Fatigue reducing glasses?

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JWSIV

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Comp ophtho here
Wondering what's going on with prescribing adolescents glasses with 1.5 add from ODs
I'd think this would prematurely weaken accommodation
Tried researching this and couldn't find any science on it

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How much are they charging for these glasses? I don’t know if it would help or provide placebo effect but I’d tell the patients that they could have gotten the same thing with cheap over the counter readers form the dollar store.
 
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reading glasses for adolescents? Why?
My question exactly
Obvious answer is to sell more glasses (clarification, I’m not prescribing / selling these, but have had several teens / 20s show up with these)
Marketed to reduce “eye fatigue”
Google “anti-fatigue glasses”
 
I’ve seen this as well. Kiddos in middle and high school coming in from outside Optoms with progressives. Has to be a financial motive. I’d imagine it’s some kind of play on people under-minusing a myope to reduce lengthening of a developing eye…but you could also just under-minus someone in an monofocal and save them $300 and the headache of a progressive lens.
 
I’ve seen this as well. Kiddos in middle and high school coming in from outside Optoms with progressives. Has to be a financial motive.
No doubt, financially motivated.
Biggest concern of mine is inducing
premature presbyopia by weakening accommodation. Is this an unfounded concern?
 
Here's a paper showing no help with bifocal to slow down myopia progression.

Pärssinen, O., Kauppinen, M., & Viljanen, A. (2014). The progression of myopia from its onset at age 8-12 to adulthood and the influence of heredity and external factors on myopic progression. A 23-year follow-up study. Acta ophthalmologica, 92(8), 730–739. https://doi.org/10.1111/aos.12387

Bifocal treatment, accommodation stimulus and reading distance​

At the end of the 3-year treatment, myopic progression was not slowed down by using bifocals or by Reading without spectacles (Pärssinen et al. 1989). Thereafter, the children received ordinary fully corrected spectacles with a recommendation of continuous use. Myopic progression up to Follow-up 5 was −3.67 D ± 1.64 in the continuous-use group, −3.67 D ± 1.97 in the distant-use group and −3.76 D ± 1.85 in the bifocal group, with no significant differences between the groups (p = 0.944). There were also no significant differences in myopic progression between the treatment groups when males and females were analysed separately. Thus, in the analyses of this study, the treatment groups are not taken into account.

When the average reading distance calculated from four measurements at childhood and SE at the end of the 3-year follow-up and at the two adult ages was compared, significant correlations were observed among females, and when both sexes were combined (Table 2), the shorter the reading distance in childhood, the greater the myopia in adulthood. However, the correlation did not hold among males. Among females, the correlations between childhood reading distances and SE at different ages remained significant, also after controlling for the age of myopia onset and body height at the respective ages. However, the less the childhood accommodation stimulus, the greater the myopia in childhood, but accommodation stimulus in childhood did not correlate with SE in adulthood.
 
Well this right here is where you can see a training and career split between Optometrists and Ophthalmologists for better or worse. And for the record some I'm sure are just selling progressives for $$ and I don't have a ton of adolescents in Add powers but do have some. I do actually utilize quite a bit of prism. So get ready for some binocular vision review for why some of this might be the case.
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Could have some Convergence excess at near, and they come in complaining of eye fatigue when reading/computer work. Sometimes you'll see them Ortho at distance, but then you do a cover test at near and you'll find that they are 14 eso and maybe a little bit of reduced accommodation. A mild Add power helps their eye posture at near just enough that they are comfortable. I do have some like this that love their progressives and will specifically request it.

That leads to accommodation testing. I am always surprised and recheck again but it can seem like they are faking. But you run them through some accommodation testing and it is poor and all over the place. You'd be surprised by some teenagers or folks in their 20's who you pull down the near card and have difficult getting down on the smaller letters. Again, a mild Add power does wonders and they love it.

Some can have a Convergence Insufficiency Aka will have a High Exo at near where they are using their accommodation all day to keep them at a better eye posture at near. Apparently most do well with "Vision Therapy" for this, I personally don't do this or don't have much thoughts on it, but you can also use a mild Add power so that it relieves some of that excess accommodation they are using at near to keep their eyes at a sustainable posture. Add doesn’t always work because adding that (+) can/will make them even more Exo.

A lot of the time if you are listening to the patient you hear my eyes feel "tired", or things are just "blurry", or sometimes even double vision. It can be easy just to say dry eye and throw an artificial tear at them.

For the double/blurred at distance who have some Divergence insufficiency, especially when driving etc etc check the phoria/cover test out there. Those Esophorias out there will love you for that mild BO prism.

And Bonus, this can be for adolescents or adults: How many hear I have blurred vision when driving, trouble seeing road signs, eyes are tired and blurry especially at the end of the day?

***This has been the biggest patient pleaser I have found, and have gained me patients for life due to this. I've found a lot of these patients aren't actually having blurred vision, but visual disparity. Where there eye posture if off just enough to where it is causing blur but not enough for diplopia. Just doing a quick Von Graefe phorio test in the phoropter and you'll find a ton of small Vertical tropias, or when you open up both eyes in the phoropter you will hear "Ahhh i'm seeing double, and then oops nevermind now it is back to single." Throwing a small amount such as 0.75 or 1.00 base up or down will relieve that double. Have them looking out at distance, place that small amount over the eye and you will hear "Wow, that is so much better." And magically the "tired" or blurred at the end of the day complaints go away. We will hear, these are the best glasses I've ever had, when really it is the same materials and what not, but the BV issues have been addressed

It may sound like BS but test it out, or test yourself. If someone is fine and you throw 1.00 BD in front of the right they won't notice anything. But if they are a 2 RightHyper and it is symptomatic you can put a 1.0BD in front of the right eye and they will say "Much clearer" even though they are probably already seeing ~20/20 or so. But the "blurred vision" isn't from refraction/cataract/whatever it is coming from that slight visual disparity.

So maybe some are being sold for the $$, but I know if you took away that mild prism from some of my patients they'd be back in the office throwing their glasses on the table saying this pair sucks. I'm sure now most of ya'll when you hear "I have blurred vision at the end of the day" are going to starting doing some phoria testing.

My whole point of this post is when you see a little prism, or an Add power in a kid, or really anyone, to you it might seem like pushing glasses but I immediately start running off a checklist in my brain of what other issues could be going on.
 
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So maybe some are being sold for the $$, but I know if you took away that mild prism from some of my patients they'd be back in the office throwing their glasses on the table saying this pair sucks. I'm sure now most of ya'll when you hear "I have blurred vision at the end of the day" are going to starting doing some phoria testing.
I am so glad there are providers like you! Well done, and kudos to you for listening to patients!
 
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