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Medical Forum / General / Vision / August 2005Prevention with the Plus... "Questions"
Dear Neil, Thanks for the message you posted the other day, I have been busy with work so I couldn't post a response, I want to do it here. >You've obviously seen what must have looked like a circus as so many >of us tried to get Otis Brown to stop posting his untested (or tested, >but proven incorrect) theories. > >Some have suggested that the circus did nothing to inform people >coming to s.m.v. for help with their vision or their eyes. Because of >that pressure, I (and many others) toned down the rhetoric. > >But I ask you: what was your perception of all that back-and-forth >regarding Otis's posts? What was it then? What is it now? > I have met Otis through i-see.org, when I felt my vision was getting worse last year and I was getting more eye strain than I used to, I started searching the web for something I can do myself, well, I have stumbled upon his website, and read "testimonials" from pilots, and felt that his book's target audience was indeed aviators. I have contacted him and my plus adventure started as such. At that time, I was limited to the material which was published on his website only. I gave the plus a try, for a long time, it relieved just a little of that stress, but didn't reverse my myopia, by the 2nd month of my plus use, I started seeing distortions in distant objects, my only guidance was Otis himself. I was, though, getting mailing list messages on conversations with ODs. I had a complete different opinion going on about ODs, which they all wanted to sell glasses and stay in business. One day I decided to make a web search using keywords that included my name and a few things about my career. I ended up with results where Otis posted my messages on SMV as success stories. Some of the ODs responded with technical terms which prompted me to research the situation further. In the meanwhile, there wasn't any improvement in my vision. I was clearly fooling myself. After I PCS'ed overseas, I decided to get involved in SMV after Otis once more used my remarks on the NG. I am thankful that William Stacy and I had a nice conversation going on and he had military background. At the end of May, I had an autorefractor exam that revealed that my Rx since I was 18 had never changed. Plus had no effect in reversing but side effects such as seeing double images. This past Tuesday I was supposed to have a full eye exam since I can feel my eyesight is worsening, unfortunately the clinic didn't have any openings that morning. The Lieutenant Colonel (OD) asked his staff to put me on the autorefractor again and my -.50 eye was -.75 this time. Left revealed -1.00 but LTC said it has to be in error since I was able to read some of the 20/15 line both eyes with a lot of blinking. Now I scheduled a military PRK pre-op exam on Tuesday, I know my Rx could be too small for it, but I want to give it a shot, they might approve it. Why am I doing all this? All my life and my aviation career I didn't have problems with my eyes, always I had 20/15, 20/20. I kept it that way for most of the day, nowadays I wake up with blurriness. Plus lenses didn't work, it is even open to discussion it might aggravated my myopia's progression. I had started with a mild plus, and was working fine, but as you can see from SMV messages, Otis asks people those are too little powered, they have to go with stronger plus lenses. A few days ago he said it to Jonsy. Well, the stronger it is, the more you mess up your convergence. I was reading fine with the mild one. I am to be blamed as much as Otis himself believing and acting like a fool. >Do you have any ideas for how the contributors to this forum can >_productively_ alert people to the potential harm of listening to >"true believers" who--with nothing more than faith on their >side--fervently offer "cures" to the unsuspecting. > >Does the weekly posting serve that end well enough, or do you think >there's something else that can be done? > There are great people on this board and I learnt a lot from them. Dr Stacy, DrG, Dr Tyner, Dr Judy, our ODs in the group should state their credentials as one sig line at least. People should consult them and often ask them about the snakeoil salesmen and such theories if they are desperate to drift that way. None of these people became ODs because they wanted to become filthy rich selling glasses. Their honesty and dedication are obvious to me by just realizing that they spent their spare time on this NG. Weekly posting should definitely name those people who theories harm people! Anyway, I would like Otis to respond to my questions please; 1. How old are you? 2. And what is your last cyclo. refractive exam revealed? Shortly, what is your true refractive status? 3. Have you tried plus lenses yourself? If you have, what is the result? When did you try it? 4. Why are the plus "test" subjects are young children? 5. Are you warning everyone about the side-effects of overkill plus lense use? Never asked these before. John Now I > scheduled a military PRK pre-op exam on Tuesday, I know my Rx could be > too small for it, but I want to give it a shot, they might approve it. Definitely report back on your pre-op exam details. They should do a cyclo unless there's some obvious reason to preclude PRK. It will be very interesting to compare your cyclo now with your previous data. But I'd also be VERY cautious about PRK or any laser surgery for you with apparently less than 1 D. of myopia. I'm especially concerned about PRK since they burn right through Bowman's layer, which is the basement membrane for the corneal epithelium. We don't know the long term effects of losing your Bowman's but I suspect if there are *any* they won't be particularly pleasant ones. In the end, you may go for the laser due to your occupational needs, and I wouldn't fault you for that. It's your decision alone to make. But I must say I would put it at or near the last resort in the spectrum of options you have. w.stacy, o.d. > Definitely report back on your pre-op exam details. They should do a > cyclo unless there's some obvious reason to preclude PRK. It will be > very interesting to compare your cyclo now with your previous data. Roger that Bill. Yes we were told to bring our sunglasses and if possible hats. It will be a full cyclo exam. > But I'd also be VERY cautious about PRK or any laser surgery for you > with apparently less than 1 D. of myopia. I'm especially concerned [quoted text clipped - 7 lines] > But I must say I would put it at or near the last resort in the > spectrum of options you have. I am well within flight duty limits but only concern at this point I have no way of knowing if this will stop or keep on going, I have yet 1 to 2 years before getting myself involved in military flight school. I am getting my minuses after this full cyclo I will have on Tuesday, I always had 20/15 vision, I should have it when I need it. Now as far as I know FDA approved some PRK lasers starting from 0.00 up to -6.00 but I don't know if Army has those. The pre-op limits start at -6.00 and even my friend who is going with me is outside of those limits with -4.75 bilateral. Though he has a greater chance of approval than mine. A lot of red tape is involved also, has to go through CO and etc. Do you know where studies on PRK stand at right now, is it pretty much stopped or continuing? > I am well within flight duty limits but only concern at this point I > have no way of knowing if this will stop or keep on going, I have yet 1 > to 2 years before getting myself involved in military flight school. One of the first rules of any laser refractive correction is stable refraction. That is, no change over .25 within the previous 12 months. If you're still changing, you almost guarantee needing re-treatment(s). > Now as far as I know FDA approved some PRK lasers starting from 0.00 up > to -6.00 but I don't know if Army has those. The pre-op limits start at > -6.00 and even my friend who is going with me is outside of those limits > with -4.75 bilateral. I'm not sure what you mean. -4.75 is between (within) 0-6.00, as is your -.75 or -1.00. > Do you know where studies on PRK stand at right now, is it pretty much > stopped or continuing? All I know is they are doing lots more PRK now than they were 2 years ago, mostly on thin corneas where LASIK is problematic. I'm sure studies are continuing, but don't keep up on them much. Someone else will chime in here I'm sure. w.stacy, o.d. > One of the first rules of any laser refractive correction is stable > refraction. That is, no change over .25 within the previous 12 > months. If you're still changing, you almost guarantee needing > re-treatment(s). I am not trusting on the last refractor exam because it showed I progressed -.75 on left and -.25 on the right, since May 31st. This is unbelievable for me since I had the same Rx for 10 years and now in 3 months I progressed this much. This has to be in error. I guess I will wait until I get the cyclo done. No I would not want any fine tuning. After this cyclo I will wait another year. Of course I will use my minuses. I would wish they would stay like this and I could wear minuses without any further progress... > I'm not sure what you mean. -4.75 is between (within) 0-6.00, as is > your -.75 or -1.00. Army's recommended minimum according to the study paper is -6.00. My friend is -4.75, this leaves him out of limits, I don't even come close, but they waiver that. > Army's recommended minimum according to the study paper is -6.00. My > friend is -4.75, this leaves him out of limits, I don't even come close, > but they waiver that. That surprises me; I would expect the minimum to be around -2.00. Maybe they recommend LASIK for lower refractions? w.stacy, o.d. > That surprises me; I would expect the minimum to be around -2.00. > Maybe they recommend LASIK for lower refractions? Hello Bill, Well, no limits are set for both PRK and LASIK. LASIK is still not trustworthy for aviation duties therefore waivers go through the US Army Aeromedicine Research Lab. The fact sheet states; Are you within the pre-surgery limits of the program? -6.00 diopters of myopia +4.00 diopters of hyperopia 3.00 diopters of astigmatism (Verify with your eye doctor, if unsure) FAQ also states; *My refraction is outside the limits of the program, is it still possible to enter the study?* Yes. The limit is based on the correction that is programmed into the laser, not your eyeglass prescription, so you may actually be within the limits of the program. Your eye surgeon should be able to provide the required laser information to your flight surgeon (PRK) or USAARL (LASIK). They will review the laser records (or the planned correction the surgeon provides you) and determine whether you are within limits. I am expecting to have a lower rx when dilated. All I have to do is try to keep my rx below -1.50 for the next few years and I am good to go. That is the stressing part, I am not worried about wearing minuses at all. On the other hand, acuity limit is 20/50-1, this is something I am not having trouble with at the moment. What refraction roughly reflect 20/50 in your experience? John John, What continues to haunt me is that you may have been suffering from convergence insufficiency all along. In fact, unless a patient reports symptoms, many eye doctors will not even test for it. Because accommodation in "recruited" to aid convergence, the excess accommmodation often expresses itself as pseudomyopia, typically accompanied by against-the-rule astigmatism. For the person with convergence insufficiency, plus lenses at near are poison, because they eliminate the accommodative crutch. In fact, some texts recommend over-minusing as a means to stimulate accommodative/convergence. Also, accommodation declines with age, leading to a breakdown in fusion in some cases. This can be treated with prism, and/or vision therapy to build fusional reserves. DrG (licensed in Texas as an optometric glaucoma specialist) >John, > [quoted text clipped - 5 lines] >accompanied by against-the-rule astigmatism. > Hello DrG, well as far as I know I had esophoria problems when I was 5 or so. I can barely remember going through treatment (I think it was just diet at the time) and reading the eyechart with pictures on it. Whenever I get tired, not always but seldom my eyes tend to drift inward, I don't know if this is a clue for that condition. At this point I am open for professional advice and suggestions. I just checked for you, I can keep my finger clear in focus until 100 mm from my eyes and I can touch my nose if I want to keep the fusion but then the finger is of course is not in clear focus. We had discussed with Dr Stacy also because he had suspected the same thing a few months ago. I can sense that my convergence doesn't feel normal either. >For the person with convergence insufficiency, plus lenses at near are >poison, because they eliminate the accommodative crutch. Especially when they are very strong such as +2.50 right?... Thank you dear plus prevention..... I threw away all my pluses except the +1.00 > In fact, some texts recommend over-minusing as a means to stimulate >accommodative/convergence. Also, accommodation declines with age, >leading to a breakdown in fusion in some cases. This can be treated >with prism, and/or vision therapy to build fusional reserves. > If we can do it online, I am wondering if there are ways you can figure what my exact convergence problem is, by say asking questions or having me try some exercises. I am on a small post and eye exams are booked until November so until then I am hoping I can fix this. >DrG (licensed in Texas as an optometric glaucoma specialist) > Thank you, this means a lot. > >John, > > [quoted text clipped - 36 lines] > > > Thank you, this means a lot. John, Since you can maintain fusion to-the-nose, then by definition you do not have convergence insufficiency. Myopia accompanied by nearpoint esophoria is probably best treated with a bifocal or nearpoint add, and there are established rules for calculating the correct prescription. DrG >John, > >Since you can maintain fusion to-the-nose, then by definition you do >not have convergence insufficiency. One question though, yes I can hold the image fused together on my nose or very close but when I move back the object fastly outwards, I lose the fusion for a brief moment and when I catch it I fuse it again, is this normal, or should I do this practice more often? > Myopia accompanied by nearpoint >esophoria is probably best treated with a bifocal or nearpoint add, and >there are established rules for calculating the correct prescription. > Do you think I might have this? I don't even know what Army limitations on this concerning flight, all I know is; (a) Any degree of tropia detected in ocular motion on the Cover-Uncover Test (Tropia Test) in any four cardinal directions of gaze, or any degree of heterotropia. (b) Esophoria greater than 8 prism diopters. (c) Exophoria greater than 8 prism diopters. (d) Hyperphoria greater than 1 prism diopter are disqualifying for me. > One question though, yes I can hold the image fused together on my nose > or very close but when I move back the object fastly outwards, I lose > the fusion for a brief moment and when I catch it I fuse it again, is > this normal, or should I do this practice more often? Sounds like normal latency to me, as I have similar findings. > Do you think I might have this? I don't even know what Army limitations > on this concerning flight, all I know is; (a) Any degree of tropia [quoted text clipped - 3 lines] > prism diopters. (d) Hyperphoria greater than 1 prism diopter are > disqualifying for me. I doubt you have any of the above. DrG > Anyway, I would like Otis to respond to my questions please; > [quoted text clipped - 10 lines] > > John >> Anyway, I would like Otis to respond to my questions please; >> [quoted text clipped - 10 lines] >> >> John Don't hold your breath. I monitor the I-See group, simply to correct Otis when he misquotes me there in the bogus "conversations" he creates by cutting and pasting various sci.med.vision threads. I note he has not posted any of your negative comments about plus lens over there, though he was quick to post your "success" here. Dr Judy > One day I decided to make a web search using keywords that included my > name and a few things about my career. I ended up with results where Otis > posted my messages on SMV as success stories. Very interesting. When Otis posts his success stories here he is often asked to get the people he is quoting to reply directly. They never do. Now we understand clearly-- they don't even know that he is quoting (misquoting?) them! Otis has been caught telling half-truths here before (=lies). He has quoted optometrists whom don't even know him. He also ignors published scientific/medical research studies which disprove his ideas. By the way, do not put any stock in autorefractor results. You need a careful refraction by an optometrist/ophthalmologist. I would suspect your refraction is more in the range of approx. -0.50 based upon posts you have made here previously. BTW, I would definitely not recommend refractive surgery to anyone who has such a small refractive error. Did you ever try disposable contacts? RM OD PhD Dear RM, Ph.D., You can think what you like. When I state that the natural eye (population of) eyes are dynamic -- I mean to test is relative to a theory that insists that there is no relationship between the visual environment (input) relative to the refractive state of the entire population of these natural eyes. When I suggest that the natural eye is "dyamic" and you insist that I am making a FALSE scientific statement, then I suggest (given your money) that we REPEAT this experiment since you obviously DENY this reality for the behavior of the natural eye. But maybe it is because I am looking for the true behavior of an entire population of natural eyes -- while you have NO INTEREST in such analysis. That is fine with me. Just do not deny objective scientifc truth of this nature. You CAN deny this reality by insisting the the natural HUMAN-primate eye behaves profoundly DIFFERENTLY that these natural PRIMATE eyes. And that is OK by me. But then you are using your "position" to deny objective scientific "truth" concerning the proven behavior of the natural primate eye. I worked with Francis Young primarily to understand what he was doing -- and why he was doing it. But also to establish exactly HOW he did his primate experiment -- and HOW it related to the performance of the natural eye as a sophisticated system. I KNOW you can not "fit" scientific facts into a situation of dealing with the general public, walking in off the street and expecting "instant" clarity of vision FROM YOU. But that is an entirely DIFFERNT issue from establishing the fact that the natural eye is dynamic in an scientifc-experimental situation. Others can judge this issue to the best of their ability. Best, Otis troll Dear P.Clar, You are such a fine person. So wise, so wonderful. Able to analyize abstract analysis and arguments. Best, Otis I think his analysis if pretty much dead on. Quite clear and succinct too! It is you who has the reasoning problem. Perhaps you spend too much time thinking about the abstract, since the obvious answer to the efficacy of use of plus lenses in humans has been tested, published, and pointed out to you multiple times. Poor tragic Otis spends too much time in the abstract and too little time in reality. How about a little daydreaming about Raphaelson and the Printers Son? How about a little fantasy thinking where Otis' proves the whole medical establishment to be wrong? Of course it's all a conspiracy anyway right? Sounds like the next Dan Brown novel. ============= > Dear P.Clar, > [quoted text clipped - 7 lines] > > Otis > When I state that the natural eye (population of) eyes > are dynamic -- I mean to test is relative to a theory > that insists that there is no relationship between > the visual environment (input) relative to the > refractive state of the entire population of > these natural eyes. Of course you realize both your theories are in your own head and have little to do with what doctors believe. You're assuming doctors can't read those studies that show a relationship between myopia and close work. You're assuming lenses completely neutralize every stimulus to increasing myopia. You're assuming doctors can replicate the stellar results you report for Dr. Young. > When I suggest that the natural eye is "dyamic" > and you insist that I am making a FALSE [quoted text clipped - 3 lines] > DENY this reality for the behavior of the > natural eye. When we suggest that plus in various forms has almost universally failed standard tests of efficacy, you feel we should modify the standards to suit your belief. > But maybe it is because I am looking for > the true behavior of an entire population of > natural eyes -- while you have NO INTEREST > in such analysis. That is fine with > me. Just do not deny objective scientifc > truth of this nature. But you can deny that MOST tests of your hypothesis have failed. > You CAN deny this reality by insisting the > the natural HUMAN-primate eye behaves > profoundly DIFFERENTLY that these > natural PRIMATE eyes. You CAN assert that humans and primates all behave IDENTICALLY AT ALL AGES. > I worked with Francis Young primarily to > understand what he was doing -- and why [quoted text clipped - 3 lines] > related to the performance of the natural eye > as a sophisticated system. So perhaps you could clue us in to what Dr. Young did that nobody has been able to repeat successfully? -MT >By the way, do not put any stock in autorefractor results. You need a >careful refraction by an optometrist/ophthalmologist. I would suspect your [quoted text clipped - 4 lines] >Did you ever try disposable contacts? > Thanks Dr. RM. I should be fine as long as I can read 20/50-1 and below -1.50 for what I want to pursue as a career... Not knowing that my current rx (as you suspect and I believe so around -.50/-.75 tops) will progress or not is my worry. I am going to (hopefully) find out my Rx with a full cyclo exam and I am leaning more towards glasses. Dr. Stacy warned me about frequent contact lense use which would cause myopia creep that is aggravated by excessive soft lense use. I know myself, once I get the contact I am going to want to have them on all the time to have god vision at all times and that kind of scares me further progressing my mild myopia. John > Plus lenses > didn't work, it is even open to discussion it might aggravated my > myopia's progression. Aaah, perhaps this explains the disclaimer posted earlier this week.  SignatureScott Reverse name to reply |
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