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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7745
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Do pediatric myopia patients require cycloplegia and/or dilation

Resolved Question:

Do pediatric myopia patients require cycloplegia and/or dilation to achieve an accurate diagnosis (prescription power)?
Submitted: 10 months ago.
Category: Eye
Expert:  Dr. Rick replied 10 months ago.

Dr. Rick :

Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

How old is the child?

Dr. Rick :

Is the child having any eye problems? Does his/her eyes cross?

Dr. Rick :

I see that you are offline. I will switch to Q&A format. This format works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)


Expert:  Dr. Rick replied 10 months ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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Expert:  Dr. Rick replied 10 months ago.
Danny,

Dr. Rick : Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.
Dr. Rick : How old is the child?
Dr. Rick : Is the child having any eye problems? Does his/her eyes cross?

Does the child have any medical problems or take any medications?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
Customer: replied 10 months ago.
6yo WF...my daughter. She initially failed her pre-school screen and I took her to about four different ODs in last year before heading to MD. No crossed eyes or other organic disease was noted by ODs or MD. ODs prescriptions were all over ranging about three diopters from around -2 to -5+ bilaterally. MD used cycloplegic/mydriatic, ODs did not. I just want to get her power accurate. To me, -5 seems to be a big progression in only a year from -2. Can an accurate refraction be done without cycloplegia? I am not opposed to its usage. If accuracy requires the drug I will head back to MD for subsequent refractions.
Expert:  Dr. Rick replied 10 months ago.
Danny,

The ODs were wrong not to use the drop in checking your daughters refraction and eyes.

As a father of 5 and an ophthalmologist with over two decades of clinical experience I would never call a refraction on a child the age of your daughter complete without cycloplegia, using Atropine 1% or,sometimes, cyclogel.

An accurate refraction in this age group, in my professional opinion, can not be done without it. And, I must admit, it makes me angry to hear about these 4 ODs and the terrible disservice they have done your family....

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

I wish your daughter the very best :)
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7745
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 10 months ago.


Ok...back to the MD we go! The rigor of USMLE1-3/boards is worth paying more for.


 


I have two or three additional questions. Without getting into tech math (std.dev, etc.) where would -5 fall on the bell curve?


 


How much difference in diopters from one year to the next would raise a red flag?


 


Lastly, slowing/reversing myopia in peds: diet, environment, etc? Ideas from priXXXXX XXXXXterature?


 


My little girl was obviously straining to see correctly when I look back at her toddler pictures. Have a good day!! Thanks for your time.

Expert:  Dr. Rick replied 10 months ago.
Danny,

It really is not thought about in those terms. -5 is just that.....myopia, not a little bit, not a lot, just what the child has. One thing for sure -- it will change over the child's lifetime.

There is no number change that would raise a red flag. Expect it to change and don't worry if it does.

There is nothing that has proven to work to change the course of refractive error in humans. The need for glasses is genetic, complex and not well understood. As long as she can see well with glasses, don't give it too much thought.

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

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