Should I increase my glasses to fix Spasm of accommodation?

[jack30]

Hello,

I was recently told that I had a spasm of accommodation in my eyes after some drops had been put in my eyes and chart test was done. I was told that I should increase my glasses prescription from +7 to + 10 for hyperopic eyes with high astigmatism. This was the first time that I was told this despite been for many eye tests over the years. I am 31 years old. I have only recently gone from +5.5 to +7.0 prescription.

I am unsure whether to proceed and use new prescription with some drops to help my eyes adjust to new power, as there will be no going back once eyes adapt. I always had problems where my eyes getting tired after reading or looking at computers all my life. My eyes just usually go to a point where I just can not see print after an hour or two.

I currently use +6 soft contact lenses for sports which are the max available. They have allowed me to go back playing sport the last two years.

I was signing up for www.neuro-vision.com program to help a lazy eye which I was told I had previously, when last eye test was done.

Any advice would be appreciated. I suppose I do not understand spasm of accommodation. Are there any other tests I should do to confirm that I have this condition?

Thanks a a lot for your help,

[Michael J Kutryb, MD]

There might be a difference between your regular refraction and cycloplegic refraction (refraction done after cylopentolate drops which paralyze your accommodating ciliary muscle.)  With the regular refraction, your body can change things very easily by just contracting or relaxing your ciliary muscle - which some people can do more than others - especially hyperopic patients.  You could really be a +9,  but wear +7 and just supply the extra 2 diopters with ciliary muscle contraction (accommodation.)  Now there is no law that you aren't allowed to do this - BUT - you could get headaches and have a drawing feeling like eyes want to turn in because accommodation is tied to convergence and eyes may feel like they want to turn inward.  Also the cilary muscle may get tired at times and eyes get blurry after reading especially when they may have to provide +2 as above but also supply +2 extra to see up close.

The two ways to tell if you might need stronger glasses are the cycloplgeic refraction (best) and a fogging refraction (trying to give the most + power possible until you can't see.) With someone like you I  would do both.  The cycloplegic refraction would represent the very highest power possible that  you could theoretically stand and the fogging refraction would represent the highest possible power you might be able to stand in the real world (it will be the lower of the two numbers.)  In all probability - the power that you end up getting will be somewhere between +7 and +10 - and in the end it may be your symtoms (less eyestrain, blurriness etc) that will determine the final answer.  What we think you need doesn't always translate into a happier, less symptomatic patients.  Sometimes  trial of a few different power options is needed which could easily be done using contact lenses.

MJK MD

[jack30]

Thanks very much for advice. This was very helpful. Jack30

[SadieSunflower]

I went to an optometrist because of intermittent problems with focus in the distance. Distant objects would only look in focus for a couple seconds, then blur. It was especially bad if I shut my right eye. She told me that nothing was wrong with my ability to focus, and made me feel like I was a total freak. Her assistant argued with me and acted like I was making it up. I got so upset that I cried right there in her office. After googling this issue, it was obvious that I had spasm of accommodation. Be glad that you found some understanding doctors.

[jack30]

I am hopeful now that I know what is going on with my eyes that I will be able to read and look at computers for longer periods again. My solution a few years ago was to start listening to audio books and change careers out of computers!
I have been describing my focus problems to many optometrists as well over the years. They told me nothing was wrong so did not really know what to do. Nevertheless it is great to get some answers now. Did stronger glasses help your eyes in the end or did you have to do something else? Thanks a lot, Jack30

[jack30]

Sorry one last question? It was suggested by the optometrist that I use cylopentolate drops to help my eyes adjust from + 7 to +10 prescription glasses. This sounds painful to me! I get migraines from extra power and/or drops. Everything just looks too big when I go up +1 especially in distance (people’s heads just seem too big etc…..)

I am currently getting use of wearing +8 glasses all day. I had them for reading anyway. I was thinking of trying +9 glasses for reading next and then trying to wear them all the time as well. Do you think this is an ok way to adjust for spasm of accommodation? Thanks for help.

[Michael J Kutryb, MD]

I don't know - I've never done that (use cyclopentolate) to help the adjustment.  I suppost it could help you to adjust more slowly over a week or two and perhaps is not a bad idea.  I can see the science in this method.  You would have to wean off the drops in a week or two and then there is no guarantee you will ever tolerate the +10 glasses - but if you have truly been having serious accommodative spasm issues then this might be a way to go at it.  I'm just not sure you will ever be able to go all the way to +10.  Give it a try - if you can't do then drop back down a little.  THe only other alternative is just go cold turkey right to +10 right away with no cyclopentolate and see really blurry for several days or weeks untill MAYBE you adapt.  Finally, I have honestly never had a patient of +10 that I can remember - so you're in slightly uncharted territory here from my perspective.

MJK MD

[SadieSunflower]

I got Base Out glasses to help with the double vision problems that I was also having. I only need to wear them when my eyes get tired. The focus problems are fleeting enough that I can tolerate it with out glasses as long as my double vision is corrected.

I got the double vision problems about a year before the focus problem so I don't know if the double vision triggered the accommodation spasm or what.

At the same time the double vision started I noticed a problem with stiff muscles in my hands and toes. If I make a strong fist it is difficult to open. If my muscles in my hands are stiff like that then maybe the muscles that focus my eyes are stiff too.

It's amazing how we can goggle a problem for a few minutes and out more about the problem than an optometrist who has gone to optometry school and been working for years. I have read that accommodation spasm is rare but I bet it is just under-diagnosed.

[SadieSunflower]

I forgot to say that I work in computers too. I think it makes the problem much worse but there is obviously more than one factor to my eye problems because my double vision started before I got my computer job.

[harrietspoodles]

A related discussion, spasms of accommodation was started.