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Question

I'm 33 years old male. In childhood i decived by eye examination. My vision acuity was according me good. After 10 year i have first problems with near [reading, writing]. My first glasses me prescribed no doctor, but opthalmologist. My first pre! scription was at both eyes +1.75D sph.With this glasses i only read and writed. Before 6 months my vision acuity on near worsened. I must visit eye doctor. He examined my vision acuity {without glasses]with results: Right 6/12, Left: 1/60, on distance 33 c! entimetr Right: Jager text No. 6 and Left: Jager text No. 20. Doctor droped in my eyes 1.5% solution of atropin. He droped this solution 3 x daily total 7deys. After this droping was my vision acuity very bad. Doctor examined my vision in full atropin cyclo! plegia with result: Right: 1/60 and Left:1/120. Doctor skiscoped my eye with result: Right: +6.0D sph., Left: +7.75D sph. Before 3 week I must visit again eye doctor. I this time was my visit again good. He examined agai! n my eyes and prescribed my now glasses. Your conclusion - diagnosis was: Hypermetropia gravis oc. utr, esotropia and amblyopia oc. sin, big error of 3D vision - without fusion on near. With full correction R: +6.0D sph and adition +2.5D sph. vision acuity! 6/6 and Jager text No. 1, Left: +7.5D sph. and addition +2.5D vision acuity 6/60 and Jager text No. 20. He my prescribed bifocal lenses. I was very much surpriesed with degree of my vision disorders. I estimated, that my disorders will maximal 2.0D. Doctor! charged me permanently daily wear this bifocal glasses. He said me: never one minut without glasses! But i wear this glasses only at reading and writing. Glasses was for me very unpleasant. One month i was again without glasses. My vision acuity was accord! ing me good. At next examination doctor established, that i wear not new glasses. He me again droped atropin in eyes. I must visit daily this eye ambulation, doctor me droped atropin solution. This droping taken time 3 w! eek. Conclusion my doctor after 3 week droping was: patient! without acomadation spasma. In atropin cycloplegia i must wear glasses permanently. Without glasses was all very much blured.In this time i'm not in cycloplegia, but my vision is not good how after 3week droping. I see blured on long and too on near distan! ce. My acomodation is not so good, so strong. By last examination i see without glasses R:6/24 and L:1/120. But with glasses is vision acuity perfectly 6/6 at right eye. Before 6months i have problem with reading, but this problem was very small. Today i ha! ve big problem with reading and in addition i have problem with vision acuity on long distance [without glasses]. Last week me prescribed "eye patching" plastic disc on righd eyes. I must training "lazy eye". According doctor i must wear minimal. 5 months ! 15 hours daily "eye patchied". I'm teacher and i have 4 month holliday. It is good, i have not problem in job. But with "eye patching" is my vision acuity bad and valking in city is for me very much riscantly. At next w! eek i must visit special orthoptic and pleiotropic treatment. I'm afraid, that doctor estabilish, that i wear not glasses with "eye patching". Doctor me prescribed special glasses for training lazy eye - it is special glasses for dim-sighted. Right lens is ! permanently oclueded, left lens is +7.5D with addition special tubus - telescope with special "Zeiss" lenses. With this special glasses is my vision acuity on lazy eye marked better, than with normal bifocal lenses. I have special PC program for training "l! azy eye" - AMBLY III. According this program i must sit in distance 2 meters at monitor and with mouse [click right, click central or click lef, click no] i must identificate object on monitor {letter E in different rotation]. Computer changed siye of lette! r E and examined my results. If i patching eye full day and presently i trainig with AMBLY III, is me resultst better, than i'm full day without "eye patching". Next week i will examined using amblyoscop and stroboscop.! According doctor i must wear in future full corection with! prisma. I'm alergic - contact and laser surgery is not possible for me. Send me instantly answer on my questions, please:
1. Was edvancement [droping atropin and prescription of full correction]of my doctor right. Doctor is cca 50 year old, is your advancenets actual?
2. 2. Must i necessary wear full correction?
3. Must i necessary wear glasses all dey?
4. Will my vision acuity on near in future better?
5. Why is my vision acuity more worse,than in time when i wear not glasses?
6. Why my left eye crossed only without glasses?
7. Why i must patching right eye?
8. Must i eye patching permanently 15hours daily?
9. Is big blunder, that i read, write and TV watching without eye patched. 10. Can eye doctor estabilish,that i wear not "eye patching"? How? 11. My vision acuity with patched eye is more better with special glasses with Zeiss telecope lenses. May i with this glasses TV watch? 12. Will I must really patched right eye minim. 1.5-2 years? 13. Why my next correction will with PRISMA? What is PRISMA lenses. Is prisma lenses thicker than spheric lenses? 14. Exist any other PC programs on Internet for trainig lazy eye. I like be trained my lazy eye with other PC programs. Send me WWW adress of this programs, please. 15. Exist any Internet PC program for examination of vision acuity and for evaluation of degree of lazy eye? What your WWW adress? 16. What it is AMBLYOSCOP and what is principle examination using amblyoscop? 18. YOU KNOW DETAIL INFORMATIONS ABOUT MY VISION PROBLEMS [VISION ACUITY WITHOUT AND WITH CYCLOPLEGIA, RESULTS OF SKIASCOPIA, MY AGE]. WHAT GLASSES WILL YOU ME PRESCRIBE? HOW WIL I USE THIS YOUR PRESCRIBED GLASSES? HOUW IS YOUR THERAPY OF MY LAZY EYE?

Thanks You very much

(John)

Answer:

Dear John,

Thank you for sharing your case. Latent, uncorrected hypermetropia is discovered frequently in your age group. You will need reading glasses at an earlier age than other people, and you will also need glasses for looking in the distance soon. In addition, your left eye is amblypic (lazy) because it has +7.75 whereas your right eye has +6.00; in other words, as a child you never bothered to focus with your left eye because the right eye already saw a sharp image at 6 diopters of accommodation.
You certainly need glasses all the time, although I personally would not have prescribed bifocals at age 33 and probably had prescribed you +4 and +5, approximately. In these case we let the patient walk around and read in our waiting room with a trial frame containing the glasses. That usually gives clear answers.
Treatment of amblyopia at age 33 is controversial. I know that some ophthalmologists do this, but they form a tiny minority these days. I would not pursue such goal.

(Herb Simonsz, MD, PhD)

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