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Atropine questions
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Dr. Leukoma
medicine forum Guru


Joined: 30 Apr 2005
Posts: 1283

PostPosted: Wed Jul 12, 2006 11:34 am    Post subject: Re: Atropine questions Reply with quote

acemanvx@yahoo.com wrote:
Quote:
I suspect I have some tonic accomodation, probably 1.5 diopters of it.
If atropine is tried, wont it blur my vision so my BCVA is 20/100? How
will I get an accurate cycloplegic refraction if the best lenses is
still blurry and I cant tell the difference between small increments of
half diopter when "one or two is better" Also is it true atropine's
effects last a week? I want to get this out of the way because my
manifast pescription is too strong for seeing clear from near and
someone said I may have significent tonic accomodation rather than
presbyopia.

People undergo cycloplegic refractions all the time. Ironically, a
cycloplegic can sometimes improve the ability to discriminate between
two lenses if it eliminates the accommodative fluctuations. Atropine's
effects last several days. Maybe cyclopentolate can do the job, and
recovery is quicker.

DrG
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Wed Jul 12, 2006 8:41 pm    Post subject: Re: Atropine questions Reply with quote

Dr. Leukoma wrote:
Quote:
acemanvx@yahoo.com wrote:
I suspect I have some tonic accomodation, probably 1.5 diopters of it.
If atropine is tried, wont it blur my vision so my BCVA is 20/100? How
will I get an accurate cycloplegic refraction if the best lenses is
still blurry and I cant tell the difference between small increments of
half diopter when "one or two is better" Also is it true atropine's
effects last a week? I want to get this out of the way because my
manifast pescription is too strong for seeing clear from near and
someone said I may have significent tonic accomodation rather than
presbyopia.

People undergo cycloplegic refractions all the time. Ironically, a
cycloplegic can sometimes improve the ability to discriminate between
two lenses if it eliminates the accommodative fluctuations. Atropine's
effects last several days. Maybe cyclopentolate can do the job, and
recovery is quicker.

DrG


I had cyclopentolate which reduced my myopia by just half a diopter but
I noticed I still had some accomodation so I feel it was incomplete. My
BCVA did not decrease. I understand it may improve discimination
because youd be able to tell if your overminused. However if atropine
blurs your BCVA to around 20/100 you may not be able to discrimiate
well with all that blur. Or am I missing something? I want to try it if
it is useful for uncovering all my tonic accomodation and it may help
releave some of it too.
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retinula@hotmail.com
medicine forum beginner


Joined: 14 Nov 2005
Posts: 44

PostPosted: Wed Jul 12, 2006 11:56 pm    Post subject: Re: Atropine questions Reply with quote

acemanvx@yahoo.com wrote:
Quote:
I suspect I have some tonic accomodation, probably 1.5 diopters of it.
If atropine is tried, wont it blur my vision so my BCVA is 20/100?

why do you think that? if you are properly refracted you should reach
your maximal acuity while cyclopleged-- probably 20/20 or better. the
lenses that are required to achieve that acuity will represent your
true myopia (=anatomical myopia) without any tonic accommodation. it
will represent the lowest prescription you would be able to achieve by
using any of your NVI relaxation schemes.

Quote:
Also is it true atropine's
effects last a week?

no

Quote:
I want to get this out of the way because my
manifast pescription is too strong for seeing clear from near and
someone said I may have significent tonic accomodation rather than
presbyopia.

people have been telling you that for ages. are you finally catching
on? no one your age is presbyopic. perhaps you're finally getting it.
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Mike Tyner
medicine forum Guru


Joined: 24 Mar 2005
Posts: 1299

PostPosted: Thu Jul 13, 2006 12:47 am    Post subject: Re: Atropine questions Reply with quote

<acemanvx@yahoo.com> wrote

Quote:
because youd be able to tell if your overminused. However if atropine
blurs your BCVA to around 20/100 you may not be able to discrimiate
well with all that blur.

Why would atropine blur your BCVA to 20/100? I've never seen it do that.

It should be that different from cyclopentolate. They both enlarge the pupil
to a comparable degree.

-MT
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Thu Jul 13, 2006 2:10 am    Post subject: Re: Atropine questions Reply with quote

retinula wrote:
Quote:
acemanvx@yahoo.com wrote:
I suspect I have some tonic accomodation, probably 1.5 diopters of it.
If atropine is tried, wont it blur my vision so my BCVA is 20/100?

why do you think that? if you are properly refracted you should reach
your maximal acuity while cyclopleged-- probably 20/20 or better. the
lenses that are required to achieve that acuity will represent your
true myopia (=anatomical myopia) without any tonic accommodation. it
will represent the lowest prescription you would be able to achieve by
using any of your NVI relaxation schemes.

Also is it true atropine's
effects last a week?

no

I want to get this out of the way because my
manifast pescription is too strong for seeing clear from near and
someone said I may have significent tonic accomodation rather than
presbyopia.

people have been telling you that for ages. are you finally catching
on? no one your age is presbyopic. perhaps you're finally getting it.



Thanks for your reply. Ive been thinking why atropine blurs vision and
maybe its because when its used in the dormant better eye in young
children with amblyopia, they lose their accomodation in that eye and
experience hyperopic blur. Their nondormant eye now becomes the better
eye and gets exercised, thereby hopefully correcting amblyopia.
Atropine would NOT work in myopic amblyopic children. Whoever said
atropine blurs must have meant only if you are hyperopic because you
can no longer accomodate around it.

Does atropine always result in a complete cycloplegia? I may need like
a week of atropine treatment to really be sure I unlock all my tonic
accomodation. How long does atropine last? Ive read it lasts a week on
average. If I cant see well from near with -4.5 glasses, I could have
significent tonic accomodation and if I dont, what other explanation is
there?
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Thu Jul 13, 2006 2:17 am    Post subject: Re: Atropine questions Reply with quote

Mike Tyner wrote:
Quote:
acemanvx@yahoo.com> wrote

because youd be able to tell if your overminused. However if atropine
blurs your BCVA to around 20/100 you may not be able to discrimiate
well with all that blur.

Why would atropine blur your BCVA to 20/100? I've never seen it do that.

It should be that different from cyclopentolate. They both enlarge the pupil
to a comparable degree.

-MT


http://www.tfn.net/~kate901/amblyopia/atropine.htm


more proof:


atropine is used to blur vision in the non-amblyopic eye and offers a
useful alternative to traditional occlusion therapy with patching,
especially in older children who are not compliant with patching.



Drops Do as Well as Patches for 'Lazy Eye'

Atropine drops given once a day to treat amblyopia, or lazy eye, the
most common cause of visual impairment in children, work as well as the
standard treatment of patching one eye, according to the March issue of
Archives of Ophthalmology. Amblyopia is a condition in which an
otherwise healthy eye has poor vision because the brain has learned to
favor the other eye. Most eye care professionals treat the condition by
putting a patch over the unaffected eye, thereby forcing the child to
use the weak eye. Atropine drops blur the vision in the unaffected eye,
and parents say it is easier than requiring a young child to wear an
eye patch.



Are they wrong? I looked it up and they say atropine blurs your vision!
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Mike Tyner
medicine forum Guru


Joined: 24 Mar 2005
Posts: 1299

PostPosted: Thu Jul 13, 2006 2:41 am    Post subject: Re: Atropine questions Reply with quote

"Mike Tyner" <mtyner@mindspring.com> wrote

Quote:
It should be that different from cyclopentolate.

I shoulda said "should NOT be".

The blur, for a myope, comes from wide pupils causing huge increases in
aberration, mostly spherical IIRC.

The pupils are a little wider with atropine, but not "20/100" worth. Total
aniridia wouldn't cause that, by itself.

If you use atropine once or twice a day for a week, it will take several
days, maybe a week, to fully recover your accommodation. Why are you working
so hard?

Since you first began posting, we've been telling you your problem is
basically excess accommodation. It isn't making anything worse because your
prescription is decreasing, not increasing. It will take care of itself.
After age 48 you'll probably be rock solid at -200, just where you'd want to
be for reading.

If you want to "train away" the excess accommodation, stare at small print
just beyond your farpoint and learn to control your accommodation.
Relaxation would be bery, bery goood, too yoo.

Knowing your absolute refractive measurements under total cycloplegia
doesn't change anything, except it might tell you when to stop your training
(ie when you reach the normal 050 difference between dry and wet
refractions.)

You could occupy yourself for hours staring at just-blurry print. It would
help some, but your accommodation is going to relax eventually, whether you
fiddle with it or not.

So you could just forget about it. Get glasses or contacts for driving with
minimum tolerable minus and if that's blurry at near, get drugstore plus. Or
skip contacts - get PALs, or a second pair for reading. And get on with your
life. Whatever that's worth.

-MT
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Mike Tyner
medicine forum Guru


Joined: 24 Mar 2005
Posts: 1299

PostPosted: Thu Jul 13, 2006 3:06 am    Post subject: Re: Atropine questions Reply with quote

<acemanvx@yahoo.com> wrote

Quote:
http://www.tfn.net/~kate901/amblyopia/atropine.htm

more proof:

No, one mother's understanding. Technically, what she calls "CV" is only
"CV" if the child wears a +250 add in the atropinized eye.

This is one of the benefits of atropine patching, for children who already
wear glasses. The atropinized eye remains mercifully clear at distance, and
functional for school.

It's the difference in NEAR VISION that challenges the "bad" eye in that
circumstance. So mother Kate was saying that the blur in NEAR vision can't
be made more than about 20/100.

You are quite right that there are situations where atropine simply wouldn't
work. If the atropine eye was -250, they'd _have_ to wear glasses or it
wouldn't do anything.

Full atropine dilation only reduces Snellen acuity by a line or two.
Remember there's still a large percentage of the cornea and lens that have
no aberration. As a result, the blur of dilation isn't debilitating blur
like out-of-focus. It's a clear image surrounded by haze, blacks are
slightly grayer and whites are slightly grayer but the image is still there.
And the IRIS isn't the only thing that frames your pupil. Slit your lids and
you're 20/15 for vertical lines.

Quote:
Are they wrong? I looked it up and they say atropine blurs your vision!

Not 20/100. 20/25.

-MT
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Thu Jul 13, 2006 5:37 am    Post subject: Re: Atropine questions Reply with quote

"If you use atropine once or twice a day for a week, it will take
several
days, maybe a week, to fully recover your accommodation. Why are you
working
so hard?"


sometimes tonic accomodation is stubborn and may take repeated use of
atropine to yield it all away. One guy mentioned he had 3 diopters of
it and it took 4 days of repeat atropine to unlock it all.


"Since you first began posting, we've been telling you your problem is
basically excess accommodation. It isn't making anything worse because
your
prescription is decreasing, not increasing. It will take care of
itself.
After age 48 you'll probably be rock solid at -200, just where you'd
want to
be for reading."


-2, not -200 lol! I cant even imagine -200 diopters, just not possible
*eek!* Well have to see how much tonic accomodation I have. My eye
exercises reduced it by a diopter or so but I still have more. I am not
gonna wait till im old, I want to do something asap because my
accomodative amplitude is reduced due to some of it "locked" and also I
just dont want such blurry distance vision.


"If you want to "train away" the excess accommodation, stare at small
print
just beyond your farpoint and learn to control your accommodation.
Relaxation would be bery, bery goood, too yoo."


I have been doing just that, its what one lady did to improve by 1.25
diopers. Atropine will let me know how much more I have to go.


"You could occupy yourself for hours staring at just-blurry print. It
would
help some, but your accommodation is going to relax eventually, whether
you
fiddle with it or not."


again, I am not gonna be more myopic than I really am. I also want to
free up accomodation.


"This is one of the benefits of atropine patching, for children who
already
wear glasses. The atropinized eye remains mercifully clear at distance,
and
functional for school."


I guess he must have been a (latent) hyperope because the 20/100 was
for distance. no matter, once the amblyopia is cured, atropine can be
discountinued and normal vision restored shortly.


"As a result, the blur of dilation isn't debilitating blur
like out-of-focus. It's a clear image surrounded by haze, blacks are
slightly grayer and whites are slightly grayer but the image is still
there."


also known as loss of contrast. my pupils dilate naturally so they
would barely get bigger with atropine but they wont shrink in light so
ill need sunglasses or stay away from bright lights.


"Slit your lids and
you're 20/15 for vertical lines"


if your retina is capable and if you dont have lots of aberrations in
the center of your cornea.


"Not 20/100. 20/25."


I already cant correct to 20/20 so I guess I wont experience additional
distance blur with atropine unless I happen to be hyperopic which is
highly unlikley with my manifast -4.5 probably my cycloplegic would be
like -3 or so but the lower, the better and perhaps once the atropine
wears off, not all my tonic accomodation will return
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retinula@hotmail.com
medicine forum beginner


Joined: 14 Nov 2005
Posts: 44

PostPosted: Thu Jul 13, 2006 10:55 am    Post subject: Re: Atropine questions Reply with quote

Quote:
Thanks for your reply. Ive been thinking why atropine blurs vision and
maybe its because when its used in the dormant better eye in young
children with amblyopia, they lose their accomodation in that eye and
experience hyperopic blur. Their nondormant eye now becomes the better
eye and gets exercised, thereby hopefully correcting amblyopia.

not sure what you mean here.
anyway, atropine blurs hyperopes because they can't accommodate and
clear their vision. its blurs more for higher hyperopes of course.
but atropine also blurs anyone because of the profound dilation it
causes.

Quote:
Atropine would NOT work in myopic amblyopic children.

they are also blurred due to dilation. and of course they can only see
at distance with the proper eyeglass Rx on and they can only see at
near at a working distance equal to their true myopic state.

Quote:
Whoever said
atropine blurs must have meant only if you are hyperopic because you
can no longer accomodate around it.

you are right in that atropine blurs hyperopes more but it also causes
significant visual blur in myopes.

Quote:
Does atropine always result in a complete cycloplegia? I may need like
a week of atropine treatment to really be sure I unlock all my tonic
accomodation. How long does atropine last? Ive read it lasts a week on
average.

there is a lot of variability in peoples response to atropine.
mydriasis (=dilation) lasts much longer than the cycloplegia
(=paraplysis of accommodation) so the complete effects of atropine may
take 1-2 weeks to wear off because the dilation is slow to go away
completely. in cases of profound ciliary spasm atropine can be given
up to twice daily for multiple days. one drop may not completely relax
accommodation especially in children. its effects in adults is usually
more complete.

using atropine is not fun.
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Thu Jul 13, 2006 12:58 pm    Post subject: Re: Atropine questions Reply with quote

Quote:
not sure what you mean here.
anyway, atropine blurs hyperopes because they can't accommodate and
clear their vision. its blurs more for higher hyperopes of course.
but atropine also blurs anyone because of the profound dilation it
causes.


Thats what I was thinking. For latent hyperopes, they will experience
worse uncorrected vision. For pseudomyopes, their uncorrected vision
will improve




Quote:
you are right in that atropine blurs hyperopes more but it also causes
significant visual blur in myopes.


Should I expect the blur of atropine to be equal to cyclopentolate? My
BCVA with glasses wasnt really effected and my uncorrected vision was
about the same indoors, its outside in bright light that everything was
all washed out and looked like a watercolor because my pupils were
huge. Normally they shrink, resulting in a pinhole effect and giving
much improved visual accuracy. This is also why eye exams should be
done in a dimly lit room with an illuminated eyechart.



Quote:
there is a lot of variability in peoples response to atropine.
mydriasis (=dilation) lasts much longer than the cycloplegia
(=paraplysis of accommodation) so the complete effects of atropine may
take 1-2 weeks to wear off because the dilation is slow to go away
completely. in cases of profound ciliary spasm atropine can be given
up to twice daily for multiple days. one drop may not completely relax
accommodation especially in children. its effects in adults is usually
more complete.



How long does cyclopegia last? I want to make sure I get to the
optometrist or ophthamologist asap after inserting drops of atropine. I
may need 5 to 7 days for a complete cyclopelgic. I had cyclogyl before
and only got a drop and only one season and I could tell it was
incomplete as I could still accomodate but not as well.



Quote:
using atropine is not fun.


But its educational and important for me to know my true myopia. Would
I stand correct in saying ill experience the same blur and dilation as
cyclogyl except a longer duration and complete cycloplegia.
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Fri Jul 14, 2006 10:04 pm    Post subject: Re: Atropine questions Reply with quote

bump, need a few more answers. I am going to schedule an appointment
very soon with an opthamologist for atropine to see how much
pseudomyopia, tonic accomodation I have
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serebel
medicine forum addict


Joined: 12 Aug 2005
Posts: 81

PostPosted: Sat Jul 15, 2006 12:34 am    Post subject: Re: Atropine questions Reply with quote

acemanvx@yahoo.com wrote:
Quote:
bump, need a few more answers. I am going to schedule an appointment
very soon with an opthamologist for atropine to see how much
pseudomyopia, tonic accomodation I have



Like a good obsessive nut, yes, waste a doctor's time.
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Sat Jul 15, 2006 1:34 pm    Post subject: Re: Atropine questions Reply with quote

serebel wrote:
Quote:
acemanvx@yahoo.com wrote:
bump, need a few more answers. I am going to schedule an appointment
very soon with an opthamologist for atropine to see how much
pseudomyopia, tonic accomodation I have



Like a good obsessive nut, yes, waste a doctor's time.


He doesnt care as hes getting paid. Besides my complaint is legitimate.
My accomodation is nowhere near normal for a person in his mid 20s.
Some of the optometrists here have been telling me I have accomodative
excess, tonic accomodation, pseudomyopia. The fact my vision improved
in the last 18 months due to eye exercises and wearing weaker minus is
proof I have tonic accomodation. I feel I may have quite a bit left
still. I may even get vision theraphy to much more rapidly eliminate
the rest of my tonic accomodation. Ive been told my true structual or
axial myopia could be -3 or even -2 based on the info ive given out.


http://groups.google.com/group/sci.med.vision/browse_thread/thread/5d3174a81751e90a/0c94fbbb782d39f6#0c94fbbb782d39f6


read this thread
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otisbrown@pa.net
medicine forum Guru


Joined: 24 Mar 2005
Posts: 1447

PostPosted: Sat Jul 15, 2006 6:21 pm    Post subject: Re: Atropine questions Reply with quote

Dear AceMan,

Subject: Work for true-prevention.

If you had put this much effort into it -- when your Snellen was
20/60 (about -1.25 diopters) -- I believe you would have cleared
to pass the DMV -- in about 4 months -- as others have done.

No one, repeat no one, wants you to get stair-case myoipia
from an over-prescribed minus. But often the OD has NO CHOICE
because the person concerned with it -- WILL REFUSE THE
USE OF A STRONG PLUS FOR PREVENTION.

But that becomes "our fault" if we are offered plus-prevention (as
the second-opinion) and turn it down cold -- in favor of that
impressive minus lens.

But maybe, the next generation (your children) will lean
from the struggle you are going though with this work.

That is a true "learning process".

Best of luck,

Otis



acemanvx@yahoo.com wrote:
Quote:
serebel wrote:
acemanvx@yahoo.com wrote:
bump, need a few more answers. I am going to schedule an appointment
very soon with an opthamologist for atropine to see how much
pseudomyopia, tonic accomodation I have



Like a good obsessive nut, yes, waste a doctor's time.


He doesnt care as hes getting paid. Besides my complaint is legitimate.
My accomodation is nowhere near normal for a person in his mid 20s.
Some of the optometrists here have been telling me I have accomodative
excess, tonic accomodation, pseudomyopia. The fact my vision improved
in the last 18 months due to eye exercises and wearing weaker minus is
proof I have tonic accomodation. I feel I may have quite a bit left
still. I may even get vision theraphy to much more rapidly eliminate
the rest of my tonic accomodation. Ive been told my true structual or
axial myopia could be -3 or even -2 based on the info ive given out.


http://groups.google.com/group/sci.med.vision/browse_thread/thread/5d3174a81751e90a/0c94fbbb782d39f6#0c94fbbb782d39f6


read this thread
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