please help, bad accomodative spasm

Hi,

I am 22 years old, I have been diagnosed with accomodative spasm with ( - 12) befor cyclogel and (- 4) after,

my doctor (neuro-ophthalmologist) prescriped cyclogel as long term treatment, and then atropine, the problem is that i got systemic side effects from both ( dizziness, unsteadiness, and hallusination ) so I stop using any of them.

my doctor run out of options, what can I do , or where can I go !! please help., am having very diffecult time .


anothher Q, is what will  happen if I just used the ( - 12) ?

thank you,

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

I suggest you ask your neuro-ophthalmologist to refer you to the closest world class tertiary eye center. You can use the search feature and pull up the top 10 eye centers in the USA.

JCH MD

[venjer]

hi this phenomena you're describing is very rare, and you're the first patient I came across with such a wide gap between what is considered the real number and the regular prescription number, 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.

[venjer]

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.

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

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[Paintingmyownpic]

My daughter is having diplopia, blurry vision and accomodative spasms.. aka conversion disorder.  She is a Junior in High school... with a 3.8 GPA.  There is a lot of history of emotional trauma with her father who is also a physician who abandoned her and is very spiteful toward her.  My heart is BREAKING!  She has been through SO much.  Since 2006 there has been a MAJOR illness each year.  she has been in psychotherapy for 6-7 years.  She takes one step forward and three steps back.  NOW SHE HAS THIS.   As a single mom with two special needs kids (one MR and Autistic and his twin Aspergers), I know how to handle quite a bit, but I am lost.  I dont know how to help her with this one.  There is no behavior modification I can do.  We have done all of the tests, MRI, CTA, Spinal Tap blood work up-up the kazoo.  Some of her hormones are out of whack like Testosterone, MCH, Prolactin, sodium, calcium... but all the docs have said they are not high enough to really do anything.  I REALLY need some help.  We have seen two neuro-ophthalmologists, 2 neurologists, psychologists, optometrist, and of course pediatricians.    What do I do?  Today the Neuro-op put her on Xanax.   She is a Junior in HS, and I dont want to see my baby disabled.   She is so beautiful, so bright, and so giving... WHAT DO I DO?  Please dont tell me to talk with her father, he is a very deranged man who can only help his patients and doesnt have three seconds for his children I have tried for YEARS and yes recently as well.  I appreciate any help you can offer.  We are in South east Tennessee.    Thank you and God Bless you!

[nathandewinter]

http://www.medhelp.org/posts/Eye-Care/Severe-spasm-of-accommodation---Neurologist-or-Ophtalmologist-/show/699827

look for my post here above,i think atropine would be a way to relieve the spasms. discuss it with your physician

[rotastrain]

Please go to a neuro ophthalmologist

U all have exophoria along with accompdative spasm


The person who is having rotating images u r in need of treatment from a neuro ophthalmologist.

My brother is having this disease and the painful journey is going on for last 3 years bit he Is recovering.

[venjer]

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
->you can also transition gradually toward the cyclo (cylcoplegia)autorefraction RX (prescription) with partial correction, until you can adjust to the full cyclo RX

*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