short sighted only on left eye - why? 
Author Message
 short sighted only on left eye - why?

Hi--
I'm no doctor, so please excuse this question:
I am short sighted, but only on my left eye. My right eye is normal.
I wonder if anybody knows of a theory about the aetiology of this.
Why is it only my left eye?

There was no accident or specific stress on my left eye.

Any ideas?

Andreas



Sat, 13 Dec 1997 03:00:00 GMT
 short sighted only on left eye - why?

Quote:
(Andreas Voigt) writes:

>Hi--
>I'm no doctor, so please excuse this question:
>I am short sighted, but only on my left eye. My right eye is normal.
>I wonder if anybody knows of a theory about the aetiology of this.
>Why is it only my left eye?

>There was no accident or specific stress on my left eye.

>Any ideas?

>Andreas:

It *might* be an adaptive effect, if it's a small amount (say -1.5 or
-2.5), but if it's highly myopic, its a genetic defect which caused the
eye to be too long or the cornea to be too steep (discounting the
possibility of injury, keratoconus, etc.)

Bill



Sun, 14 Dec 1997 03:00:00 GMT
 short sighted only on left eye - why?

Quote:
>It *might* be an adaptive effect, if it's a small amount (say -1.5 or
>-2.5), but if it's highly myopic, its a genetic defect which caused the
>eye to be too long or the cornea to be too steep (discounting the
>possibility of injury, keratoconus, etc.)

Are you saying that it could have been from looking at his notes with his
left eye while looking at the chalkboard with the other, for example? How
often, in your experience, does this happen? I've met quite a number of
people with this kind of anisometropia.

--Alex



Sun, 14 Dec 1997 03:00:00 GMT
 short sighted only on left eye - why?

writes:

Quote:


>>It *might* be an adaptive effect, if it's a small amount (say -1.5 or
>>-2.5), but if it's highly myopic, its a genetic defect which caused the
>>eye to be too long or the cornea to be too steep (discounting the
>>possibility of injury, keratoconus, etc.)

>Are you saying that it could have been from looking at his notes with
his
>left eye while looking at the chalkboard with the other, for example?
How
>often, in your experience, does this happen? I've met quite a number
of
>people with this kind of anisometropia.

My guess is that there is usually no difference in the mechanism for
unilateral myopia than that for bilateral.  I assume in infancy one eye
was more hyperopic than the other.

As he shifted towards myopia in pre-{*filter*} years (from private e-mail
info), the eyes shifted together, except that the less hyperopic eye
became myopic, while the more hyperopic eye ended up about emmetropic.

Assuming somewhat normal binocularity and roughly equal corrected
acuities, your thesis is no doubt how he operates as a result of the
optics involved, but I doubt that his aniosmetropia developed as a
result of that operation.

Bill



Mon, 15 Dec 1997 03:00:00 GMT
 short sighted only on left eye - why?

Quote:

>Several guides we use in behavi{*filter*}optometry:

>Function Alters Structure; how we use ourselved over time will alter
>the structure of ourselves.  Harmon, "We grow along the lines of stress
>to reduces stress."  When the stress is applied asymmetrically the
>adaptation will be asymmetric.  This could be astigmatism or aniso.

>I hope this helps.  I understand that I might have to lay a lot of
>ground work for this.  Let me know if I have communciated in any way.

>Paul Harris, O.D.,F.C.O.V.D., F.A.C.B.O.
>Director, Baltimore Academy for Behavi{*filter*}Optometry

You have communicated, and I would like to ask what I hope is
a related question.

Background:
I usually have about 0.50 D of astigmatism in my left eye.
I have had this for over 15 years, I am 43.
I also have several diopters of nearsightedness in each eye.
I say usually because I beleave I don't have it when I first wake
up in the morning, and sometimes durring the day.
I beleave that I have learned what this astigmatism looks like when
I am looking at a large fat round black circle, or a large fat black
"x" shaped figure.  In particular, when looking at the "x"
the line from upper left to lower right is always sharp and black, but
the line from upper right to lower left is often gray and fuzzy.
I have a large black "x" on the wall near my TV.  When I watch the
TV from about 10 feet away while wearing my 20/40 glasses (these
glasses have no cylinder correction) I often look at the "x" on the
wall when I feel that I am seeing well.  The anoying thing is that
often when I first look at the "x" the two lines look almost the same
and I think that the astigmatism is almost gone, but 5 to 15 seconds later
the upper right to lower left line gets gray and fuzzy again.
It's almost like there is something in my brain/body that says,
"Oh, he is looking for his astigmatism, I know how to make some
for him to see."

Anyway, here are the questions:

If I have a large "x" with one of the arms fuzzy, what should
I do to correct it?  Look back and forth along the fuzzy arm, or
back and forth along the sharp arm?  Should I move only my eyes, or
only my head, or both?
--

"Roman scientists would not even look through Galileo's telescopes."



Tue, 16 Dec 1997 03:00:00 GMT
 short sighted only on left eye - why?

writes:

Quote:


Eulenberg)
>writes:


Stacy) writes:

>>>It *might* be an adaptive effect, if it's a small amount (say -1.5
or
>>>-2.5), but if it's highly myopic, its a genetic defect which caused
the
>>>eye to be too long or the cornea to be too steep (discounting the
>>>possibility of injury, keratoconus, etc.)

>>Are you saying that it could have been from looking at his notes with
>his
>>left eye while looking at the chalkboard with the other, for example?
>How
>>often, in your experience, does this happen? I've met quite a number
>of
>>people with this kind of anisometropia.

>My guess is that there is usually no difference in the mechanism for
>unilateral myopia than that for bilateral.  I assume in infancy one
eye
>was more hyperopic than the other.

PMFJI but.....  One can develop asymmetrically from a starting point of
balance.  Many times there is some slight or subtle problem in the body
that gets reflected through into vision development.  

i.e. chronic earaches in the 18-36 month old and strabismus,

or functional leg length differences developing into hyperphorias,

Several guides we use in behavi{*filter*}optometry:

Function Alters Structure; how we use ourselved over time will alter
the structure of ourselves.  Harmon, "We grow along the lines of stress
to reduces stress."  When the stress is applied asymmetrically the
adaptation will be asymmetric.  This could be astigmatism or aniso.

I hope this helps.  I understand that I might have to lay a lot of
ground work for this.  Let me know if I have communciated in any way.

Paul Harris, O.D.,F.C.O.V.D., F.A.C.B.O.
Director, Baltimore Academy for Behavi{*filter*}Optometry



Tue, 16 Dec 1997 03:00:00 GMT
 short sighted only on left eye - why?
Dennis,

Quote:
>You have communicated, and I would like to ask what I hope is
>a related question.

>Background:
>I usually have about 0.50 D of astigmatism in my left eye.

Low amounts of astigmatism (under 1.00 diopters; NOTE: the border here
is fuzzy) are secondary to other problems in the visual process.  In
optometry we use the minus cylinder notation.  with low cylinders
(-0.25, -0.50 and -0.75) with the axis at 90 the primary problem is a
problem with focusing (we use the term identification but I will use
the narrowly focused term "focusing" here to communicate).  When the
cylinder axis for the same powers is at 180 the primary problem is with
"centering" (orienting ones self in space and localizing one self to
the task at hand).  

During the day, depending on what the person is doing, the amount a
these cylinders can vary.  I generally do not prescribe these small
cylinders and concentrate on treating the underlying problems.  The
axis 90 problems are best treated with (1) appropriate compensatory
lenses at distance (too many times a person has been over-minused) (2)
an appropriate lens for sustained near centered activities (less minus
in the myope and a plus lens for emmetropes.  NOTE: there is no
discussion here of preventing or undoing myopia just simply optimizing
performance.  This is VERY well established in the literature) (3)
visual training for any significant accommodative disorder which the
lenses alone will not deal with.  

When the cylinder axis is at 180 generally vision therapy is the only
way to make major changes although the appropriate plus lens for near
can help also.  

I hope that this answers your questions although I did not get in the
specifics.  I agree that your sight can and most likely does change
throughout the day.  The best way to care for it is to be seen by a
behavi{*filter*}vision care practitioner and with them decide on the best
course of action.  Lenses alone may do the trick!

Hope that helps.

Paul Harris, O.D., F.C.O.V.D., F.A.C.B.O.
Director, Baltimore Academy for Behavi{*filter*}Optometry



Wed, 17 Dec 1997 03:00:00 GMT
 short sighted only on left eye - why?

Quote:

>Dennis,

>>You have communicated, and I would like to ask what I hope is
>>a related question.

>>Background:
>>I usually have about 0.50 D of astigmatism in my left eye.

>Low amounts of astigmatism (under 1.00 diopters; NOTE: the border here
>is fuzzy) are secondary to other problems in the visual process.  In
>optometry we use the minus cylinder notation.  with low cylinders
>(-0.25, -0.50 and -0.75) with the axis at 90 the primary problem is a
>problem with focusing (we use the term identification but I will use
>the narrowly focused term "focusing" here to communicate).  When the
>cylinder axis for the same powers is at 180 the primary problem is with
>"centering" (orienting ones self in space and localizing one self to
>the task at hand).  

>During the day, depending on what the person is doing, the amount a
>these cylinders can vary.  I generally do not prescribe these small
>cylinders and concentrate on treating the underlying problems.  The
>axis 90 problems are best treated with (1) appropriate compensatory
>lenses at distance (too many times a person has been over-minused) (2)
>an appropriate lens for sustained near centered activities (less minus
>in the myope and a plus lens for emmetropes.  NOTE: there is no
>discussion here of preventing or undoing myopia just simply optimizing
>performance.  This is VERY well established in the literature) (3)
>visual training for any significant accommodative disorder which the
>lenses alone will not deal with.  

>When the cylinder axis is at 180 generally vision therapy is the only
>way to make major changes although the appropriate plus lens for near
>can help also.  

>I hope that this answers your questions although I did not get in the
>specifics.  I agree that your sight can and most likely does change
>throughout the day.  The best way to care for it is to be seen by a
>behavi{*filter*}vision care practitioner and with them decide on the best
>course of action.  Lenses alone may do the trick!

>Hope that helps.

>Paul Harris, O.D., F.C.O.V.D., F.A.C.B.O.
>Director, Baltimore Academy for Behavi{*filter*}Optometry

Paul, I am sure you are a very nice fellow and I do not want to be to
critical however, your characterization of different astigmias as being a
symptom of different underlying problems which you wish to treat is
something that I do not believe is taught in any optometry school as
anything like an accepted thing. So my question to you is when you make a
presentation to people do you give them a choice of a standard lens or
the other approach you would suggest- and do you say stuff like 99.9% of
my colleagues do not believe this and it is not taught in any optometry
school in the nation yet I am reasonable convinced we need to treat the
underlying condition. I do not want you to misunderstand me- for I know
there is some probable truth to the things you say exaggerrated as it may
be, what I am really trying to ask you is if you inform your patients
that you are not taking a classical approach and give them a choice. If
you do not then I have a disagreement with you, for like it or not they
will often believe what you say and act on it- I just think they should
have a well informed choice. The other question I have is whether you
dilate peoples eyes or adhere to the old tenet that it only gives you
erroneous ( as in not useful)information. I fully support the concept of
giving people glasses for the task that will improve their comfort and
efficiency.I think enhancement of visual skills is great. I am just not
sure I would classify the need for these things as deeper problem in a
conventional sense.
Hollis Stavn



Tue, 23 Dec 1997 03:00:00 GMT
 short sighted only on left eye - why?
Hollis,

Sorry I didn't get back to you right away.  I was off on Holiday with
my family.....

Quote:
>Paul, I am sure you are a very nice fellow

I like to think so, but this is actually irrelevant to the content.

Quote:
> and I do not want to be to
>critical

I have no trouble with critical.

Quote:
> however, your characterization of different astigmias as >being a
>symptom of different underlying problems which you wish to >treat is
>something that I do not believe is taught in any optometry school as
>anything like an accepted thing.

You are fully entitled to your beliefs.  However, once you become aware
that there is different data that that which was taught one needs to
have a mechanism for dealing with that new data.  I'm not making this
stuff up!

First, is it taught in Op schools?  Not sure.  It was in mine, SUNY.
I'm also sure of some professors at other schools and know that this
would be part of their approach and what they teach.  Second, is it an
accepted thing?  I assume not.  Does that concern me?  NO!  A suggested
reading would be Thomas Kuhn, "The Structure of Scientific Revolution".

Now my sources:  The first writings about this are from Skeffington in
the 1940's and restated by such authors as Hendrickson, McDonald,
Forrest, Birnbaum and many many others.  

Quote:
> So my question to you is when you
>make a presentation to people do you give them a choice of a standard
>lens or the other approach you would suggest- and do you say stuff
>like 99.9% of
>my colleagues do not believe this and it is not taught in any
>optometry school in the nation yet I am reasonable convinced we need
>to treat the underlying condition.

I give all patients four choices in their care.  1- Do nothing (what
would happen if you don't do anyhting different that what you are doing
now.) 2- Compensatory lens (Conventional care) give them the lens which
restores standard distance acuity.  The lens which would be given by
MOST eye care practitioners. 3- Lens treatment alternative (includes
any modification away from the subjective which is given to prevent,
protect or to optimize performance which could include adds, yoked
prisms, cutting minus, cutting cyls, rotating axis towards 90 or 180,
cutting aniso, etc.... (and there are many etcs...)) 4 - VT.  

All patients are given all alternatives in such a manor as to allow
them to make an informed choice as to their vision care.  I do not make
the choice for the patients.  I don't play GOD.  I do however, give (in
my opinion) which alternatives I feel are the best.  I see them ranging
from good, to better to best and do not put a negative on the straight
conventional care.  I do use the word "conventional" BTW.  Also, BTW,
if you think it really is 99.9% you would have another guess coming.
There are many that understand precisely that which I am talking about
here.

Quote:
> I do not want you to misunderstand me- for I know
>there is some probable truth to the things you say exaggerrated as it
>may
>be, what I am really trying to ask you is if you inform your patients
>that you are not taking a classical approach and give them a choice.

I think above should help you understand that I am doing precisely that
which you recommend!

Quote:
> The other question I have is whether you
>dilate peoples eyes or adhere to the old tenet that it only gives you
>erroneous ( as in not useful)information.

Not sure what you are asking here.  I dilate to look at the retina.
Dilation, has little to do with the refraction.  Please clarify here.

Quote:
>I fully support the concept of
>giving people glasses for the task that will improve their comfort and
>efficiency.I think enhancement of visual skills is great. I am just
>not sure I would classify the need for these things as deeper problem
>in a conventional sense.

I'm not sure I understand you here either.  Please clarify your comment
so I can get back to you on this.

Paul Harris, O.D., F.C.O.V.D., F.A.C.B.O.
Director, Baltimore Academy for Behavi{*filter*}Optometry



Sat, 27 Dec 1997 03:00:00 GMT
 short sighted only on left eye - why?

Quote:

>I give all patients four choices in their care.  1- Do nothing (what
>would happen if you don't do anyhting different that what you are doing
>now.) 2- Compensatory lens (Conventional care) give them the lens which
>restores standard distance acuity.  The lens which would be given by
>MOST eye care practitioners. 3- Lens treatment alternative (includes
>any modification away from the subjective which is given to prevent,
>protect or to optimize performance which could include adds, yoked
>prisms, cutting minus, cutting cyls, rotating axis towards 90 or 180,

How would rotating the axis towards 90 or 180 help the patient?

Quote:
>cutting aniso, etc.... (and there are many etcs...)) 4 - VT.  

What is aniso?
--

"Roman scientists would not even look through Galileo's telescopes."


Fri, 02 Jan 1998 03:00:00 GMT
 short sighted only on left eye - why?

writes:

Quote:
>How would rotating the axis towards 90 or 180 help the patient?

>(...)
)>
>What is aniso?

I have never heard of purposely Rxing a cylinder off axis, except in
this thread.  The resulting astigmatic error would be most annoying to
most, especially if the cylinder is significant (over 1.00 d.).  

Anisometropia is a condition where the refractive errors for the two
eyes of a patient are significantly different from each other.

Bill



Sat, 03 Jan 1998 03:00:00 GMT
 short sighted only on left eye - why?
Dennis,


writes:

Quote:


Harris) writes:

>>I give all patients four choices in their care.  1- Do nothing (what
>>would happen if you don't do anyhting different that what you are
doing
>>now.) 2- Compensatory lens (Conventional care) give them the lens
which
>>restores standard distance acuity.  The lens which would be given by
>>MOST eye care practitioners. 3- Lens treatment alternative (includes
>>any modification away from the subjective which is given to prevent,
>>protect or to optimize performance which could include adds, yoked
>>prisms, cutting minus, cutting cyls, rotating axis towards 90 or 180,

>How would rotating the axis towards 90 or 180 help the patient?

I just was mentioning this as an option.  Since the major axes of most
astigmia are 90 or 180 there might be times, to facilitate a better
overall posture (particularly if the patient is working with a
chiropractor, Alexander or Feldenkrais therapist, etc).

See my post on astigmatism. about 2 weeks ago.

Quote:
>>cutting aniso, etc.... (and there are many etcs...)) 4 - VT.  

>What is aniso?
>--

Different amounts of myopia or hyperopia in each eye.  Example:
Right eye -2.00
 Left eye -5.00

Paul Harris, O.D., F.C.O.V.D., F.A.C.B.O.
Director, Baltimore Academy for Behavi{*filter*}Optometry



Sun, 04 Jan 1998 03:00:00 GMT
 short sighted only on left eye - why?
Hollis


writes:

Quote:

>Dear Paul,

>Cycloplegia can also give you refractive information in some folks
>that you are
>going to get otherwise. It is an added tool.

I agree.  I have it in my arsenal and my choose to use it in the
future.  Right now is has not been necessary.

Quote:
> I appreciated your comments about the
>choices you give people.  I know that people can do well the way you
>rx them, and
>that there are for sure probably some people who are more comfortable
>with what you
>give them than what someone else may, I mean there are other
>considerations than
>20/20 at 6 meters.

We agree fully here.

Quote:
> I just wonder if you are overminusing them to begin with by not
>using a cycloplegic and then backing off a bit to give them the
>correct
>prescription.

The word "correct" here is interesting.  I don't really see a
correctness about this at all.  There are different levels of lenses
which will be available to do the job at different levels.

Example: For my professional athletes I don't cut anything for their
Rx's for competition.  I give the absolute optimum performance lens.
One of the criteria I use for determining this is once I have reached
the power that is my least minus to 20/20 I begin adding minus
binocularly asking the question, "Which is larger?" not "Which is
blacker and clearer?".  I find that the percieved size change is a good
criteria to use here.  When the more minus lens makes it larger it is
something that will aid them in performance now.  Now, I also may make
them a second pair of glasses for general walking around that don't
have soooo much minus or just another pair for reading with a bifocal
etc.  Don't think that I never prescribe full minus.  

The idea is that different people have different needs and we have to
be open to them and serve them.  

We must also understand that the manifest refraction will vary during
the day and during the week, more so if the person has a near centered
task that they do at work.  Possibly by knowing about and taking into
considerations these cycles I have not needed the cycloplegic.  

BTW, these cycles operate over long periods of time also.  Example, I
treat a first time myope in June different than in September.  The one
in June who is 20/40 uncompensated showing -0.50 may get no lens at all
because I might expect the finding to dissipate over the summer.  But
the same finding in September generally will not go back to plano or
into plus with the demands of school work working on the child.

Quote:
> Hyperopea usually give you different data, as do pre presbyopes,
>accommodative excesses etc.

BTW, you should know that I am a reformed hyperope!  I was +2.50 in the
left eye and +2.25 in the right for 10 years!  I wore a +1.50 add and
was measured with a 14 to 1 AC/A ratio!  I was not hyperopic beyond
+1.00 until the age of 15.  From the age of 10-15 I was a subject in
the most intensive longitudinal myopia research project ever done.  I
have the data on myself which includes wet and dry refractions, A-scan,
measures of the radii of curvature of my lens (front and back) my
cornea (front and back surface), full analyticals as well as lots of
other data.  I developed the adverse hyperopia after the study was
over.  I wore the above Rx for 10 years and now only wear plano/+1.50
add for near.  I am now 41 and my distance refractive findings are
about +1.00 in the distance.  

Quote:
> I am just saying thjat if you do not do this in your
>quest to be more thorough than anyone else you are leaving out
>information everyone
>else would have which puts you at a disadvantage.

Thank you for your opinion.

If I get some time I will be glad to load up a case or two.  In fact,
maybe we can do one like a grand rounds.  I could load up my data, all
of it on a case and let the forum have at it in terms of what they
would prescribe and why.  Then, I will give what I did and the outcome
of the case.  Anybody game????

Paul Harris, O.D., F.C.O.V.D., F.A.C.B.O.
Director, Baltimore Academy for Behavi{*filter*}Optometry



Mon, 05 Jan 1998 03:00:00 GMT
 short sighted only on left eye - why?
Dear Paul,

Cycloplegia can also give you refractive information in some folks that you are
going to get otherwise. It is an added tool. I appreciated your comments about the
choices you give people.  I know that people can do well the way you rx them, and
that there are for sure probably some people who are more comfortable with what you
give them than what someone else may, I mean there are other considerations than
20/20 at 6 meters. I just wonder if you are overminusing them to begin with by not
using a cycloplegic and then backing off a bit to give them the correct
prescription. Hyperopea usually give you different data, as do pre presbyopes,
accommodative excesses etc. I am just saying thjat if you do not do this in your
quest to be more thorough than anyone else you are leaving out information everyone
ele would have which puts you at a disadvantage.

Best Wishes,

Why don't you give us some examples of a person or two you saw last week for whom
you did something different than a regular optometrist would do and why and what
benefit there was to them. Don't get me wrong- I am not trying to suggest you
refract like an ophthalmologist- just that sometimes it certainly saves a great deal
of time. Why those guys get refractions down to 6 minutes- that is impressive
efficiency.

Hollis Stavn



Mon, 05 Jan 1998 03:00:00 GMT
 
 [ 14 post ] 

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