Eye

Ask an Eye Doctor and Get an Answer ASAP

Ask a Doctor,
Get an Answer ASAP!

Eye
This answer was rated:

I hope you can help me regarding this fairly rare matter. I

Hello Doctor, I hope you can...
Hello Doctor,
I hope you can help me regarding this fairly rare matter.
I have been diagnosed with an accommodative spasm at both eyes. I am 28 years old.
Refraction with cyclopegia (Atropine) : + 0,50 (slight hyperopia)
Refraction WITHOUT cyclopegia : - 4,50 (pseudomyopia)
This constant spasm appeared right after a lasik surgery, 6 month ago.
However, before the surgery, there was no difference found between cyclopegic and non-cyclopegic refraction. I was hyperopic, +3,50 for the right eye and +2,00 for the left one
This situation causes me constant headaches and very blurry vision for targets near AND far.
I have to strain a lot to get images into focus which is exhausting. Of course I cannot hold accommodation all the time with such a big spasm, at rest everything is blurry.
To relieve the symptoms I had atropine for 3 months (1 drop per day in each eye), thanks to these drops my vision was perfect for targets far. During this time I used +3.00 readers for close vision.
My problem is : After 3 months i stopped the drops and when atropine wore off (2 weeks later which is quite long), accommodative spams came back.
My surgeon doesn't know what to do anymore. I have been to other ophtalmologists and unfortunately, they have no further idea.
I live in France and unfortunately, there are no neuro-ophtalmologists like in the US (I read that ciliary muscle contraction is linked to neurologic system)
I have got 2 questions in my mind :
1) Should I try atropine longer (1 year ?). Are there risks for the retina by having a long-term atropinization ?
2) In my case, as the 3-month atropine treatment didn't work, do you think that a clear lens extraction could be a good idea ?
I would be very grateful if you could advise me.
Thank you
Show More
Show Less
Ask Your Own Eye Question
Answered in 1 hour by:
6/20/2013
Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11,511
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Verified
Dr. Rick :

Hi. My name is***** and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

Sorry to hear about all the difficulties you have been having. As a retina surgeon, let me go over your questions in order:

Dr. Rick :

1. Yes. I believe using the atropine for a year is a good idea. There are no significant risks to the retina from long term atropine use.

Dr. Rick :

2. I would not rush to a clear lens extraction, especially since you seem willing to give the atropine treatment a longer trial. Obtaining the correct post-operative refraction with clear lens extraction can be complicated after having had lasik surgery. You run the risk of making things worse....and you can not "undo" surgery.

Dr. Rick :

If things do not change after a year of atropine, then you might need surgical treatment...

Dr. Rick :

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

Dr. Rick :

Hi. Are you there?

Customer:

Thank you for your answer

Customer:

Yes I am here

Dr. Rick :

My pleasure. Is there anything else you would like to ask me tonight?

Dr. Rick :

(it is 8 pm here in the USA

Customer:

I just would like some further information about point 2

Dr. Rick :

ok

Customer:

In France it's 3 am :D

Customer:

you say it's complicated to have a correct refraction for the implant after lasik surgery

Customer:

but i wonder why ?

Dr. Rick :

After lasik surgery it is hard to select the intraocular lens power after your natural lens is removed. If this were to happen you might need to use thicker glasses after the lens extraction than you did before lasik surgery. This is why I counsel patience.

Dr. Rick :

It has to do with the formula for calculating intraocular lens power....

Dr. Rick :

does this make sense to you?

Customer:

ok that's very clear, thank you. i don't care about having glasses again, i've been through a lot of pain with my spasm, especially when it was not diagnosed yet

Dr. Rick :

I can understand your pain and frustration :(

Dr. Rick :

I hope things get better soon.

Customer:

and would you advise to have clear lens extraction for both eyes if atropine doesn't work ?

Customer:

or try just one eye ?

Dr. Rick :

I'd try one eye first and see how it goes.....

Customer:

okay

Customer:

do you also know if the ciliary muscle could "push" the implant ?

Customer:

because it couldn't change the shape of the implant, but i was thinking that maybe it could move it

Customer:

if the spasm is still active

Dr. Rick :

No. The ciliary muscle will not be able to move the implant. No worries there.

Customer:

that's at least one good news :-)

Dr. Rick :

Glad to be the bearer of good news :)

Customer:

would you recommend monofocal implant ?

Dr. Rick :

Yes...especially after all you have been through...keep it simple..

Customer:

that's what i think as well, i don't want to take further risks if long term atropinization doesn't work

Customer:

thank you for your answers

Dr. Rick :

My pleasure. Take care.

Dr. Rick :

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11,511
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Verified
Dr. Rick and 87 other Eye Specialists are ready to help you
Ask your own question now
Just one more thing: I do not think there is much, if any, long term risk to using atropine. I'd not worry about giving this a try, even for a year.
Ask Your Own Eye Question
Customer reply replied 4 years ago

I have got 3 more technical questions, if you think you would be able to answer them :-)

1. Is there any drop, or another possibility than atropine to paralyse accommodation, without having pupil dilated ?

Because I am always blinded when outdoors, even with sunglasses it is sometimes difficult to stand the light when it is very sunny.

For example, small quantities of botulinum toxin can be used to weaken some overactive muscles (for strabismus...). Is it possible to paralyse the ciliary muscle with this substance ?

2. How is it possible to get an accommodative spasm with such a huge amplitude (5 diopters) right after a lasik surgery ?

Because there are some cases of ciliary spasms released in scientific publications which lead to a difference of 0.25 or 0.50 diopters, sometimes 1 diopter, but my case seems to be nearly unique. All the lasik specialists I met since my surgery told me I was the first one to have a spasm of this amplitude (in france where there are however 150'000 lasik surgeries per year which is a lot).

I found some cases with the same amplitude as me, but for people who have got some head trauma after an accident.

3. Do you know if there is some medical research in the world about accommodative spasm ? Or regarding links between autonomic nervous system and ciliary muscle ?

From what I read in publications, the origin of this phenomenon is relatively unknown

Thank you.

1. Atropine is the best and, unfortunately, there is no drop that will stop accomodative spasm and, as the same time, not dilate your pupil.
2. That is a great question...and I don't know :(
3. The best place in Europe to get help and state-of-the-art care with this issue would be at Moorfields Eye Hospital. They are, without a doubt, one of the best eye hospitals in the world. If anyone can figure this out, it would be them :) Here is a link to their web page:
http://www.moorfields.nhs.uk/Home
Does this make sense to you?
It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Ask Your Own Eye Question
Customer reply replied 4 years ago

Ok perfect,

I think we have examined the question from all sides.

Thank you very much for your accurate answers

My pleasure. I wish you the very best. :)
Ask Your Own Eye Question
Hi John,
I was just thinking about you today and wondering if you have had a chance to speak to the doctors at Moorfields. I hope you are on the road toward getting some solutions to your spam.
Let me know if there is anything else I can do to help you.
Dr. Rick MD FACS
Ask Your Own Eye Question
Customer reply replied 4 years ago

Thank you for your help.

No I didn't make an appointment at Moorfields yet, and I am not sure if my spoken english is good enough for that. I searched for e-mail contacts to ask some advice but it seems that it's only possible to make a new appointment.

I must see two more specialists my surgeon recommended to me, as wella as an eye hospital in Paris (Les Quinze Vingts), then if i have the feeling that i get no satisfactory answer i will get in touch with Moorfields

John,
You don't type with an accent lol!
I'm sure that there is an institute in France that can help, I just don't know much about your country -- you might ask around....
Let me know if there is anything else I can do to help.
Ask Your Own Eye Question
Ask Dr. Rick Your Own Question
Dr. Rick
Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11,511
11,511 Satisfied Customers
Experience: Ophthalmology since 1994 with Retina sub-specialty interest

Dr. Rick is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me.

Susan O.USA

Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help.

Mary C.Freshfield, Liverpool, UK

This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!!

AlexLos Angeles, CA

Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult.

GPHesperia, CA

I couldn't be more satisfied! This is the site I will always come to when I need a second opinion.

JustinKernersville, NC

Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around.

EstherWoodstock, NY

Thank you so much for taking your time and knowledge to support my concerns. Not only did you answer my questions, you even took it a step further with replying with more pertinent information I needed to know.

RobinElkton, Maryland

< Previous | Next >

Meet the Experts:

Dr. Dan B.

Dr. Dan B.

Board Certified Ophthalmologist

3,334 satisfied customers

Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology

Dr. Stan

Dr. Stan

Ophthalmologist

905 satisfied customers

Johns Hopkins Fellowship Trained, Certified and Licensed Medical Physician and Surgeon

Dr. Stevens

Dr. Stevens

Ophthalmologist

629 satisfied customers

Board Certified Ophthalmologist

Dr. Susan

Dr. Susan

Ophthalmologist

217 satisfied customers

Board Certified & Fellowship trained eye surgeon.

Dr. JP

Dr. JP

Ophthalmology, Oculoplastic Surgery

28 satisfied customers

Harvard Medical School, Massachussetts Eye and Ear

Dr-Trace

Dr-Trace

Board Certified Ophthalmologist

26 satisfied customers

Board Certified in General Ophthalmology

Dr. Daniel Jewelewicz

Dr. Daniel Jewelewicz

Board Certified Ophthalmologist

11 satisfied customers

Glaucoma Specialist, Associate Professor FAU, Teaching Faculty Bascom Palmer Eye Institute

< Previous | Next >

Related Eye Questions
I had cataract surgery and had a multifocal lens implanted.
Hello, I had cataract surgery and had a multifocal lens implanted. From the beginning I've seen halos around bright lights at night. But for a few weeks watching TV was great, then credits in bright c… read more
Dr. Rick
Dr. Rick
Board Certified MD
11,511 satisfied customers
Has lasik to correct near sightedness 16 years ago.
Has lasik to correct near sightedness 16 years ago. Excellent results. Over time vision got blurry. Had a second lasik on Sept 22, 2017. This time they did monovision. After 7 weeks vision was still q… read more
Gaurav Gupta
Gaurav Gupta
MD, CEO
Post-Doctoral Degree
22 satisfied customers
I see through cracked glass only in the morning goes away
I see through cracked glass only in the morning goes away after a short while is that a retnal detachment … read more
Gaurav Gupta
Gaurav Gupta
MD, CEO
Post-Doctoral Degree
22 satisfied customers
Can a Technis ZLB00 lens be defective? I am having double
Can a Technis ZLB00 lens be defective? I am having double vision when looking out the side of my eye to the left. Looking straight on, the vision is almost sharp, but as I turn my head to the right, a… read more
Dr. Rick
Dr. Rick
Board Certified MD
11,511 satisfied customers
Am 68 years old. I had lasik surgery in September of 2000
am 68 years old. I had lasik surgery in September of 2000 and a final adjustment in January of 2001. After 10 years I had cataract surgery in my right eye with a toric lens being installed. I was left… read more
Dr. Thomas, MD
Dr. Thomas, MD
2,227 satisfied customers
I have strabismus, with my left eye stronger than my right.
I have strabismus, with my left eye stronger than my right. Lately I've been feeling a little light headed, but attributed it to seasonal allergies. Two days ago, when I went from a dimly-light hallwa… read more
Dr. Thomas, MD
Dr. Thomas, MD
2,227 satisfied customers
The last time I got glasses my doctor said I have the
The last time I got glasses my doctor said I have the beginnings of cataracts. He said it won't affect me for a while. I'm wondering if lasic eye correction would help with that. Let me know if this i… read more
Dr. Rick
Dr. Rick
Board Certified MD
11,511 satisfied customers
Out of nowhere I seem to have a line of blurry vision in
out of nowhere I seem to have a line of blurry vision in both eyes that is really disorienting … read more
Dr. Chip
Dr. Chip
M.D.
12,944 satisfied customers
I am 46 years old. Last Thursday, I had Lasik surgery. I
My name is***** am 46 years old. Last Thursday, I had Lasik surgery. I could not read small print without readers but I felt as though my long distance vision was good. Since Lasik, I feel as though m… read more
Gaurav Gupta
Gaurav Gupta
MD, CEO
Post-Doctoral Degree
22 satisfied customers
My 12 year old started out complaining of blurry vision- ER
My 12 year old started out complaining of blurry vision- ER visit diagnoses uveitis. That was 7 weeks ago. He has since had the other diagnosed as well. Struggling with day to day. He has IBS so we ha… read more
Dr. Longo
Dr. Longo
Optometrist
Doctor of Optometry
42 satisfied customers
I have mild blurry vision in my right eye. Had eye exam and
I have mild blurry vision in my right eye. Had eye exam and new glasses in June. No issues. My eye doc took pictures on Tuesday and said I have an infarct in the eye. Said I have symptoms of severe di… read more
Dr. Rick
Dr. Rick
Board Certified MD
11,511 satisfied customers
I briefly stepped outside without my sunglasses but I'm
I briefly stepped outside without my sunglasses but I'm worried that the exposure to UVA rays might have caused some eye damage. How long does it take for UVA rays to damage eyes? Is just a few second… read more
Dr Uzair
Dr Uzair
FCPS (R) General Surgery
M.B.,B.S. FCPS
3,670 satisfied customers
I was outside Sunday and only wore my sunglasses for a short
I was outside Sunday and only wore my sunglasses for a short time. when I woke up Monday morning, I felt like I have vertigo. Today I still have the dizzyness but my eyes do not dialate and they are a… read more
Dr. Mo
Dr. Mo
Board Certified Physician
MD
1,423 satisfied customers
I had a question on lasik. I had lasik 7 days ago and
yes, I had lasik 7 days ago and although I am experiencing great vision I have a question about an issue for you does lasik cause nerve damage to the cornea nerve and is that why i am experiencing dry eye? … read more
Dr. Longo
Dr. Longo
Optometrist
Doctor of Optometry
42 satisfied customers
I'm having blurry vision after being pepper sprayed. I'm not
I'm having blurry vision after being pepper sprayed. I'm not sure what kind of spray it was. I was able to see yesterday but when I woke up today my eyes were blurred … read more
Dr Stan
Dr Stan
DO
2,364 satisfied customers
I just has Strabismus surgery June 2nd. today I noticed a
today I noticed a bubble wondering if it's just chemosis or something I should address at the hospital. How can I send a picture Dr? … read more
Dr. Longo
Dr. Longo
Optometrist
Doctor of Optometry
42 satisfied customers
Will this blurry vision following a detached viterous humor
Will this blurry vision following a detached viterous humor subside with time? Also may I continue running after this? … read more
Dr. A.S. Desai
Dr. A.S. Desai
Board certified general ophthalmologist
Master\u0027s Degree
1,570 satisfied customers
I have had blurry vision in one eye when waking up in the
Hello, I have had blurry vision in one eye when waking up in the morning on and off for months now, today I woke up to a red blood spot on my eye and its also quite blood shot. I wear glasses but when… read more
Dr. Rick
Dr. Rick
Board Certified MD
11,511 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x