See Dick.  See Dick make stupid, disruptive posts.  See Dick speak
disparagingly to and about eye doctors on a newsgroup dedictated to the
science of vision.  See Dick get what he deserves.  Will Dick behave,
go home and pout, or will Dick become even more abusive?

DrG

If you do a little back reading, you'll find that Dan's eye problems go
well beyond cataracts and IOLs (just like you'll find that these same
discussions have happened many times before).  IOL's are routine these
days, and are hardly vision threatening (though my heart does go out to
the recent poster who experienced complications with cataract surgery,
this is relatively uncommon).  You were never facing permanent blindness
or loss of vision as a real possible outcome. When it comes to people
with real vision problems, you're nowhere near to being in that group.

Or, as otis would have it, a few diopters too strong if you were to take
responsibility for your own vision.

That seems excessive for a simple refraction.

Many docs will absorb the cost of lenses when the prescription turns out
to be wrong, by way of customer service.  I get new glasses about every
two years, which is probably more than I have a right to expect from a
frame lifetime.  The money I spend on them per year is somewhat less than
the money I spend on shoes.  Many people spend more money on sneakers
than I usually spend on shoes.  The financial arguments about why "the
man" wants to keep us myopic just don't hold water, especially when one
considers what a person would pay to have some witch doctor wave a
chicken over his head to magically clear his vision.

I have no particular urge to insult you, but I'd personally be insulted
if someone accused me of prattling on and on without having anything of
substance to say.  One doesn't need to be abusive to point out
shortcomings, but I'm somewhat tickled by the tea kettle allusion, as its
never really seemed so apt before.  

Dear Dicky,

As you know, I love to do fundamental research.

The concept of the "dynamic" eye (all eyes) seemed very
reasonable -- and Jacob Raphaelson simply expanded
on that concept.

If you want to know WHY an OD will NEVER become
involved with TRUE PREVENTION, then read
the commentary by that idiot Neil Brooks.

If you want to think of the "public mind" and its
"thinking" then just read what Neil has to
say about science and the dynamic natural eye.

Even "beyond" the plus -- the parents should be
taught HOW to manage their child.  (Like "rap"
the kid with a ruler everytime he puts his
nose on the page.  In its initial stage
that kind of "dicipline" is more important
than ANY OTHER PROCESS.

To make that "recommendation" you would have
to be far more than a doc-in-a-box.  You
would have to supply the supporting
education for this preventive process.

But of course, there is no "profit" in
"supporting" a parent with his child -- by
giving this type of advice.

And secondly -- Neil Brooks would sue
the hell out of you.  No, there is no
incentive in helping parents understand
true prevention is there?

Q. E. D.

______________

Dear Prevention minded friends,

Subject: Remarks on SUPPORTING sincere preventive
optometrists.

Re: The actions you can take with your own
children (with second-opinion) support -- if
you wish to help them.

Long ago, I realized that the "kids" themselves "induce" that
first stage of nearsightedness. Thus you will see them "reading"
at 5 to 4 inches (effectively -10 diopters). They can certainly
do this -- for short periods of time. But the natural eye IS
CONTROLING ITS REFRACTIVE STATE to that environment.

Thus the child then goes from "plus" to "minus". What is of
absolute importance is that the child be STOPPED from doing this
-- however difficult it may be for THE PARENT do "prevent" the
child from doing it. That has got to be a "struggle" for any
parent who wishes to keep his child's vision clear (better than
20/40) through the school years.

No "plus", and no "preventive" measure can have ANY EFFECT,
UNTIL both parent and child "wake up" to this necessity.
True effective prevention must start in the home.

But once this is "understood", and the child is at 20/40 to
20/50 (still functional -- does not require the minus) SOME ODs
will prescribe a -2 diopter lens. That is a real "killer".

What the child needs is support, and yes, needs to begin
HABITUAL wearing of the plus. This is obviously very difficult
for the parent to comprehend. But there is very little choice,
but "neglect" and deeper myopia.

Prevention is indeed the "second-opinion", but the
majority-opinion ODs can think up endless reasons (excuses) for
"trashing" ANY OD WHO SUGGESTS THAT THE ABOVE APPROACH IS
NECESSARY.

Best,

Otis

Simple:

Not all eyes share the same "transfer function," and the transfer
function is not based upon accommodation.

Are you trying to make all of the evidence fit the model, or are you
constructing a model to fit the evidence?  It seems to me that you are
ignoring the evidence that doesn't fit your model.

DrG

I'll leave whether accommodation is open-loop or closed-loop to the
experts on the system.  I'll point out that there is another option that
is used when a system with feedback delay needs to work very fast, which
is to make the system open-loop, monitor for long term reproducible
errors, and actually change system parameters when they exist.  Most
people in the know would still call this open loop, as it has little to
do with moment-to-moment adjustments in function, but rather long term
errors.  If this were a motor system (electrical, not physiological),
true feedback would be supplying more current to a motor when something
impedes its rotation.  This long term process is much more analogous to
somebody realizing that the motor doesn't have enough oomph, so he
increases the number of windings in the motor.

The accomodation system is slow (i.e., your 0.75 second time constant),
it is problaby able to deal quite well with the large delays associated
with retinal feedback, on the order of 0.075 sec (which are death to
other responses that can't afford the 75ms delay), and I'd suspect it
would be closed loop, as in the Ciuffreda models, or perhaps DYNAMIC in
your parlance.  An expert would know for a fact, but not me.  However,
the closed loop nature of any system may have VERY LITTLE TO DO with how
it adjusts to long-term changes in function-- but much more with how it
would respond to perturbations in the input or output on a moment-by-
moment basis, and thus the closed-loop nature doesn't necessarily hit on
the issues at hand. To put it another way, even if the system is
demonstrably closed-loop, that has very little impact on whether you can
use this fact to your advantage to cure myopia.  In fact, if it worked
the way you want it to, as a perfect closed loop system, the defocus
caused by myopia would be enough to fix the system all by itself, with or
without the plus.  It's not what's happening to the muscles of
accomodation-- it's what's happening to the developing eye (if anything)
in response to what's going on with the muscles of accomodation-- and
none of your models really address this.  You have a curve fit to the
exponential process in the infant monkey and chick, but that's about it.  
No hypothesized mechanism.  Thus, your "second system" is nothing but a
black box. We can wax philosophical about the transfer function of the
system, but its more important to establish whether this functionality is
present at all.

Until you can show REAL DATA that describe the functionality of the black
box in post-developmental humans, and explain why all of the studies that
contradict the functionality of the black box in adults don't mean much,
there's little to talk about.  Yeah, we all acknowledge that there is
something functioning in the adult, in that near work has something to do
with myopia, but a variety of studies in humans seem to say that there's
little we can do optically to alleviate this situation.  So, a lot the
data that's out there seem to suggest that in the adult human, we have a
non-linear system-- it goes towards myopic, but doesn't go back the other
way so easily, or perhaps at all.  

Given the absence of mechanism, an absence of categorical data that shows
this happens in humans at all, and even if it did, little proof that it
happens in humans past infancy, and the inability to categorically
demonstrate staircase myopia, and the fact the undercorrected myopes tend
to remain undercorrected myopes, and a ton of other negative evidence
brought up here over the course of years, many hold that plus lens
therapy for myopia prevention doesn't hold much hope.  Despite hundreds
of posts, you've offered nothing new to change anybody's mind.  You've
proposed studies, but your weird ideas about the subjects self-assessment
simply does not allow for valid measurements or controls, and your
lumping of accomodative problems from axial myopia really discredit the
whole process.  Everyone here pretty much agrees that you might be able
to successfully clear an accommodative portion of myopia by about a
diopter or so using a variety of methods--plus lenses possibly being one
of them (possibly through just dorking around with the
accommodation/convergence ratio??)-- but there's no evidence that you can
do anything about the axial portion.  You also fail to address the entire
developmental issue.  We know that there is something special about
development, but that specialness seems to go away with maturity.  We all
think that studies looking at the effect of plus lenses in real HUMAN
infants would be valuable, but we all know that those studies can't be
done because of the huge ethical issues.  We also know that you can't
just extrapolate the developing primate data to the adult prep because
development is special.

Last, but not least, I just don't buy the idea that myopia prevention
deserves much in the way of research funding.  I just don't think that
basic eyecare, including spectacle correction, eats up enough of our
health care dollar to make it worthwhile.  I think a better approach to
myopia prevention is to put effort behind the molecular biology of
development, and when we have a grip on that, we might have a good basis
for a pharmacological intervention for myopia.

So, there it is.  A larger review than you would have gotten from any
individual reviewer if you put this proposal in front of the NEI, believe
it or not.  Those reviewers would have more to say about the actual
accomodative process than I do, but they would cover most of the issues
I've brought up--especially your dodging of any issues regarding
development.  Our beef with you is that we've made our concerns known to
you, and instead of addressing them, you just keep reading us the same
anecdotal evidence over and over again, and blowing off other studies
saying "those people didn't take responsibilty for their vision"-- which
addresses absolutely nothing.  Also, you keep making the same
recommendations to parents with very little basis in reality, and that's
really got some folks upset.