On May 5, 9:32 pm, "David Robins, MD" <trasha... at (no spam) runbox.com> wrote:
On 5/5/08 5:42 PM, in article
be7a4524-2b14-4f0b-9fa4-d3ba98faa... at (no spam) u12g2000prd.googlegroups.com, "douglas"





Protoman2... at (no spam) gmail.com> wrote:
On May 3, 10:19 pm, "David Robins, MD" <trasha... at (no spam) runbox.com> wrote:
On 5/3/08 3:00 PM, in article 481cdf4b$0$828$58c7a... at (no spam) news.kabelfoon.nl,

"Jan" <nos... at (no spam) nospam.nl> wrote:
douglas schreef:
On May 3, 2:34 pm, Jan <nos... at (no spam) nospam.nl> wrote:
douglas schreef:

I was reading a clinical trial "A randomized trial of atropine vs.
patching for treatment of moderate amblyopia in children", in the
March 2002 issue of Archives of Ophthalmology. My optometrist, Dr
Ryan, says that I need to be patched, but the study says that atropine
is equally effective. My prescription in my amblyopic eye is -11.25
-2.50x178, SER of -12.50. My left eye is around a -3.00 to a -3.75.
What acuity does that translate into? Should I take the results of the
study over Dr Ryan, or what? I don't think Dr Ryan read the study.
Thanks!
Otis Brown, I hereby command you not to proffer your counsel. Amen.
Douglas, you are fake.
A 16 year old getting the advice to patch one eye?

Jan (normally Dutch spoken)

BTW, this newsgroup is not moderated, so you and other fake people can't
be avoided.

Yes he did say that. He said "it's still possible to get some
improvement".

Sure, temporarily at the moments you are patched it might be possible.

  Also, this study "Randomized Trial of Treatment of
Amblyopia in Children Aged 7 to 17 Years", in the April 2005 issue,
says it's possible. So there.

And isn't amblyopia caused by the ciliary muscles in the amblyopic eye
not fully developing?

Douglas you still are a fake.
Try to google on amblyopia or better read a good book about the subject,
(and no, I'm not given advises which book you should read)

  So, shouldn't simply disabling the ciliary
muscles, instead of occluding, the good eye reach the same effect,
more efficiently, w/ a better quality of life?

First try to became familiar with the real knowledge needed before you
put one and two together.

Jan (normally Dutch spoken)

Actually, they ARE studying the efficacy of patching  older ages than have
traditionally been treated. Textbooks used to say to reason to patch after
age 8. However, the brain is still developing in some past that age, and we
(I, at least) routinely patch kids 9-11 years old and get some effect.
Obviously, it doesn't work well if they are very amblyopic, and won't work
at all if they cannot co the treatment hours necessary. The older kids take
much more patching than the younger kids. Thus, this interferes with
school,
homework, and other activities, and they are often failures due to being
unable to patch enough.

I will also say that the results of some of the PEDIG (Pediatric Eye
Diseases Group) studies that are being quoted have to be taken with a grain
of salt. I know the people publishing all this, Dr. Mike Repka from Wilmer
at Hopkins, where I did my training. For example, they say 2 hrs is as
effective as 6 hrs of patch, and 6 hrs is as effective as full-time, but we
all know that is not true for everyone, and has to be tailored to the
individual.

Regarding atropine: amblyopia is not due to the ciliary muscle, etc as
mentioned. It is due to the brain have received a blurry image, or a
conflicting image (as in strabismus), and not learning to see well.
Atropine
works by blurring the image for near, at reading distance, and really only
works if the blurred image is blurry enough to switch fixation preference
to
the amblyopic eye so it is being used. Therefore, it works only in low to
moderate amblyopes, since it can't blur the image enough in bad amblyopes.
You can help it along by using glasses that are sufficiently "wrong" so as
the blur the eye at near in addition to the atropine. Problem is, one is
not
reading all day, so it only is treating part of the time. In addition, some
feel that light getting in the better eye still competes with the amblyopic
eye, and slows treatment. Also, atropine is basically all or none; you
can't
really modulate it the way you can with adjusting number of hours of
patching.

I use atropine when I can't use a patch due to poor cooperation, or when I
am patching all out-of-school hours, and need more, but don't want to patch
in school. I also sometimes use it as maintenance after stopping patching.

Regarding the amblyopia treatment in this highly anisometropic myope, he
has
not told us what his visual acuity is. He still thinks looking at the
eyeglass power tells you what vision this corresponds to. This kind of
amblyopia is probably severe, and rather resistant to treatment anyway, but
who knows, there still might be some improvement with patching. I think
atropine would be a waste of time if there is any significant amblyopia.


Now, I will also tell you that I have seen some prominent specialists use
full-time patching in full-grown adults (age 40, etc), and get some
improvement. We all joked because he was in Iowa, and we said, sure, you
can
tell only an Iowa farmer to patch all day for a year ...  (this was Dr.
William Scott, in Iowa City, very respected, now retired).

David Robins, MD
Board certified Ophthalmologist
Pediatric ophthalmology and adult strabismus subspecialty- Hide quoted text
-

- Show quoted text -

Great! I was getting tired of Jan calling me a liar. Could severe,
untreated-for-decades amblyopia cause optic nerve degeneration?

No.
Amblyopia is a brain problem, NOT an optic nerve problem.
Amblyopia cannot influence the health of the optic nerve.- Hide quoted text -

- Show quoted text -

But don't nerves that aren't stimulated atrophy?

On May 5, 9:30 pm, "David Robins, MD" <trasha... at (no spam) runbox.com> wrote:
On 5/5/08 5:45 PM, in article
4de2f189-bbcc-45a0-882e-2aa7ac705... at (no spam) w5g2000prd.googlegroups.com, "douglas"





Protoman2... at (no spam) gmail.com> wrote:
On May 3, 10:19 pm, "David Robins, MD" <trasha... at (no spam) runbox.com> wrote:
On 5/3/08 3:00 PM, in article 481cdf4b$0$828$58c7a... at (no spam) news.kabelfoon.nl,

"Jan" <nos... at (no spam) nospam.nl> wrote:
douglas schreef:
On May 3, 2:34 pm, Jan <nos... at (no spam) nospam.nl> wrote:
douglas schreef:

I was reading a clinical trial "A randomized trial of atropine vs.
patching for treatment of moderate amblyopia in children", in the
March 2002 issue of Archives of Ophthalmology. My optometrist, Dr
Ryan, says that I need to be patched, but the study says that atropine
is equally effective. My prescription in my amblyopic eye is -11.25
-2.50x178, SER of -12.50. My left eye is around a -3.00 to a -3.75.
What acuity does that translate into? Should I take the results of the
study over Dr Ryan, or what? I don't think Dr Ryan read the study.
Thanks!
Otis Brown, I hereby command you not to proffer your counsel. Amen.
Douglas, you are fake.
A 16 year old getting the advice to patch one eye?

Jan (normally Dutch spoken)

BTW, this newsgroup is not moderated, so you and other fake people can't
be avoided.

Yes he did say that. He said "it's still possible to get some
improvement".

Sure, temporarily at the moments you are patched it might be possible.

  Also, this study "Randomized Trial of Treatment of
Amblyopia in Children Aged 7 to 17 Years", in the April 2005 issue,
says it's possible. So there.

And isn't amblyopia caused by the ciliary muscles in the amblyopic eye
not fully developing?

Douglas you still are a fake.
Try to google on amblyopia or better read a good book about the subject,
(and no, I'm not given advises which book you should read)

  So, shouldn't simply disabling the ciliary
muscles, instead of occluding, the good eye reach the same effect,
more efficiently, w/ a better quality of life?

First try to became familiar with the real knowledge needed before you
put one and two together.

Jan (normally Dutch spoken)

Actually, they ARE studying the efficacy of patching  older ages than have
traditionally been treated. Textbooks used to say to reason to patch after
age 8. However, the brain is still developing in some past that age, and we
(I, at least) routinely patch kids 9-11 years old and get some effect.
Obviously, it doesn't work well if they are very amblyopic, and won't work
at all if they cannot co the treatment hours necessary. The older kids take
much more patching than the younger kids. Thus, this interferes with
school,
homework, and other activities, and they are often failures due to being
unable to patch enough.

I will also say that the results of some of the PEDIG (Pediatric Eye
Diseases Group) studies that are being quoted have to be taken with a grain
of salt. I know the people publishing all this, Dr. Mike Repka from Wilmer
at Hopkins, where I did my training. For example, they say 2 hrs is as
effective as 6 hrs of patch, and 6 hrs is as effective as full-time, but we
all know that is not true for everyone, and has to be tailored to the
individual.

Regarding atropine: amblyopia is not due to the ciliary muscle, etc as
mentioned. It is due to the brain have received a blurry image, or a
conflicting image (as in strabismus), and not learning to see well.
Atropine
works by blurring the image for near, at reading distance, and really only
works if the blurred image is blurry enough to switch fixation preference
to
the amblyopic eye so it is being used. Therefore, it works only in low to
moderate amblyopes, since it can't blur the image enough in bad amblyopes.
You can help it along by using glasses that are sufficiently "wrong" so as
the blur the eye at near in addition to the atropine. Problem is, one is
not
reading all day, so it only is treating part of the time. In addition, some
feel that light getting in the better eye still competes with the amblyopic
eye, and slows treatment. Also, atropine is basically all or none; you
can't
really modulate it the way you can with adjusting number of hours of
patching.

I use atropine when I can't use a patch due to poor cooperation, or when I
am patching all out-of-school hours, and need more, but don't want to patch
in school. I also sometimes use it as maintenance after stopping patching.

Regarding the amblyopia treatment in this highly anisometropic myope, he
has
not told us what his visual acuity is. He still thinks looking at the
eyeglass power tells you what vision this corresponds to. This kind of
amblyopia is probably severe, and rather resistant to treatment anyway, but
who knows, there still might be some improvement with patching. I think
atropine would be a waste of time if there is any significant amblyopia.


Now, I will also tell you that I have seen some prominent specialists use
full-time patching in full-grown adults (age 40, etc), and get some
improvement. We all joked because he was in Iowa, and we said, sure, you
can
tell only an Iowa farmer to patch all day for a year ...  (this was Dr.
William Scott, in Iowa City, very respected, now retired).

David Robins, MD
Board certified Ophthalmologist
Pediatric ophthalmology and adult strabismus subspecialty- Hide quoted text
-

- Show quoted text -

I forgot what Dres Hertzog and Ryan said my acuity is...it's like
20/80 in my right. But I'm not sure. It's pretty bad. My left is
around 20/35.

If it is 20/80, that is not SEVERE amblyopia.- Hide quoted text -

- Show quoted text -

OK, the power diff in my eyes is over 8 diopters...Dr Ryan says your
brain can only tolerate a 3 diopter difference.

On 5/5/08 10:04 PM, in article
c4c2bc1c-72bd-47a8-922c-044a18bfa... at (no spam) w4g2000prd.googlegroups.com, "douglas"





Protoman2... at (no spam) gmail.com> wrote:
On May 5, 9:32 pm, "David Robins, MD" <trasha... at (no spam) runbox.com> wrote:
On 5/5/08 5:42 PM, in article
be7a4524-2b14-4f0b-9fa4-d3ba98faa... at (no spam) u12g2000prd.googlegroups.com, "douglas"

Protoman2... at (no spam) gmail.com> wrote:
On May 3, 10:19 pm, "David Robins, MD" <trasha... at (no spam) runbox.com> wrote:
On 5/3/08 3:00 PM, in article 481cdf4b$0$828$58c7a... at (no spam) news.kabelfoon.nl,

"Jan" <nos... at (no spam) nospam.nl> wrote:
douglas schreef:
On May 3, 2:34 pm, Jan <nos... at (no spam) nospam.nl> wrote:
douglas schreef:

I was reading a clinical trial "A randomized trial of atropine vs..
patching for treatment of moderate amblyopia in children", in the
March 2002 issue of Archives of Ophthalmology. My optometrist, Dr
Ryan, says that I need to be patched, but the study says that atropine
is equally effective. My prescription in my amblyopic eye is -11.25
-2.50x178, SER of -12.50. My left eye is around a -3.00 to a -3.75.
What acuity does that translate into? Should I take the results of the
study over Dr Ryan, or what? I don't think Dr Ryan read the study..
Thanks!
Otis Brown, I hereby command you not to proffer your counsel. Amen.
Douglas, you are fake.
A 16 year old getting the advice to patch one eye?

Jan (normally Dutch spoken)

BTW, this newsgroup is not moderated, so you and other fake people can't
be avoided.

Yes he did say that. He said "it's still possible to get some
improvement".

Sure, temporarily at the moments you are patched it might be possible.

  Also, this study "Randomized Trial of Treatment of
Amblyopia in Children Aged 7 to 17 Years", in the April 2005 issue,
says it's possible. So there.

And isn't amblyopia caused by the ciliary muscles in the amblyopic eye
not fully developing?

Douglas you still are a fake.
Try to google on amblyopia or better read a good book about the subject,
(and no, I'm not given advises which book you should read)

  So, shouldn't simply disabling the ciliary
muscles, instead of occluding, the good eye reach the same effect,
more efficiently, w/ a better quality of life?

First try to became familiar with the real knowledge needed before you
put one and two together.

Jan (normally Dutch spoken)

Actually, they ARE studying the efficacy of patching  older ages than have
traditionally been treated. Textbooks used to say to reason to patch after
age 8. However, the brain is still developing in some past that age, and we
(I, at least) routinely patch kids 9-11 years old and get some effect..
Obviously, it doesn't work well if they are very amblyopic, and won't work
at all if they cannot co the treatment hours necessary. The older kids take
much more patching than the younger kids. Thus, this interferes with
school,
homework, and other activities, and they are often failures due to being
unable to patch enough.

I will also say that the results of some of the PEDIG (Pediatric Eye
Diseases Group) studies that are being quoted have to be taken with a grain
of salt. I know the people publishing all this, Dr. Mike Repka from Wilmer
at Hopkins, where I did my training. For example, they say 2 hrs is as
effective as 6 hrs of patch, and 6 hrs is as effective as full-time, but we
all know that is not true for everyone, and has to be tailored to the
individual.

Regarding atropine: amblyopia is not due to the ciliary muscle, etc as
mentioned. It is due to the brain have received a blurry image, or a
conflicting image (as in strabismus), and not learning to see well.
Atropine
works by blurring the image for near, at reading distance, and really only
works if the blurred image is blurry enough to switch fixation preference
to
the amblyopic eye so it is being used. Therefore, it works only in low to
moderate amblyopes, since it can't blur the image enough in bad amblyopes.
You can help it along by using glasses that are sufficiently "wrong" so as
the blur the eye at near in addition to the atropine. Problem is, one is
not
reading all day, so it only is treating part of the time. In addition, some
feel that light getting in the better eye still competes with the amblyopic
eye, and slows treatment. Also, atropine is basically all or none; you
can't
really modulate it the way you can with adjusting number of hours of
patching.

I use atropine when I can't use a patch due to poor cooperation, or when I
am patching all out-of-school hours, and need more, but don't want to patch
in school. I also sometimes use it as maintenance after stopping patching.

Regarding the amblyopia treatment in this highly anisometropic myope, he
has
not told us what his visual acuity is. He still thinks looking at the
eyeglass power tells you what vision this corresponds to. This kind of
amblyopia is probably severe, and rather resistant to treatment anyway, but
who knows, there still might be some improvement with patching. I think
atropine would be a waste of time if there is any significant amblyopia.

Now, I will also tell you that I have seen some prominent specialists use
full-time patching in full-grown adults (age 40, etc), and get some
improvement. We all joked because he was in Iowa, and we said, sure, you
can
tell only an Iowa farmer to patch all day for a year ...  (this was Dr.
William Scott, in Iowa City, very respected, now retired).

David Robins, MD
Board certified Ophthalmologist
Pediatric ophthalmology and adult strabismus subspecialty- Hide quoted text
-

- Show quoted text -

Great! I was getting tired of Jan calling me a liar. Could severe,
untreated-for-decades amblyopia cause optic nerve degeneration?

No.
Amblyopia is a brain problem, NOT an optic nerve problem.
Amblyopia cannot influence the health of the optic nerve.- Hide quoted text -

- Show quoted text -

But don't nerves that aren't stimulated atrophy?

The optic nerves are stimulated just fine. It is the vision areas of the
visual cortex in the brain that atrophy (the dominance columns that were
described by Hubel and Weisel)- Hide quoted text -

- Show quoted text -