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Post Info TOPIC: Spasm of accommodation

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Posts: 74
Date: Sat Jan 27 2:45 PM, 2018
Spasm of accommodation

"this condition is really one giant PITA"

You have hit upon the one thing that is unquestionably true about keratoconus!

Your experimental observations are consistent with what I have observed.

Correction of HOAs can be done to some extent by neutralizing the front surface of your cornea with a well fit contact lens and making the front surface of the contact lens the primary refracting surface. Achieving a good fit that effectively neutralizes the irregular keratoconic cornea is the challenge.

Correction of HOAs can also be done by designing an aspheric front optical surface for a contact lens that neutralizes the measured aberrations of the contact lens plus eye optical system. This requires a contact lens that has a very stable position on the eye, advanced equipment for measuring the HOAs of the optical system, and a difficult design and manufacturing process to produce the necessary lens. The only person I am aware of who follows this approach outside of a research setting is Dr. Gemoules of LaserFit in Texas.

Some people use eye drops to constrict the pupil and improve night vision.

Good luck finding something that works to improve your vision. It can be a maddening quest.



Status: Offline
Posts: 6
Date: Sat Jan 27 5:02 PM, 2018

Yup, I'm starting to see LaserFit might be the final solution but it's quite an investment especially if I actually get unaided 20/20 vision most of the time, sharpness wise. But definitely worth considering, I need it for one eye only anyway...

I see anything other than LaserFit (or that one too??) relies on proper tear film for decent correction? i'm sure I have issues with this, I'm working on a computer and mobile screens about 70% of my awake time, so...

I did some more careful observing today and am starting to think I only like one pupil size... bright apartment in the morning is a disaster for my eyes, dusk as well, won't even mention nighttime... What I like are sunny days with sunglasses on, anything other is bad, especially cloudy days with diffused light. BTW I managed to lessen problems in diffused light etc. with special computer glasses that block the blue wavelengths, does wonders both with computer screens and daytime activities in diffused light + even with driving at night (eyes "hurt" less).



Status: Offline
Posts: 31
Date: Sun Jan 28 4:50 PM, 2018

The main tool we use is the aberrometer. It's a good one and I rarely see a patient I cannot measure (can't really remember one). I love showing the patient how the computer thinks they see, and most of the time there is good agreement. In 100% of KC cases, when we measure the wavefront through their contact lenses, the map has many colors - i.e. from red to blue. Red areas show relative myopia, and blue areas show relative hyperopia (farsightedness). The spread can be a dozen diopters or more within the pupil area with their own contact lenses being worn.  The presence of all of those colors indicates that the lens simply does not fully correct the vision.

If you think of the KC cornea as having at least two or more focal points, then it's easier to understand how the eye cannot resolve them into one clear image, and will soon become exhausted in the attempt. Typically the contact lens has a power that is basically the average of the range in diopters. As it turns out, the result is that one area is farsighted and another area is nearsighted. The eye learns that if it accommodates to correct the farsighted area, the pupil also constricts, generally causing a better retinal image. An eye that habitually accommodates can and will go into spasm, and I often have to use a cycloplegic agent to break this spasm so I can get a more accurate reading. I take different readings for consistency.  The key is in targeting the red and blue areas individually with precision, something that is not possible using conventional optics.

This process might appear confusing to a lot of patients, but there is a method as we need both science and experience to solve the problem.


Dr. G.

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