ask me about eyes

[slim]

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Hi slim, I had very bad sight from about 5 y/o untill around 15 (during which time my view gradually got better). At 15 I was 20/20 and no longer needed glasses.

My ophtamologist says this is because I went through an operation when I was 11 months old (my eyes crossed... I don't knwo what the word is in english) and they had to cut an optic nerve or something similar.

How come my sight got better and better untill the point where I didn't need glasses anymore? How come I didn't have glasses from 1 year old untill 5? Also, is this common or rare?

Thanks!

[/ QUOTE ]


From what you've told me, it sounds like you were far sighted at a young age and had esotropia (eye turning in towards your nose). The surgery which sometimes involves cutting muscles that control eye movement (not cutting the optic nerve!) corrected the eye turn but it definitely did not correct your prescription. However, sometimes farsightedness lessens as a child grows and so your vision may have improved to a point where you no longer need glasses. My guess is that you are still farsighted but not enough to need glasses and your focussing ability is good enough to give you 20/20 vision.BTW, What part of Montreal are you from? [img]/images/graemlins/cool.gif[/img]

[7ontheline]

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7ontheline,

Here in Canada, Toronto specifically, ophthalmologists do not see patients without referals. There is no way they can. They are already so busy as is, there is no way they can accept patients just walking into their offices with any sort of ailments. Like our hospital emergency waiting rooms, which are filled with patients with colds and flus, MD offices would be filled with people with pink eye and styes and subconj hemes. This is where OD's come in.....we are here to rule treat minor problems and direct patients who need tertiary care appropriately. I think the problem is that MD's feel threatened by OD's increasing scope of practice.Maybe they should be, I don't know....we don't really have that problem in Canada. MD's can't seem to shake that image of optometrists from 60 years ago as a guy who only does refractions and knew nothing about pathology. Fast forward to 2006......many optometry schools have MD's on staff teaching OD's. DO you really think they teach us anything different than they teach med students? Do you really think that 4 years studying one organ is not enough to make OD's competent front line eye docs? Yes you see some cases from OD's that may be misdiagnosed, but there are way more that are correctly diagnosed. Perhaps we should ask OOT to tell stories about visits to their GP for non-ophthalmic health issues that are misdiagnosed and see if it's MD's are really that perfect. When an OD or chiropractor or other health care misdiagnose or mistreat, it's bc we're not MD's.....but when an MD misdiagnoses, there is backing from fellow MD's and coverups.

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We may agree about more things than we disagree about. I can't speak for the Canadian system, since I'm in the U.S. For things like styes, pink eyes, subconj heme, etc., I don't have any problem with ODs taking care of them. I do have a problem with optometrists taking care of things like glaucoma, for instance. I am a glaucoma specialist and I am amazed at how mismanaged it is in many optometrists' (and to be fair, many ophthalmologists') hands.

I think the problem lies in the term "primary eye care" doctor. What does that mean? The definition could be very broad or very narrow. Clearly optometrists get a lot of training in dealing with the eye, so to restrict them ONLY to refractions is a bit much. I do believe that ODs have tried to expand their scope of practice beyond what they are capable of however. Having worked with numerous OD residents, I have not been particularly impressed with their diagnostic or exam abilities. These are ODs who are through with school and legally allowed to go out and set up their own practice, and they fall below what I would expect out of a "primary eye doc." Of course everyone has different levels of competence and some ODs are extremely well-read and experienced. It's hard here in the U.S. though because the ODs attempt to reach for things for the entire optometric community, when many of them are IMO not trained properly for the expanded scope.

[slim]

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7ontheline,

Here in Canada, Toronto specifically, ophthalmologists do not see patients without referals. There is no way they can. They are already so busy as is, there is no way they can accept patients just walking into their offices with any sort of ailments. Like our hospital emergency waiting rooms, which are filled with patients with colds and flus, MD offices would be filled with people with pink eye and styes and subconj hemes. This is where OD's come in.....we are here to rule treat minor problems and direct patients who need tertiary care appropriately. I think the problem is that MD's feel threatened by OD's increasing scope of practice.Maybe they should be, I don't know....we don't really have that problem in Canada. MD's can't seem to shake that image of optometrists from 60 years ago as a guy who only does refractions and knew nothing about pathology. Fast forward to 2006......many optometry schools have MD's on staff teaching OD's. DO you really think they teach us anything different than they teach med students? Do you really think that 4 years studying one organ is not enough to make OD's competent front line eye docs? Yes you see some cases from OD's that may be misdiagnosed, but there are way more that are correctly diagnosed. Perhaps we should ask OOT to tell stories about visits to their GP for non-ophthalmic health issues that are misdiagnosed and see if it's MD's are really that perfect. When an OD or chiropractor or other health care misdiagnose or mistreat, it's bc we're not MD's.....but when an MD misdiagnoses, there is backing from fellow MD's and coverups.

[/ QUOTE ]

We may agree about more things than we disagree about. I can't speak for the Canadian system, since I'm in the U.S. For things like styes, pink eyes, subconj heme, etc., I don't have any problem with ODs taking care of them. I do have a problem with optometrists taking care of things like glaucoma, for instance. I am a glaucoma specialist and I am amazed at how mismanaged it is in many optometrists' (and to be fair, many ophthalmologists') hands.

I think the problem lies in the term "primary eye care" doctor. What does that mean? The definition could be very broad or very narrow. Clearly optometrists get a lot of training in dealing with the eye, so to restrict them ONLY to refractions is a bit much. I do believe that ODs have tried to expand their scope of practice beyond what they are capable of however. Having worked with numerous OD residents, I have not been particularly impressed with their diagnostic or exam abilities. These are ODs who are through with school and legally allowed to go out and set up their own practice, and they fall below what I would expect out of a "primary eye doc." Of course everyone has different levels of competence and some ODs are extremely well-read and experienced. It's hard here in the U.S. though because the ODs attempt to reach for things for the entire optometric community, when many of them are IMO not trained properly for the expanded scope.

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I respect your opinion because you sound reasonable and you draw on past experiences to making conclusions. I have no respect for Renodoc bc he just comes on here and starts bashing my profession and boasting about his great academic acheivements.

As far as "primary eye care" goes, I suppose whether or not OD's are competent does depend on your definition of primary eye care.With your experience working with OD's, you feel that some are more than competent whi;le others are not. I think that for the betterment of eye care as a whole, it would make more sense for MD's to encourage and work with OD's to make them better primary eye care doctors than to trash and discredit them, don't you? Would that not help ophthalmology as a whole rather than getting rid of OD's or just making them refract? I'm sure if Renodoc had his way he would choose the latter.

One comment about glaucoma management.....I would guess that the treatment of a typical glaucoma patient (POAG,PXE,NTG,PDS etc) is as much an art form as it is science. There really is no one protocol that is universal among ophthos. One MD might use Xalatan, another might use Travatan first and would not be wrong.There is a bit of trial and error with meds and monocular trials etc...so bc an OD or another MD uses a different protocol than yourself, you wouldn;t call that mismanagement would you? In Toronto, OD's cannot treat glaucoma and in all honesty, I have no desire to treat glaucoma from a financial perspective. However, do you feel that OD's are capable of comanaging glaucoma under the supervision of an MD?

[renodoc]

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Avastin and the like are all overated. You make a living off these drugs and as such you promote them.

Lowly optometrist,

Slim

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I give the drug away for pete's sake. (since it is only about $20 a dose its not quite such a big deal if we don't get reimbursed-- as it would be for Lucentis which is $1950 a dose) If you want to get into an argument about the costs of medicines, take it to the politics forum and I will be happy to bash big pharma along with you.

From wiki:

Treatment
Most of the treatments that are available now and and currently being studied are aimed at stopping the neovascular (or wet) form of AMD.
In June 2006, the drug ranibizumab (Lucentis) has been approved by the FDA for use in the treatment of AMD.[9] Ranibizumab has been shown to halt the progession of the disease in most patients receiving the treatment. Unlike previous treatments, a significant minority of patients (20-40%) receiving Lucentis had an improvement in vision. [10][11] Ranibizumab is given as an injection into the eye. The initial studies required an injection every 4 weeks for 2 years.
Bevacizumab (Avastin), a drug approved for use in colon cancer, has been used by ophthalmologists in the treatment of wet macular degeneration. The drug is very similar to ranibizumab and targets the same molecule as ranibizumab. Doubts about whether this drug can penetrate the layers of the retina led to the development of ranibizumab. Before Lucentis was available, Avastin was widely used by ophthalmologists who treat macular degeneration. Some of their experiences with large numbers of patients with relatively short follow-up times were recently published. No randomized controlled clinical trial with systematic safety data collection has been performed to validate its efficacy and safety with same certainty as ranibizumab. Bevacizumab, when administered at the usual cancer treatment doses (more than 100 times the dose used in the eye), has been shown to cause systemic adverse effects. The most common adverse effect was hypertension. There is a continued interest as the Avastin for use in the eye can be obtained for about 30-50 dollars per dose, compared to 2,000 dollars per dose for Lucentis. Following the recommended protocol for Lucentis costs about $50,000 per eye over two years. The National Eye Institute is planning a head-to-head Lucentis vs. Avastin, randomized, controlled clinical trial for treatment of macular degeneration. Currently more than 50% of retinal specialists use Avastin as the first line drug (ACRS Practice Patterns Survey).

[renodoc]

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PS I asked him if I should see an ophthalmologist for something like this and he said no, not since optometrists can prescribe drugs and good ones are going to be able to correctly diagnose just about all problems.

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Slav,
Did you then proceed to ask a realtor if you should buy a home?, or an insurance agent if you need a policy?, or perhaps a salesman if a new car is in order?

[Jim14Qc]

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Hi slim, I had very bad sight from about 5 y/o untill around 15 (during which time my view gradually got better). At 15 I was 20/20 and no longer needed glasses.

My ophtamologist says this is because I went through an operation when I was 11 months old (my eyes crossed... I don't knwo what the word is in english) and they had to cut an optic nerve or something similar.

How come my sight got better and better untill the point where I didn't need glasses anymore? How come I didn't have glasses from 1 year old untill 5? Also, is this common or rare?

Thanks!

[/ QUOTE ]


From what you've told me, it sounds like you were far sighted at a young age and had esotropia (eye turning in towards your nose). The surgery which sometimes involves cutting muscles that control eye movement (not cutting the optic nerve!) corrected the eye turn but it definitely did not correct your prescription. However, sometimes farsightedness lessens as a child grows and so your vision may have improved to a point where you no longer need glasses. My guess is that you are still farsighted but not enough to need glasses and your focussing ability is good enough to give you 20/20 vision.BTW, What part of Montreal are you from? [img]/images/graemlins/cool.gif[/img]

[/ QUOTE ]

The thing is, the ophtamologist predicted it at the time of the operation (that I'd be alright in ~10-15 years) :X

Also, I'm from Quebec, not Montreal. Thanks for the answer [img]/images/graemlins/smile.gif[/img]

[slim]

[ QUOTE ]
[ QUOTE ]
[ QUOTE ]
Hi slim, I had very bad sight from about 5 y/o untill around 15 (during which time my view gradually got better). At 15 I was 20/20 and no longer needed glasses.

My ophtamologist says this is because I went through an operation when I was 11 months old (my eyes crossed... I don't knwo what the word is in english) and they had to cut an optic nerve or something similar.

How come my sight got better and better untill the point where I didn't need glasses anymore? How come I didn't have glasses from 1 year old untill 5? Also, is this common or rare?

Thanks!

[/ QUOTE ]


From what you've told me, it sounds like you were far sighted at a young age and had esotropia (eye turning in towards your nose). The surgery which sometimes involves cutting muscles that control eye movement (not cutting the optic nerve!) corrected the eye turn but it definitely did not correct your prescription. However, sometimes farsightedness lessens as a child grows and so your vision may have improved to a point where you no longer need glasses. My guess is that you are still farsighted but not enough to need glasses and your focussing ability is good enough to give you 20/20 vision.BTW, What part of Montreal are you from? [img]/images/graemlins/cool.gif[/img]

[/ QUOTE ]

The thing is, the ophtamologist predicted it at the time of the operation (that I'd be alright in ~10-15 years) :X

Also, I'm from Quebec, not Montreal. Thanks for the answer [img]/images/graemlins/smile.gif[/img]

[/ QUOTE ]

If you really had bad eyesight in BOTH eyes (i.e. much worse than 20/20) and your ophtalmologist predicted you would have 20/20 in both eyes after a few years, then I don't know the answer. Any ophthos care to explain this to me please?

[slim]

[ QUOTE ]
[ QUOTE ]

Avastin and the like are all overated. You make a living off these drugs and as such you promote them.

Lowly optometrist,

Slim

[/ QUOTE ]

I give the drug away for pete's sake. (since it is only about $20 a dose its not quite such a big deal if we don't get reimbursed-- as it would be for Lucentis which is $1950 a dose) If you want to get into an argument about the costs of medicines, take it to the politics forum and I will be happy to bash big pharma along with you.

From wiki:

Treatment
Most of the treatments that are available now and and currently being studied are aimed at stopping the neovascular (or wet) form of AMD.
In June 2006, the drug ranibizumab (Lucentis) has been approved by the FDA for use in the treatment of AMD.[9] Ranibizumab has been shown to halt the progession of the disease in most patients receiving the treatment. Unlike previous treatments, a significant minority of patients (20-40%) receiving Lucentis had an improvement in vision. [10][11] Ranibizumab is given as an injection into the eye. The initial studies required an injection every 4 weeks for 2 years.
Bevacizumab (Avastin), a drug approved for use in colon cancer, has been used by ophthalmologists in the treatment of wet macular degeneration. The drug is very similar to ranibizumab and targets the same molecule as ranibizumab. Doubts about whether this drug can penetrate the layers of the retina led to the development of ranibizumab. Before Lucentis was available, Avastin was widely used by ophthalmologists who treat macular degeneration. Some of their experiences with large numbers of patients with relatively short follow-up times were recently published. No randomized controlled clinical trial with systematic safety data collection has been performed to validate its efficacy and safety with same certainty as ranibizumab. Bevacizumab, when administered at the usual cancer treatment doses (more than 100 times the dose used in the eye), has been shown to cause systemic adverse effects. The most common adverse effect was hypertension. There is a continued interest as the Avastin for use in the eye can be obtained for about 30-50 dollars per dose, compared to 2,000 dollars per dose for Lucentis. Following the recommended protocol for Lucentis costs about $50,000 per eye over two years. The National Eye Institute is planning a head-to-head Lucentis vs. Avastin, randomized, controlled clinical trial for treatment of macular degeneration. Currently more than 50% of retinal specialists use Avastin as the first line drug (ACRS Practice Patterns Survey).

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Renodoc,

I will do my best to be civil with you. There is no point in trashing one another. My point is that ODs are capable of being front line eye docs, and you feel otherwise. Let's leave it at that.I retract calling you an ahole when we have never even met so I apologize for that. It just rubbed me the wrong way when I felt I was doing a good job in answering OOT questions about generic eye problems and then got slammed about being incompetent.

I never hinted in anyway that OD's ,myself included, know more about the eyes than MDs and certainly not more about the retina than you do, so I don't see the point in you asking me about Lucentis,Avastin etc and how that would prove that OD's are not comeptent front line docs if I did not know the answer. It is like asking a general practioner to decide the best course of action between surgery vs chemotherapy vs radiation for a patient with stage 3 esophageal cancer and deeming him incompetentif he can't.My only knowledge of these drugs is from CE lectures and reading medical journals and my limited experience with patients whom I referred to have these treatments.My job is to detect eye disease and refer them off appropriately, and I feel that I along with most other ODs can do this as well as anyone. Having said all this, I'm sure it doesn't change your views of my profession......so like 7thonline says, we'll agree to disagree. But I do want to ask you a question about cnvm. What is the difference bw CNVM from histo,amd, progressive myopia or whatever? IS there a different protocol when using these newer drugs to treat each type of CNVM?

[slim]

7thonline,

I would like to ask you a couple of glaucoma questions if I may.

1) If a patient has no cupping, can they have glaucoma. i.e if a patient has has pressures of 28mmHG but no cupping at all, is there a point in doing fields? Why or why not?
2) Are you currently using dynamic tonometry? IF so, what is now considered abnormal IOP's considereing that the old standards were flawed?

[Lyric]

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I found an old prescription of mine from 5-6 years ago. My eyes were -3.00 and -4.00 (the first number, I also had some astigmistism).

I just had my eyes tested last week and the first number -1.50 for one eye and -1.75 for the other.

Is it common for eyes to change that much in a few years? I'm 35 years old, if that matters.

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your prescription dropped by quite a bit. No it is not common for it to drop that much....not until your 40's anyways.

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What causes the vision to get better as we age? People often have better vision around 40 yrs old? This seems backwards to me.