First normalised for my 6 years old son

Dear Endmyopia fellows,

as some of you might know, Im trying to help my son Tim to reduce his myopia. He has been wearing glasses since April 2018. I remember vaguely his first prescription being -1.75D both eyes and no cylinder. In Early 2019 they added cylinder and this is the prescription in his current glasses:

R myopia = -2 diopters, cylinder = +1 diopter, axis = 100 grades

L myopia = -2 dioptres, cylinder = +1 diopter, axis = 90 grades

she explained there can be another way of writing my son´s glasses´ properties (she did not use any tool to calculate it, just off the top of her head):

R myopia = -1, cylinder = -1, axis = 10 grades

L myopia = -1, cylinder = -1, axis = 180 grades

A month ago, we went to the optometrist and she measured him again and apparently his astigmatism got worse (well most likely it is just lens-induced) but I did not change it.

The latest measurement was probably a bit off and he does not have such high astigmatism. He seems to do quite well without glasses for a distant vision. He does not wear glasses for his limited close up (his differentials have zero correction) and he started participating in active focus as well. But I still feel that reducing cylinder in 2 steps might be the best approach.

Anyway, I was freaking out last week as I was in doubt I might be able to help my son. I studied astigmatism on Endmyopia and saw couple of Jake´s videos to the point that I do have some level of understanding of that topic. I also got lots of posts on my previous thread from all great Endmyopia members that gave me some great advice. I want to thank the members for the great help and support and all the great advice which helped me to decide what to do next.

Considering his glasses have -1D myopia and -1D cylinder, I want to do this approach:

  1. As a first step, I want to reduce his cylinder and his new cylinder will be -0.5D. His sphere will remain the same, i.e. -1D. The Spring has just started in Europe so I want to get him get used to less cylinder now and will keep this prescription for some 3 months.

  2. At the end of June/beginning of July, I would then perform his first spheric reduction - based on Snellen I might go 0.25D or even 0.5D lower to give him some slight blur challenge.

  3. I would then let him wear it till the end of the year. It will be his first year at school, so everything might be a bit too much for him, so I might just go with the step nr. 3 till Spring 2022. But of course, I would keep playing Spy games with him etc. to practise active focus and check his Snellen ocassionally.

  4. In the Spring 2022, I might get rid of this last -0.5D of astigmatism.

I have not decided on the further steps just yet, but I will make that decision as I go. I need to see how his progress is and if he is doing well with it. I do want to reduce his prescription in small increments and quite gently so that I keep him motivated.

I might deal with the last bit of astigmatism (-0.5D) even differently, that I might add -0.25D to the spheric instead but I have not decided on that yet. Im somehow not such a big fan of trading astigmatism for sphere. This is what my intuition tells me at the moment.

I definitely want him to have both his astigmatism and also spheric a bit lower before he starts with his school (or at least by October). We still have 5 months before his school starts.

I just wanted to ask, if his current prescription is this:

R myopia = -1, cylinder = -1, axis = 10 grades

L myopia = -1, cylinder = -1, axis = 180 grades

and I want to reduce his cylinder by half, does that mean that I should order his first normalised with this prescription?:

R myopia = -1, cylinder = -0.5, axis = 10 grades

L myopia = -1, cylinder = -0.5, axis = 180 grades

Meaning that the only change will be the cylinder but the axis stays the same? I have never ordered glasses with cylinder and its complications before (axis etc.) so I just want to double-check it before I order.

I just want to start with cylinder reduction first, is the prescription I wrote correct then?

Thanks a lot!

Mischa

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Hmmm.

Firstly is we can’t give diopter specific advice. We can only give general advice. So we can’t tell you if the prescription you wrote above is correct or not. We don’t know, only your son does! :slightly_smiling_face::slightly_smiling_face:

Second, general rule for any reduction is to only reduce by 0.25. You mentioned that you want to reduce by 0.5. This may be a bit to big of a jump and may cause nausea and headaches etc. Always best to err on the side of caution and do the most minimal change to the focal plane as possible.

Thirdly, I went to the opthomologist a while back and she said I had 0.5 CYL and she said I didn’t need to correct for it. So I just dropped it out of my prescription and only correct for Spherical now.
This is not to say that you should also do this…its just to say that some professionals don’t even correct for this small amount of astigmatism. I know this sounds like contradictory advice but it just shows that everybody’s situation is unique.

I would try and go to an opthamologist rather than an optometrist for getting updates. Opthamologists aren’t trying to sell you glasses so they will give you much better and less bias advice.

Hope that helps

Edit: Fourthly! For such a small amount of correction (-1) you should be aiming to use his glasses as little as possible. I would try and only use the glasses for when he really really needs it, like, at night or if he needs to read something during class on a distant white board. The rest of the time, especially during the day with natural light he really shouldn’t use them…

Alex thank you so much for your thoughts! I know that people should reduce only 0.25. And this is what I want to do with his spheric for sure. But I think he has anyway a high overcorrection.

When he looks at the Snellen in a good light without the glasses, he has 20/30. Now the funny thing is, that I do have with my current -3D normalised also 20/30. And I would estimate that the level of dioptres to my 20/20 (full vision) might be some 0.5D or even 0.75D as I discovered that I might even have some astigmatism (on the astigmatism wheel) which I have never dealt with. And the funny thing is that my son has still better visual acuity without glasses than me!!! So I would say that his “real prescription” should be something like -0.5D. Even when Im ready to do an active focus outside, as I see a bit of a blur, he has to search for an object that is further away to see a bit of blur.

Of course he is 6 years old and maybe he is not able to distinguish a situation between an object being fully in focus and having the tiniest bit of blur… That is also possible. But I even performed a test. We both sat on a bench and there was a street sign about 14 metres away from us. There was a number on the street sign written and the number was some 20 cm high. I could not read the number even with an AF. My son managed!!!

I started giving him glasses-free time now and want to keep it this way over the European Spring and Summer.

I therefore think that reducing his first astigmatism normalised correction by 0.5D might work as he can really see well without glasses.

After this first astigmatism reduction being 0.5D, im planning to do a spheric reduction of 0.25D and then continue with astigmatism also by 0.25 increments till his astigmatism is gone.

Now because he is doing so well with a zero diopters reset (having no correction whatsoever when having no glasses), I think he might be fine with his new glasses having 0.5D less astigmatism, keeping the spheric the same.

Yesterday, Tim had about 25 minutes of AF exercises whilst we spent 3 hours outside on a playground and playing football!

Today I want to take him outside again (and my younger son too) and get him involved in his peripheral vision fun exercises a bit also and give him a break from AF as to not to overwhealm him.

As for the opthalmologist - I have been to one and he has been overcorrecting me a bit time. So I might find another one and ask him to correct Timmy just for what he needs.

Michaela

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Yes, if you want to take out half of the CYL correction of -1 you would leave the grades (axis) alone (keep them the same) and change the CYL from -1 to -0.5. [In keeping with the spirit of the forum I’m not saying to do that, just that you’ve correctly described the math.]

If I were you, I’d limit screen time and make sure it’s on only on faraway devices (watch TV from across the room, not on a phone). Maximize his outdoor time as much as possible. If the weather is nice and he has to read a book for school, read it outside under a tree. Schedule as much outdoor play and activity as you can (more is better.)

As his eyes are getting better, If he has to do close work on a phone or computer or book for school, I’d have him using plus lenses maybe even with base-in prism (you should probably work with a friendly optometrist if you can find one). The plus lens use would be only when he’s doing his schoolwork on the laptop they assign when distance is impossible.

My general thoughts:

  1. Make sure he’s not getting over-corrected or wearing minus correction when he shouldn’t
  2. Get outdoors as much as possible (join the local kids soccer football team?)
  3. Limit near work as much as possible
  4. Reduce harm from near work when it’s unavoidable (better lighting, more distance, computer/reading glasses for when computer and reading activities are unavoidable.)
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Hi nycmao,

thank you very much for confirming that the first normalised I want to buy for my son Tim is mathematically correct!

I totally limit his screen time already and if he wants to watch screen, he watches TV. Very ocassionally if he wants a tablet, I do allow him to watch 30 minutes and without glasses.

He does not go to school yet, he is starting in September and we are having now 5 months of spring/summer time ahead, so I want to take a full advantage of it and even reduce his glasses twice before his school starts.

He is already getting involved in AF, does peripheral exercises and as of this week, he wears no glasses even for distant vision.

Thank you very much for giving me the tip of reading a book below a tree later on, when he goes to school. That is a great idea, as the light outside is always better than inside.

But that was a good idea to give him plus lenses later on, when he uses a computer. His myopia is quite small (it is written at the beginning of this topic) but I want him to improve a bit before I introduce plus lenses for his computer work. But it will still be like 6 months before he goes to school, so there will be no computer till then anyway.

He plays football already and from the time he started with football, he did not wear glasses there - the coaches said it might be better without glasses. That gave me the idea that he might do really well without glasses for distance vision.

I want to regulate/improve his eyes now as much as I can, build as many habits as I can before his school starts.

It was interesting you said that I should introduce the plus lenses with base-in prism. What does that mean? I have been doing my own endmyopia programme for 3 years now, have heard about the prism once or twice but never really looked into it. What does that mean? How would plus lenses with prism be better for Timmy than without prism?

Thank you very much!

Michaela

Hi, I’ve seen it mentioned in various papers (from 90 years ago until the present) that plus lens use without prism for near work as a myopia control strategy creates a situation where the eyes are receiving rays as if they’re looking at something distant but the eyes are rolled inwards because they’re converging on something right in front of your nose which means they should be normally be using accommodation. With base-in prism and plus lenses you can simulate distance where the eyes can be looking straight ahead (as they would for distance) and focus for distance as if the book were up on a screen across the room. So it just does a better job of simulating distance if everything is set up properly.

Normally looking at something right in front of you nose means using lots of accommodation and rolling the eyes inwards to converge on the thing in front of your nose, the plus lenses take away the need for accommodation, the prism takes away the need for vergence. They’re only to be used for near work (test at school, reading, working on a laptop computer, etc.) For regular daily activities you wouldn’t use them so you still get the normal chances to use accommodation and vergence where it’s appropriate (checking a price tag in a store, reading the label on a package, reading a text message…). They’d be potentially useful for situations where he has to spend hours at the computer writing an essay or doing math homework.

In the modern terminology they’d be called “occupational lenses”.

Thank you nycmao for the answer! I have been participating in endmyopia programme and have gone from -6.25D to -3D (my current normalised) in 3 years. I also use reading glasses over my contact lenses for close-focus-work.

I just was not sure, what the prism was but thanks for explanation. I will then buy reading glasses with prism for Tim for sure when the time comes.

Today I measured in without glasses on our balcony in a very good light and he had even 20/25!!! And a week ago, he had 20/30. I guess his eyes accomodated somehow and even got a bit better by not wearing the glasses for distance, if that is even possible. (He has not been wearing minus lenses for close up for already a year).

But this shows me how much do the doctors overprescribe.

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Sounds like you’re pretty experienced!
Your son sounds like he’s in a good position. And you know kids, they change so fast because they’re growing. Soundsl like he’ll be glasses free in no time.

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