adderall, a few questions.. – ADD Forums – Attention Deficit …

Hi there,

I’m new to adderall XR, too 7 days x 5mg and now I’m at my first day of 7 days x 10mg.

I can’t stand my computer monitor anymore. It’s like the white background of word and stuff is making my vision unable to keep looking at the computer and stuff. Of course, right now, I am using contact lenses without my astigmatism correction because I’m waiting for my new pair of glasses (just did before starting adderall xr). Now I read about pupil dilatation and that I did my glasses and my correction of astigmatism will be wrong….am I overparanoid?

Also, the first 3 days @ 5mg did something, now it doesn’t appear to do anything? tolerance? Today I am on the internet supposed to review a text done by my wife and I’m surfing this site and facebook…bleh…

Can I drink decaf coffee??

thank you

Congenital Ptosis (Drooping Eyelids in Children) Surgery Treatment …

Ptosis (Droopy Eyes / Droopy Eyelids) can affect one eye or both eyes. Ptosis may be present at birth, or may be acquired later in life. If a droopy eyelid/ droopy eyes are present at birth or within the first year of life, the condition is called congenital ptosis.


Congenital Ptosis

Droopy Right Eyelid in Child


Congenital Ptosis (Droopy Eyelids in Infants, Toddlers, Children) Etiology (Causes):

In most cases of congenital ptosis, the cause is idiopathic (unknown).

The eyelids are elevated by the contraction of the levator palpebrae superioris. In most cases of congenital ptosis, a droopy eyelid (droopy eyes) results from a localized myogenic dysgenesis. Rather than normal muscle fibers, fibrous and adipose tissues are present in the muscle belly, diminishing the ability of the levator to contract and relax. Therefore, the condition is commonly called congenital myogenic ptosis (Droopy eyelids causes by a defective eyelid muscle).

Congenital ptosis may occur through autosomal dominant inheritance. Common familial occurrences suggest that genetic or chromosomal defects are likely – Genetic causes are likely for their occurence.

Other rare potential causes of congenital blepharoptosis (droopy eyes in children) include:

•Blepharophimosis syndrome
•Third cranial nerve palsy (paralysis)
•Horner syndrome
•Marcus Gunn jaw-winking syndrome
•Birth trauma
•Duane syndrome
•Periorbital tumor
•Kearns-Sayre syndrome
•Myotonic dystrophy
•Myasthenia gravis

Congenital Ptosis (Drooping Eyelids in Infants, Toddlers, Children) Complications:

Amblyopia (lazy eye, in which vision does not develop normally) may result from obscuration of the vision directly or from development of astigmatism indirectly. Development of amblyopia is an indication for immediate surgical correction of the blepharoptosis.

•Occlusion amblyopia (Obstruction of light entering the eye causes a lazy eye and abnormal visual development)
•Astigmatism (visual refractive errors, requiring glasses for correction) from the compression of the droopy eyelid
•Ocular torticollis (Torsion of the neck, as the child turns the neck to see clearly)

Congenital Ptosis (Droopy Eyelids in Infants, Toddlers, Children) Management, Surgery & Treatment (Cure):

  • Not all patients with congenital ptosis need surgical intervention.
  • But, the children need to be closely monitored for the possible development of occlusion amblyopia (lazy eye occurring due to visual deprivation by the droopy eyelids). Since amblyopia may not be reversed after age 7-10 years, appropriate and timely medical and surgical treatment of congenital ptosis is critical to preserve the child’s vision.
  • Uncorrected congenital ptosis can result in amblyopia secondary to deprivation or uncorrected astigmatism.
  • An abnormal eyelid position can have negative psychosocial effects. Children can be very cosmetically and socially aware and if peers treat them differently because of their drooping eyelids, the ptosis may have huge lifetime lasting, confidence damaging psychological impact.
  • Uncorrected acquired blepharoptosis results in decreased field of vision (superior) and frontal headaches.

General treatment

Early consultation with an oculoplastic surgeon, trained in both ophthalmology and plastic surgery, to avoid amblyopia.
•Must be able to rule out and document other possible causes of ptosis (eg, Horner syndrome, third cranial nerve palsy), which may impact growth and other parts of the body’s development.

Medical therapy

Only observation is required in mild cases of congenital ptosis, if no complications like signs of amblyopia, strabismus, and abnormal head posture are present.

Ptosis Surgery (Eyelid Lift Surgery for Droopy Eyelids in Children, Toddlers & Infants) Treatment & Cure:

Congenital blepharoptosis has physical, functional, and psychological consequences.

  • The method of repair depends on treatment goals, the underlying diagnosis, and the degree of levator function. Although the primary reason for the repair is functional, the oculoplastic surgeon has an opportunity through this procedure to produce symmetry in lid height, contour, and eyelid crease for better cosmesis. A good eyelid surgeon understands that ptosis correction has to have a cosmetic (aesthetic) thought process – When a child looks at the world, the world looks at their eyes – And, so, the eyes must look the same (symmetrical eyelid heights) and beautiful, post surgery.
  • Surgical correction of congenital ptosis can be undertaken at any age depending on the severity of the disease. Earlier intervention may be required if significant amblyopia or ocular torticollis is present.

Types of Eye lift / Eyelid Lift Surgery for Congenital Ptosis (Droopy eyelids in children):

Levator muscle resection

◦This procedure is the shortening of the levator-aponeurosis complex (muscle responsible for raising the eyelid) through a lid-crease incision. The skin incision is hidden either in the existing lid fold or in a new lid fold created to match that of the contralateral eyelid.

Tarso-Frontalis suspension procedure

◦This procedure is designed to augment the patient’s lid elevation through brow elevation. This surgery is performed in those children in which the levator muscle (muscle responsible for raising the eyelid) is very weak. The eyelid is suspended from the frontalis muscle (muscle over the eyebrow), to allow the frontalis muscle to take over the function of the levator muscle and raise the drooping eyelid.

◦Surgical technique: Several materials are available to secure the lids to the frontalis muscles. These materials include:

  • Silicone bands, silicone rods (Preferred Material for ptosis surgery)
  • Autogenous fascia lata: Autogenous fascia lata can be obtained from the leg of patients older than 3 years. This surgery is now almost never performed, because of the morbidity associated with a huge leg incision and surgery to harvest the tissue.
  • Preserved (tissue bank) fascia lata
  • Nonabsorbable suture material (eg, 2-0 Prolene, Nylon (Supramid) or Mersilene)
  • ePTFE (expanded Poly Tetra Fluoro Ethylene), Gore-Tex
  • Autogenous materials used less frequently include palmaris longus tendon and temporalis fascia.

◦Surgical outcome: Patients may not be able to close their eyelids during sleep from a few weeks to several months following surgery. Families must be warned of this outcome before the operation. The problem of open lids during sleep improves with time; however, aggressive lubrication is needed to avoid exposure keratopathy.

Fasanella-Servat procedure

◦The upper lid is elevated by removing a block of tissue from the underside (red, conjunctival eyelid surface) of the lid. This tissue includes the tarsus, conjunctiva, and Müller muscle.
◦This procedure is not commonly performed for cases of congenital ptosis.

Müller muscle–conjunctival resection

◦This surgery is chosen if the eyelid has had a good response to phenylephrine (a medicine which causes papillary dilatation).
◦The conjunctiva and the Müller muscle are marked off, clamped, and sutured. The tissues are resected. Then, the conjunctival layer is closed.
◦This procedure is not commonly performed for cases of congenital ptosis.

Video of Ptosis Surgeries performed by Dr. Debraj Shome, Oculoplastic Surgeon:

 Results & Prognosis post surgery for Congenital Ptosis (Drooping Eyelids):

•The repair of Congenital Ptosis (Droopy eyelids in children) via ptosis surgery (Eye Lift Surgery / Eyelid Lift Surgery) produces excellent functional and cosmetic results. Ptosis surgery can be performed at reasonable cost (price of ptosis surgery). For more information on ptosis & eyelid lift surgery, click here:



Oculoplasty & Oculoplastic Surgery in India

Oculoplasty is a fast growing super-specialty in India, with many institutes now offering fellowship training programs for young oculoplastic surgeons. For eyelid, orbital, brow, lacrimal, socket and mid-face surgery, please seek and look for a good oculoplastic surgeon, Mumbai, Delhi, Chennai, Hyderabad, Kolkata, Pune and most other Indian cities will have a few.

Most of the top oculoplastic surgeons are trained in the Western world and have come back to India post that and costs will be 1/5th the costs you would pay in the US, Europe or Singapore.

Dr. Debraj Shome is one of the best oculoplastic surgeons, top / best orbital surgeons & facial plastic surgeons in the world and is currently based in Mumbai, India. He has received super-specialty training in oculoplastic surgery, facial plastic and cosmetic surgery, eyelid surgery, orbital and lacrimal surgery. For more information on Dr. Shome’s work, please click on:


For appointments with Dr. Debraj Shome:

A lot of our patients visit us from Hyderabad, New Delhi, Chennai, Bangalore, Kolkata, Pune, Ahmedabad, Chandigarh, Jaipur, Nagpur, Kolhapur, Cochin, Trichy, Bhopal, Indore, Assam, Manipur, Mizoram and many other cities in India. Many of our consumers (medical tourism) also come in from the USA, Singapore, Dubai, Qatar, Canada, Nigeria, Kenya, Mauritius, UK, South Africa and many other top countries in the world.

Locally, from Mumbai and the surrounding areas, we cater to consumers from Thakur Village, Thakur Complex, Kandivali, Borivali, Dahisar, Andheri, Dadar, Malad, Powai, South Mumbai, Worli, Thane, Bandra, Santacruz, Chembur, Navi Mumbai, Mira Road, Bhayender, Vashi, Panvel, as we have multiple centers in Mumbai.

Copyrighted to The Esthetic Clinic 2013.

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The Cost of Cataract Surgery | Timothy D. McGarity, M.D., P.C. …

happy couple asking questions about how much does cataract surgery cost in columbia, missouriThere are many variables in the cost of cataract surgery: type of intraocular lens (IOL), type of preoperative testing (basic or basic plus refractive), geographic location (urban vs rural), and length of postoperative care.

According to’s 2012 report, the average, basic cataract surgery in the US would cost roughly $3,429 per eye if you paid everything yourself. If you wanted an advanced technology lens which corrects astigmatism or presbyopia, expect to pay an additional $449 or $895 per eye.

But Isn’t Cataract Surgery Covered by Insurance?

Yes, for most people! Most people undergoing cataract surgery qualify for Medicare or commercial health insurance to “cover” the procedure. “So the whole procedure is covered.” Yes and No. The whole part of the procedure which is medically necessary is covered, but not any part of the procedure which is deemed not medically necessary such as screening tests, Refractions, Astigmatism Correction, Presbyopic Correction, LASIK or Excimer Laser surgery, Touchups, or extended postoperative care for a year (anything past the typical 90 days).

Take a basic single focus IOL for example. Medicare covers the whole cost of the part of the procedure which is medically necessary. This is because your natural prescription lens (cataract) is removed during the cataract surgery and a basic single focus IOL is implanted. This is medically necessary because your eye needs an artificial, prescription lens after the cataractous lens is removed in order to restore sight. Determining the prescription power of the basic IOL is a covered procedure as well. Advanced refractive testing (any type of testing to determine the refractive state of the eye), topography screenings, pupil screening, OCT screenings and other screening tests part of a refractive procedure are not a medically necessary set of tests, but may be recommended to achieve refractive results. The costs of any of these tests before cataract surgery should be very explicit and given to the patient. These refractive tests are not mandatory, but may be recommended to screen for issues which may impact great results with basic cataract surgery outcomes.

What about astigmatism correction? Same rules apply here. Remember that most commercial insurances and secondary insurance companies follow Medicare’s rules. Medicare usually determines that astigmatism correction is not medically necessary since this can be corrected with glasses. Most studies indicate that correcting astigmatism in the eye is better than correcting astigmatism in the glasses, but Medicare still sees this as non-medically necessary. Medicare will cover all of the medically necessary part of the cataract surgery including the cost of a basic IOL. If a Toric Astigmatism Correcting IOL is used or if a Limbal Relaxing Incision is used, Medicare and secondary insurances will not cover this part of the procedure because if is deemed non-medically necessary.

I get the picture. Probably a Multifocal or Accommodating IOL (Presbyopic IOL) is not covered, right? Yes and no. Remember, Medicare (secondary or commercial insurance companies, too) still covers a majority of the surgery; most of the surgical cost is the basic, medically necessary portion-this is covered. The portion that relates to advanced refractive preoperative testing, presbyopia correction, the presbyopic IOL, and any extended postoperative care (days 91-365) is not a covered portion.

This doesn’t make sense. What’s the deal? Insurance companies state:

  • Over-the-counter Readers are cheap and provide you with vision to function
  • If you need a prescription to see well at distance after the cataract surgery, even if you didn’t need one before the cataract surgery, you would still be responsible for this on your own
  • vision correction (Refractive) such as Glasses, contacts or LASIK surgery are typically out of pocket costs.

I’m still a bit confused because all of my friends and family who had cataract surgery could see great and didn’t have to pay any extra. Everyone is different and some people achieve different results. Be certain to ask your eye surgeon’s billing coordinator about a detailed description and costs. Remember, there are 2 major costs: The surgeon’s fee and the facility’s fee, each having portions which are medically necessary and non-medically necessary (cosmetic). You get to choose if you want to have any of the non-medically necessary portions. Each of the medically-necessary portions will have associated copays and deductibles, while each of the non-medically necessary portions are out-of-pocket charges you are responsible for paying to the doctor and facility.

Standard Medicare and Health Insurance Coverage for Cataract Surgery

If you choose to have basic cataract surgery (no advanced preoperative refractive testing or astigmatism/presbyopia correction or extended postoperative care), then Medicare coverage is very easy to understand with respect to paying the surgeon and facility where the surgery is performed. Remember, most private or commercial health insurances tend to follow medicare’s rules on what is allowable or medically necessary.

Questions to Ask Your Insurance Provider:

  • Is cataract surgery covered or medically necessary?
  • Is astigmatism or presbyopia correction covered or medically necessary?
  • Is Refractive or Refraction technology covered or medically necessary (such as refraction, topography, pupil analysis, wavefront analysis, angle kappa)?
  • Are non-medically necessary screening tests covered?
  • How much is the copay at the surgery center?
  • How much is the copay for the surgeon?
  • How much does insurance cover the non-medically necessary portion for the surgery center?
  • How much does insurance cover the non-medically necessary portion for the surgeon?
  • How much deductible do I need to meet?
  • Is the cataract surgeon a preferred provider?
  • Is the surgery center a preferred provider?


Credit: much of this article was paraphrased from For the whole article, read here:


About the author

Dr. Timothy D. McGarity

A skilled and caring professional, Dr. Timothy McGarity has been providing exceptional ophthalmologic care to patients in the Columbia, Missouri, area since 2003. Dr. McGarity is respected not only for his personal approach to patient care, but for his commitment to the advancement of the field of ophthalmology. Come see why he is a trusted LASIK and Cataract Surgeon.

Can read better without correction | Ask the Optician – Specsavers …


I have astigmatism and I’m slightly near sighted, but when I went for my eye exam, the doctor told me I seem to favour the lens without the correction for astigmatism. So I was prescribed glasses and and contacts without astigmatism correction. I am now starting to realise that working on my computer up close is making it difficult to keep my eyes in focus, even though I am wearing my contacts or glasses. I find it helps me remove them when I am on the computer. Is this normal? These are my first pair of glasses and contacts.

Femtosecond laser-assisted intrastromal corneal ring segment …

Femtosecond laser-assisted intrastromal corneal ring segment implantation for high astigmatism correction after penetrating keratoplasty.

J Cataract Refract Surg. 2013 Sep 3;

Authors: Lisa C, García-Fernández M, Madrid-Costa D, Torquetti L, Merayo-Lloves J, Alfonso JF


PURPOSE: To assess the visual and refractive outcomes of femtosecond laser-assisted implantation of Ferrara-type intrastromal corneal ring segments (ICRS) in post-penetrating keratoplasty (PKP) eyes.

SETTING: Instituto Oftalmológico Fernández-Vega, Oviedo, Spain.

DESIGN: Cohort study.

METHODS: Patients with previous PKP had ICRS implantation after femtosecond laser tunnel creation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities and residual refractive errors were recorded before and 6 months after ICRS implantation. The power vector method was used to analyze refractive errors preoperatively and postoperatively.

RESULTS: This study enrolled 32 eyes of 30 patients. The mean UDVA (Snellen decimal) changed from 0.16 ± 0.15 (SD) preoperatively to 0.43 ± 0.28 postoperatively (P<.0001). Postoperatively, the UDVA was 20/40 or better in 40.6% of eyes. The mean CDVA was 0.67 ± 0.22 preoperatively and 0.80 ± 0.19 postoperatively (P<.0001). Postoperatively, the CDVA was better than 20/40 in 96.9% of eyes and 20/25 or better in 56.2% of eyes. By 6 months postoperatively, no eye had lost more than 2 lines of CDVA, 4 eyes lost 1 line, 6 eyes had no change, 9 eyes gained 1 line, and 13 eyes gained 2 or more lines. The safety index at 6 months was 1.20. The spherical equivalent and astigmatism components were significantly reduced after ICRS implantation (P<.04).

CONCLUSION: Intrastromal corneal ring segment implantation using the femtosecond laser may be a good alternative for high astigmatism correction in post-PKP eyes.

FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

PMID: 24011932 [PubMed – as supplied by publisher]

Contact Lens: toric, colored & circle: Astigmatism Correction in one …

So i had my eyes rechecked after not seeing well with original Rx (first time glasses wearer). I have a slight astigmatism in left eye. Right eye is fine.So the doctor made a slight change in the Rx. Right eye still was fine. When i received the glasses back , the owner of the store said “We put a little power on the Right side to balance it a little”.Is this normal? especially since the Doctor did not write a prescription for the right eye? It is very minimal, but it very slightly degrades my distance vision in the right eye. Overall the glasses are much better now and i don’t feel disoriented as a did before. The doctor said I can wear these for all around purpose (i believe he is unaware of any change in the right eye lens). Just want a professional opinion on this matter.

См. статью: Astigmatism Correction in one Eye. Slight magnification in other to Balance it?

Understand Your Astigmatism Better | What Is Health

The word “Astigmatism” is often mispronounced, misunderstood – or simply not understood at all. However, of those who wear eyeglasses, a large majority actually suffer from some sort of astigmatism. So why don’t we know what it is? It’s actually pretty simple once you learn a bit more about it. Typically our eyes are shaped like a round ball; however with an astigmatism the eye is elongated – more like a football. Having an astigmatism does not mean that there is a problem with the health of one’s eyes; simply that due to interactions with light, the eye has an issue focusing correctly. Instead of light coming in to a central location and pinpointing it with clear vision, it appears from multiple points of view – both in front of, and behind the retina.

There are a several different kinds of astigmatisms, and they can be broken down a few different ways: myopic astigmatism, hyperopic astigmatism, and mixed astigmatism, and regular and irregular astigmatism. Like nearsightedness in vision, myopic astigmatism affects meridians of the eye in a nearsighted fashion; this is to say that light is brought into focus in front of the retina. Hyperopic astigmatism – like farsighted vision – affects your close vision, and light is brought to focus behind the retina in one or both eyes. A mixed astigmatism is a combination of the two, in each eye. An irregular astigmatism cannot be corrected by eyeglasses, but can be correct by contact lenses. Regular astigmatisms are typically align the meridians perpendicular to each other and cause that football shape.

If you’re looking at your prescription, you can know whether or not you have an astigmatism very easily.

Typically you will see SPH, or your “sphere”; these values are used to know your vision correction needs. However, if you have additional information underneath the CYL (or “cylinder”) and Axis section, you will know that you have an astigmatism. The cylinder lets you know the correction for the astigmatic refractive error; and the value is added or subtracted cylindrically on the meridian depending on your needs. The axis tells you where to put the cylinder. These two values always come together; it is not possible to have a CYL on your prescription without the Axis.

The next time you get your eyes tested, there is no doubt that your doctor will likely give you an astigmatism examine as well. Whether you need single vision lenses, or bifocal glasses, it may be the case that you will also have an astigmatism correction, as well. Correcting an astigmatism shouldn’t cost more than already receiving prescription eyeglasses since the main change is the placement of the lens within the frames. Only if you have a very high astigmatism will the price of your glasses change significantly. However, if you are getting charged more for adding an astigmatism, or just feel that your glasses are too much, you should certainly check out some eye glasses online; you will be sure to find great glasses for a fraction of the price!