sleeping) which also didn't help me to sleep and relax muscles I would like to add that since i stopped to wear glasses visual acuity tests showed -0.5.
If I understand well I had ciliary spasm since the beginning but was more made complicated with minus lenses cause they make more pressure on ciliary muscle. How to find the way from this condition ???
minus (-) lens will NOT help accommodative spasm, in fact it may make them worse. You ne plus (+) lens and then just for reading.
See a neuroophthalmologist. Do not let the staff put any drops in your eye till you see the Eye MD. Also ask for a "fogging refracting" before drops and a "post cycloplegic refraction" after eye drops.
Find a Eye MD with neuro speciality near you at www.aao.org
I went to neuroophtalmologists, she concluded that spasm is so strong that eyedrops couldnt have realese it for 3 days so she ordered to me to continue usage neurological pescription for general muscles relaxation lorazepam, propranolol, vitamins b6 i E. and arranged to have VEP test in February.
I did VEP test and it showed monocular amplitudes normal for both eyes but very low amplitude for binocular vision. Last prescription is -0,5 only for distance viewing but Im afraid to wear glasses cause wearing made my condition much worse till i reached -1.75 and gain all-day headache. Still have strong headaches and not sure how to deal with it.
Stil have constant ciliary pain, headache. I feel strong contractions when trying see objects at different distances. Dont wear glasses cause even with smallest prescription I can feel stronger pressure when to accommodate. Ive been using therapy propranolol 2x10 mg and lorazepam before sleeping for a long time without visual improvements.
Another doctor told me to try amyzol cause it has as side effect reduction of accommodation. Im very afraid of new experiments and would be grateful for any advice.
Also would like to ask which eye exercises are good for this problem cause it seems to me that sterograms and pencil pushups even make thing worse and more tension in ciliary muscles.
Im back with some fresh news. Last prescription is -0.25 and -0.5 but spasm is still present and strong pain with headaches. It seems that I was all the time hypermetropic but was treated with strong minus lenses (-1.75)
I would be very grateful for opinion whether to use plus lenses for reading because close work is real torture for me.
In my country its very hard to find neuroophtalologist who is well aquainted with this problem. They just send me to neurologist for therapy.
I went to 2 neurologists-One prescribed lorazepam before sleeping, small dosage of propranolol during the day plus vitamins.
The second one prescribed me small dosages of rivotril but 3 times per day.
Both therapies helped me to sleep but havent helped me to relieve spasm and pain. Even small dosages of sedatives make my binocular fusion weaker.
I have read in the article by Harvard professors that it should be prescribed belladonna alkaloids and just mild sedatives (cause ciliary muscles are smooth) as stronger sedatives alone negatively affect binocular vision.
In the end it is discovered that all the time I have had pseudomyopia and spasm of accommodation had basis in uncorrected latent hyperopia. Minus lenses have just made the things worse. I would remind that in one moment -2 was prescribed. Still have strong asthenopic symptoms and unbearable headache. Doctor is against plus lenses but it is very hard to read due to strong pain. She prescribed me only change of focus training.
hi this phenomena you're describing is very rare, so hopefully, thanks to this community by forcing hands, we could go to the root of that.
I'm a patient that suffer from a similar similar condition: while cycloplegic examination reveal -3 prior regular examination revealed -9 !!!! and that is also after I reduced my number by a factor of 2 by wearing glasses with lower prescription number prior to this specific vision examination...
No Doctor could have helped me (Ophthalmologist, Optometrist, etc), so I started using my common sense and doing my own research, despite not being able to read and and all the pain, eventually I found some clues and instructed my doctors/optometrist to follow my guidance which PROVED ITSELF. In retrospect it make a lot of sense. The problem is that each professional focuses on a narrow area of expertise, so no professional is able to SEE the big picture. They failed to understand that everything is intra-related and affect one another. The result is that the Left hand doesn't know what the right hand is doing....Once you integrate it all to a full picture, it become so simple and obvious in retrospect.
I have been having this problem since I can remember myself, for many years...though I think it wasn't as severe when I was a child, nevertheless, with no doubt was present. I won't dwell you with all my history and background and rather focus on sharing with you the treatments that works for me, and hopefully could offer you some relief- so stay tune with me :-)
However, I should mention that I also have sever dry eyes with Schrimer score 0 in both eyes, very low TBUT and Severe Blepharitis and MGD (Meibomian Glands Dysfunction) as well as other eye related issues. Had my dry eyes since I can remember myself. In my case there is a strong correlation between my Dry Eyes (Dry Eye Syndrome) and my Accommodative Spasm. The dryer my eye are the more cramp/tight my eye muscle become, and it get more and more cramped and contracted until I can't keep my awareness and in the desert I faint, this how tough it's. The eye muscles pain spread through my whole body, and my body get stiff and my mind become very gross, similar to being very very drunk, like getting continuous injection of alcohol until you lose your conscious. So you got the picture.
I found a framework (set of treatments) which SUBSTANTIALLY improved my condition, though I'm still having this problem and suffering, though to a far less extent. I could now see the light in the end of the tunnel, though I'm not 100% sure that I could resolve this problem, and hence constantly seeking for other alternatives. For the time being, I continue with what worked for me, and hope that in a few months I would resolve this problem completely.
Leaving my treatment for Dry Eyes/MGD/Blepharitis out of this discussion let me focus on Spasm of Accommdation.
I have been starting reducing my prescription number since July 2008 and still in the process...
It has been EXTREMELY painful process and images kept rotating, sometime I would see only with my right eye while my left eye vision is extremely foggy/hazy to the extent that it can't see, and other time I would be able to see only with my left eye and not be able to see with right eye, as well as other weird visual stuff, which are the result of the muscles loosening up and adjusting themselves with the reduced prescription glasses number (Boston Ocular Scleral Prosthesis in my case).
1) Vision Acuity Examination:
have an eye exam under the influence of Cycloplegic (the strongest agent) which relax/paralyse the focus muscles, and for our purpose, this allows the doctor to neutralize the effect of the eye strained (contracted muscles). This would reveal a more accurate prescription number, neutralize the cramped eye muscles effect (spasm)
2) Reducing the Prescription number
have your Optometrist prescribe you a glasses with Cycloplegic prescription number, or if the gap is too wide, a reduced prescription number in between the prescription number of the normal examination and the prescription number under the influence of Cycloplegic.
Also have a similar (Cycloplegic) vision acuity examination for reading/computer glasses (see CVS-Computer Vision Syndrome for more info)
*This would be an EXTREMELY PAINFUL processes and would take several months or in my case more than a year and a half, and I 'm still in the process, the if I'm lucky I'm looking for two years period….
3) Vision Therapy:
ONLY after reducing your prescription number somewhat substantially Improve Visual Skills such as Binocular (eye teaming) -Vergence, and Accommodation with Vision Therapy, which without a doubt where severely deteriorated and damaged due to the accommodative spasm.
This would further reduced your prescription number toward the target Prescription Number of the Cycloplegic Examination, and most importantly would train your muscles and brain to accommodate and hopefully eventually resolve the problem or at least facilitate it to a more tolerable extent.
Traditional Vision Therapy is less effective (see researches and very expensive). The best Vision Therapy Application - The Most Effective and the Most Economical (cheap) is a Vision Therapy Software called: HTS - Home Therapy System, which you could google homevisiontherapy or Computerized Home Vision Therapy Systems (the website in the top of the list). This software monitor your progress and allow your optometrist to monitor your progress as well and adjust the goals and settings if necessary. Based on your initial examination the software set you goals, and exhibit your progress in colorful graph. It also combine game vibe, which make it a lot of fun and easy to use, whether you're are a child or a senior citizen.
For more info google visiontherapysolutions net or google home therapy solutions (the webiste on the top of the list), to read about the functionality.
*Most optometrist, would try to convince/solicit you to visit their clinic for a traditional vision therapy sessions, with the excuse that it's more beneficial and that they would be able to monitor your progress. All this is BS! The truth is that they charge outrages fees for each session ($150-$400), while, with the software they lose all this potential cash machine... This software could be purchase only through a licensed Optometrist or Ophthalmologist. So simply insist your optometrist to order it on your behalf. The price for the end user range anywhere between $150 to $400, depending on how much the optometrist charge you (selling this software is also very profitable for the optometrist). It should come with a Red-Blue glasses (for the vergences exercises) and a set of flippers with different lenses power (for the accommodative rock exercises).
* Note prior to reducing your prescription number more toward your REAL (Cyclo) number, vision therapy would not be effective and would cause a lot of pain. So the key is to let the muscles relax and loosen up by reducing the prescription number first, and then only to apply vision therapy.
4) Due to my Dry Eyes I'm wearing Scleral Contact Lenses, however, since they are rigid and MAINLY due to the liquid inside which smooth the cornea lense, scleral lenses provide excellent vision correction where the corneal surface is uneven or even for "normal cornea" !!!
As a last resort, I suggest you look into Sclarel . Scleral lenses - these are large rigid gas permeable (RGP) lenses which rest on the sclera but not on the cornea. You fill the lenses with lubrication solution so the space between the lense and the cornea is filled with lubrication. Because they are rigid, scleral lenses give excellent vision correction where the corneal surface is uneven. They also offer better protection for damaged corneas.
The Boston Ocular Surface Prosthesis (BOSP) is an FDA approved therapeutic/prosthetic device that fits over the front of the surface of the eye, including the portion under the lids. Each BOSP is custom designed to align with and rest on the sclera (white part of the eye) and avoid physical contact with any diseased or damaged corneal tissue (transparent front part of the eye). While the lens is worn, the cornea is bathed in a balanced salt solution to maintain its health and integrity. In addition to the therapeutic effect, the lens acts as a prosthesis to optically replace diseased irregular corneal surfaces and thereby enhance vision correction. The scleral lens is fabricated from itafluorofocan B, a highly oxygen permeable plastic.
its usually treated with atropine over a period of 2 weeks or so,im just not sure of the correct dosage,also you would need to ensure that you dont have any indications glaucoma present before strating the therapy.
strange that apparentely no doctor mentioned this to you?
apart from that,abstain from near work,or looking at a computer or lcd/plasma tv screen.
what helped me improve my vision a bit and relaxing my eyes and relieving the type of headaches that seem to come from your eyes was watching in the distance through a pinhole in a cartonboard,getting a clear image this way. with both eyes or covering the other eye..i would do this on the average 1-1.5 hours a day for each eye or 2-3 hours for both eyes
NOT SURE at all if this has anything to do with this kind of spasm since im not sure yet that i have it,but it could be that your muscle relaxed from the clear image stimulus even more so cause my eyes seem to get a bit flatter and softer after that which could indicate a flatter lens caused by the more relaxed state of the ciliary muscle
sometimes soon after that i would start to get headaches when doing near work. but on the overall i dont have that much trouble with headaches as with eyestrain and a general feeling of eye fatigue
make sure that you cover your eyes with the sufficiently protective and sunglasses if/when using atropine or any other mydriatic and avoid bright sunlight
if you have any additional information about treating/preventing this or symptoms in general free to contact me, i am gonna make an appointment to undergo a retinoscopy under atropine to be sure what's the matter here
So its really unbelievable destiny that despite I complained to so many optalmologists since I started to study that reading make hard effort for my eyes and (in the beginning reversible) distance blur and they told me that it is normal and to come back when it get worse. After each returning with complaints that I have pain while wearing minus glasses they would prescribe stronger minus. And they kept rising it till -1.75 WITHOUT CYCLOPLEGIA. When I asked why they use drops for some people not for me they answered that drops are for people who dont see to read and that I dont need it. You really cant imagine what horror of life was made by such ignorance.
With complete reducing of reading i manage more often to have clear distance view but its variable with blinking. Eyepain and headache still never stop. I would like to point out that my eyes and nervous system have been tortured with minus glasses for almost 10 years.
Cocernning the fact that I needed 3 weekends applying homatropine to realese accommodation form -1.75 to -0.75 and after 1 year of abstaing of close work and one more time of applying homatropine for 3 days my manifest refraction is -0.25 and I am finally able to see clearly on moments (bliking interrupts it) it can be proof that strong spasm cant be relieved with several days of applying homatropine.cause complete nervous system is affected.
So lets go to the questions...
1)I would be grateful for an advice whether atropine (cause it is stronger then homatropine) is worth of trying to reveal the true refractive error.
2) My second question concerns whether computer refraction values have any relevance in the case of spasm of accommodation.
In the end would like to add that I am conscious of importance of prisms and plus glasses for reading but I still havent found ophtalmologist who is aware of that to prescribe me and trying to relax accommodation with more timr spent outdoors and abstaing of reading.
Homatropine 5 % three times per day will generally relax even a young constricted ciliary muscle. No problem with trying atropine 1% twice/day other than it takes longer to wear off. If your RX cycloplegic is -0.25 you don't need glasses for distance and should be able to read with a cheap over the counter +2.50 for reading and +1.50 for computer and shopping. After drops are stopped you will feel more comfortable with smaller numbers.
Your help is very important for me. I hope the worst days have gone. What a shame for all ofthalomologists who made this suffering to me. Many of them even dare to regard themselves university professors, PhDs and are not able to check cycloplegic refraction of paitent with such symptoms.
I used earlier Homatropine 2%, so maybe I should try Homatropine 5% or Atropine 1%. What is your opinion for how many days I should instill it.
I found in one article this citation:
The cycloplegic must be carefully chosen and properly administered. Full mydriasis is not
necessarily an indication of full accommodative relaxation. A spasm of accommodation
is often induced or aggravated in the early stages of cycloplegic
drug action (SLOANE, 1970). In such cases, atropine is the drug of choice and
should be used over several days. It is, however, possible to use the short
acting cycloplegic agents such as cyclopentolate if one waits the proper amount
of time for full effect to have taken place.
When I told that to one of "my professors" he answered that it is not true. He regard that it is enough instilling cyclopegics half hour before an examination. When I told to him that Harvard professors wrote that he was annoyed and comented that Harvard professors are ordinary ophtalmologists not better than any other.
I would like to add one more interesting fact that after I visited 4 PhD, mostly professors he was the first who found out that I have spasm of accommodation by fogging method but even him didnt make cyclopegia but his idea was to wear contact lenses -1.75 instead of glasses. Thanks to him for diagnosis but luckily I suspected to this idea and started own research. Before I visted him I was already in horrific condition. If I listened to him who knows what would happen with me.
I believe in USA is not possible that somebody have misfortune like me.
Let me give you full disclosure. Spasm of accommodation is very rare. Few ophthalmologists (including me) have much experience treating it. Most treatment is down by neurooopthalmologist or strabismus specialists.
I would be grateful for your opinion about home or clinic vision exercises in this condition. Exercises were prescribed to me before spasm was discovered and they made more suffering to me cuase i did push ups, fusion exercises and prisms ALL WITH MINUS GLASSES ON and it had as result inducing stronger spasm and this neverending ciliary pain and headache.
So would I have any benefit of doing exercises in this state WITHOUT GLASSES. In my opinion not cause all exercises are done in close so ciliary muscle would be constricted to maximum power.(WITH MINUS GLASSES ON EVEN BEYOND ITS EXTREMES) Maybe only change of focus looking at finger and distance may have some usefulness.
PS sorry by mistake I posted this question also in another topic
anonymous951: I will not carry this conversation further. I told you that it is a rare condition. It is a condition I have not seen in my practice. What I know is what I've read in medical journals and scientific journals. You can access these yourself. I like www.emedicine.com
I am a medical student from the last three years.I have a older brother who also was in college with me.
I will explain his histroy first
My brother used to allways have cold hands and feet after travelling or reading from when i can remember.At that time he never had any symptoms but had a occasional severe muscular cramp in the stomach.
As time went by and his reading activity increased by the tim he was 18 he started showing a myopia.COREECTING THE MYOPIA MADE IT HELL FOR HIM.He stoppd using spectacles and was contet with blurred vision.
As time went by he started complaining of a vertigous feeling when travelling by car.A muscle tightining started occuring in his body.He would feel as if his back is stiff.All this inreased on reading.
Slowly the problem got worse and now his myopia was -4.00
No avail and made things even worse
When his second year of mbbs was done he decompensated with massive pain in legs hands back neck blurred vision vomiting vertigo and was unable to walk
We took him to eurorpe to a neuro opthalmologist in a WHEEL CHAIR
HE WAS DIAGNOSED WITH SPASM OF ACCOMODATION .CAUSE: ExOPHORIA
Treatment and progress was slow.I gave up my second year in college to RESERACH this problem
Contradictory to belief a BASE OUT PRISM WILL MAKE THINGS MUCH MUCH WORSE
The patient must be relaxed using a base in prism and all such patients are actually hypermetrops.Its been two years now and his spasm is at a level where he can walk now but CANNOT READ..
A professor call Proffesor Dr.Muehlendyck in GOTIINGEN Germany is the right person for this.He is a neuroopthalmologist and strabologist and HIMSELF HAD THIS PROBLEM and solved it himself.
unilateral spasm of accomodation after lasik ?!!
2 years post-lasik..my patient's refraction is -3.00 O.D. +0.25 O.S. after cyclop. refraction is (0.00 O.D) (+0.25 O.S.) what's the best management ?
( cyclop. drops or what ? ) please reply me......thanks
I began having very intense headaches about two years ago. I’d never had any ocular problems beforehand. My primary care physician felt it was tension headaches and prescribed flurbiprophen....which did nothing. A CT scan was done to prove that it wasn't Sinus related....the CT scan was clear.
He sent me to a well respected opthomalogist.....who thoroughly checked my eyes and sent me home with a clean bill of eye health. Meanwhile, the headaches were persistent and very VERY intense.
He then sent me to a neurologist. She did all the cranial nerve tests and concluded honestly, that she didn't know what I was suffering from. She prescribed Topamax.....which made the headaches worse, giving me the overwhelming sensation of wanted to sleep.....all the time.
I scheduled an appointment at the Novus Clinic (Akron) for another opthomalogist session. He concluded (in a 7 minute visit on his part), that I was suffering from presbyopia, even though I mentioned the possibility of Accomodation Spasms, after doing some research on my own. The doctor (James Johnston) in his arrogance, suggested I was incorrect in diagnosing myself.
Getting no relief, I looked into a headache specialist. A MRI was ordered with contrast, as was an MRA. Basic blood work was also taken. No conclusions. Over a period of several months, he prescribed several migraine/cluster headaches drugs (ie. Imitrex, Migranol, Amitryptiline, Neurontin and Prednisone), of which NONE improved the headaches.
Family and friends gave many suggestions, since the doctors weren't helping.
My sister, who'd had previous eye problems, suggested a Neuro-Optho doctor. Upon my first visit, after almost two years of intense pain (VERY INTENSE), several nights of vomiting, missing work, roller-coaster emotional cycles (because of the pain), and many many sleepless nights.....she concluded within a few minutes.....that I was suffering from Accomodation Spasms.....something I'd mentioned to one of the two Ophomalogists I'd seen almost a year earlier.
The doctor prescribed some ‘computer glasses’ (plus side), and has mentioned that
over time, the ciliary muscles need to be ‘re-trained’ into believing they can
relax. I am having the prescription filled today, and will start wearing them at work,
All of the above took place at the Cleveland Clinic.
The question still remains though…..what can be done about the pain?
go to a doctor who can examine your vision acuity with 2% Cyclogyl (a brand by alcon, cyclonpentolate is the generic name) and that has an Auto-Refractor Machine also known as Objective Refraction.
(1) have them examine your eyes with Auto-Refraction (machine -this take 15 seconds) when you arrive before the cycloplegia effect
don't forget to take the print of your RX from the machine
(2) instill one drop of 2% Cyclogyl in each eye, and maintain your eyes shut until the next instillation
(3) maintain your eyes shut for 10 minutes (set an alarm clock)
(4) instill 2% Cyclogyl
(5) maintain your eyes shut for 10 minutes (set an alarm clock)
(6) instill 2% Cyclogyl for the third time
(7) maintain your eyes shut for 40 minutes (set an alarm clock), 30 minutes could also work but wait 40 min if possible
(8) have them examine your eyes with Auto-Refractor machine (it take 15 seconds)
don't forget to take the print of your RX from the machine
and you're done !
(9) Ask to measure your dual PD , they should give you 2 PDs number, one for each eye. That mean, you ask them to measure the PD for each eye separately. PD for each eye should be in the range of 24-35
* if they give u a single PD in the range of 50-70 ask for dual aka 2 PDs
**(10) cycloplegia subjective refraction-IS NOT RELEVANT TO OUR GOAL. they would probably insist you perform subjective refraction as well - this is when doctor switch different lens power and ask you how well you can see
ask them to write the prescription result right after the examination is done
(11) USE THE CYCLOPLEGIA AUTO REFRACTION PRESCRIPTION FOR YOUR NEW GLASSES /LENSES
*the most important variable is the vision balance between the two eyes, or as I refer to as Gap between the eyes ( GAP= Left - Right ) which determined load effort balance.
(12) take a month to adjust to new prescription, then start training your eyes with HTS vision therapy computer software or Ablyopia dedicated software by HTS or other vendors.
**From our point of view, the problem with subjective refraction is that the aim of this evaluation is to neutralize the focus muscles strain by applying cycloplegia which relax these muscles. The more you use your eyes, and the more effort impose on the focus muscles, the more it set off and reduce the cycloplegia effect. What happen is that the relatively long process of the subjective refraction, combined with the effort imposed on your "relaxed" ciliary muscles reduce the cycloplegia effect, and therefore distort the refraction result.
Many doctors do not fully understand this point and its importance, in particular with patients with muscles problems like you, me and others. Know this, almost any eye problems also cause muscles problems cause the balance of vision, effort load balance, cause a secondary effect in the form of fusion /vergence problem. with that being said, while vision therapy is the gold standard for muscles problem, the initial cause of the eyes problems must be resolved beforehand, in order for the vision therapy to prove successful
I am having the same visual issues. 'i've been to multiple doctors of different expertise, but havent received promising information. After conducting experiments, and research on my own, I noticed that relaxing the accommodating muscle spasm is imperative. I've asked to be prescribed small doses (.01% altropine) of altropine. Please contact me as we can discuss this futher.
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