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Medical Forum / General / Vision / November 2005Squinting when not wearing glassee
I'm myopic and astigmatic, about -2.75 myopia and -1.75 astigmatism in my right eye and -1.25 in my left. When I don't wear my glasses, my right eye strays off and I get headaches. I'm trying not to become too dependent on my glasses so fr closework I try to survive without my glasses. What can I do to prevent my sight from worsening? >I try to survive without my >glasses. What can I do to prevent my sight from worsening? Wear your glasses and don't squint. Myopia is to some degree progressive but will at some point in your life (for me, late 30s) slow or stop. I've been wearing the same Rx for five years after nearly 3 decades of increasing myopia plus astigmatism. +++++++++++++ Reply to the list as I do not publish an email address to USENET. This practice has cut my spam by more than 95%. Of course, I did have to abandon a perfectly good email account... > I'm myopic and astigmatic, about -2.75 myopia and -1.75 astigmatism in > my right eye and -1.25 in my left. When I don't wear my glasses, my > right eye strays off and I get headaches. I'm trying not to become too > dependent on my glasses so fr closework I try to survive without my > glasses. What can I do to prevent my sight from worsening? Stop having birthdays? :) Usually myopia increases for a while, then slows and stops changing. Your doctor will say there's little you can do to alter that pattern. "Don't read too close" and "Don't read without breaks" are about the only advice supported by evidence. Wearing glasses, not wearing glasses, wearing special glasses, all make very little difference. The internet is full of contrary opinions, and exceptions do exist. Near birth, the human eye is probably VERY responsive. By age 9 or 10, when most nearsightedness begins, eyeballs don't change much in response to wearing lenses, because groups wearing glasses get no more nearsighted than groups who don't. That finding is important because it applies to humans. Lots of studies show that neonatal animal eyes can be influenced by lenses, but they also show an age where the response fades away. There's some indication that an atropine analog called pirenzepine may be used effectively to limit myopia. And there have been some promising results recently with bifocal contacts in certain subgroups. But I don't think you should waste much energy worrying about what you can do to alter the natural history of your myopia. It's mostly genetic. -MT > ... groups wearing glasses get no more nearsighted than groups > who don't ... What glasses? Under what conditions? How well controlled? Yeah, yeah, I know, you tried the plus lens trick and it did not work. I tried too -- good for burning ants on the sidewalk when you are a kid. > they also show an age where the response fades away. Everything fades away pretty quick when you are over 95. So what? > There's some indication that an atropine analog called pirenzepine may be > used effectively to limit myopia. Can it be made into a pill? Pills, and any medicines, I guess, which you keep taking forever, are highly regarded by the pharmaceutical companies. > And there have been some promising results > recently with bifocal contacts in certain subgroups. Bifocal contacts? Has anybody responsibly tried reading glasses for myopia candidates. At the age where that might be effective, it is doubtful the subjects could manage contacts of any kind. Bifocal contacts do not make any sense at all to me, for anybody, much less kids. -- Dicky > Everything fades away pretty quick when you are over 95. So what? So by the time humans start wearing glasses, the plasticity seen in neonatal animal studies doesn't hold. If it did, plus lenses would slow myopia. > Can it (pirenzepine) be made into a pill? Pills, and any medicines, Not likely. It acts on growth-regulating receptors in the sclera. It isn't likely you could get the same effect with orals except with fatal doses. > Has anybody responsibly tried reading glasses for myopia candidates. > At the age where that might be effective, it is doubtful the subjects > could > manage contacts of any kind. Yes, it's been tried several ways. The COMET group is soliciting patients now for a new trial. > Bifocal contacts do not make any sense at all to me, for anybody, > much less kids. It's best not to rely on what "makes sense." I don't think bifocal contacts are that promising, but I can't ignore Tom Aller's findings - after fitting young myopes with a bifocal contact lens in one eye and a single-vision contact in the other, he found the bifocal eyes consistently got less nearsighted. I'm not recommending it yet, but I'm interested to see if the effect can be replicated independently. Anytime somebody patents a procedure, like Dr. Aller did, you have to watch out for proprietary interests. -MT > ... by the time humans start wearing glasses, the plasticity seen in neonatal > animal studies doesn't hold. If it did, plus lenses would slow myopia. Well, I am still betting on fragility of the cartilaginous elements which support the "crystalline" lens. (It is hardly crystalline, you know!) > > Can it (pirenzepine) be made into a pill? Pills, and any medicines, > Not likely. It acts on growth-regulating receptors in the sclera. Well, maybe. But it is a medication, to be taken over a long period of time. Bias may be suspected if such agents are promoted by their manufacturers. Likewise, professional lethargy may contribute to the overprescription (and inappropriate prescription) of medications. > > Has anybody responsibly tried reading glasses for myopia candidates. > Yes, it's been tried several ways. The COMET group is soliciting patients > now for a new trial. Studies seem gimmicky. Why, for instance, are the COMET trials based on progressive addition lenses? Wouldn't single-vision reading glasses, under carefully controlled conditions, be more appropriate? (Remember, I am calling for a convergence adjustment as well as for plus and for and astigmatism correction). And, in this vein, I doubt if bifocal contacts, whatever in blazes they may be, can make any sense at all. > It's best not to rely on what "makes sense." Some things clearly do not make sense. Like lumping a lot of stuff in an experimental therapy. If something works, you might never know what, and if it doesn't work, you would not know if some single element alone would have been effective. > I don't think bifocal contacts are that promising, but I can't ignore Tom > Aller's findings - after fitting young myopes with a bifocal contact lens in > one eye and a single-vision contact in the other, he found the bifocal eyes > consistently got less nearsighted. I'm not recommending it yet, but I'm interested > to see if the effect can be replicated independently. I would not want that done on any child of mine. > Anytime somebody patents a procedure, like Dr. Aller did, you have > to watch out for proprietary interests.. Fuckin' "A"!!! And for any one who is subsidized or entertained by a manufacturer. -- Dicky P.S. It is all pretty academic with me, since I see now through silicone, and my severely myopic "one-eyed" child is supported by a husband. But this may be of interest: After my implants, my wife read about accommodating implants. Well, I had not been told about that possibility. Good thing, too, because I might have been dumb enough to try it. -d (seeing my screen very clearly through +1.25 Walgreens readers) > Well, I am still betting on fragility of the cartilaginous elements which > support the "crystalline" lens. (It is hardly crystalline, you know!) You're saying myopia is caused by the zonular fibers? > > Has anybody responsibly tried reading glasses for myopia candidates. If you mean putting Walgreen +125's on a group of emmetropes or myopes, no. If you mean making young myopes wear glasses that are +075 blurry far away, yes. They got worse _faster_ and ethical guidelines forced the experimenters to remove the +075 and shut down their experiment. > Studies seem gimmicky. Why, for instance, are the COMET trials based on > progressive addition lenses? Wouldn't single-vision reading glasses, > under > carefully controlled conditions, be more appropriate? It isn't practical or humane to blur distance vision in students when your study extends over two or three school years. Single-vision reading glasses would be appropriate for a group of emmetropic children, but three-quarters of them will never get myopia and COMET isn't targeted at _preventing_ myopia. Their kids already _have_ myopia and the purpose is to test a practical treatment in practical circumstances. For another look at practical treatments, see the abstract I pasted at bottom. > (Remember, I am calling > for a convergence adjustment as well as for plus and for and astigmatism > correction). You may have something, but you're mixing variables, as you criticize below. > And, in this vein, I doubt if bifocal contacts, whatever in blazes they > may be, can > make any sense at all. They don't make sense to me either. What makes sense is "THIS group got less nearsighted than THAT group." > Some things clearly do not make sense. Like lumping a lot of stuff in > an experimental therapy. If something works, you might never know > what, and if it doesn't work, you would not know if some single element > alone would have been effective. Like correcting accommodation and convergence simultaneously. FWIW, the bifocal results, if verifiable, only seem to work when vergence maintains an eso fixation disparity. > I would not want that done on any child of mine. So you agree that some treatments (and some experiments) are too intrusive to be practical. -MT ************************************** Br J Ophthalmol 1989 Jul;73(7):547-51 Effect of spectacle use and accommodation on myopic progression: final results of a three-year randomised clinical trial among schoolchildren. Parssinen O, Hemminki E, Klemetti A. Department of Ophthalmology, Central Hospital of Central Finland, Jyvaskyla. Two hundred and forty mildly myopic schoolchildren aged 9-11 years were randomly allocated to three treatment groups and the progression of myopia was followed-up for three years. The treatment groups were: (1) minus lenses with full correction for continuous use (the reference group), (2) minus lenses with full correction to be used for distant vision only, and (3) bifocal lenses with +1.75 D addition. Three-year refraction values were received from 237 children. 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). There were no differences between the groups in regard to school achievement, accidents, or satisfaction with glasses. In all three groups the more the daily close work done by the children the faster was the rate of myopic progression (right eye: r = 0.253, p = 0.0001, left eye: r = 0.267, p = 0.0001). Myopic progression did not correlate positively with accommodation, but the shorter the average reading distance of the follow-up time the faster was the myopic progression (right eye: r = 0.222, p = 0.0001, left eye: r = 0.255, p = 0.001). It seems that myopic progression is connected with much use of the eyes in reading and close work and with short reading distance but that progression cannot be reduced by diminishing accommodation with bifocals or by reading without spectacles. > > Well, I am still betting on fragility of the cartilaginous elements which > > support the "crystalline" lens. (It is hardly crystalline, you know!) > > You're saying myopia is caused by the zonular fibers? I do not know exactly how the tension is maintained on the lens when the circular (ciliary) muscle is relaxed. Frankly, I do not feel too bad about not knowing that, because I do not think I am alone in that respect. > > > Has anybody responsibly tried reading glasses for myopia candidates. > > If you mean putting Walgreen +125's on a group of emmetropes or myopes, no. I never suggested +1.25D. That seems a bit weak. Also I figured on correcting vision at infinity then applying the "add" and whatever amount of base out prism is consistent with the "add" chosen. To fool the eyes into thinking they are seeing the book, or work, at infinity. > It isn't practical or humane to blur distance vision in students when your > study extends over two or three school years. No blur. Sharp focus at infinity with distance glasses (or naked eyes if correction is not needed), and (same) sharp focus at working distance with reading glasses. Kids needing some correction for distance might not want to wear eyeglasses in public, but for reading and close working, which are solitary things, it should be easier to persuade them. > Single-vision reading glasses would be appropriate for a group of emmetropic > children, but three-quarters of them will never get myopia and COMET isn't > targeted at _preventing_ myopia. > Their kids already _have_ myopia and the purpose is to test a practical > treatment in practical circumstances. I am not thinking about reversing myopia, but keeping it from getting worse. Maybe preventing it in some cases where it can be reasonably expected to develop. (I suspect that once the condition is reached where the images of distant objects come to focus short of the retina, there is no going back.) > For another look at practical treatments, see the abstract I pasted at > bottom. OK. It concluded "It seems that myopic progression is connected with much use of the eyes in reading and close work and with short reading distance but that progression cannot be reduced by diminishing accommodation with bifocals or by reading without spectacles." Considering that close work is pretty definitely causative for myopia, it is very enigmatic that fooling the eyes into thinking they are seeing at infinity does not or would not prevent the progression or development of myopia. Perhaps the effort of fooling those eyes was not stringent enough. > > (Remember, I am calling for a convergence adjustment as well as for plus > > and for and astigmatism correction). > > You may have something, but you're mixing variables, as you criticize below. Fooling they eyes into thinking they are seeing at infinity. How is that mixed? > [ ... ] > They don't make sense to me either. What makes sense is "THIS group got less > nearsighted than THAT group." OK. Which group was that? > > Some things clearly do not make sense. Like lumping a lot of stuff in > > an experimental therapy. If something works, you might never know > > what, and if it doesn't work, you would not know if some single element > > alone would have been effective. > > Like correcting accommodation and convergence simultaneously. Probably eyes know better how to focus if they get some triangulation information. Do you remember close-up attachments for rangefinder cameras for decades ago? Such an attachment would put a prism over one of the rangefinder ports so that the rangefinder could be used close up. I think the range-finder camera model is more generally useful. Consider the difficulty involved in superimposing two images, as would be necessary to obtain distance information, if one image could not be sharply focused. For eyes, then, one best starts with corrected, balanced, vision. That is to say, each eye, relaxed, sees the same sharply focused image at infinity. I can imagine there would be a lot of eyeball consternation if the eyes needed to bring together two images which could not be superimposed. Even, I would guess that such continual crisis could lead to myopia and other evil conditions. > FWIW, the bifocal results, if verifiable, only seem to work when vergence > maintains an eso fixation disparity. Several of those words are not in my dictionary. Doubtful if I could diagram the sentence even if I knew the meanings of the words. Hey, why don't we start on "blur"? What exactly does that mean? > So you agree that some treatments (and some experiments) are too intrusive > to be practical. The idea of using one eye as a control on the other upset me. Keeping eyes balanced, if there is an option, would seem a kinder goal. -- Dicky > ************************************** > Br J Ophthalmol 1989 Jul;73(7):547-51 [quoted text clipped - 24 lines] > reading distance but that progression cannot be reduced by diminishing > accommodation with bifocals or by reading without spectacles. > I do not know exactly how the tension is maintained on the lens > when the circular (ciliary) muscle is relaxed. Frankly, I do not feel too > bad about not knowing that, because I do not think I am alone in that > respect. I tend not to tell people how things work when I don't have a clue.  SignatureDan Abel dabel@sonic.net Petaluma, California, USA Dear Dick, Subject: The second opinion about the eye's behavior Mike is very selective in reporting "his" studies. The truth is that these studies consistently "conflict" -- and no one has resolved them as yet. It does depend on the type of question you learn to ask. > > ... groups wearing glasses get no more nearsighted than groups > > who don't ... > > What glasses? Under what conditions? How well controlled? Otis> A very biased study. The "second opinion" study run by Dr. Francis Young showed that children fitted with a "high plus", (who were expected to look THROUGH the plus), had the following rates (approximately). The single-minus went "down" at a rate of -1/2 dioper per year. The "plus" bi-focal stopped going "down". I am not a "fan" of the bi-focal, but with this suggests is that more agressive use of the plus BEFORE the person is in deeper than -1/2 to -3/4 diopters could be effective in prevention. To date, no such preventive study has been conducted. > Yeah, yeah, I know, you tried the plus lens trick and it did not > work. I tried too -- good for burning ants on the sidewalk when > you are a kid. > > > they also show an age where the response fades away. Otis> MIke is right about this point -- based on the Oakley-Young study, if you wish to keep your distant vision clear, you are going to have to teach youself how to consistently use the plus for all close work. This suggests that the person should be informed in a manner that would encourage him to use the plus in this manner. Further, it would appear to be a wise choice of the person himself -- more so than a "medical" decision. > Everything fades away pretty quick when you are over 95. So what? > [quoted text clipped - 3 lines] > Can it be made into a pill? Pills, and any medicines, I guess, which you > keep taking forever, are highly regarded by the pharmaceutical companies. Otis> This is the standard "drop" in your eyes for "exams" Very unpleasant stuff -- if you ever had it. Also called a cycloplegic. I would think that a low-cost plus would make more sense on a scientific level. > > And there have been some promising results > > recently with bifocal contacts in certain subgroups. > > Bifocal contacts? Otis> Rather expensive -- if you check. The over-the-counter plus sells for about $8. > Has anybody responsibly tried reading glasses for myopia candidates. Otis> To a certain extent -- but the person must "get the idea" and must understand the results of the "primate" studies, which the ODs on sci.med.vision think are a big joke. At > the age where that might be effective, it is doubtful the subjects could manage > contacts of any kind. Otis> The plus (for prevention) has never been systematically tested on a scientific basis. (i.e., undertand the meaning of the primate studies. Thus the preventive approach would require an "educated mind" before anything is attempted. That fact alone would prevent a "blind" study, and make the effort scientific rather than "medical" -- if you know what I mean. > Bifocal contacts do not make any sense at all to me, for anybody, much less > kids. Otis> Dick, I agree with you -- they seem to make "sense" to only ODs. Otis > Dicky > Subject: The second opinion about the eye's behavior Seems there's more than two. > The truth is that these studies consistently "conflict" -- and no > one has resolved them as yet. It does depend on the > type of question you learn to ask. And on the words used! > The "second opinion" study > run by Dr. Francis Young showed that children fitted > with a "high plus", (who were expected to look THROUGH > the plus), had the following rates (approximately). Exactly how high would "high plus" be? Plus what? (Units??!!) Look through "the plus" (??) at what? > The single-minus went "down" at a rate of -1/2 dioper per year. Could one say that Young's studies showed that children who useed single-vision reading glasses with some certain positive sperical correction (in diopters, what?) experienced myopic progression of about a half diopter per year? Does that represent an improvement over some worse expected rate, or what? > The "plus" bi-focal stopped going "down". You seem to be saying that Young found that bifocal eyeglasses did not change, in the sense of becoming more concave, during the study. (Certainly not an allusion to "muff diving".) (Well, most people take off their eye glasses first.) > I am not a "fan" of the bi-focal, but with this suggests > is that more agressive use of the plus BEFORE the person > is in deeper than -1/2 to -3/4 diopters could be effective > in prevention. To date, no such preventive study > has been conducted. I guess I can figure out what you mean by that. Could I assume that, if eyes were out of balance by some fraction of a diopter, and that, if there were any astigmatism, appropriate optical corrections were made before the "add" was applied for reading glasses or panes? I would think such corrections would be appropriate, as well as base out prism for convergence correction. > MIke is right about this point -- based on the Oakley-Young study, > if you wish to keep your distant vision clear, you are going [quoted text clipped - 4 lines] > would appear to be a wise choice of the person > himself -- more so than a "medical" decision. "Plus" is a hopeless word in this context. If I could replace it with "reading glasses" (as discussed above), perhaps we could be in agreement. Maybe Mike even could agree? > This is the standard "drop" in your eyes for "exams" Very > unpleasant stuff -- if you ever had it. Also called a cycloplegic. > I would think that a low-cost plus would make more sense > on a scientific level. Good luck to anyone who would like to try atropine analogs to help their Magoo vision. Anybody who has tried to see the road on a sunny day on the homeward drive from a visit with a cycloplegoid eye doctor will not rush towards the experience. > > Bifocal contacts? > Otis> Rather expensive -- if you check. The > over-the-counter plus sells for about $8. They sell OTC reading glasses with specific values of correction, stated in terms like +1.25D, +1.50D, etc. I got a pair for $3.98 on sale. No base-out prisms, however, and they do not correct residual astigmatism. But, no matter. My silicone eyes are not going to change much anymore, and stuff at reading distance is not too hard to see anyway, even if a bit out-of-focus on one axis or another. > > Has anybody responsibly tried reading glasses for myopia candidates. > Otis> To a certain extent -- but the person must "get the idea" and > must understand the results of the "primate" studies, which > the ODs on sci.med.vision think are a big joke. I think we could take the primate studies off the plate. A kid probably doesn't even know what a primate is, or that he is, in fact, one. > the preventive approach would require an "educated mind" > before anything is attempted. Guess we better get started pretty quick, while there are still some of those left. > That fact alone would prevent a "blind" study, and make the effort > scientific rather than "medical" -- if you know what I mean. If you mean that the buggers seem to be all wound up in their jargon, I might know. But who isn't? > Otis> Dick, I agree with you -- they seem to make "sense" to only ODs. Well, Otis, we have to remember that the eye guys are in business to sell eyeglasses and stuff, and thus they are different from us, and have problems we cannot understand, or even suspect, in some cases. -- Dicky > > The "plus" bi-focal stopped going "down". > > You seem to be saying that Young found that bifocal eyeglasses did > not change, in the sense of becoming more concave, during the > study. (Certainly not an allusion to "muff diving".) (Well, most > people take off their eye glasses first.) That makes no sense. How are you going to see what you are doing if you take your glasses off? :-) Back when I was severely myopic, I very seldom removed my glasses. I certainly wore them for swimming and sex. SignatureDan Abel dabel@sonic.net Petaluma, California, USA |
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