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Medical Forum / General / Vision / May 2005Request for a citation for your single-minus "down" rate.
To: Mike Tyner OD William Stacy Dear Mike, Re: What if there are at least two other experiments with equally careful design that point exactly opposite? Care to see citations? No? You've seen them before and you didn't pay any attention then. Mike Tyner. Otis> Yes, I want to see the citations. I will publish and discuss them with interested parties -- concerning the "down" rate of -1/2 dioper per year. Otis> Willaim Stacy stated that very few children show a "progression" of -1/2 diopter per year. Willaim, of those people you prescribe a minus lens to -- what do you estimate to be the AVERAGE "down" rate for the students wearing a minus lens, on the basis of your practice? Otis> 0.0 diopters per year? -1/10 diopter per year? -1/4 diopter per year? -1/2 diopter per year? Stacy> I see that kind of progression in maybe 1% of my patients. And I'm talking MANY THOUSANDS OF PATIENTS. Stacy> Come on, Otis. YOUR NUMBERS ARE WRONG. Sorry. Do some real research, and stick to facts, preferably verifiable facts. Stacy> w. stacy, o.d. Otis> I posted the following "down" rate of: Minus vision lenses: - 1.23 D increase (2 years) Progressive lenses with +1.50 add: - 0.76 D increase (2 years) Progressive lenses with +2.00 add: - 0.66 D increase (2 years) Otis> I have also reviewed the "down" rate of a number of these studies, and the single-minus "down" rate has been consistently between -4/10 diopters per year and -6/10 dipoter per year. Otis> Yes, I would like to see citations for rates for single-minus wear that are significantly different thatn the above. Otis> Please ignore the "bifocal" part -- just stick with the single-minus group, and their published "down" rate. ++++++++++++++++++++++++++++++ Mike> Excellent design. Hard to argue with. I'm convinced... no wait... Mike> What if there are at least two other experiments with equally careful design that point exactly opposite? What do we do then? Mike> Care to see citations? No? You've seen them before and you didn't pay any attention then. -MT Otis> Source: Leung JT, Brown B. Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses. Optom Vis Sci 1999; 76:346, 354. Published 10/07/00. My dear man, What indeed is the down-rate of myopia without minus lenses? DrG Dear DrG, The post was made by William Stacy and Mike Tyner. I will review their response -- since only they can provide their answer. Best, Otis > Otis> Yes, I want to see the citations. I will publish and > discuss them with interested parties -- concerning > the "down" rate of -1/2 dioper per year. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=2667638 "The differences in the increases of the spherical equivalents were not statistically significant in the right eye, but in the left eye the change in the distant use group was significantly higher (-1.87 D) than in the continuous use group (-1.46 D) (p = 0.02, Student's t test)." http://www.newscientist.com/article.ns?id=dn3082 "Indeed, his study of 94 children in Malaysia sought to prove the value of undercorrection. Instead, it showed the opposite." -MT Dear Mike, Your statement was to the effect that you do not see "down" rates (average) of -1/2 diopter per year. You the demanded that I DOCUMENT this "down" rate in children who have been put into a minus lens. THAT IS THE ONLY ISSUE. Not prevention, not the plus -- just your "challenge" to produce scientific facts on that specific issue. >From one study you cited, the "down" rate for the single-minus group is: - 1.87 in 3 years, therefore the "down" rate in one year is: - 6.25 diopters per year -- confirming what I said about this rate. You put a child into a minus lens -- and his parents can expect the child's eyes to go down at a rate exceeding -1/2 diopter per year. But you said your experience with children in your office differs from these scientific studies. What is your estimate for the children in your office? 0.0 diopters per year? -1/10 diopter per year? - 1/3 diopter per year? -1/2 diopter per year. Best, Otis _________________ but in the left eye the change in the distant use group was significantly higher (-1.87 D) Correction: The calculated down rate from -1.87 diopters in 3 years would be - 0.635 diopters which simply verifies even more strongly the rate of -1/2 dipoter per year for children wearng the single-minus. To "O'Leary" study is not to be trusted for a number of reasons. Further, no single-minus value was published in what you provided. Best, Otis > Your statement was to the effect that you do not > see "down" rates (average) of -1/2 diopter per year. You must be reading some other "Mike." Of course some populations get myopic at 1/2D per year. How can you possibly believe that holds true for every population? > You the demanded that I DOCUMENT this "down" rate > in children who have been put into a minus lens. Nonsense. Which "Mike" said that? We asked you to document your claim that minus lenses contribute to this 1/2-D rate. We have repeatedly asked you to document your claim that minus lenses make myopia worse. Instead you misquote us and avoid answering. > THAT IS THE ONLY ISSUE. Not prevention, not > the plus -- just your "challenge" to produce > scientific facts on that specific issue. Nonsense. Our issue is with the Rehm-Brown theory - "minus lenses make myopia worse and plus lenses prevent it." We know people get nearsighted. > You put a child into a minus lens -- and his parents can > expect the child's eyes to go down at a rate exceeding > -1/2 diopter per year. Actually I don't. When children 5-10 come in with the first signs of myopia, I _don't_ urge glasses if the kid isn't having trouble functioning. Then they come back a year or two later and it's worse. Why is that? How can you imagine that proves minus lenses increase myopia? -MT Dear Mike, cc: William Stacy You are right, it was William Stacy who insisted that the young eye with a minus lens on it does not go down at an average rate of -1/2 diopter per year. But William challenged this statement by insisting that it was not scientifically true, Stacy> Come on, Otis. YOUR NUMBERS ARE WRONG. Sorry. Do some real research, and stick to facts, preferably verifiable facts. Forcing me to post the "verifiable facts", i.e., the "down" rate of -1/2 diopter per year for kids when they begin wearing a single-minus lens. I believe I am "sticking to the facts" concerning this issue -- far more than Stacy. He insists that my "numbers are wrong", but then fails to post any other numbers concerninig this "down" rate in scientific studies. Office "judgments" do not "count" under these circumstances. Best, Otis __________ Otis>> It is obvious that the situation is only preventable (potentially) -- given the -1/2 dioter per year for children wearing a single-minus, as shown in a number of published scientific studies. Stacy> ok so according to this if the kid starts at -1.00 at age 6: Stacy> he'd be -2 at age 8 Stacy> -3 at age 10 Stacy> -4 at age 12 Stacy> -5 at age 14 Stacy> -6 at age 16 Stacy> I see that kind of progression in maybe 1% of my patients. And I'm talking MANY THOUSANDS OF PATIENTS. Stacy> Come on, Otis. YOUR NUMBERS ARE WRONG. Sorry. Do some real research, and stick to facts, preferably verifiable facts. Stacy> w. stacy, o.d. > Forcing me to post the "verifiable facts", i.e., the "down" rate > of -1/2 diopter per year for kids when they begin wearing > a single-minus lens. I believe I am "sticking to the facts" > concerning this issue -- far more than Stacy. If you are sticking to the facts Otis, please provide facts from medical websites OUTSIDE your website. I bet you won't / can't. Is it because your facts are made up???????? Allen > Forcing me to post the "verifiable facts", i.e., the "down" rate > of -1/2 diopter per year for kids when they begin wearing > a single-minus lens. I believe I am "sticking to the facts" > concerning this issue -- far more than Stacy. I don't get why you want to make an issue over any particular rate. For any group you measure at "1/2 D down per year" I can show you another group that changes more, or less. How is that important? What matters is comparing those who wear minus with those who don't. What matters is comparing those wearing plus with those who don't. Those comparisons are necessary to "prove" your theory that minus lenses accellerate myopia and plus lenses retard it. Anything else is just bluster. You've cited one study that shows some benefit to plus treatment. I've shown you two that showed the opposite. How does this make the Rehm-Brown hypothesis "proven fact?" -MT Dear Mike, You asked for formal studies demonstrating the average "down" rate of -1/2 diopter per year. This is not just one study -- that might be suspect -- but a very large number of studies, with substantial numbers of young children wearing the single minus. If you wish to tell the people on sci.med.vision that your "down" rate is -1/10 diopter per year -- then go ahead. Is that your rate? Best, Otis Otis, my man. Well, of course the "down rate" of myopia in myopic children is about 0.50 diopters/year, but not every year, and not every child. This "down rate" is the same whether the child is wearing minus lenses or not wearing minus lenses. Prove it otherwise, or please go to bed. DrG Dear DrG, The information is that the entire group in the minus lens when down by -6/10 diopters over a period of three years. This is the AVERAGE of the group. If a parent thinks his child will avoid this "down" rate -- then that is fine. I would be deeply concerned with this statistic before I put my child into an over-prescribed minus. It is a fact to be presented to a parent -- that might be interested in assistance in working with the plus -- before a minus lens is used. I think any parent would be interested in the plus-alternative, even if he should reject it. Then when his child's vision goes down at that rate -- he will have no reason to complain about the expected result. This issue is indeed the concern of Steve Leung OD, and "avoiding" this -1/2 diopter per year is the reason he has his own children wearing a strong plus -- when their refractive status is zero. This is the reason for a true "second opinion". Going into nearsighedness with the minus is indeed a one-way street, as these statistics show. This is the major reason why I "pushed" my sister's kids into using the plus -- to avoid this -1/2 diopter per year effect of wearing a minus 16 hours a day. Best, Otis You still avoid the issue. The issue is proving that myopic children who wear minus progress at a faster rate than those who do not. I answered this question myself in clinical practice, and I can say with utter confidence that children who wear minus lenses do not become more myopic than those who wear no lens. I can also state with confidence born out of 20 years of clinical experience that children who wear bifocals do not become less myopic than those who wear single vision minus lenses. DrG Dear DrG, No, that is not the issue. The issue is whether the child understands the consequences (to him) of wearing an over-prescribed minus all the time. Mike Tyner said quite frankly that he can not be involved with prevention (for pilots) because he judged it was "illegal" if he gave that advice, or the pilot "though" it was medical, rather than scientific advice. Mike is totally candid on that point -- as I am. Since Mike can't do it -- then who can. It leaves the person (pilot) himself to figure out what HE is going to do about -- because Mike can not. I accept Mikes challenge -- with my sister' kids, and explained the visual requirements that had to pass -- and the consequences TO THEM, of neglecting: 1. Reading their own eye-charts to verify their distant vision met "standard". 2. The fact that if they did not do this -- some one would put them into a minus -- when there vision when below 20/40 -- there would be no choice at that point. 3. The responsibility rested with them to learn more, understand more, and act effectively for their own personal protection and interest. They are now about 40, and have kept their distant vision -- while many of their friends are seriously nearsighed. Obviously no one in "optometry" could "prescribe" this type of consistent effort, and I explained to them that the scientific facts showed that the natural eye is dyanamic, and controls its refractive state to its average-visual enviroment. But this issue separates how you deal with the great mass of people walking in off-the-stree, who probably have no interest in protecting their distant vision -- versus and "educated" person who is truly aware of the science behind the natural of the natural eye's proven behavior. This issue was of concern to them -- and so they took the "high road" of reason, logic and science. But equally, I know that you could NEVER implement this type of solution -- except with your own chidren. And that does become a personal choice indeed. Best, Otis But what ARE the consequences of wearing a minus lens, Otis? Better vision? Certainly. More myopia compared to wearing nothing, compared to wearing a bifocal, compared to wearing pluls? Certainly not. Thus far, you are unable to prove that any of your interventions are effective, bluster, verbosity, and obfuscation notwithstanding. DrG > Mike Tyner said quite frankly that he can not be > involved with prevention (for pilots) because he > judged it was "illegal" if he gave that advice, > or the pilot "though" it was medical, rather > than scientific advice. Please learn to use your mail reader to quote. I can't remember saying anything like that. I might have said I'm liable if my prescription only gives a pilot 20/40 vision. > Mike is totally candid on that point -- as I am. Your reference is totally obscure to me - i.e. I haven't a clue what you're talking about. > They are now about 40, and have kept their > distant vision -- while many of their friends > are seriously nearsighed. My kids are 19 and 23 and managed to avoid nearsightedness WITHOUT lectures on taking personal responsibility for the shape of their cartilage. In fact, 3/4 of the US population seems to do pretty well without your ministrations. -MT > This is the major reason why I > "pushed" my sister's kids into > using the plus -- to avoid this > -1/2 diopter per year effect > of wearing a minus 16 hours > a day. Kids who DON'T wear glasses also change at 1/2D per year. Please show us the studies that indicate wearing minus causes 1/2D progression per year, or stop preaching myths as fact. -MT > You asked for formal studies demonstrating the average > "down" rate of -1/2 diopter per year. I did NOT. I KNOW you can find groups where the average refractive error changes by -0.50D/year. I did not ask that. I DO NOT CARE what rate you consider "correct". We know people get nearsighted. You can even believe they all get nearsighted at the same rate, with no respect for age, ethnicity, IQ, education, time spent in near work, or working distance. They all get nearsighted at one-half-diopter per year. FINE. My questions are - where you find evidence that myopes get worse BECAUSE they wear minus? And where you find it a "proven fact" that human myopes get better by wearing plus? If you aren't going to answer these questions then don't bother responding. The rest isn't relevant to the Rehm-Brown hypothesis. The average "down" rate in my practice is of no possible relevance. Besides the pitfalls of a self-selected sample, only about 1/3 of my patients are nearsighted and only about half of those are actively changing. Do you believe myopes get worse their entire lives? -MT |
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