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Medical Forum / General / Vision / February 2005The effect of a +2.0 diopter lens on refractive status of natural eye
Dear Friends, Since RM posts "blasts" against vision scientists like Dr. Francis Young, I hardly judge it is worth it to respond -- since RM referred to Dr. Francis Young and other Blah Blah. Apperently RM has NO RESPECT for this gifted vision scientist. RM > OTIS, PLEASE EXPLAIN WHY STUDIES ON HUMAN SUBJECTS SHOW NO EFFECT ON MYOPIA PROGRESSION USING PLUS LENSES. The Oakley-Young study demonstrated that a "high plus" where the child actually looked THROUGH THE PLUS had the effect of stopping the "downward" change of refractive status for these young children. The over-all result was that the test-group show a rate of (approximagely) zero diopters, where the control-group (single-vision minus) showed a "downward" rate of -1/2 diopter per year. This suggests that the use of the plus AT THE THRESHOLD would stop the deveopment of nearsighedness AT THE THRESHOLD -- if used logically and agressively. The practical problems (lack of motivation of the person) are well-understood by me. That does become a question of how "motivated" a person can, and must be at the threshold. Further it is clear that the "judgment faculity" must be a matter of THAT PERSON's scientific (and engineering) training. The plus simply can not "casually" be prescribed for prevention -- and NOT as a "medical" device. Best, Otis Engineer > RM referred to Dr. Francis Young and other Blah > Blah. Apperently RM has NO RESPECT for this > gifted vision scientist. Too many textbooks contradict your gifted scientist. So medical texts don't count? Show us it works and we'll use it, I promise. -MT > Too many textbooks contradict your gifted scientist. Now the truth is in the hands of a majority? This is your science: the dominance of the gullible mass. Dear Friends, Subject: Asking for information concerning scientific research -- and then TOTALLY INGNORING IT. As ususal -- Mike asks for infromation -- and then thinks up endless excuses and "rationalizations" to totally ignore scientific research. The next thing Mike will do it post "blasts" against all researches who do not do things that HE approves of. Talk about intellectual blindness of a closed mind. But, as always, you decide. Best, Otis Engineer _________________ > > RM referred to Dr. Francis Young and other Blah > > Blah. Apperently RM has NO RESPECT for this [quoted text clipped - 7 lines] > > -MT > As ususal -- Mike asks for infromation -- and then > thinks up endless excuses and "rationalizations" > to totally ignore scientific research. So you DO have human results? Show us it works, in the target population, and we'll use it. I promise. -MT So, Otis . . . Despite my best efforts at adding you and your pet topic to my killfile in every conceivable permutation, here you are again. A couple quick things: 1) I suppose the bar for "proof" should be lower for you than for the rest of the scientific community because you want it to be? Seems a little narcissistic and self-serving; 2) In the wake of recent events (Aleve, Vioxx, Celebrex, etc.) I'm reminded that scientific hypotheses should be held to the /highest/ of scrutiny before introduced as "safe," "accurate," "state-of-the-art," or "conventional wisdom." Reach for it, Mister. It's up there for you to surmount. Time and time again, you eagerly and blithely foist your theories on unsuspecting folks who stop by S.M.V. looking for help. The general public must rely on the kindly doctors to alert them to your lack of credentials, potential for harm, and untested hypotheses. Look, Otis, I'll allow for the possibility that /all/ of the eye doctors on this NG /could possibly be/ avaricious, self-serving monsters who have a lock on a huge chunk of change that comes from doing things "their" way. They may be a member of the vast ocular conspiracy that defends its wealth by maintaining the status quo. All of this /may/ be true, though I don't think so. But you still come across as a petulant, Napoleonic idiot. The bar for proving your theories is the same as it is for all others. Go prove your theories (yes, the old fashioned way: proper testing, accurate data, peer-review) and -- if there's a kernel of truth in what you spout -- you'll be rich and you'll be right up there with Bagolini, Heimholz, Donders, Schirmer, Robert A. Strabismus, and all the other paragons whose names are memorialized in ophthalmology/optometry. Until then, you're a troll . . . who creates risk for unsuspecting, often desperate, people seeking help. "Engineer" in your signature expiates some of your guilt. It does nothing to ameliorate the risk. Perhaps if your signature said, "I am not a doctor. My theories are my own and are not shared by most in the medical community. Consult your doctor." Neil > Dear Friends, > > Subject: Asking for information concerning > scientific research -- and then TOTALLY INGNORING IT. Foolish Otis, Valid scientific studies have failed to show a preventative effect on myopia progression using plus lens treatment on the human eye. You have been informed of this over and over again by people who hold advanced degrees in vision science. Why do you pretend to know better. It is YOU who TOTALLY IGNORS our request to produce proof of your claims. I direct you to the following two articles. Now you tell me what data YOU have. Skip the anecdotal reports of pseudomyopes. Skip the old non-blinded studies without controls. Skip your reminescent stories about "The Printers Son". I'm talking about real valid controlled scientific studies. And since you can't find them, then spend your energy producing them. We would love nothing more than to offer an effective form of treatment to our patients. Quit pontificating and prove it to the medical community. But until then, all you offer is false hopes and snake-oil. Saw et al. British Journal Ophthalm. 2002 86: 1306 Saw et al. Ophthalmology 2002 109: 415. RM PhD OD And again, your anecdotal evidence is more credible than the National Eye Institute's multicenter, randomized, double-masked clinical trial . . . WHY? Note the conclusion: "Use of PALs compared with SVLs slowed the progression of myopia in COMET children by a small, statistically significant amount only during the first year. The size of the treatment effect remained similar and significant for the next 2 years. The results provide some support for the COMET rationale-that is, a role for defocus in progression of myopia. The small magnitude of the effect does not warrant a change in clinical practice." Now, would you kindly set up a better study that controverts this one? Or, at least, go find out whether ANY of the participants in this study has changed his or her clinical practice in ANY way as a result. =======================================================Correction of Myopia Evaluation Trial (COMET) Purpose To evaluate whether progressive addition lenses (PALs) slow the rate of progression of juvenile-onset myopia (nearsightedness) when compared with single vision lenses, as measured by cycloplegic autorefraction. An additional outcome measure is axial length, as measured by A-scan ultrasonography. To describe the natural history of juvenile-onset myopia in a group of children receiving conventional treatment (single vision lenses). Background Myopia (nearsightedness) is an important public health problem, which entails substantial societal and personal costs. It is highly prevalent in our society and even more frequent in Asian countries; furthermore, its prevalence may be increasing over time. High myopia contributes to significant loss of vision and blindness. At present, the mechanisms involved in the etiology of myopia are unclear, and there is no way to prevent the condition. Current methods of correction require lifelong use of lenses or surgical treatment, which is expensive and may lead to complications. The rationale for this trial, the Correction of Myopia Evaluation Trial (COMET), arises from the convergence of research involving (1) the link between accommodation and myopia in children and (2) animal models of myopia showing the important role of the visual environment in eye growth. A contribution of this research is that blur is a critical component in the development of myopia. The primary aim of COMET, to evaluate the efficacy of progressive addition lenses, a noninvasive intervention, in slowing the progression of myopia, follows from this line of reasoning. These lenses should provide clear visual input over a range of viewing distances without focusing effort by the child. The comparison of myopia progression in children treated with PALs versus single vision lenses will allow the quantification of the effect of PALs on myopia progression during the followup period. Description The COMET is a multicenter, randomized, double-masked clinical trial to evaluate whether PALs slow the progression of juvenile-onset myopia as compared with single vision lenses. The study is a collaborative effort that involves a Study Chair at the New England College of Optometry; four clinical centers at colleges of optometry in Boston, Birmingham, Philadelphia, and Houston; and a Coordinating Center at the State University of New York at Stony Brook. The sample size goal, 450 children with myopia in both eyes who met specific inclusion and exclusion criteria, was attained with the enrollment of 469 children in one year. Children were identified from school screenings, clinic records, and referrals from local practitioners. Eligible children were randomly assigned to receive progressive addition or single vision lenses. Participating children are being examined at 6-month intervals following baseline, for at least 3 years, to measure changes in refractive error and to update prescriptions, according to a specified protocol. A dilated examination to evaluate the study outcome measures is performed at the annual study visits. A standardized, common protocol is used at all centers. The primary outcome of the study is progression of myopia, defined as the magnitude of the change relative to baseline in spherical equivalent refraction, determined by cycloplegic autorefraction. The secondary outcome of the study is axial length measured by A-scan ultrasonography. Patient Eligibility Children between the ages of 6 and 12 years with myopia in both eyes (defined as spherical equivalent between -1.25 D and -4.50 D in each eye as measured by cycloplegic autorefraction), astigmatism less than or equal to 1.50 D, and no anisometropia (defined as a difference in spherical equivalent between the two eyes greater than 1.0 D) were eligible for inclusion. Exclusion criteria included visual acuity greater than 20/25, strabismus, use of contact lenses, birth weight less than 1,250 grams, use of bifocal or progressive addition lenses, or any conditions precluding adherence to the protocol. Patient Recruitment Status Completed. Child recruitment began in September 1997 and was completed in September 1998. Current Status of Study Ongoing Results The mean age of the 469 COMET children at baseline is 9.3 years (range 6-11 years); 52 percent are female. This group of children is ethnically diverse, according to a self-report, with 46 percent white, 26 percent African-American, 14 percent Hispanic, and 8 percent Asian. Mean residual accommodation measured twenty minutes after instillation of two drops of tropicamide (1 percent) was found to be small (0.38D in the right eye and 0.30D in the left eye). Thus, tropicamide (1 percent) is an effective cycloplegic agent in myopic children. Baseline mean (± sd) cycloplegic refractive correction in COMET children is -2.38 D (± 0.81) in the right eye and -2.40 D (± 0.82) in the left eye. Young children have significantly less myopia than older children, but the amount of myopia does not differ by gender or ethnicity. Mean axial dimensions are: 4.0 ± 0.2 mm (anterior chamber), 3.4 ± 0.2 mm (lens), 16.8 ± 0.7 mm (vitreous chamber), and 24.1 ± 0.7 mm (axial length). Girls have significantly shorter eyes than boys. Mean corneal radii are 7.73 mm (horizontal) and 7.59 mm (vertical). Ninety-five percent of the children have a ratio of axial length to corneal radius greater than 3.0. These baseline measures provide cross-sectional data on a large group of ethnically diverse myopic children and will serve as a basis for examining changes that occur over a minimum of three years of follow-up. Use of PALs compared with SVLs slowed the progression of myopia in COMET children by a small, statistically significant amount only during the first year. The size of the treatment effect remained similar and significant for the next 2 years. The results provide some support for the COMET rationale-that is, a role for defocus in progression of myopia. The small magnitude of the effect does not warrant a change in clinical practice. Publications Gwiazda J, Marsh-Tootle W, Hyman L, Norton T, and the COMET group: Baseline refractive and ocular component measures of children enrolled in the Correction of Myopia Evaluation Trial (COMET). Invest Ophthalmol Vis Sci, in press. Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MC, Manny R, Marsh-Tootle W, Scheiman M, and the COMET Group: A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci 44: 1492-1500, 2003. Hyman L, Gwiazda J, Marsh-Tootle W, Norton T, and the COMET Group: The Correction of Myopia Evaluation Trial (COMET): Design and baseline characteristics. Controlled Clinical Trials 22: 573-592, 2001. Manny R, Hussein M, Scheiman M, Kurtz D, Nieman K, Zinzer K, and the COMET Study Group: Tropicamide (1%): An effective cycloplegic agent for myopic children. Invest Ophthalmol Vis Sci 42: 1728-1735, 2001. Clinical Centers Alabama Wendy Marsh-Tootle, O.D. University of Alabama-Birmingham School of Optometry 1716 University Boulevard Birmingham, AL 35294-0010 Telephone: (205) 934-5702 Fax: (205) 934-6758 Massachusetts Daniel Kurtz, O.D., Ph.D. New England College of Optometry 424 Beacon Street Boston, MA 02115 Telephone: (617) 236-6251 Fax: (617) 369-0168 Pennnsylvania Mitchell Scheiman, O.D. Pennsylvania College of Optometry 1200 West Godfrey Avenue Philadelphia, PA 19141-3399 Telephone: (215) 276-6057 Fax: (215) 276-6108 Texas Ruth Manny, O.D., Ph.D. University of Houston, College of Optometry 4901 Calhoun Houston, TX 77204-6052 Telephone: (713) 743-1944 Fax: (713) 743-2053 Resource Centers Chairman's Office Jane Gwiazda, Ph.D. New England College of Optometry 424 Beacon Street Boston, MA 02115 Telephone: (617) 236-6234 Fax: (617) 369-0188 E-mail: gwiazdaj@neoptometry.edu Coordinating Center Leslie Hyman, Ph.D. M. Cristina Leske, M.D., M.P.H. Division of Epidemiology Department of Preventive Medicine University Medical Center Stony Brook, NY 11794-8036 Telephone: (516) 444-7525 E-mail: lhyman@prevmed.som.sunysb.edu NEI Representative Donald Everett, M.A. National Eye Institute National Institutes of Health Executive Plaza South, Suite 350 6120 Executive Boulevard MSC 7164 Bethesda, MD 20892-7164 Telephone: (301) 496-5983 Fax: (301) 402-0528 Data and Safety Monitoring Committee Ex Officio Members M. Cristina Leske, M.D., M.P.H. Division of Epidemiology Department of Preventive Medicine University Medical Center Stony Brook, NY 11794-8036 Telephone: (516) 444-7525 Fax: (516) 444-7525 Robert J Hardy, Ph.D. (Chair) University of Texas Health Science Center at Houston School of Public Health Coordinating Center, Suite E827 1200 Herman Pressler Houston, TX 77031 Telephone: (713) 500-9550 Fax: (713) 500-9530 Argye Hillis, Ph.D. Director of Clinical Epidemiology and Biostatistics Scott and White Memorial Hospital/Foundation Texas A&M Health Science Center 2401 South 31st Street Temple, TX 76706 Telephone: (817) 724-3307 Fax: (817) 662-3867 Don Mutti, O.D., Ph.D. College of Optometry Ohio State University 338 W. 10th Avenue Columbus, OH 43210 Telephone: (614) 247-7057 Fax: (614) 247-7058 Richard Stone, M.D. Department of Ophthalmology University of Pennsylvania Medical School D603 Richards Building 3700 Hamilton Walk Philadelphia, PA 19104-6075 Telephone: (215) 898-6950 Fax: (215) 898-0528 Sr Carol Taylor, R.N., Ph.D. Georgetown University School of Nursing 3700 Reservoir Road, NW Washington, DC 20007 Ex Officio Members Donald Everett, M.A. National Eye Institute National Institutes of Health Executive Plaza South, Suite 350 6120 Executive Boulevard Bethesda, MD 20892 Telephone: (301) 496-5983 Fax: (301) 402-0528 Jane Gwiazda, Ph.D. Department of Vision Science Assistant Professor New England College of Optometry 424 Beacon Street Boston, MA 02115 Telephone: (617) 236-6234 Fax: (617) 424-9202 Mohamed Hussein, Ph.D. Department of Preventive Medicine University Medical Center at Stony Brook Stony Brook, NY 11794-8036 Telephone: (516) 444-2140 Fax: (516) 444-7525 Leslie Hyman, Ph.D. Division of Epidemiology Department of Preventive Medicine University Medical Center Stony Brook, NY 11794-8036 Telephone: (516) 444-7525 Fax: (516) 444-7525 Last Updated: 3/25/2003 This page was last modified in November 2004 Dear MT, Given the "blasts" the RM posts, (and you repeat), followed by Jan's statement that the concept of the plus-preventive "second opinion" MUST BE DESTROYED, and I would suggest you are a hypocrite. Fruther -- I do not advocate that a BI-FOCAL be used. If you are gong to do something -- do it right. That means, while the person still PASSES the DMV, he makes a decision to BEGIN using the plus. He has nothing to lose. But that type of decision, would turn responsibility can CONTROL over to him -- and that is not MEDICAL in concept or execution. You asked for INDICATIONS of the result of a PREVENTIVE study. The Oakley-Young intimates the result of a well-ruen ENGINEERING (NOT MEDICAL) study run for prevention -- with engineers IN CONTROL. It would make all the difference -- where the person knows the "score" and will "intellectually" participate and actually use the plus "correctly". This would REQUIRE that detailed instructions be provided, and that would absolutly PREVENT a "blind" study. An engineering-scientific study had no "blind" requirement. Best, Otis Engineer > Dear MT, > [quoted text clipped - 4 lines] > MUST BE DESTROYED, and I would > suggest you are a hypocrite. And this is what I (Jan) realy said and keep saying until you deliver proof that forces me to draw back my conclusion.  SignatureFree to Marcus Porcius Cato: ''Ceterum censeo Carthaginem esse delendam" In conclusion, I think that the "Otis therapy" should be destroyed Jan (normally Dutch spoken) Snip....... > You asked for INDICATIONS of > the result of a PREVENTIVE study. [quoted text clipped - 17 lines] > An engineering-scientific study > had no "blind" requirement. Okay Otis, than show us results wich can be verified instead of anectodes of your famous pilots, nephews, nieces, grandchilds etc... for a start. O, and do not forget to cc this posting to uncle Arnie and aunt Edith. SignatureFree to Marcus Porcius Cato: ''Ceterum censeo Carthaginem esse delendam" In conclusion, I think that the "Otis therapy" should be destroyed Jan (normally Dutch spoken) > The Oakley-Young intimates > the result of a well-ruen ENGINEERING > (NOT MEDICAL) study run for > prevention -- with engineers > IN CONTROL. Otis, I asked this in another post and I will ask again!!! Please "entertain" me!!!! Where on the web OUTSIDE your website is this Oakley - Young study on the web???? NOT ON YOUR WEBSITE, but a website that is unbiased. Or is this another imaginary thing like your subjects.... Allen > The Oakley-Young intimates > the result of a well-ruen ENGINEERING > (NOT MEDICAL) study run for > prevention -- with engineers > IN CONTROL. Show us your technique works for humans, and we'll use it. I promise. -MT > The Oakley-Young study demonstrated that a "high plus" > where the child actually looked THROUGH THE PLUS Otis, Please "entertain" me!!!! Where on the web OUTSIDE your website is this Oakley - Young study on the web???? NOT ON YOUR WEBSITE, but a website that is unbiased. Allen Dear Prevention minded friends, I am a practicing optometrist. Today I had an adolescent male patient who I had seen previously 3 years ago. At that time his refraction was approximately -3.00-1.00 X 180 in both eyes. He bought a pair of glasses and wore them for about 6 months but then lost them. He has been going around for the last 2.5 years without any spectacle correction at all. This condition is optically equivalent to wearing +3.00-1.00 x 180 lenses in both eyes all the time. His refraction again today was the same as what it was 3 years ago. If Otis' theory of plus lens prevention is correct, then why didn't this patient's refraction improve? I have asked this question of Otis many times before and he never answers. Otis-- please answer this time. Why not ask your good friends Dr. Young, Dr. Cheung, etc. to reply since you obviously are at a loss. PS-- for anyone really interested in the REAL TRUTH about the status of scientific research regarding myopia prevention, I offer the following unbiased medical references: 1. http://annals.edu.sg/pdf200401/V33N1p4.pdf 2. http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/apr01/lesson_0401.htm 3. http://dels.nas.edu/ilar/jour_online/40_2/V40_2NortonAnimalModels.asp 4. http://www.optometrists.asn.au/gui/files/ceo865276.pdf Regards, RM PhD OD > Dear Prevention minded friends, > [quoted text clipped - 5 lines] > This condition is optically equivalent to wearing +3.00-1.00 x 180 lenses > in both eyes all the time. Mistype RM? Refraction error S+3,00=C+1,00 180? > Regards, > > RM PhD OD SignatureFree to Marcus Porcius Cato: ''Ceterum censeo Carthaginem esse delendam" In conclusion, I think that the "Otis therapy" should be destroyed Jan (normally Dutch spoken) > Dear Friends, > > Since RM posts "blasts" against vision scientists > like Dr. Francis Young Quit trying to misquote and misrepresent me Otis. I post warnings (you like to call them "blasts") only against YOU -- not others. YOU have no training or understanding of the functioning of the human eye. You are just a single-minded zealot. You never listen to reason or scientific facts. Dr. Young was one of a group of optometrists who believed some time ago that myopia progression might be arrested or reduced by using plus lenses. Since those early days a number of human studies have shown NO EFFICACY for that form of treatment. Only die-hard zealots like yourself continue to argue the point. Do not misquote and lie any more Otis. I have kept a long listing of the examples of your lying and I will be happy to post it to everyone. For those that are truly interested in the topic of myopia prevention, I am happy to provide the following current medical references for your personal evaluation. http://annals.edu.sg/pdf200401/V33N1p4.pdf http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/apr01/lesson_0401.htm http://dels.nas.edu/ilar/jour_online/40_2/V40_2NortonAnimalModels.asp http://www.optometrists.asn.au/gui/files/ceo865276.pdf Dear RM, Professor Theodore Grosvenor -- YES PH.D. Optometrist stated that it would be WISE to begin the use of a PLUS PREVENTIVE lens BEFORE the nearsighedness even starts. This is EXACTLY MY POSITION -- no more -- no less Francis Young is a vision scientists -- world famous He stated the same concept concerning the dynamic behavior of the natural eye. Dr. Grosvenor -- said exactly the same thing, Prevention is indeed difficult -- and depends on the person (not you and your "blasts" against these other people. The plus is indeed the "second opinion" but the person should be informed of this choice BEFORE ANY LENS IS USED. The choice shouild belong to the individual since even starting with the minus lens will have life-time consequences. It is not up to me to make that choice. You "blasts" are in fact against the second opinion -- so you can spin the dials on your phoropter and not take any responsibility for the consequences. Fortunately, some ODs are recognizing this basic professional responsibility -- even if you do not. So, but "unknown" freind (are you Robin Parsons, morphed into "RM") post another "blast" to keep you position. You can fool all the people some of the time. You can fool some of the people all the time. But eventually you can not fool all the people all the time. Best, Otis Engineer [RM's "Blast" will be posted below for those people who wish to be denied access to the "second opinion" at the threshold -- when it must be used to be effective. ] Neither "medicine" nor science is ever "set in stone" and I would keep this in mind as we review the proven behavior of the dynamic eye. >(not you and your "blasts" against > these other people. Please post a link to the "blasts" that I have made against other people. I only make them against YOU Otis because you give unlicensed medical advice to people, which is illegal, and you should be stopped! > The plus is indeed the "second opinion" but > the person should be informed of this > choice BEFORE ANY LENS IS USED. Oh. So if the dynamic natural eye uses a minus lens only for a short time, it is irrevocably changed. It changes from dynamic to static? Is that what you are saying? That wretched minus! > You "blasts" are in fact against > the second opinion So now you are trying to redefine my remarks again! Read my lips -- my warnings (you like to call them "blasts") are only against YOU. Because you are an unlearned fool who by your own admission doesn't understand anything about the anatomy and physiology of the human eye. Readers beware. Avoid Otis the Engineer! > [RM's "Blast" will be posted below for those people > who wish to be denied access to the > "second opinion" at the threshold -- when > it must be used to be effective. ] Yes. You figured it out. My goal is to deny people access to plus lenses. Soon our legions will disperse to all the drug stores around the world and collect all the plus reading glasses and burn them! Our next conspiracy meeting in Jamaica in March will discuss this plan along with our other strategies to take over the world and force everyone to wear eyeglasses for eternity! > Neither "medicine" nor science is ever > "set in stone" and I would keep this in > mind as we review the proven behavior > of the dynamic eye. All we have ever asked you is to show us the proof that you keep speaking of Otis. Go take another thorazine! > http://www.optometrists.asn.au/gui/files/ceo865276.pdf Actually, the last paragraph of this paper is very supportive of plus lens treatment. No proof, but a little biochemistry to justify somebody's next project. -MT I noticed that. The other references also discuss plus lenses and bifocal therapy in a neutral light. I said these papers were objective and unbiased as they should be. I think there IS value for some patients with plus lens therapy. The question is which ones. A problem is someone needs to prove it and define it a little better. A large in-depth longitudinal study using A-scans, Orb scans, careful consistent refractions etc. of different age groups might show a benefit for a subpopulation of patients. You would have to wonder whether, since muscarinic antagonists, and bifocal corrections, seem to sporadically show some positive influence, accommodation being controlled via plus lenses might not work for some people too. I can see Otis' next post-- "Even the unknown RM (aka Robin Parsons) who slams the "second opinion" admits that he recommends +3 glasses to all his patients". Otis-- when you read this be sure you get the message. Your "model" is weak and insufficient. You need to prove what subgroup of patients might benefit from plus lens (if any at all). Prove it, and no one will argue with you. Go around giving unfounded advice is practicing medicine without a license and you will be continuously opposed. PS: Hint-- the eye is most "dynamic" in young people (ages 0-18). Your chance of showing that plus lenses influence the anatomy of the eye most likely lies within that group. Once the anatomy is set, then the only group where plus lenses will help will be accommodative myopes. ====================== >> http://www.optometrists.asn.au/gui/files/ceo865276.pdf > [quoted text clipped - 4 lines] > > -MT I have read the report, and clearly the study indicates the most efficient time period for myopia prevention is before the human stop growing, such as before 12-15 years age. According to the study, human constantly adjust the growth of the eye based on the stimuli: "stop" or "growth", which are based on the kind of blur the eye received. By this theory, letting a myopic child wear a plus lens before the child finish growing should help generating the "stop" signal the eye needed to stop the eyeball from further elongation. Furthermore, the study suggests, even after the eyeball has already elongated, if the child has not finished his/her growth, there is still chance for the eyeball to become round again since the overall eyeball size will be larger. Anyway, that is my understanding about the study, and in my opinion a very good one. Otis has always suggested to use plus lens on myopic children when onset, so he is right along with this study. Anyway, I do not have the intention to debate on this issue. Sometimes people get lost when they just want to prove they were right at first place. Yan > I noticed that. The other references also discuss plus lenses and bifocal > therapy in a neutral light. I said these papers were objective and unbiased [quoted text clipped - 33 lines] > > > > -MT The paper is a review paper. The section where this is discussed is in the "discussion" part of the paper. You understand correctly what the author speculates about. Unfortunately none of it is proven. It is only theory at this point. While it seems logical, scientific studies need to be performed. And I speculate that this approach would not work for all adolescents. I believe studies using plus lenses have been tried before without success. Otis proposes much more that treating 12-15 year olds with plus lenses. ------- >I have read the report, and clearly the study indicates the most > efficient time period for myopia prevention is before the human stop [quoted text clipped - 72 lines] >> > >> > -MT Dear RM, Subject: What I advocate. What I propose is that a pilot who is entering a four year college be presented with the engineering concept that the natural eye is dynamic. This person would be only on the THRESHOLD, i.e., could still pass the DMV test but was SLIGHTLY nearsighed. (A negative refractive state of the natural eye -- in my parlance.) This is a very LIMITED proposal, since no action could be taken until the pilot was convinced as to the necessity of his taking complete control and doing all the confirming measurements himself. That means he would measure his refractive state using a phoropter (with a two-man team) and he would confirm all measurements as an engineering (not medical) study. I believe in this type of limited effort a high percentage of motivated pilots would clear both their 20/40 eyes to 20/20, and confirm that the refractive status of their natural eyes would change from a negative value to a positive value -- as THEY measure it. This would be in the face of the know fact that the refractive status of college students goes "down" by between -1.1 diopters to -1.6 diopters at West Point. If these pilots were successfull -- i.e., cleared to 20/20, with refractive status moving "positive" then they will have proved what we alrady know about the beahvior of the natural eye. The only issue is the practical implementation of this effort on as scientific (not medical) level. Best, Otis Engineer You are right, this is extremely LIMITED. Why do you think the most-likely-to-respond segment of the population with regard to plus lens therapy would be "pilot-engineers entering a 4-year college". That scientifically makes no sense. The eye is most "dynamic" in the actively growing child when axial length, corneal curvature, lens curvature, etc. can be most likely influenced. Your "theory" would be most likely to be proven correct if you could do a longitudinal study comparing no-treatment, minus lens treatment, and plus lens treatment therapies. You would need a small group of professionally trained (and consistently trained) refractionists to periodically measure refractive error as well as several other interesting parameters (axial length, corneal topography, etc.) in numerous subjects. The treatment groups would need to be "blinded" to the researchers as much as possible (perhaps the subjects wouldn't bring in their glasses on the days they got their exams so the refractionist wouldn't be able to tell if they were plus, minus, or whatever). This would have to be a longitudinal study lasting for 10-15 years. If you do anything short of something like this, like have "two-man teams" or do an "engineering (not medical) study" you will make no headway convincing anybody of anything. All medical, and scientific studies must be unbiased and controlled Otis, otherwise they are not valid! You will continue to have no credibility with anyone. ===================== > Dear RM, > [quoted text clipped - 44 lines] > Otis > Engineer Dear Yan, You are correct when you preceive tha the natural eye is "dynamic" and that is true-prevention is to be achieved, that process must START before a minus lens is applied. This concept, while difficult, is in fact the second-opinion. Further it is reflected in the fact that some ODs are getting their own children to wear the plus, when the child still has 20/20, but a refractive status of zero. Further, the recognition, by professor Theodore Grosvenor U. o f Houston was that this is an either-or decision the parents and child must make -- BEFORE the minus lens is applied. If you child is on the THRESHOLD of nearsighedness, i.e., passes the legal 20/40 line, but is slightly nearsighed, then it would be good to be aware of this advocacy for fundamental "change". You have nothing to lose. You might enjoy reading Steve Leung's opinion on the subject. www.chinamyopia.org There is no "right" or "wrong" here -- only your right to an "informed" choice. Keep an open mind. Understanding new ideas and concepts can not hurt you. Enjoy, Otis Engineer Dear Yan, You are correct when you preceive tha the natural eye is "dynamic" and that is true-prevention is to be achieved, that process must START before a minus lens is applied. This concept, while difficult, is in fact the second-opinion. Further it is reflected in the fact that some ODs are getting their own children to wear the plus, when the child still has 20/20, but a refractive status of zero. Further, the recognition, by professor Theodore Grosvenor U. o f Houston was that this is an either-or decision the parents and child must make -- BEFORE the minus lens is applied. If you child is on the THRESHOLD of nearsighedness, i.e., passes the legal 20/40 line, but is slightly nearsighed, then it would be good to be aware of this advocacy for fundamental "change". You have nothing to lose. You might enjoy reading Steve Leung's opinion on the subject. www.chinamyopia.org There is no "right" or "wrong" here -- only your right to an "informed" choice. Keep an open mind. Understanding new ideas and concepts can not hurt you. Enjoy, Otis Engineer
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