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Medical Forum / General / Vision / June 2004Children Get Glasses They Don't Need
One possible reason why some exotic treatments for eye disorders seem to work is that the disorders did not exist in the first place: By Liz Szabo, USA TODAY A study out today finds that up to 20% of children with normal eyes who undergo comprehensive vision exams may be prescribed glasses they don't need. In an article published online in the Journal of the American Association of Pediatric Ophthalmology and Strabismus, researchers examined the records of more than 100,000 preschoolers who were screened through a statwide program in Tennessee. More than 3,600 children were referred to specialists for follow-ups because of suspected disorders, such as lazy eye, according to the study. About one-quarter, or 890, were found to have no eye problems. Yet nearly one in five of these children were prescribed glasses.  SignatureRobert T. Kopp http://analytic.tripod.com/ > One possible reason why some exotic treatments for eye disorders seem > to work is that the disorders did not exist in the first place: [quoted text clipped - 12 lines] > study. About one-quarter, or 890, were found to have no eye problems. > Yet nearly one in five of these children were prescribed glasses. Schamen Sie sich. Where did these preschoolers get their glasses? From other pediatric ophthalmologists? DrG I haven't seen this article either. However, in large screening programs such as this, most kids do not get a see a pediatric ophthalmologist. They usually see either an optometrist or a general ophthalmologist. On 6/23/04 8:53 PM, in article Xns9511E9F25FC33drgleukomacom@204.127.204.17, >> One possible reason why some exotic treatments for eye disorders seem >> to work is that the disorders did not exist in the first place: [quoted text clipped - 17 lines] > > DrG Actually, in most large screening programs, the children see neither an optometrist nor an ophthalmologist, but a "screener." I feel that I am on solid ground if I say that the bulk of pediatrician referrals go to pediatric ophthalmologists(at least in our neck of the woods), which is why I said what I said. As much as is suggested by the post, there is no substance. With mandatory vision exam initiatives picking up steam across the country, I'm not surprised to see these kinds of "scare tactics" being promoted. DrG > I haven't seen this article either. However, in large screening > programs such as this, most kids do not get a see a pediatric [quoted text clipped - 27 lines] >> >> DrG Here's the link to the full text article: http://www.usatoday.com/news/health/2004-06-23-eyeglass-usat_x.htm The actual study as published in J of AAPOS does not appear to be on-line as the article states. Perhaps Dr. Robins can find it and comment following. Meanwhile, my take on children's vision screenings, having organized and done them for years, is simple: Out of 1,000 kids screened (for example) It is far better to properly diagnose and treat the 200 kids that would otherwise go through school with learning disabilities and perhaps unnecessarily prescribe for a couple of dozen (who would probably toss the specs anyway.) But forget the numbers. In any event, I don't believe that a proper vision screening and proper comprehensive exam follow-up will lead to over prescribing. Over examining, perhaps---and so what? False positive is far better than false negative in this case. In my personal experience, (and here's some actual numbers), of 400 children (grades K-4) screened, 40 were found to have significant vision problems that were not previously diagnosed or treated. Possibly one or two were missed, one or two were targeted for comp exams that did not really need it. Of the 40, perhaps 30 actually went on to get comp exams (parents in denial, poor follow-up on the part of the school, and other excuses). Virtually all of them needed vision correction of some kind. No one got spectacles or vision therapy they did not need. One child was found to have a brain tumor. You simple cannot deny the value of pre-school and elementary school vision screening, when properly protocoled (is that a word?) and with proper follow-up to the appropriate eye professional. And one more thing: It really, really bothers me. Parents bring their kids to THEIR eye exam. Both parents have vision correction. The child? Who knows? The parents, having heard no alarm bell from the school (that doesn't do vision screening) or pediatrician (who at best has a nurse or staff person drag the kid in front of a Snellen chart hung on a door) have never had the child's vision checked. I offer to screen the child. Parent says: "maybe when I come to pick up my glasses", or "the school will do it." So, are school vision screenings a good idea? Heck, almost any kind of screening is better than nothing at all. But it's time parents demand a proper vision screening at school. And demand their pediatricians get on the ball and do it right. We have to legislate this kind of thing? Whatever happened to common sense? No money is not an excuse. If we (local docs) are asked, we do it, for free. End of rant. Larry Parent of a third grader. Organizer of vision screenings. Provider of in-office screenings for free if that's what it takes! > Actually, in most large screening programs, the children see neither an > optometrist nor an ophthalmologist, but a "screener." I feel that I am on [quoted text clipped - 7 lines] > > DrG SignatureDr. Larry Bickford, O.D. Family Practice Eye Health & Vision Care The Eyecare Connection http://www.eyecarecontacts.com larrydoc at eye-care-contacts dot com (remove -) > ... > So, are school vision screenings a good idea? Heck, almost any kind of [quoted text clipped - 10 lines] > Parent of a third grader. Organizer of vision screenings. Provider of > in-office screenings for free if that's what it takes! Good for you! My husband didn't find out he needed glasses until he had a mandatory vision test when he entered college. I guess nobody noticed that he could only read stuff that was 6" from his nose. I'd really like to smack his mom for not noticing, but she wouldn't remember it anyway :-(. If he didn't look so much like pictures of his father, I'd swear he was switched at birth with somebody else's kid -- how can somebody who breezed through Caltech be spawned by a woman who talks to psychic hotlines? SignatureCheers, Bev --------------------------------------------------------- If I know that chaining yourself to a dead cow is stupid, how come Carly makes so much more money than I do? > Good for you! My husband didn't find out he needed glasses until he had > a mandatory vision test when he entered college. I guess nobody noticed > that he could only read stuff that was 6" from his nose. I'd really > like to smack his mom for not noticing, but she wouldn't remember it > anyway :-(. I shared an office with a woman who didn't think much of her in-laws. Her husband was a straight A student in high school, but they were convinced he was stupid because he couldn't learn his colors! Yup, he was color blind. SignatureDan Abel Sonoma State University AIS dabel@sonic.net >I shared an office with a woman who didn't think much of her in-laws. Her >husband was a straight A student in high school, but they were convinced >he was stupid because he couldn't learn his colors! Yup, he was color >blind. This is a serious problem. I once had a child brought to me because the teacher was telling the patients that he was "not ready for first grade" and she wanted to keep him back a year. Her reason: he was "immature" because he couldn't learn his colors. Yep, color blind. I copied the principal on the letter I sent the teacher: No kindegarden teacher should be unaware that a fairly high percentage of boys will not easily distinguish colors..... BTW, there were a lot of flawed statistics in that news study you all were discussing. The story used the fact that few pediatric ophthalmologists prescribed glasses as "evidence" that other practitioners may over-prescribe. Nonsense. Pediatric ophthalmologists generally DON'T Rx glasses. They are generally strabismus surgeons. They tend to refer the kids who need glasses back to the optometrists who referred them....in other words, they tend to only see the kids who need surgery, not those who need glasses.... Interesting comment. Most of the pediatric ophthalmologists I know in private practice probably make most of their money doing eyeglasses . >> I shared an office with a woman who didn't think much of her in-laws. Her >> husband was a straight A student in high school, but they were convinced [quoted text clipped - 16 lines] > only > see the kids who need surgery, not those who need glasses.... Yes, Larry, very commendable of you, the high road and all that. I was doing vision screenings possibly before you were born(I'm 54, don't know how old you are), and developed my own database of nearly 1000 kids. Unfortunately, it is but a drop in the bucket of what is needed. I'm sure you will agree that screenings leave something to be desired. Yes, you and I armed with retinoscopes, skiascopy racks, and ophthalmoscopes can be extremely accurate, but that is not the real world. The real world is that pediatricians go to med school, where they are taught that anything less than 4 diopters of hyperopia needs no correction, and that no child less than 5 years/old has the ability to read 20/20. I say that no screening is no substitute for a proper exam, even if I have to do it at a discounted fee. DrG > Here's the link to the full text article: > http://www.usatoday.com/news/health/2004-06-23-eyeglass-usat_x.htm [quoted text clipped - 65 lines] >> >> DrG > I say that no screening is no substitute for a proper > exam, even if I have to do it at a discounted fee. Should have read "no screening is a substitute for a proper exam... DrG >> Here's the link to the full text article: >> http://www.usatoday.com/news/health/2004-06-23-eyeglass-usat_x.htm [quoted text clipped - 65 lines] >>> >>> DrG > Yes, Larry, very commendable of you, the high road and all that. I was > doing vision screenings possibly before you were born(I'm 54, don't know [quoted text clipped - 10 lines] > > DrG Agreed, absolutely. Too bad it is next to impossible to get parents to get exams for their kids. Even for free! ---Same age as you, old man! Just still a little stuck in the 60's mindset. I know. I'm trying to get over it. ---Every couple of years I do a big-time community education/outreach to encourage children's exams. Fails to make a dent----every time. Yet I will do it again this September. If only to satisfy my delusions. I'm trying to get over it. ---For you pediatrician friends (non-presbyopes): have them read a couple of pages of text through - 3D lenses. No rubbing, no squinting allowed! Then have them explain why hyperopic kids don't need correction. Larry SignatureDr. Larry Bickford, O.D. Family Practice Eye Health & Vision Care The Eyecare Connection http://www.eyecarecontacts.com larrydoc at eye-care-contacts dot com (remove -) > ---Every couple of years I do a big-time community education/outreach to > encourage children's exams. Fails to make a dent----every time. Yet I > will do it again this September. If only to satisfy my delusions. I'm > trying to get over it. Due to your recommendations here, I insisted that my children get their children REAL eye exams checking specifically for amblyopia, which they did. That's four right there. So far so good... SignatureCheers, Bev ------------------------------------------------------------ VISE GRIPS (VYS'-gripz) [n] A tool used to transfer intense welding heat to the palm of the welder's hand. -- DS > Agreed, absolutely. Too bad it is next to impossible to get parents to > get exams for their kids. Even for free! Mandatory physicals, dental exams, but the sensory process vital to learning goes by the wayside. It's a matter of education, and we in the eyecare professions send out a mixed message because we do not speak with one voice. If I don't seem to be in a very good mood it's because of the mother who nearly literally threw her daughter's glasses at us yesterday after she went to a pediatric ophthalmologist for a second opinion. He exploited the situation to his benefit. Said the girl(4 years/old) didn't need them. This was after I refracted the girl twice cycloplegically at +1.75 in the O.D. +2.50 in the O.S. with VAs of 20/20 and 20/30 respectively, and recommended a bit of occlusion therapy. Too young, he said. I'd like to take a chunk out of his a**. I've seen 20 years of this nonsense. Consider yourself lucky that you don't have one of these troublemakers practicing near you. Any comments? DrG > Mandatory physicals, dental exams, but the sensory process vital to > learning goes by the wayside. [quoted text clipped - 12 lines] > > Any comments? But of course! I sent you a private email. I terminated my relationship with the AOA and COA for their lack of getting involved with fixing this problem, and wasting my money on senseless in-fighting and ultimately caving in to the OMDs at every opportunity. Hold on Dr. David----I fully realize that some of you are good guys---really good guys even, but your professional organizations want nothing more than to protect what they consider their turf. Too bad. Ends up with mixed messages and the public, our children are the ones that get hurt for the sake of the bottom line. And thanks for your note, Bev! So where's Otis on this? Only kidding----------- Larry >> Mandatory physicals, dental exams, but the sensory process vital to >> learning goes by the wayside. [quoted text clipped - 30 lines] > > Larry I have great interprofessional relationships with many subspecialty MD's. Unfortunately, I haven't been able to get anywhere with local pediatric ophthalmologists. Their attitudes toward optometrists are abolutely poison. I take that back. I have an excellent relationship with one pediatric ophthalmologist who is my patient, but doesn't practice anywhere near me. I've basically given up trying. DrG Dear Dr L, As both of us know, the practice of medicine (or optometry) is not an EXACT science. For this reason, there is difference of opinion. As long as the parent is made aware of this difference, and the reasons for it -- and the potential consequences, then, while difficult, there should be no problem. DrL> He said the girl(4 years/old) didn't need them. This was after I > refracted the girl twice cycloplegically at +1.75 in the O.D. +2.50 in the > O.S. with VAs of 20/20 and 20/30 respectively, and recommended a bit of > occlusion therapy. Too young, he said. I'd like to take a chunk out of > a__ You did not state it, but I assume you would have put the 4 year-old in +1.75 O.D., and a +2.5 O.S. Is that correct? Your opinion is that the child should be wearing the glasses. DrL> Consider yourself lucky that you don't have one of these troublemakers practicing near you. I consider an ophthalmologist a highly qualified medical doctor, as competent as you. He might say EXACTLY the same thing about you -- did you consider THAT possiblity. The parents were informed of their choice. They obviously must now think very carefully about the consequences. Best, Otis ****** DrL> Any comments? The > > > Agreed, absolutely. Too bad it is next to impossible to get parents to [quoted text clipped - 18 lines] > > DrG > I consider an ophthalmologist a highly qualified medical doctor, > as competent as you. He might say EXACTLY the same thing > about you -- did you consider THAT possiblity. > > The parents were informed of their choice. They obviously > must now think very carefully about the consequences. Since I didn't say that about him, I don't know what you're talking about. But he evidently said or implied that about me. The irony is that he is another doctor in a large group practice that lost a patient to me recently. The mother of a teenage boy was distraught because his new doctor disagreed completely with his former doctor, whom he had been seeing since early childhood. Mind you, they were in the same practice. Well, it so happened that he was one of those high unilateral hyperopes you can't put in glasses, and unless you can put them in a contact lens and make them appreciate the difference, you may as well not treat them at all, unless they are amblyopic, and he wasn't. So, I explained at length how such polar opinions might have merit, but really agreed more with one than the other, and wound up putting the boy in a contact lens, which he really seemed to like. The point is that I deliberately tried to defuse the situation. But, somehow I'm not surprised that you would stick up for an unprofessional jackass. DrG Otis: I agree with the Dr. G and LarryDoc on this one - the pedi-oph in this case does sound like a jerk. This child is amblyopic and should have treatment - glasses, and probably patching. Age 4 is not too young ever. Guy sound like he's playing a turf war, and not taking case of the problem. On 6/25/04 1:49 PM, in article 6dbddb9.0406251249.14634fa4@posting.google.com, "Otis Brown" <otisbrown@pa.net> wrote: > Dear Dr L, > [quoted text clipped - 62 lines] >> >> DrG > Otis: > > I agree with the Dr. G and LarryDoc on this one - the pedi-oph in this case > does sound like a jerk. This child is amblyopic and should have treatment - > glasses, and probably patching. Age 4 is not too young ever. Guy sound like > he's playing a turf war, and not taking case of the problem. Dear David, It is not so much as whether I agree or disagree. What I do suggest is that the pedi-oph, would treat his OWN CHILD, in the manner that he treated this woman's child. That does set the ethical standard. Equally, I am certain that bout you and Dr. L would put a child of 2 diopters (refractive state) is a +2.0 diopter lens. I do not think that "amblopic" was given in the measurement of the child's eyes. Only the refractis status was mentioned. The recommendations become a matter of what the man would do with is own child. As long as that issue is clear, then I have no problem with EITHER recommendation -- as long as the woman is informed of BOTH opinions before a lens is prescribed. Had that been done, the woman would have had no cause for anger. It would have been HER choice, and not a decision by anyone else. Best, Otis > The recommendations become a matter of what > the man would do with is own child. As long > as that issue is clear, then I have no > problem with EITHER recommendation -- as long > as the woman is informed of BOTH opinions before > a lens is prescribed. So are you saying that I owe it to the patient to recommend that they get a second opinion before I prescribe lenses for them? In this instance there was FINDING #1: statement of visual complaint. Then there was FINDING #2: reduced vision in one eye which met the definition of amblyopia. FINDING #3 was significant bilateral hyperopia which was higher in the eye with the reduced vision. Can you honestly tell me that I should have considered doing nothing and telling the mother this? You have no problem with either recommendation because you don't know any better. DrG > > The recommendations become a matter of what > > the man would do with is own child. As long [quoted text clipped - 5 lines] > So are you saying that I owe it to the patient to recommend that they get a > second opinion before I prescribe lenses for them? No, I think that it is ESSENTIAL that you spell out the conditions that YOU SEE, as YOU SEE IT, but also mention that some OPHTHALMOLOGISTS believe that the eye is still in a state of development, and that THEY would not use a plus lens ON THEIR OWN CHILD. After the woman understands this issue, then SHE could make the decision. If she does not like YOUR OPINION, then she could take he business and interest in her child's welfare to the ophthalmologist who would not use a plus at this point. > In this instance there was FINDING #1: statement of visual complaint. I did not read the woman's staement of complaint. Did you post what SHE SAID, or asked for? Then there was FINDING #2: reduced vision in one eye which met the definition of > amblyopia. A VA of 20/30 (for a 4 year old child is not that surprising. Under different measurement conditions she might have measured 20/25 or even 20/20. I think you are "jumping the gun" in this case. That is why I believe that this woman should have been presented with the second-opinion. FINDING #3 was significant bilateral hyperopia which was higher in the eye with the reduced vision. A large number of normal eyes (i.e., 20/20, refractive range zero to +2 diopters, will have a difference of 1/2 diopters. 3/4 diopters could well be considered outside-normal. You again are jumping to a conclusion, about this issue. Further, measurements to 1/4 diopter are simply not that accurate. It is entirely possible, that another measurement made by an ophthalmogist would have shown a difference of 1/2, rather than 3/4 diopters. This is an "edge" call, and the concept of the second-opinion certainly applies in this case. The woman had every right to be presented with a right-of-choice, since this is a jugement call, not an absolute. Can you honestly tell me that I should > have considered doing nothing and telling the mother this? Since a qualified ophthalmolgist stated the second-opinion (do not use the plus at this point), I strongly believe that she should have heard BOTH SIDES OF THE PRESENTATION. So no, I do not trust your judgment in this case. If you has talked to the woman, and said, Mrs "Y", You child has a "marginal" case of amblyopia. There are doctors who would not place a plus lens on her at this point -- because they believe that her eyes are still developing. Further they would not use a plus on their own child based on that judgment, I, DrG, however believe that a treatment should be started at this time. Please take the time to review these issues, and I will take actions based on your considered judgment. I believe that is how this issue should have been handled. I believe that the woman would have had greater respect for your honesty and respect for her intelligence in the matter. I know I would. Best, Otis > You have no problem with either recommendation because you don't know any > better. Otis> As ususal this is further proof our you arrogance -- in the extreme. Otis> I would like to hear from both Dr "X", and this woman "Mrs Y" on this issue. Because I deal very poorly with people of such incredible and blind hubris. Best, Otis > DrG > Otis> As ususal this is further proof our you > arrogance -- in the extreme. [quoted text clipped - 7 lines] > > Otis Why do you post here, then? Personally, I think you belong on some alt.newsgroup. You're not a doctor, and you're not a visual scientist, and seem to demonstrate a propensity for coming down on the wrong side of the issue repeatedly. DrG > Why do you post here, then? Personally, I think you belong on some > alt.newsgroup. You're not a doctor, and you're not a visual scientist, and > seem to demonstrate a propensity for coming down on the wrong side of the > issue repeatedly. Like over and over and over again. Like a broken record. Like a digital recorder stuck on one track. Like a one-track mind or otherwise mindless. An absolutely useless position. No insight, no intelligent discussion, just repeat, repeat, repeat ad nausium . To silly to insult. Define: Otis. Does anyone really know what time it is? Does anyone really care? LB Dear DrL, By "wrong side", you mean the ophthalmologists and optometrist who disagree with you -- but of course. I believe that a person should receive proper information from you about alternatives. You do not. That why we disagree. If a person is informed of the proven effect the minus lens has on the eye, (primate eyes -- proven beyond doubt, experimental SCIENCE, i.e., FACT) and still decides he LOVES stair-case nearsightedness, then the issue is his to understand, and accept the consequences. Best, Otis Engineer > > Otis> As ususal this is further proof our you > > arrogance -- in the extreme. [quoted text clipped - 14 lines] > > DrG > If a person is informed of the proven > effect the minus lens has on the [quoted text clipped - 9 lines] > Otis > Engineer Again you are walking around in circles Otis. No proof at all from your side. A bunch of repeating nonsense blabla. The only reason why I should respond at your very boring and wrong advises is that I want to explain to laymen (as you are one off them) who are seeking for advises that nothing of your ideas is proven by you Otis, Otherwise I already "ploinked" you. PROOF Otis or shut your mouth please.(the proof may be delivered from one of your famous assistants Otis) Jan (normally Dutch spoken) Dear Jan, If fact, I have offered proof that the natural eye, when directly tested is PROVEN to be dynamic. I think it was Dr Mike who then stated, "we are only interested in putting minus lenses on eyes that have a negative refractive status. I think his (and most likel your) statement make any sembeleance of scientific proof impossible. That also suggests, the the person who wishes to prevent or avoid nearsightedness (a negative refractive status of the natural eye) will have to learn to do it himself -- under his own control. The proof is more for the person who is willing to reject your notion that a minus lens has NO EFFECT on the refractive status of the eye -- and appreciate what the factual data actually DOES TELL US about the behavior of the natural eye. For the ODs who would practice this PREVENTIVE approach -- I give my TOTAL SUPPORT. For the parent who will accept the use of the plus -- at the critical zero-diopters stage -- I also give very strong support. But the real responsibility must rest with the parent, to sort out these two contradictory methods (i.e., the second opinion). No one can abritarily use EITHER method until he first consults the parent (respects their intelligence) abou this issue. Sadly, that "respect" for intelligent choice is sadly lacking in your profession at this time. I do not care which method is used -- only that the parent has the education to understand the alternative, and more importantly, the reasons for and the necessity for the alternative. This issue of proof must rest more for the parents understanding of the issues involved. This is what you dis-respect in the person who walks into your office. Best, Otis cc: Dr. Steve Leung ********** > > If a person is informed of the proven > > effect the minus lens has on the [quoted text clipped - 22 lines] > > Jan (normally Dutch spoken) > If fact, I have offered proof that the natural eye, > when directly tested is PROVEN to be dynamic. You have not offered any proof that neutralizing myopia in humans causes it to accellerate. > I think it was Dr Mike who then stated, > "we are only interested in putting minus lenses > on eyes that have a negative refractive status. > > I think his (and most likel your) statement make > any sembeleance of scientific proof impossible. Then you agree that neutralizing minus has no effect. If it happened, we'd see differences in myopia corrected and uncorrected. Easy enough to measure. So how many ophthalmologists recommend plus for preventing myopia? I missed your answer. -MT > The proof is more for the person who is willing > to reject your notion that a minus lens has > NO EFFECT on the refractive status of the > eye -- and appreciate what the factual > data actually DOES TELL US about the > behavior of the natural eye. Again walking around in circles Otis. You may use the term "factual data" but again you "forget" the show up with (f)actual data wich tells me you are imcompetent in this field of eyeCARE. Please shut up or deliver proof and let me keep my mouth shut. > For the ODs who would practice this PREVENTIVE > approach -- I give my TOTAL SUPPORT. How nice. > For the parent who will accept the use > of the plus -- at the critical zero-diopters > stage -- I also give very strong support. How nice of you. > But the real responsibility must rest with > the parent, to sort out these two contradictory > methods (i.e., the second opinion). A second opinion normally is given by a specialist of at least the same calibre as the specialist who has given the first. You are not an eyecareprofessional Otis. You have no knowledge in this field. > No one can abritarily use EITHER method until > he first consults the parent (respects their [quoted text clipped - 14 lines] > This is what you dis-respect in the person > who walks into your office. The language of a charlatan. Also the language used by persons who do not have to respect the needs to solve a (vision) problem. Also the language of persons who don't have to take responsibility for there advises. Jan (normally Dutch spoken) > Best, > [quoted text clipped - 3 lines] > > ********** Dear Jan, We can call each other "names" if you like. If the subject is atomic physics, then you my friend are a "lay man". If the subject is organic failure of the eye, i.e., detached retina, the David R. is the expert and you are the "layman" as am eye. If you use the term "error" to describe your profession, then on that narrow grounds you can call youself an "expert" and myself a "layman". But if we are talking about the dynamic behavior of the natural eye, as a sophisticated system, (engineering) then you, my friend are a "layman". But I will post your statement to Dr. Steve Leung for his enjoyment, and others who have a more educated and technical mind on the subject of the natural eye's proven behavior characteristic. Best, Otis cc Steve Leung Alfred Stirling Colgate Francis Young David Guyton ***************** > > The proof is more for the person who is willing > > to reject your notion that a minus lens has [quoted text clipped - 62 lines] > > > > ********** > But if we are talking about the > dynamic behavior of the natural eye, > as a sophisticated system, (engineering) > then you, my friend are a > "layman". See if you can understand that no one here is your friend, Otis. YOU are the odd-man out. The quack, the nut case. We only bother with your junk posts to assure that new readers to this group grasp an immediate understanding of you and the uselessness of your arguments. > But I will post your statement > to Dr. Steve Leung for his enjoyment, > and others who have a more educated > and technical mind on the > subject of the natural eye's > proven behavior characteristic. You have been asked and you have not ever proved anything. Nothing. Garbage in equals garbage out. You should know that. After all, it's engineering, technical, and the natural order of things. Got it? LB Major snip......... > But I will post your statement > to Dr. Steve Leung for his enjoyment, [quoted text clipped - 12 lines] > Francis Young > David Guyton You forgot your aunt Evelyn and uncle Bernie. Jan (normally Dutch spoken) Dear Jan, Being filppant does not become you. The issue of effective prevention is a very serious matter. The fact that you make a "joke" of it tells me of your nature. But I will let others decide that issue. You did call me a "charlatan" -- I guess to impress others. But, with honesty, I will post a response. Best, Otis > Major snip......... > [quoted text clipped - 18 lines] > > Jan (normally Dutch spoken) > Dear Jan, > [quoted text clipped - 16 lines] > > Otis Feel free to respond Otis, maybe you can send some proof of your ideas along with the response? Please take my request, to proof you are right, serious. Jan (normally Dutch spoken) > Dear DrL, > [quoted text clipped - 22 lines] > Otis > Engineer That is a totally false set of premises. DrG > By "wrong side", you mean the ophthalmologists > and optometrist who disagree with you -- but > of course. So, how many ophthalmologists believe plus prevents myopia? Still no answer? > I believe that a person should receive proper > information from you about alternatives. Don't expect us to practice alternative medicine. -MT Dear Mike, There are people, engineers, scientists, optometrists, pilots, college students, and optometrists who are willing to learn new ideas and concepts. They are willing to learn that the minus lens method was put "into use" with almost no science -- other that the fact that it works instantly -- and little proof that is was even "save" in the long-term. All of use who advocate fundamental change in concept also acknowledge that both the pilot (or concerned parent) must understand the nature of this change. Yes, there are optometrists who will support the plus lens as the second-opinion. In private conversations with ophthalmologists, I know they agree that "change" of this nature is necessary. To prove this fact why not read the site: www.chinamyopia.com to understand that skilled optometrists disagree with your one-sided arguments. But, to answer your questions Otis> > By "wrong side", you mean the ophthalmologists > > and optometrist who disagree with you -- but > > of course. > > So, how many ophthalmologists believe plus prevents myopia? Still no answer? Otis> Please check the web-site I posted. Otis> Also read the statement by Professor Paul Romano posted on my site. Otis> Dr. David Guyton has also published a paper on the scientific studies concerning the eye's behavior. > > I believe that a person should receive proper > > information from you about alternatives. > > Don't expect us to practice alternative medicine. Otis> Then some optometrist are not in fact doing what you refuse to do. 1. Treat a person with respect for both his intelligence and potential motivation. A person of motivation must understand that you have no concept that a person has a right to be informed of alternatives -- and specifically, alternative possiblities that you hate to consider. Best, Otis Engineer > -MT > pilots, college students, and optometrists who are > willing to learn new ideas and concepts. Only those who are ignorant of history can consider old, discarded ideas "new". > They are willing to learn that the minus lens method > was put "into use" with almost no science -- other > that the fact that it works instantly -- and little > proof that is was even "save" in the long-term. And you pretend we haven't measured the difference between people wearing minus and people who don't. > All of use who advocate fundamental change in concept > also acknowledge that both the pilot (or concerned parent) > must understand the nature of this change. Like you must understand cellular biochemistry before your antibiotic will work. > Yes, there are optometrists who will support the plus lens > as the second-opinion. In private conversations with > ophthalmologists, I know they agree that "change" of > this nature is necessary. To prove this fact why > not read the site: I'd prefer you to answer the question: what percentage of ophthalmologists believe that plus prevents myopia? 1%? 0.01%? > to understand that skilled optometrists disagree > with your one-sided arguments. I'd welcome them to present their data. Until they do, I have to believe the data that's been published. > > So, how many ophthalmologists believe plus prevents myopia? > Still no answer? > > Otis> Please check the web-site I posted. That isn't an answer. Please choose from the following: a) 1%, b) 0.1%, c) 0.01% d) no significant percentage. > > Don't expect us to practice alternative medicine. > > Otis> Then some optometrist are not in fact > doing what you refuse to do. And those who are ignorant of history are doomed to repeat it. The number of optometrists prescribing plus has diminished greatly. It is not a new idea. > A person of motivation must understand that > you have no concept that a person has a right > to be informed of alternatives -- and specifically, > alternative possiblities that you hate to consider. And you have every right to treat your cancer with peach pits. Just don't ask me to recommend it. -MT I would not let 2 lines of vision go untreated. The vision was tested several times on that visit, and agreed. Waiting to see what happens is prolonging the problem. The purpose of the glasses wasn't to reduce the relatively mild hyperopia, but to equalize the focus of the eyes, which is the first step in treating amblyopia. > FINDING #2: reduced vision in one eye which met the definition of >> amblyopia. [quoted text clipped - 82 lines] > >> DrG > What I do suggest is that the pedi-oph, would treat > his OWN CHILD, in the manner that he treated > this woman's child. > > That does set the ethical standard. Now you're a medical ethicist! Scott Amblopia WAS mentioned in the posting - the child's vision was 20/20 and 20/30, which meets the definition of amblyopia, assuming it is not refractive error. On 6/26/04 8:23 PM, in article 6dbddb9.0406261923.5762e0eb@posting.google.com, "Otis Brown" <otisbrown@pa.net> wrote: >> Otis: >> [quoted text clipped - 35 lines] > > Otis Otis, you have made the mistake before of not believing that a person has amblyopia when they have had a lifelong diagnosis of it. You did this on my group, FOVT, because the man in question, a young pilot, was amblyopic but myopic, just to greatly varying degrees in each eye. You kept at him, trying to convince him that he was not amblyopic. Fortunately he did not follow your advice. This is why the members here are upset with you. When you take that kind of attitude, you can do real harm. You can't keep making errors in judgement like that and get the respect of the doctors here. And don't say that you don't want it, and don't care what they think. If this were true you would have ceased posting here long ago. You would have set up your own forum about plus lens. Why haven't you done that? Why haven't you taken the responsibility on yourself? You would reach more people that way. I wish you would set up your study and stop trying to talk the docs here into believing in your ideas. As you know I think plus lens is likely to have value for prevention of myopia in people with a genetic propensity toward it. The anecdotal evidence is there, and you have helped to provide it. Studies should be made to prove or disprove it, and I would welcome them. The genetics underlying myopia are becoming much better understood. Don't you want them to be? This would be valuable information, for YOU, and for families that run to myopia. I thought this was something that you cared about. No one here can believe that ALL eyes behave in the same manner, because they do not. All organisms and their parts simply do not behave alike. This is a fact of nature, and for some reason you choose to ignore it. You should read "You are Extraordinary" and "Biochemical Individuality," by Roger J Williams, who discovered Pantothenic Acid. If all organisms had the same response to stimulus, there would be no evolution, and all species would still be living on this planet as they evolved. They simply had differing capacities to survive, and to adapt. Your citing primate and chick studies, and describing Dr Leung's agreement with you, only serve to discredit you. They discredit him as well. Does Dr Leung believe that all eyes behave in a similar manner? I seriously doubt it, and we would all like to hear this from him. Has he prevented myopia in his children, in a family where myopia runs rampant? Yes, I think he has, and this is why I think the idea of prevention, in this particular situation, has merit. But not the rest of it. Human eyes do not behave the same as the eyes of chickens. The studies on primates, in a totally deprived visual environment, do not prove your theory either. No human child has minus lenses put on him at birth before refractive error is evident. No human child has the glasses attached to him without respite, as the primates did. Some people, subjected to intensive near work, never get myopia. In the West, most of them don't. Asians are more prone to stomach cancer than Westerners. These are general tendencies which have been observed. No doubt envirnment plays a part, but is not the only thing of consequence. There are biological differences between people; this is something we know to a certainty. Take some time off from this group, and set up the study. You are retired and have the time to do it. Get in touch with some vision scientists. The Journal of Vision Science would be of use to you. Perhaps something could be set up at SUNY College of Optometry. If you write a decent proposal, and don't harangue people, it will at least get some attention. Everyone would respect you more if you did this. And what would it matter if the study happened today, or tomorrow, or even after your death, if it did happen? You want to help people, don't you? You are in a position to make a difference, but you're going about it the wrong way. The way you carry on, it appears that you just want to win the argument, here, and now, and that nothing else matters as much. Fran > Amblopia WAS mentioned in the posting - the child's vision was 20/20 and > 20/30, which meets the definition of amblyopia, assuming it is not [quoted text clipped - 43 lines] >> >> Otis > I consider an ophthalmologist a highly qualified medical doctor, > as competent as you. Unless he says plus doesn't prevent myopia. When ophthalmologists test the effects of plus on human myopia, it proves to be worthless. So they must be wrong. Only engineers can measure myopia and determine the effectiveness of the plus. So let's have the subjects measure it themselves with a Snellen chart. THEN it'll work. -MT > > I consider an ophthalmologist a highly qualified medical doctor, > > as competent as you. > > Unless he says plus doesn't prevent myopia. You are jumping to a conclusion that you wish to believe in. You wish to express your own opinion, fine. You wish to say -- all people believe as I do -- that is not fine. > When ophthalmologists test the effects of plus on human myopia, it proves to > be worthless. If you use a strong minus lens on a person and create stair-case myopia, then yes, I agree, you can not un-do the effect of that process with a plus lens. But of course, as per "Catch-22" no PREVETIVE study has ever been conducted by engineers, not ODs. > So they must be wrong. Only engineers can measure myopia and determine the > effectiveness of the plus. Please, I never said "measure myopia" I said measure the refractive status (slightly negative) of the natural eye. > So let's have the subjects measure it themselves with a Snellen chart. THEN > it'll work. With trained engineer-pilot, who can do an excellent and consistent job of it, then I believe we will obtain the statistical results that I published on my site. But until we overcome the "Catch-22" both of use know that nothing is going to change. Best, Otis Engineer > -MT > If you use a strong minus lens on a person > and create stair-case myopia, then yes, > I agree, you can not un-do the > effect of that process with a plus lens. You need to explain yourself here. Do you mean that only people with severe myopia who need to wear a strong minus lens will suffer from "stair- case myopia?" Or do you mean that wearing a minus lens that is much stronger than necessary will lead to "stair-case" myopia? Or, are you reversing cause and effect? Myopia is known to increase naturally and without use of a minus lens. DrG > You wish to express your own opinion, fine. You > wish to say -- all people believe as I do -- that > is not fine. So how many ophthalmologists believe as you do, that plus lenses prevent myopia? > If you use a strong minus lens on a person > and create stair-case myopia, then yes, How many ophthalmologists believe correcting myopia causes it to "stair-case"? > I agree, you can not un-do the > effect of that process with a plus lens. > But of course, as per "Catch-22" no PREVETIVE study > has ever been conducted by engineers, not ODs. > > So they must be wrong. Only engineers can measure myopia and determine the > > effectiveness of the plus. > > Please, I never said "measure myopia" I said measure > the refractive status (slightly negative) of the > natural eye. There's the advantage of making up your own definitions. When you contradict the real world, you can obfuscate. > > So let's have the subjects measure it themselves with a Snellen chart. THEN > > it'll work. [quoted text clipped - 3 lines] > will obtain the statistical results that I > published on my site. If they measure mass with a voltmeter, and do it very carefully, they're bound to get it right. -MT Dr G: Of course you are right. This child seems to have amblyopia, by definition, since best corrected is 2 lines of difference. Whether it has to do with the refraction itself it a question as 0.75D of anisometropia won't USUALLY cause anisometropic amblyopia. But that is not a reason not to order glasses. In order to get the best resolution of the amblyopia, both eyes should be in focus, so order the Rx to balance the eyes. Occlusion therapy is probably needed, but you COULD order the Rx and wait a few months and see what happens, at least at this age. This child, at age 4, certainly is not too young for occlusion, and some part-time occlusion would most likely speed up resolution of the amblyopia. What does that pediatric ophthalmologist do, patch them when they're 9 years old??? Doesn't sound like anyone I know - it does sound like nonsense and a power play. Guy sounds like a jerk. David Robins, MD Board certified Ophthalmologist Pediatric and strabismus subspecialty Member of AAPOS (American Academy of Pediatric Ophthalmology and Strabismus) On 6/25/04 6:07 AM, in article Xns951353D05BE29drgleukomacom@216.148.227.77, >> Agreed, absolutely. Too bad it is next to impossible to get parents to >> get exams for their kids. Even for free! [quoted text clipped - 17 lines] > > DrG Thanks, Dr. Robbins. Let me expand. The background is that the mother brought the child in because of perceived vision difficulties. The child was not referred by a pediatrician. On the first visit, the child's manifest refraction was +0.50 in the right eye and +1.00 in the left. The tech had performed the VA using Peek-a-Boo optotypes, and measured 20/20 OD and OS. However, I got an easy 20/20 in the right, but 20/30 in the left on the Snellen chart. Having been snookered before by a smart child who could memorize, I rechecked the Peek- a-Boo, and got 20/30. The cycloplegic refraction was +1.75 and +2.50, with the same BVA. I told the mother that I would order the glasses and we would have the child wear them for a few weeks without patching and recheck. On the second visit the mother said that the child had not been wearing the glasses full-time, and the way in which she said it had me concerned about a problem in supervision. I also observed that the child was looking over the top. When I rechecked the acuity with spectacles, it wasn't good with either eye, so I redid the manifest and the cycloplegic, again with the same results. Obviously, the child was not adapting to the cycloplegic refraction. HOWEVER, before changing the Rx, I asked the mother to give it one more try, this time with occlusion therapy for two weeks. She never returned for followup. Of course, I have treated many cases similar to this with good results following the same protocol. I will probably dictate a letter to the mother and try to have a consultation with the OMD. The daughter's pediatrician made the referral to the OMD, in what was probably a defensive maneuver. DrG > Dr G: > [quoted text clipped - 48 lines] >> >> DrG Thanks, Dr. Robbins. Let me expand. The background is that the mother brought the child in because of perceived vision difficulties. The child was not referred by a pediatrician. On the first visit, the child's manifest refraction was +0.50 in the right eye and +1.00 in the left. The tech had performed the VA using Peek-a-Boo optotypes, and measured 20/20 OD and OS. However, I got an easy 20/20 in the right, but 20/30 in the left on the Snellen chart. Having been snookered before by a smart child who could memorize, I rechecked the Peek- a-Boo, and got 20/30. The cycloplegic refraction was +1.75 and +2.50, with the same BVA. I told the mother that I would order the glasses and we would have the child wear them for a few weeks without patching and recheck. On the second visit the mother said that the child had not been wearing the glasses full-time, and the way in which she said it had me concerned about a problem in supervision. I also observed that the child was looking over the top. When I rechecked the acuity with spectacles, it wasn't good with either eye, so I redid the manifest and the cycloplegic, again with the same results. Obviously, the child was not adapting to the cycloplegic refraction. HOWEVER, before changing the Rx, I asked the mother to give it one more try, this time with occlusion therapy for two weeks. She never returned for followup. Of course, I have treated many cases similar to this with good results following the same protocol. I will probably dictate a letter to the mother and try to have a consultation with the OMD. The daughter's pediatrician made the referral to the OMD, in what was probably a defensive maneuver. DrG > Dr G: > [quoted text clipped - 48 lines] >> >> DrG > One possible reason why some exotic treatments for eye disorders seem > to work is that the disorders did not exist in the first place: [quoted text clipped - 12 lines] > study. About one-quarter, or 890, were found to have no eye problems. > Yet nearly one in five of these children were prescribed glasses. That's about as misleading a first paragraph that I have seen. Out of a representative sample of 100,000 screened preschoolers, about 150 prescribed glasses they may not have needed. How does one get 20% out of that? About 97% of the "normal" children screened got no further evaluation. Less than 0.2% of those in the screening program seem to have ended up with glasses that weren't deemed necessary. Let's reduce it to those actually referred. Now, out of 3,600 referred, 150 who didn't seem to have eye problems were prescribed glasses? How do we get 20% out of that? Scott What were the criteria used to define an "eye problem?" Amblyopiagenic factors are present in 5% of the childhood population. So, 3600 sounds like a reasonable number. However, I would like to know what the authors meant by "no eye problems." Does this mean that there was no refractive error? Or, did they mean that there was no amblyopia or strabismus? Or, did they mean that only small refractive errors were present, which did not constitute a "need" by the authors? DrG >> One possible reason why some exotic treatments for eye disorders seem >> to work is that the disorders did not exist in the first place: [quoted text clipped - 25 lines] > > Scott > > A study out today finds that up to 20% of children with normal eyes > > who undergo comprehensive vision exams may be prescribed glasses they > > don't need. [snip] > > More than 3,600 children were referred to specialists for follow-ups > > because of suspected disorders, such as lazy eye, according to the > > study. About one-quarter, or 890, were found to have no eye problems. > > Yet nearly one in five of these children were prescribed glasses. > Let's reduce it to those actually referred. Now, out of 3,600 referred, > 150 who didn't seem to have eye problems were prescribed glasses? How do > we get 20% out of that? A fairly simple change to the first paragraph will fix things: A study out today finds that up to 20% of children with normal eyes who undergo comprehensive vision exams AND WHO WERE FOUND TO HAVE NO EYE PROBLEMS may be prescribed glasses they don't need. I suspect that some editor found the paragraph too cluttered and cut out a phrase to make it simpler. However, the whole thing doesn't make any sense. Why would *any* children who were found not to have eye problems be prescribed glasses? Does this mean that they had the kids checked twice? Unlikely. Why do I have this nagging feeling that we'll later find a retraction (or "clarification")? Like maybe they were prescribed glasses years later? SignatureDan Abel Sonoma State University AIS dabel@sonic.net >A study out today finds that up to 20% of children with normal eyes >who undergo comprehensive vision exams AND WHO WERE FOUND TO HAVE NO >EYE PROBLEMS may be prescribed glasses they >don't need. > I suspect that some editor found the paragraph too cluttered and cut > out a phrase to make it simpler. I rather suspect that an ambitious reporter, if not the author of the study, or the editor, wrote it to highlight a not-so-stunning finding. In fact, your paragraph isn't right. Out of the 100K screened, about 96K of them were found to have no eye problems. Further, 890 of those who didn't pass the screening also had no eye problems. So, out of around 97,000 children with no eye problems, 150 of them ended up wearing glasses-- still near the 0.1% area. Out of the roughly 4K who failed screening, roughly 1K had no vision problems, and less than 200 of them ended up with glasses. Think of this as the false-positive rate for the combined screening/eye exam procedure. Now compare that to the false positive rate for something like mammograms, which is somewhere around 3%. Personally, I think this low false positive rate is absolutely stunning! Especially when considering the possibility that some young children can be quite uncooperative during eye exams. Keep in mind that even though these kids had no vision problems, they were uncooperative enough to fail a simple screening protocol--- these are the tough patients, almost by definition! There aren't many diagnostic procedures that yield less than 0.1% false positives. Scott Dear Robert, Excellent report. This suggests variation in a child's eyes, and lack of consistency in the measurement. It suggests the need for some double-checking, perhaps by the parent and the Snellen eye chart. I will pass it on the the interested parties. Since I advocate the plus lens (for prevention) it follows that some children would be wearing a plus lens with a refractive status of 0.0 diopters. THAT sort of work indeed needs "understanding" by both the parent and child. This is why I only wish to talk to a mature engineer, or his child who is at 0.0 diopters. Best, Otis Engineer > One possible reason why some exotic treatments for eye disorders seem to > work is that the disorders did not exist in the first place: [quoted text clipped - 12 lines] > one-quarter, or 890, were found to have no eye problems. Yet nearly one in > five of these children were prescribed glasses. |
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