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Medical Forum / General / Vision / April 2004Objective Scientific Report: -1/3 diopter per year
Dear Friends, It has been stated that many people in a four year college "snap out of 20/40 vision". Anectdotal stories were told about people spontaneously "recovering" from nearsighedness. Here is a report confirming that the natural eye goes "down" at a rate of about -1/3 diopter per year in collge. I did not see a report on the number of people who went from -1/2 diopter to +1/2 diopter. Apparently there were none. Enjoy! Otis ****** The Gmelin Report Selected items: In the unpublished report by Maj McKenney "A Study of Refractive Trends at West Point", concluded: 1. Pseudo-myopia during periods of stress associated with studying may result in blurred vision in cadets with little hyperopic reserve ** ** [Their refractive status was very close to zero] 2. The average increase in myopia was -1.37 diopters (the range being -1.12 diopters through -1.62 diopters). 3. 39 percent of the graduating class (1956) has less than 20/20 vision at graduation 4. Recommendation that the visual standard remain unchanged -- that hyperopia over +2.0 diopters and myopia over -1.5 diopters should be cause for ENTRANCE disqualification. The Gmelin Summary: After a century of investigation, it has been established that the cadets at the United States Military Academy become progressively myopic (or less hyperopic) ** during their four years of education. Still to be accomplished however, is an in-depth study of myopia progression and prevention among these USMA Cadets. ** The natural eye changes its refractive status in a negative at a rate of -1/3 diopter per year (where accurate records are maintained) in a four year college. Otis please......... The study is about cadets in the year 1956. The study is not published. Again and again you use out of this report what you wanted without knowing how to interpret. Again and again it is explained to you, but you are unteachable Otis. Boring Otis and misleading. Maybe the above or one similar and written in better English is to be used every time Otis makes an boring old statement which already is explained to him. Jan (normally Dutch spoken) > Dear Friends, > [quoted text clipped - 56 lines] > at a rate of -1/3 diopter per year (where accurate records > are maintained) in a four year college. Dear Jan, Since I know you are only going to quick-fix the public with a minus lens -- I realize YOU have no interest in statistics and scientific analysis of the dynamic nature of the fundmental eye. But do not presume that everyone is like you. There are engineers and scientiest ( and yes engineering students ) who can "connect the dots", and it is their right to examine this type of data as they enter a four year college. You demean their intelligence and potential understanding with your remarks. It is were me, I would like to be informed of an intelligent alternative -- and that choice would depend on MY review of the medical "second opinion", as well as the successful work of Dr Stirling Colgate. But we differ on a person's right-of-choice on this difficult subject. If you find this boring -- then just do not read these accurate reports of the cybernetic nature of the eye's behavior. Clearly, any work of prevention will necessarily transfer control and understanding to the pilot who must do and judge the work himself. Best, Otis cc: Dr. Steve Leung Dr. Stirling Colgate Dr. Dave Guyton in message news:<40838e11$0$203$58c7af7e@news.kabelfoon.nl>... > Otis please......... > [quoted text clipped - 73 lines] > > at a rate of -1/3 diopter per year (where accurate records > > are maintained) in a four year college. "Otis Brown" <otisbrown@pa.net> wrote in > Since I know you are only going to quick-fix the public > with a minus lens -- I realize YOU have no interest > in statistics and scientific analysis of the > dynamic nature of the fundmental eye. Which statistical or scientific analysis describes a "fundmental" eye? > would depend on MY review of the > medical "second opinion", as well as the > successful work of Dr Stirling Colgate. You ignore the major studies in favor of Dr. Colgate's anecdote. By your standards, Dr. Linus Pauling was "successful" at curing the common cold. > But we differ on a person's right-of-choice > on this difficult subject. We cannot agree because you refuse to use our dictionary. > If you find this boring -- then just do not > read these accurate reports of the cybernetic > nature of the eye's behavior. Boring is your insistence that anecdotes are better than t-tests, and your rubber definitions. > Clearly, any work of prevention will necessarily > transfer control and understanding to > the pilot who must do and judge the > work himself. Clearly, any "prevention" will necessarily be based on assumption and false premises. -MT > Dear Jan, > > Since I know you are only going to quick-fix the public > with a minus lens -- I realize YOU have no interest > in statistics and scientific analysis of the > dynamic nature of the fundmental eye. What science says that the correct use of a minus lens causes problems or that using plus reverses or prevents myopia. We ask repeatedly for you to provide published human research evidence and you have yet to provide any. snip > It is were me, I would like to be informed of > an intelligent alternative -- and that choice > would depend on MY review of the > medical "second opinion", as well as the > successful work of Dr Stirling Colgate. snip > Clearly, any work of prevention will necessarily > transfer control and understanding to > the pilot who must do and judge the > work himself. If we accept your premise that the use of lenses can change the refractive status of the eye, then a proper informed consent would include the following points: 1) About 40% of military students become myopic during their college years. 2) Using plus lenses at near may prevent myopia in that 40%. 3) About 60% of military students do not become myopic during their college years. 4) Using plus lenses at near may cause hyperopia in that 60% 5) Hyperopia may cause discomfort with reading and make the need for reading glasses permanent. After age 35, hyperopes may need glasses for distance vision as well. 6) There is no way to know whether an individual is in the 40% group or the 60% group. 7) A military student using plus at near has a 40% chance of preventing myopia and a 60% chance of inducing hyperopia. Dr Judy snip balance >> Dear Jan, >> [quoted text clipped - 42 lines] > > snip balance Why be so civil? DrG > Why be so civil? 1. The newsgroup would be less pleasurable to read and post in if posters are uncivil. 2. Arguments are taken more seriously, and better believed, if the post is civil. This is especially true when the reader doesn't understand the arguments. 3. It's the professional thing to do. 4. It's the polite thing to do.  SignatureDan Abel Sonoma State University AIS dabel@sonic.net >> Why be so civil? > [quoted text clipped - 8 lines] > > 4. It's the polite thing to do. Actually, the question was entirely rhetorical and I did not expect a response. It was more a comment than a question. DrG > >> Why be so civil? > > > > 1. The newsgroup would be less pleasurable to read and post in if > > posters are uncivil. [snip of other reasons to be civil] > Actually, the question was entirely rhetorical and I did not expect a > response. It was more a comment than a question. I have an unfortunate tendency to be overly literal. :-) SignatureDan Abel Sonoma State University AIS dabel@sonic.net Dear Judy, Of course you have not defined anything here. Emmertopia is defined as a refractive state of exactly zero. I think that is a bogus word based on a sweeping assumption. So just measure the eye and determine if it has a positive or negative refractive status. Yes, you can then argue that an eye with that is not negative (must be positive) is therefore "defective" also. I think a motivated engineer will have a better preception than you do. But of course he will make a choice here. To make this clear, only those who meaasure their refractive status at zero or slightly negative would be using the plus lens. But that again, would be their choice. Best, Otis Engineer ] > >> Dear Jan, > >> [quoted text clipped - 46 lines] > > DrG > Of course you have not defined anything here. We repeatedly invite you to use the definitions actually published in dictionaries. You repeatedly refuse. > Emmertopia is defined as a refractive state of > exactly zero. I think that is a bogus word > based on a sweeping assumption. I think "engineer" is a bogus word based on a sweeping assumption. You don't think like the engineers I know. -MT > Dear Judy, > > Of course you have not defined anything here. Why would I define anything? You insist that military students should be informed that they might become myopic during their college years and that they might prevent the myopia by using plus lenses to read -- so they can make their own informed choice. I pointed out that, if this is done, it would be necessary to actually give them all the information, including the probability of becoming myopic and the possible induction of hyperopia. > Emmertopia is defined as a refractive state of > exactly zero. I think that is a bogus word > based on a sweeping assumption. No matter what you think, that is the definition. Latitude North has a definition, as doesLatitude South. I might think they are bogus words, but if I stand on the equator on the coast of Brazil, facing the sea, objects to my right are located on some latitude south and objects to my left are north and my opinion doesn't change the names. If individual pilots decided to rename latitudes because they didn't like the words, you can imagine the problems they would have describing their positions to each other. > So just measure the eye and determine if > it has a positive or negative refractive status. > > Yes, you can then argue that an eye with that is > not negative (must be positive) is therefore > "defective" also. No one but you calls refractive error a "defect". Just like north is defined as one direction and south is defined as another, myopia and hyperopia are defined as refractive errors that vary from zero in one direction or the other. Hyperopia can cause visual discomfort and blur, just as myopia can. > I think a motivated engineer will have a better > preception than you do. But of course he > will make a choice here. I would hope that an engineer would know left from right and not make an "choice" as to which direction to call which name. > To make this clear, only those who meaasure > their refractive status at zero or slightly > negative would be using the plus lens. > But that again, would be their choice. Again, if the student is going to make a choice, the student needs to know that there is a 60% chance that hyperopia might be induced and a 40% change that myopia will be prevented. Dr Judy > It has been stated that many > people in a four year college > "snap out of 20/40 vision". > Anectdotal stories were told > about people spontaneously > "recovering" from nearsighedness. Many myopic adults get spontaneous improvement. Ignoring my experience of 40,000 refractions, let's look at what the journals say: From the Blue Mountains Eye Study: "THE MEAN AGE-ADJUSTED CHANGE IN REFRACTION WAS +0.14 D FOR HYPEROPIC EYES, +0.32 D FOR EMMETROPIC EYES, AND +0.15 D FOR MYOPIC EYES." From the Beaver Dam Eye Study: THE 10-YEAR CHANGE IN REFRACTION WAS +0.48, +0.03, AND -0.19 D FOR PERSONS 43 TO 59, 60 TO 69 AND 70+ YEARS OF AGE AT THE BASELINE EXAMINATION, RESPECTIVELY. From the Andhra Pradesh Eye Study: HYPEROPIA WAS SIGNIFICANTLY HIGHER IN SUBJECTS > OR =30 YEARS OF AGE COMPARED WITH THOSE 16 TO 29 YEARS OF AGE Please tell us how your methods are better than these. -MT ----------------------------------------------- 1: Ophthalmology. 2003 Jul;110(7):1364-70. Related Articles, Links Five-year refractive changes in an older population: the Blue Mountains Eye Study. Guzowski M, Wang JJ, Rochtchina E, Rose KA, Mitchell P. Department of Ophthalmology, University of Sydney Centre for Vision Research, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, Sydney, Australia. PURPOSE: To examine 5-year changes in refractive error and astigmatism in an older population. DESIGN: Population-based cohort study. PARTICIPANTS: The Blue Mountains Eye Study examined 3654 residents aged 49 years or older from 1992 to 1994. After excluding 543 persons who died since baseline, 2335 (75.1%) attended 5-year examinations from 1997 to 1999. METHODS: Both examinations included a detailed eye assessment, with subjective refraction performed according to a modified Early Treatment of Diabetic Retinopathy Study protocol. MAIN OUTCOME MEASURES: Spherical equivalent (sum of sphere + cylinder) was used as the measure of refractive error. Only phakic eyes with best-corrected visual acuity >20/40 were included (n = 3701). RESULTS: Similar changes in refractive error were observed for the two eyes. Symmetric changes were found in 72% of participants when the difference between eyes was within 0.5 diopters (D) and in 91% when the difference was within 1.0 D. The 5-year change in spherical power was in a hyperopic direction for younger age groups and in a myopic direction for older subjects, P < 0.0001. The gender-adjusted mean change in refractive error in right eyes of persons aged 49 to 54, 55 to 64, 65 to 74, and 75 years or older at baseline was +0.41 D, +0.30 D, +0.05 D, and -0.22D, respectively. Refractive change was strongly related to baseline nuclear cataract severity; grades 4 to 5 were associated with a myopic shift (-0.33 D, P < 0.0001). Education level and age of onset of myopia, but not gender or diabetes, also predicted refractive change. The mean age-adjusted change in refraction was +0.14 D for hyperopic eyes, +0.32 D for emmetropic eyes, and +0.15 D for myopic eyes. The mean change in cylinder power over the 5-year period was small, irrespective of baseline refraction. The axis of astigmatism remained stable in most cases (64%), whereas 12% changed to "against the rule" and 11% to "with the rule." CONCLUSIONS: This report has documented refractive error changes in an older population and confirmed reported trends of a hyperopic shift before age 65 years and a myopic shift thereafter associated with the development of nuclear cataract. PMID: 12867393 [PubMed - indexed for MEDLINE] -------------------------------------------------------- Invest Ophthalmol Vis Sci. 2002 Aug;43(8):2566-71. Related Articles, Links Changes in refraction over 10 years in an adult population: the Beaver Dam Eye study. Lee KE, Klein BE, Klein R, Wong TY. Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, Wisconsin 53726, USA. klee@epi.ophth.wisc.edu PURPOSE: To quantify the 10-year change in refraction in persons more than 40 years of age. METHODS: All people 43 to 84 years of age and living in Beaver Dam, Wisconsin, in 1988 were invited for a baseline examination (1988-1990), a 5-year follow-up examination (1993-1995), and a 10-year follow-up examination (1998-2000). Refractions were determined according to the same protocol at all examinations. Aphakic and pseudophakic eyes and eyes with best corrected visual acuity of 20/200 or worse were excluded. After exclusions, refraction data were available on 2362 right eyes of the 2937 people examined at baseline and 10-year follow-up. RESULTS: Age was related to the direction and amount of change in refraction. Spherical equivalent became more positive in the youngest subjects and more negative in the oldest. After adjustment for the severity of nuclear sclerosis and other factors, the 10-year change in refraction was +0.48, +0.03, and -0.19 D for persons 43 to 59, 60 to 69 and 70+ years of age at the baseline examination, respectively. Severity of nuclear sclerosis was also strongly related to amount of change. Those with mild nuclear sclerosis at baseline had a change of +0.35 D, whereas those with severe nuclear sclerosis had a change of -0.53 D. The amount of change was also related to diabetes and weakly related to baseline refractive error, but was unrelated to gender and education. In addition to the longitudinal changes observed, there was a birth cohort effect. In comparing people of the same age across examinations, those born in more recent years had more myopia than those born in earlier years. CONCLUSIONS: Significant changes in spherical equivalent in adults occur over a 10-year period. Younger people became more hyperopic, whereas older people became more myopic. These data provide evidence of a longitudinal change in refraction in adults, which may explain the refractive patterns observed in cross-sectional studies. PMID: 12147586 [PubMed - indexed for MEDLINE] ---------------------------------------------------- Invest Ophthalmol Vis Sci. 1999 Nov;40(12):2810-8. Related Articles, Links Refractive errors in an urban population in Southern India: the Andhra Pradesh Eye Disease Study. Dandona R, Dandona L, Naduvilath TJ, Srinivas M, McCarty CA, Rao GN. Public Health Ophthalmology Service, L.V. Prasad Eye Institute, Hyderabad, India. rakhi@lvpeye.stph.net PURPOSE: To assess the prevalence, distribution, and demographic associations of refractive error in an urban population in southern India. METHODS: Two thousand five hundred twenty-two subjects of all ages, representative of the Hyderabad population, were examined in the population-based Andhra Pradesh Eye Disease Study. Objective and subjective refraction was attempted on subjects >15 years of age with presenting distance and/or near visual acuity worse than 20/20 in either eye. Refraction under cycloplegia was attempted on all subjects < or =15 years of age. Spherical equivalent >0.50 D in the worse eye was considered as refractive error. Data on objective refraction under cycloplegia were analyzed for subjects < or =15 years and on subjective refraction were analyzed for subjects >15 years of age. RESULTS: Data on refractive error were available for 2,321 (92.0%) subjects. In subjects < or =15 years of age, age-gender-adjusted prevalence of myopia was 4.44% (95% confidence interval [CI], 2.14%-6.75%), which was higher in those 10 to 15 years of age (odds ratio, 2.75; 95% CI, 1.25-6.02), of hyperopia 59.37% (95% CI, 44.65%-74.09%), and of astigmatism 6.93% (95% CI, 4.90%-8.97%). In subjects >15 years of age, age-gender-adjusted prevalence of myopia was 19.39% (95% CI, 16.54%-22.24%), of hyperopia 9.83% (95% CI, 6.21%-13.45%), and of astigmatism 12.94% (95% CI, 10.80%-15.07%). With multivariate analysis, myopia was significantly higher in subjects with Lens Opacity Classification System HI nuclear cataract grade > or =3.5 (odds ratio, 9.10; 95% CI, 5.15-16.09), and in subjects with education of class 11 or higher (odds ratio, 1.80; 95% CI, 1.18-2.74); hyperopia was significantly higher in subjects > or =30 years of age compared with those 16 to 29 years of age (odds ratio, 37.26; 95% CI, 11.84-117.19), in females (odds ratio, 1.86; 95% CI, 1.33-2.61), and in subjects belonging to middle and upper socioeconomic strata (odds ratio, 2.10; 95% CI, 1.09-4.03); and astigmatism was significantly higher in subjects > or =40 years of age (odds ratio, 3.00; 95% CI, 2.23- 4.03) and in those with education of college level or higher (odds ratio, 1.73; 95% CI, 1.07-2.81). CONCLUSIONS: These population-based data on distribution and demographic associations of refractive error could enable planning of eye-care services to reduce visual impairment caused by refractive error. If these data are extrapolated to the 255 million urban population of India, among those >15 years of age an estimated 30 million people would have myopia, 15.2 million hyperopia, and 4.1 million astigmatism not concurrent with myopia or hyperopia; in addition, based on refraction under cycloplegia, 4.4 million children would have myopia and 2.5 million astigmatism not concurrent with myopia or hyperopia. PMID: 10549640 [PubMed - indexed for MEDLINE] otisbrown@pa.net (Otis Brown) wrote in news:6dbddb9.0404181955.51239f04 @posting.google.com: > In the unpublished report by Maj McKenney "A Study of > Refractive Trends at West Point", concluded: The key phrase is, of course, "unpublished". Scott > Dear Friends, > > Here is a report confirming that the > natural eye goes "down" at a rate > of about -1/3 diopter per year > in collge. Is attrition taken into account? Myopes are about 8 IQ points smarter than the general population. In an educational program, as the dumber, less myopic students flunk out, there would be an apparent increase in myopia. SignatureRobert T. Kopp http://analytic.tripod.com/ > > Dear Friends, > > [quoted text clipped - 6 lines] > the general population. In an educational program, as the dumber, less > myopic students flunk out, there would be an apparent increase in myopia. Left-handers are smarter than right-handers because their parents were too smart to try changing them into right-handers. SignatureCheers, Bev ================================================================ I can picture a world without war, without hate. I can picture us attacking that world, because they'd never expect it. > Dear Friends, > [quoted text clipped - 39 lines] > 3. 39 percent of the graduating class (1956) has less than 20/20 > vision at graduation major snip > ** The natural eye changes its refractive status in a negative > at a rate of -1/3 diopter per year (where accurate records > are maintained) in a four year college. What about the 61% who apparently showed no change? Apparently not all eyes are natural eyes. DrG These figures seems reliable enough, military _trivial_ records need not be published as a _research paper_ to be accepted as evidence. You may ignore the mediocric critisim. > Dear Friends, > [quoted text clipped - 56 lines] > at a rate of -1/3 diopter per year (where accurate records > are maintained) in a four year college. > These figures seems reliable enough, military _trivial_ records > need not be published as a _research paper_ to be accepted as evidence. > > You may ignore the mediocric critisim. It's no secret that myopia is more prevalent among college and graduate students, military or otherwise. It's more obvious in other populations - 98% in a Singapore medical school. The "mediocric critisim" arises when someone claims that plus lenses slow or reverse myopia. The published research shows that treatment to be ineffective. -MT |
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