Dear Philip,

Subject:  The preventive second-opinion and difficulties of
implementation.

I go directly to the point.  I represent the natural eye as
an "entity" as a sophisticated mechanism.

I agree that engineering-scientific concepts can not be
reduced to a "magic pill" in 15 minutes.

I also agree that dealing with a largly ignorant or non-motivated
public is almost impossible.

The person himself must go through an "educational process"
if there is going to be intelligent use of the plus.

I have cited "legal reasons" why you personally can not
offer the plus, i.e., mal-practice, insurance.

You can also include the public's rejection of the
plus as described by Jacob Raphaelson many years
ago.

1.  Raphaelson was successful with the plus.

2.  The parents did not understand, and so rejected the plus.

3.  I am certain the young man got right back into nearsighedness,
given the -1/2 diopter per year "down" rate for kids in school.

I do not see how ANY OD could "break" this cycle, until the
person (or parents) understand this issue.

Indeed, I would PROMOTE ANY OD WHO WOULD OFFER
THIS TYPE OF SUPPORT.  But the parents would have
to understand these issues -- and THAT TAKES TIME.

It is not clear who has the responsibility here.  I think
the parents do, if not the child.

But enjoy this pleasant academic discussions
about the issue of true-prevention.

In time, I believe that "the public" will learn to accept
the necessity of wearing the plus for prevention.

Only AFTER they have that "understanding" could you
offer it.  For now, I believe that the person himself
will have to "take control" because you legally
can not -- and the effort is indeed difficult.

        _____________________________

WHY ISN'T THE PREVENTATIVE APPROACH OFFERED?

With this type of scientific understanding of the eye's behavior, you
would think that the insightful and motivated optometrist or
ophthalmologist could introduce a practical and effective method of
solution. Dr. Jacob Raphaelson did exactly that in the following
example -- with the following result:

THE PRINTER'S SON

"It was the year 1904 that I met a mother at a social lodge meeting.
She told me about her son's trouble with his eyes in school. I gave her
my card and told her to bring him to my office and I would fit him with
a pair of spectacles.

"She said that she had no money at the time and that her husband was a
printer working in another city. She did not expect him home for the
next six weeks. I told her all this would not matter, that she should
bring the boy over and I would fit him with a pair of spectacles. I
told her that she could pay for them when her husband returned home.

"She brought the boy in and I examined his eyes. I found that his
vision for distance was poor. It was less than 20/40. I made him a pair
of plus 1.00 diopter spectacles. She was to pay me when her husband
came back home.

"In about six weeks she came back and returned the glasses to me. She
stated that her husband was provoked with her for getting the glasses.
He had tried the boy's eyes with different prints, far and near, and
had found him to have perfect vision with his naked eyes. In fact, she
said, the boy could see even better without the glasses than with them.

"I was surprised that the plus lens could produce recovery that
quickly. I could hardly believe this story. I persuaded the mother to
bring the boy back to let me check to see if he could really see well
with his naked eyes. She again brought the boy in and I checked his
vision. I found that the father was indeed right. The boy had good
eyes, with 20/20 vision and better.

"I was in a dilemma. I did not have the nerve to say anything to the
mother. I just let her go. How was I to prove that the boy had poor
vision before he received his glasses? And who would believe that
vision could be restored by just wearing a pair of plus 1.00 glasses
for a few weeks?

"My experience with the printer's son aroused my inborn tendency for
exploration. It gave me an incentive to try to do special work on
children's eyes and on vision restoration. It also enticed me to
investigate myopic (nearsighted) eyes because I was myself nearsighted.

"On the other hand, this experience was a warning to be cautious in
doing such work. For selling spectacles to persons who, supposedly, did
not need them was almost a crime. And the fitting of glasses without
the advice or consent of a medical doctor to unhealthy or diseased
eyes, or even to an unhealthy person who might need or be under medical
attention, was, and is now, and encroachment on the medical profession.

"To shield myself against possible enmity and involvement, I took the
following precautions: First, I quit using the title 'doctor' in any
form, in print or verbally. I was to be known as a spectacle fitter and
nothing more. Second, I charged a reasonable price for the spectacles I
sold but nothing extra for any special work or relief I gave. I did not
advertise about this special work. I just did it as a matter of routine
whenever or wherever I was given the opportunity.

"Thus in 1904 I became an independent researcher on the relationship of
the eye's behavior to spectacles, vision, and health. I have kept it
up, and will continue to do this work as long as I continue to have the
incentive and capability.

"Who would believe it? Who would believe that by just wearing a pair of
plus one (+1.00) glasses for a few weeks, that normal vision to the
naked eye could be restored to children whose eyes have a negative
focal state? This was true in 1904, and it is also true now, in this
decade of 1950." (It continues to be true in this decade of 1990 --
Otis Brown)

SCIENTIFIC VERIFICATION

With such strong recognition that a negative lens has such a profound
and adverse effect, you would think that it should be possible to
develop scientific verification for this characteristic of the normal
eye. You would be correct. The testing and verification is impeccable
-- if we restrict our attention to the normal eye's behavior.

BASIC OPTICAL PHYSICS

In order to understand the design and behavior of the normal eye it is
necessary to understand its basic optical properties.

When a light ray enters water it is refracted (bent). The equation that
describes this bending is shown below. Water has an Index-of-Refraction
of 1.33. The normal eye has 1.38 as an over-all Index-of-Refraction.
(Figure 1)

SNELL'S LAW OF REFRACTION

Figure 1.

When light travels through a curved surface, the light rays converge on
a single point. Since an image is made up of a large number of points
of light, an image will form where the light rays converge. (Figure 2)

THE APPROXIMATE REFRACTIVE CHARACTERISTIC OF THE EYE

Figure 2 (from Gullstrand's schematic eye, Reference 1).

The distance between the surface of the lens and the point of image
formation is called the focal length.

Focal Power = (Refractive Index) / (Focal Length)

By using this equation it is possible to analyze the basic optical
properties of the eye. The approximate dimensions of the eye have been
established. The radius of the cornea is 0.66 centimeters, the index of
refraction is 1.38, and the length of the eye is 2.4 centimeters. By
using these numbers we can calculate the focal power of the normal eye.
(For reasons of clarity, I have not included the effect of the internal
lens. A more detailed analysis can be found in Reference 1.)

Focal Power = 1.38 / .024 Meters

Focal Power = 57 Diopters

THE NORMAL EYE

The eye has an internal lens which controls the short-term focal state
of the eye. The lens is controlled by blur sensed at the surface of the
retina. This information is "fed back" to lens position so that sharp
focus can be maintained. (Figure 3)

Figure 3.

As objects are moved from distance to near, blur is produced at the
retina. In response to this, the lens is thinned or thickened
repeatedly under neurological/muscular control, thus maintaining sharp
focus on the retina. (Figure 4)

Figure 4.

As we move objects from far to near, the focal change required of the
eye increases drastically. Thus the focal change required for an object
at 1 yard is 1 diopter. At 20 inches the increase in power is 2
diopters, and at 10 inches the increase is 4 diopters.

The normal eye has a second system which is responsible for controlling
its long-term focal state. This system controls both the power
(curvature) of the cornea and the relative length of the eye. (Figure
5)

Figure 5.

The normal eye feeds information from the accommodation system to the
long- term control system to maintain highly accurate focus. The focal
state of the eye is almost a direct replica of its visual environment.
By direct experimental means it has been determined that the focal
state of the normal eye is equal to its visual environment, offset by
about +1.5 diopters.

Whenever the average value of accommodation is shifted by a "delta",
the focal status of the normal eye will change, (over a period of
months) by the same quantitative amount. This statement has been
effectively proven over the last thirty years by thorough experimental
techniques. (2)

As the previous discussions have demonstrated, the eye functions as a
camera. We should not, however, jump to the conclusion that it is
therefore a rigid box camera. It is a sophisticated camera that
controls its long-term focus by a "feedback" process. We can use an
analog computer to accurately represent this fundamental behavior
characteristic of the eye. (Figure 6)

Figure 6.

THIS OPERATIONAL AMPLIFIER WILL ACCURATELY REPRODUCE THE FUNDAMENTAL
BEHAVIOR CHARACTERISTIC OF THE NORMAL EYE

The above representation of the normal eye is experimentally valid.
When the normal eye is actually tested, it always shows the following
two major behavior characteristics. (2)

1. When a strong negative change is made in your visual environment,
your normal eyes will change their focal state as shown below. (Figure
7)

Figure 7.

2. The eye will also show a similar response to a strong positive =
change in its environment. There is -- and this is important -- a limit
to = the amount by which you can change your visual environment in a
positive direction. (Figure 8)

Figure 8.

The conclusion, that the eye is dynamic and behaves as expected, has
been reached by a number of scientists. Dr. Peter Greene (5), Dr.
Antonio Medina (6), and Dr. Josh Wallman (7) have published papers
analyzing various aspects of the time-constant behavior of the natural
eye.

CONCLUSION

Perhaps the best assessment of the difficulties and opportunities of
nearsightedness prevention was made by Chalmers Prentice in 1895. How
many more years will it take us to understand and respond intelligently
to the wisdom in his words?

It is common and natural to cling to a belief in things and methods
that have long been established, and in which leading men and authors
concur; and, if the results of such following are universally perfect,
more cannot be desired. But, when they fall far short of satisfaction,
we are warranted and even impelled to search outside of established
authority for the aid that it fails to give; otherwise, science and art
would never advance.

REFERENCES

1. Southall, J. P. C., "Introduction to Physiological Optics", Dover
Publications, Inc., pp 46, (1937)

2. Schaeffel., F. Glasser, A. Howland, H. C., "Accommodation,
Refractive Error and Eye Growth in Chickens", Vision Res., Vol 28, No
5, pp. 639-657 (1988)

3. Raphaelson, J., "A Preventative and Remedy for School-Myopia",
Research Foundation for Prevention of Myopia, Inc. pp 60 (1958)

4. Holzman, D., "Trying to Get Myopia Into Focus", Health, pp 52-53,
(Feb. 1987)

5. Greene, P. R. & Guyton, D. L., "Time Course of Rhesus Lid-Suture
Myopia", Exp. Eye Res., V 42, p. 529-534, (1986)

6. Medina, A. & Fariza, E., "Emmetropization as a First-Order Feedback
System", Vis. Res., V. 33, No. 1, p. 21-26, (1993)

7. Wallman, J. Turkel, J., Trachtman, J., "Extreme Myopia Produced by
Modest Change in Early Visual Experience", Science, V. 201, p.
1249-1251, (Sept. 1978)