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Medical Forum / General / Vision / January 2006Appraising the OD
I will appreciate some help on this. I am trying to work out a series of simple questions to ask during a refraction to assess the competency of the refractor. So far I am up to here: 1. What is a diopter? 2. What is a prism diopter? 3. If not glass, what are my eyeglasses to be made of? 4. What is meant by 20/20 vision? 5. How can there be a 20/20 line on this chart 20 inches from my face? 6. What about my eyes makes me nearsighted (farsighted)? 7. How did my eyes get that way? 8. One of my eyes is an OD and you are an OD -- how do you explain that? 9. If I happened to be simply 2 spherical diopters nearsighted in each eye, thus to see print sharply at ~20 inches, should I read without my eyeglasses? 10. Isn't there a machine that figures out my required correction automatically? Why don't you have one of those? 11. If you are not the OD, is he the one who trained you to do OD stuff? 12. How do you expect me to drive home in bright sunshine with my pupils the size of poker chips? Please understand I am not asking for answers. What I want is more questions. Let's start with simple eyeglasses, and work our way up, if thats OK with you. Thanks, -- Dicky > I will appreciate some help on this. I am trying to work out a series of > simple questions to ask during a refraction to assess the competency [quoted text clipped - 19 lines] > Please understand I am not asking for answers. What I want is more questions. > Let's start with simple eyeglasses, and work our way up, if thats OK with you. Since you don't want answers, I assume you think you know all the answers. But that assumption is incorrect since some of the questions are nonsensical. Like the last one. If your pupils are that large, you are not human, so I will not let you in my front door. w.stacy, o.d. [snip] >Please understand I am not asking for answers. What I want is more questions. >Let's start with simple eyeglasses, and work our way up, if thats OK with you. I would probably go with something simpler: credit check, enneagram, DNA tests, and NCIC screening. Far more revealing.... If those aren't efficacious, I would simply offer to arm wrestle the prospective refractor. Good luck, Ace -- er, Dicky. Sigh. This one's simple, Dick: a good refractor achieves a good result. You may want to consider a little less emphasis on this pedantic bullshit and a little more emphasis on how well you see through the glass. One practical consideration: don't be afraid to ask to be refracted via autorefractor, trial lenses, /and/ the phoropter, asking that the prescription be written from the one that gave /you/ the best vision.]  SignatureLive simply so that others may simply live > I will appreciate some help on this. I am trying to work out a series of > simple questions to ask during a refraction to assess the competency > of the refractor. So far I am up to here: I could conduct a refraction quite accurately in the time it takes to work through your list, and that's just the questions you have so far. I'm not sure how I'd feel if I had to slow down to answer a bunch of questions, some of which have no solid answers. -MT > I'm not sure how I'd feel if I had to slow down to answer a bunch of > questions, some of which have no solid answers. 7. is the only tough one. "We don't know" is an acceptable answer. With that, all of the questions could be answered in 60 seconds or less. (I could send you the answers by email.) > I could conduct a refraction quite accurately in the time it takes to work > through your list, and that's just the questions you have so far. That seems pretty fast. But that's good. You'll probably need some speed to catch up with state-of-the-art autorefractors. "William Stacy" <wstacy@obase.net> wrote in message news:2gSuf.47104$q%.6120@newssvr12.news.prodigy.com... > Since you don't want answers, I assume you think you know all the > answers. But that assumption is incorrect since some of the questions > are nonsensical. Like the last one. If your pupils are that large, you > are not human, so I will not let you in my front door. The answer to the last question is "We will give you some sunglasses for your trip home". The only question I don't know how to answer is #7. "Neil Brooks" <neil0502@yahoo.com> wrote in message news:vssnr1hlko1k1qsq6u9adjl3g1nu2gourv@4ax.com... > This one's simple, Dick: a good refractor achieves a good result. That's the point -- to determine which refractor is the good one, > You may want to consider a little less emphasis on this pedantic bullshit > and a little more emphasis on how well you see through the glass. ... to identify the good one before one pays for the spectacles (glass or whatever). BTW, "Pedantic" is a very crass and insulting way to refer to my bullshit. -- Dicky >BTW, "Pedantic" is a very crass and insulting way to refer to my bullshit. Your goal should be to get a refraction that is as accurate as my use of the word 'pedantic' in this context. SignatureLive simply so that others may simply live > That seems pretty fast. But that's good. You'll probably need some > speed to catch up with state-of-the-art autorefractors. 12 minutes is plenty, except for engineers and old people. "State-of-the-art" autorefractors have managed in the last 10 years to come close to retinoscopy, another "objective" technique we've used for over a century. Retinoscopy and modern autorefractors can give quite consistent results (same from trial to trial) but they still don't match the subjective refraction to a satisfactory degree. If we prescribe from "objective" results (retinoscopy or auto) about half the patients will be pretty happy, another quarter will be a little dissatisfied, and the remaining quarter will be totally pissed. -MT >The only question I don't know how to answer is #7. > > That's the easiest of all: genetics, environment and time... w.stacy, o.d. > Please understand I am not asking for answers. What I > want is more questions. Let's start with simple > eyeglasses, and work our way up, if thats OK with you. Ummm, this is a bit of a waste of everyone's time (those who could answer) don't you think? You simply spewed out some questions (some obviously silly) and asked for more. If you actually want to know more (so you know enough to ask the questions) why don't you start reading at someplace like allaboutvision.com? I think it just a weak attempt at an inane troll but I wasted my time on the above anyway. -Quick Dear Dick, I see that the experts here have several methods to answer your question. 1. As counter-questions. 2. Insult you. 3. Ask you to come if ro a "visit". Suggest that as a layman you don't know jack s___. As always, enjoy our pleasant analytical discussions about these issues. Or, as Charlie Chan has said, The answers are easy -- it is the questions that are difficult. Best, Otis > The answers are easy -- it is > the questions that are difficult. Answers are easy if you make up your own, without training or experience. -MT 1. What is a diopter? 2. What is a prism diopter? 3. If not glass, what are my eyeglasses to be made of? 4. What is meant by 20/20 vision? 5. How can there be a 20/20 line on this chart 20 inches from my face? 6. What about my eyes makes me nearsighted (farsighted)? 7. How did my eyes get that way? 8. One of my eyes is an OD and you are an OD -- how do you explain that? 9. If I happened to be simply 2 spherical diopters nearsighted in each eye, thus to see print sharply at ~20 inches, should I read without my eyeglasses? 10. Isn't there a machine that figures out my required correction automatically? Why don't you have one of those? 11. If you are not the OD, is he the one who trained you to do OD stuff? 12. How do you expect me to drive home in bright sunshine with my pupils the size of poker chips? answers: 1. A diopter is a unit of measurement that helps determine how much a lens should be altered to bend or refract light rays to achieve correct focus. 2. In some cases, your doctor may prescribe prism power to help your eyes work more efficiently as a team an/or stay in proper alignment. Prism is added to an eyeglass lens prescription only if a problem with eye teaming or eye alignment is detected. Prism is measured in special power units called prism diopters (p.d.). Unlike the diopter units used for sphere power and cylinder power, prism diopters are usually expressed in fractions (e.g. 1 1/2) rather than in decimal units. If prism power is prescribed, a second value called the prism base (or simply, base) is included to indicate the direction (in, out, up or down) of the prism in the lens. Your eye doctor may prescribe base-in prism if your eyes have a tendency to become misaligned in an outward direction. If your eyes tend to cross inward, base-out prism may be prescribed. In some cases, lateral prism (base-out or base-in prism) is prescribed for eyestrain. Lateral prism is always prescribed in the same direction for both eyes (i.e. base-out prism for both eyes or base-in prism for both eyes). Sometimes lateral prism is prescribed for one eye only. Vertical prism (base-up and base-down prism) is used for vertical eye misalignments or difficulties in maintaining the eyes in comfortable vertical alignment. Vertical prism is prescribed in opposite directions for the two eyes (base-up prism for one eye and base-down prism for the other). Sometimes vertical prism is prescribed for one eye only. 3. Glasses are often made of cr-39 or some other plastic but super high index 1.8 and 1.9 uses glass 4. 20/20 is the standard for "normal" vision and a level of very, very good vision where the eye is usually plano and doesnt have too many high order aberrations and no other pathalogies. 5. This is the nearpoint chart to test for presbyopia. I am not 20/20 on the near chart unless I take my glasses off. 6. Otis is the expert on what makes one nearsighted :) 7. Genetics and bad vision habits 8. OD stands for Ocular Dexter or right eye and OS stands for Ocular Sinister meaning left eye. 9. This is a big yes!!!!!!! I could make a whole book on why. Simply put, you are nearsighted and see fine from near without glasses. 10. This is autorefractor and its an estimate. its best to get a manifast refraction 11. I am not an OD but my knowlege comes from reading :) 12. sunglasses helps. Best to have someone else drive you! >12. sunglasses helps. Best to have someone else drive you! > Not a bad job, and your last answer is better, and more correct than Dicky's. But I think he wanted more questions. I think he thinks he has all the answers. w.stacy, o.d. > 11. I am not an OD but my knowlege comes from reading :) So according to Dick, you're qualified to get your own phororaptor and go to work doing manifast refractions! -MT > 1. What is a diopter? > 2. What is a prism diopter? [quoted text clipped - 80 lines] > > 12. sunglasses helps. Best to have someone else drive you! >get your own phororaptor and go to >work doing manifast refractions! > >-MT > Og, man *have* to work fast when phororaptor breathing down neck... Dear Dicky, Here are some staight answers -- where possible. Have you gotten any from the experts? Please note, these are striclty engineering answers, not medical answers. Dick> I will appreciate some help on this. Dick> I am trying to work out a series of simple questions to ask during a refraction to assess the competency of the refractor. [Comment: If you had your own trial-lens kit -- and some experience -- you could do it yourself. The true-medical part is essential -- and you can not do that. Medical means checking for incipient detached retina, glaucoma, RP, Macular degeneration, and things of that nature. Dick> But determining the refractive state of the natural primate eye is just a matter of putting a lens in front of your face, and finding a lens that makes your vision sharpest (i.e., Best Visual Acuity.) Dick> So far I am up to here: 1. What is a diopter? a. A unit of optical power. A +1 diopter lens will have a focal length of 1 meter. A +2 diopter lens a length of 1/2 meter. The average human eye has a total power of about 60 diopters and a length of 2.4 cm. 2. What is a prism diopter? a. The ability of a prism to change the direction of an image. (My cat is sitting on my lap -- so I will have to get a more complete description at a later date.) 3. If not glass, what are my eyeglasses to be made of? a. Mostly plastic. Others can add their commentary. 4. What is meant by 20/20 vision? a. The ablity to read 0.9 cm letters at 6 meters in room illumination. Or letters that subtend 5 minutes of arc at 6 meters. The original was 3/8 inch letters at 20 feet. Since BVA (with a minus) was mostly at that level, that became the "standard". 5. How can there be a 20/20 line on this chart 20 inches from my face? a. If you use the 5 minute-of-angle, then you can calculate the size of the letters at 20 inches. 20/20 at 20 inches does not make scientific sense. 6. What about my eyes makes me nearsighted (farsighted)? a. The refractive state of the primate eye changes as the visual enviroment is changed. In the wild the natural primate eye has a postive refractive state of from 0.0 to +2 ditpers (gaussian distribution.) If you live in the "open" yur eyes will have a positive refraction. b. Move your eyes indoors, and the natural eye will change its refractive state in that direction. Keep the eye in that "near" envrioment, and the refraction goes from "plus" to "minus", A natural process. There is not "cause" to it. 7. How did my eyes get that way? a. How many years did you spend in school? 8. One of my eyes is an OD and you are an OD -- how do you explain that? OD (Dexter) Right eye OS (Sinister) Left eye OD Optometry Doctor 9. If I happened to be simply 2 spherical diopters nearsighted in each eye, thus to see print sharply at ~20 inches, should I read without my eyeglasses? a. Majory opinion? No b. Second opinoin? Yes 10. Isn't there a machine that figures out my required correction automatically? Why don't you have one of those? a. Provided you paralyize your eyes, you can use an "auto-refractor". Accuracy is very poor. The OD are much better with there phoropter and Snellen at 20 feet. (However they tend to "over-prescribe.) b. Quite of few do have the auto-refractor -- but they wisely don't rely on it. (I hope.) 11. If you are not the OD, is he the one who trained you to do OD stuff? a. OD are trained by other ODs in OD college. This costs about 120 K and 4 years of their life. Only ophthalmologists and optometrists are permitted to "measure" your refractive state and write a "prescription". 12. How do you expect me to drive home in bright sunshine with my pupils the size of poker chips? a. Bring your wife along. b. Don't drive. c. A dialated eye is about 8 mm, unless you are using a small poker chip. Dick> Please understand I am not asking for answers. Otis> ????. That is an interesting statement. Then why ask the questions? Are you afraid some professional will insult you -- by evading the question. Otis> What I want is more questions. Otis> Fine. How many answeers have you received thus far? Otis> Let's start with simple eyeglasses, and work our way up, if thats OK with you. Otis> It is OK with me, after all, that is what science is all about -- and this is a SCIENCE.med.vision group. Just do not get the scientific questions and answers mixed up with MEDICAL questions and answers. Otis> Also, when you ask the correct questions about the dynamic performance of the natural eye -- you may not like the "answers" you receive. Witness all the "Hoop-Laa" the goes on on sci.med.vision. Best, Otis Dicky > 9. If I happened to be simply 2 spherical diopters nearsighted in > each eye, thus to see print sharply at ~20 inches, should I [quoted text clipped - 3 lines] > > b. Second opinoin? Yes Dear Dickey, Please disregard Otis's postings. He is not in the medical profession and the **second opinion** is not in the position to give medical advice. Thank you! Allen > Dear Dickey, > Please disregard Otis's postings. He's a funny guy. I can figure out what to believe. So can most people, I think. All of these Otis warnings seem unnecessary. With regard to his reaction to my question: > > > If I happened to be simply 2 spherical diopters nearsighted in > > > each eye, thus to see print sharply at ~20 inches, should I > > > read without my eyeglasses? namely that his opinion AKA "second opinion" would be affirmative, I must say that I don't see why a person with a natural "add 2.0" should not read without eyeglasses. Further, I would probably be in agreement with Otis in feeling that such a person should probably consider not using his -2.0 spheres for reading. The situation would be more complicated for a myope with a need for dissimilar corrections, including cylinder, for right and left. My guess is that much eyestrain is due to trying to superimpose and focus dissimilar images. So it would be a rare myope who could be advised to read without eyeglasses. Similarly, for a person with dissimilar eyes, but corrected to be similar, reading with (single-vision) distance eyeglasses might be preferable to naked-eye reading. Furthermore, I do not see any reason why a young person feeling his eyes may be strained by much close work should not consider using reading glasses, according to prescription if his eyes need it. Maybe that would forestall myopia -- who knows?! I do not see how it could hurt. That is not exactly to say that I agree with Otis that "The Plus" is good for everybody, whatever "The Plus" might be taken to mean. I personally feel that reading through bifocals, or trifocals, or continuous or whatever, is a big nuisance, and quite conducive to eyestrain, neckstrain, and asspain. But the markup on complicated eyeglasses is higher, that the need for "professional" upkeep is higher, so people will continue to be encouraged to order them particularly if they have some insurance that offsets the cost. -- Dicky > should not read without eyeglasses. Further, I would probably be > in agreement with Otis in feeling that such a person should probably > consider not using his -2.0 spheres for reading. The thing is, many ODs, including me, are fine with it. I find it tragic when a parent has the notion that children MUST wear glasses full time. It's such a waste of energy to enforce this silly rule when there are many more substantial issues for parents to focus on. > Furthermore, I do not see any reason why a young person feeling > his eyes may be strained by much close work should not consider > using reading glasses, according to prescription if his eyes need it. Nor do we. But insisting children wear "reading glasses" usually leads to embarrassing situations because the next doctor down the line (often an MD) says "that's ridiculous." > Maybe that would forestall myopia -- who knows?! We know it won't make enough difference that we should be spouting the "second opinion" at every child and every parent. > I personally feel that reading through bifocals, or trifocals, or > continuous > or whatever, is a big nuisance, and quite conducive to eyestrain, > neckstrain, > and asspain. That's why I uniformly suggest that myopes in their 30's considering LASIK shoot for "planned undercorrection." There's very little a doctor can prescribe that's better than a natural -2.00 of myopia. > But the markup on complicated eyeglasses is higher, that the > need for "professional" upkeep is higher, so people will continue to be > encouraged to order them particularly if they have some insurance that > offsets the cost. We have several good bifocal studies that show they don't offer substantial benefit to asymptomatic young people. So where are these "professionals" recommending bifocals for non-presbyopes? -MT > We have several good bifocal studies that show they don't offer substantial > benefit to asymptomatic young people. So where are these "professionals" > recommending bifocals for non-presbyopes? My 9 year old son was prescribed bifocals. I don't have his script in front of me, but both eyes are around -7.50 with 1D of astig. He has +3. The reason being is that when wearing the -7's he reads over the tops of his glasses about 3 inches from his face because he cannot focus in his glasses at a comfortable distance to read. They seem to be working, meaning that he can now read and do his homework with his glasses on, but sometimes I do catch him reading over the tops of his glasses. He does that consistently if he wants to examine something close up. He has contacts too (Proclear) and in those he's forced to read from a greater (and probably more correct) distance. He doesn't like wearing them for that reason because he can't bring things up to the tip of his nose like he's used to. He's certainly not a presbyope! Signature~RT > > We have several good bifocal studies that show they don't offer substantial > > benefit to asymptomatic young people. So where are these "professionals" [quoted text clipped - 14 lines] > > He's certainly not a presbyope! BTW: his glasses are progressives. he adapted to them very quickly. Signature~RT > MT We have several good bifocal studies that show they don't offer > substantial [quoted text clipped - 15 lines] > > He's certainly not a presbyope! No, but he has symptoms- he's uncomfortable reading through -750. My comment hinged on the word "asymptomatic." -MT > [ ... ] > We have several good bifocal studies that show they don't offer substantial > benefit to asymptomatic young people. So where are these "professionals" > recommending bifocals for non-presbyopes? Bifocals were used in one group against myopia in a mentioned study, without reported benefit. The conundrum returns: if myopia results from close work, and close work can be optically moved to distant, why can't myopia be prevented/forestalled with appropriate eyeglasses? For bifocals, a simple answer is that they are a big pain in the a.s to try to read through, and kids hate to wear eyeglasses in the first place, and probably did not wear the glasses when they were not being watched. Another defect in the studies may have to do with vergence: base-out prisms would be needed to complete the illusion that the book is at visual infinity. Another possibility, which maybe everybody but me has considered, is that being driven to study, and possibly to "fail", could cause a spastic ciliary response as well as spastic colon. For instance, what do you suppose the focusing mechanism is doing during REM (rapid eye movement)? Has anybody but me ever dreamed of looking at a page but not being able to make out the words? -- Dicky Magooeyes > The conundrum returns: if myopia results from close work, and close work > can > be optically moved to distant, why can't myopia be prevented/forestalled > with > appropriate eyeglasses? It _is_ a conundrum, one that forces us to examine the possibility that accommodation, the logical culprit, in reality doesn't play a significant role in stimulating myopia. Other evidence includes the fact that uncorrected hyperopes accommodate vigorously but don't get nearsighted, while myopes accommodate less than anybody but continue to get myopic. > Another defect in the studies may have to do with vergence: base-out > prisms > would be needed to complete the illusion that the book is at visual > infinity. It's a logical avenue to investigate, but for two things: 1) exophores must exert additional convergence to maintain single binocular vision, but as a group I don't think they are more prone to myopia and 2) the additional convergence required for near vision is trivial compared to the normal range of vergence ability. > Another possibility, which maybe everybody but me has considered, is that > being driven to study, and possibly to "fail", could cause a spastic > ciliary > response as well as spastic colon. Yes but accommodative spasm must be separated from "real" myopia and as we've seen, excess accommodation doesn't make the eye grow longer. -MT Dear Dicky, Subject: Reading of the results of the "plus" (bifocal) studies. There are two "readings" of this type of study. Since there is NO AGREEMENT, then say "majority opinoin", i.e., 1. a lens has no effect on the refractive state of the natural primate eye, and 2. The natural eye WILL change its refactive state (as a classical scientific experiment) when you place a mild -3 diopter lens on a population of dyds. Our discussions thus far have proven the need for a second-opinon on this subject. Further I do not support the "bi-focal" concept, i.e., using BOTH a minus and plus. The minus (on the threshod) will in fact prevent "clearing". Just work with the simple plus -- if you have a strong motive to do so. The issue remains open. The "motivation" to use the plus at the threshold is a serious problem -- because it depends completely on the judgment of the person who is actually using the plus -- and monitoring his own eye chart. To further respond: Mike> We have several good bifocal studies that show they don't offer substantial > benefit to asymptomatic young people. Otis> Given that the bifocal is very expensive, and not understood -- I would agree. But to day that all bifocal studies indicate NOTHING is something I can not agree with. Just state that your majority opinion. So where are these "professionals" recommending bifocals for non-presbyopes? Otis> It is easy to make a "recommendation". The real issue is how that "recommendation" is taken or "accepted". And is the issue pure-science, or is it medicine? Dicky> Bifocals were used in one group against myopia in a mentioned study, without reported benefit. Otis> Simply not the case. The Oakley-young study showed what the effect could be if the plus were used at the threshold, i.e., effective PREVENTION could be achieved. The real show-stopper it the parents and kids. But just say that the second-opinon (from the Oakley-Young study) is that the plus must be used before the situation gets out-of-hand. But I do agree that decision or choice will depend on the person himself. Dicky> The conundrum returns: if myopia results from close work, and close work can be optically moved to distant, why can't myopia be prevented/forestalled with appropriate eyeglasses Otis> As Mike pointed out -- he can not do it. It is going to depend on the parents. If fact, modifying the child's reading "habits" is crucial -- if there is to be any "change" in this situation. But that is like modifying a child's habits in stuffing his face and becomming obese. The problem is not "medical" it is the profound "bad habits" of this kid -- and the "doctor" has NO COTROL OVER IT. This is equally true for the kid who has his nose 4 inches (-10 diopters) from the page. The kid needs to be "swatted" at home or at school when he does that. True prevention starts at home. And that is only the FIRST STEP. But that "understanding" transferrs a lot of responsibility to the person. Best, Otis > Our discussions thus far have proven > the need for a second-opinon on this subject. Isn't it nice to feel needed? > Otis> Given that the bifocal is very expensive, > and not understood -- I would agree. But What part of bifocals don't you understand? > Otis> It is easy to make a "recommendation". > The real issue is how that "recommendation" > is taken or "accepted". And is the > issue pure-science, or is it medicine? Whoosh. (That's the point of a discussion flying right past you.) > Otis> As Mike pointed out -- he can not > do it. It is going to depend on the parents. Whoosh. > If fact, modifying the child's reading > "habits" is crucial -- if there is to be Yes. All myopia results from reading at 4 inches. > But that "understanding" transferrs > a lot of responsibility to the person. Oh. Now I get it. Myopia results from misunderstanding and irresponsibility. It's their own fault. -MT Dear Dicky, Subject: Reading of the results of the "plus" (bifocal) studies. There are two "readings" of this type of study. Since there is NO AGREEMENT, then say "majority opinoin", i.e., 1. a lens has no effect on the refractive state of the natural primate eye, and 2. The natural eye WILL change its refactive state (as a classical scientific experiment) when you place a mild -3 diopter lens on a population of dyds. Our discussions thus far have proven the need for a second-opinon on this subject. Further I do not support the "bi-focal" concept, i.e., using BOTH a minus and plus. The minus (on the threshod) will in fact prevent "clearing". Just work with the simple plus -- if you have a strong motive to do so. The issue remains open. The "motivation" to use the plus at the threshold is a serious problem -- because it depends completely on the judgment of the person who is actually using the plus -- and monitoring his own eye chart. To further respond: Mike> We have several good bifocal studies that show they don't offer substantial > benefit to asymptomatic young people. Otis> Given that the bifocal is very expensive, and not understood -- I would agree. But to day that all bifocal studies indicate NOTHING is something I can not agree with. Just state that your majority opinion. So where are these "professionals" recommending bifocals for non-presbyopes? Otis> It is easy to make a "recommendation". The real issue is how that "recommendation" is taken or "accepted". And is the issue pure-science, or is it medicine? Dicky> Bifocals were used in one group against myopia in a mentioned study, without reported benefit. Otis> Simply not the case. The Oakley-young study showed what the effect could be if the plus were used at the threshold, i.e., effective PREVENTION could be achieved. The real show-stopper it the parents and kids. But just say that the second-opinon (from the Oakley-Young study) is that the plus must be used before the situation gets out-of-hand. But I do agree that decision or choice will depend on the person himself. Dicky> The conundrum returns: if myopia results from close work, and close work can be optically moved to distant, why can't myopia be prevented/forestalled with appropriate eyeglasses Otis> As Mike pointed out -- he can not do it. It is going to depend on the parents. If fact, modifying the child's reading "habits" is crucial -- if there is to be any "change" in this situation. But that is like modifying a child's habits in stuffing his face and becomming obese. The problem is not "medical" it is the profound "bad habits" of this kid -- and the "doctor" has NO COTROL OVER IT. This is equally true for the kid who has his nose 4 inches (-10 diopters) from the page. The kid needs to be "swatted" at home or at school when he does that. True prevention starts at home. And that is only the FIRST STEP. But that "understanding" transferrs a lot of responsibility to the person. Best, Otis Dear Dicky, If you ever wonder why no OD will ever explain true-prevention, you might read Neil Brooks slander against me. If I were an OD -- I would not put myself at risk for your long-term visual welfare. Would you? But I have acted to "protect" my nephew -- to get him to face and make this difficult choice that has life-time visual consequences. Would you like you intelligence rerspected in this matter -- what ever your choice. I know I would -- but that is NEVER GOING TO HAPPEN -- with idiots like Neil Brooks loose in this land. All the other ODs are "off the hook". They can do absolulty NOTHING for prevention for this reason alone. This is not science -- this is stupidity. Best, Otis >If you ever wonder why no OD will ever explain true-prevention, >you might read Neil Brooks slander against me. Now you're just consistently replying to your own repititious posts. A lunatic, trapped in Waynesboro, Pennsylvania, alone with his fear. "What have I done??" But ... but ... but ... I fixed Keith's eyes, didn't I? Isn't /that/ enough to prove the case?? Shouldn't I be able to go out and prescribe to others?? Unfortunately, Uncle Otie, the OD's on this site have years and years and years of education and clinical practice. They also have a thing called 'liability' that you didn't *think* you had. But you do ... and the chickens (since you're such an aphoristic old coot) are coming home to roost. I just hope you have sufficient pluck (ha-ha. I made a funny!) SignatureLive simply so that others may simply live Neil, you are an idiot! Neil> Ijust hope you have sufficient pluck (ha-ha. I made a funny!) But, I will write up the effect of you crazy reaction to scientific truth concerning the behavior of the natural eye. Again, If I spent 100K in college, and then 120 K for four years in OD school -- I would not put myself at risk to help ANYONE with true-prevention with the plus. You make an absolute case why no OD will ever help the "public" with true-prevention for fear of the loss of $240 K, and eight years of their life. No, I can never expect them to help ANYONE WITH TRUE-PREVENTION, but it must be absolutly clear to the person on the threshold WHY they get no help. And you and your legal threats are the reason. Copy to Keith, so he understands the why he had little choice but to "take control" and clear his distant vision to always pass all LEGAL VA requirments. At last report he is above the 20/20 line. How may parents have kids with "stair-case" myopa -- now wearing minus-lens coake bottles -- wondering how their kids "got that way -- and why". Think about it. Otis >Neil, you are an idiot! Gosh. Thanks, Uncle Otie. I have severe dry eye. You making me bawl so profusely has brought much needed tears. How can I ever repay you? >But, I will write up the effect of you crazy reaction to >scientific truth concerning the behavior of the natural eye. I tried the Google translator, but can't figure out what that means. >Again, If I spent 100K in college, and then 120 K for >four years in OD school -- I would not put myself >at risk to help ANYONE with true-prevention with >the plus. But since you didn't think you would incur any liability, you have no problem with the notion of practicing medicine WITHOUT the benefit of schooling or education. >And you and your legal threats are the reason. I've made no threats. Only promises. And I delivered. Suffer, Bi*tch! >Copy to Keith, so he understands the >why he had little choice but to "take control" and >clear his distant vision to always pass >all LEGAL VA requirments. At last >report he is above the 20/20 line. Ah, Keith. The much fabled Keith. Your 'great white hope' for proving your thesis. How IS ol' Keith these days, Uncle Otie? >How may parents have kids with >"stair-case" myopa -- now wearing >minus-lens coake bottles -- wondering >how their kids "got that way -- and why". Was that supposed to be "coke" or "cake?" Nobody has any idea what you're talking about. Saw the letter from the State of PA, didn't you. How's your blood pressure, Uncle Otie? Call your lawyer yet? The walls closing in?? SignatureLive simply so that others may simply live > But you do ... and the chickens (since you're such an > aphoristic old coot) are coming home to roost. > > I just hope you have sufficient pluck (ha-ha. I made a > funny!) Yes, but it could have been a lot better. Maybe something about the chickens being able to see their way home now. -Quick >> But you do ... and the chickens (since you're such an >> aphoristic old coot) are coming home to roost. [quoted text clipped - 4 lines] >Yes, but it could have been a lot better. Maybe something >about the chickens being able to see their way home now. I'll give you that, but it /was/ getting to be nearly 1am.... SignatureLive simply so that others may simply live Dear Dicky, I have a question for you. 1. What is the biggest block to preventing the development of a negative refractive state? The optometrist or, The patient? 2. If an second-opinion offered you the peventive alternative what would you do? a. Investigate the natural eye's proven behavior more completely. b. Thank him, and state that you only want your eye chart made very sharp. c. Run screaming from the shop -- and report him to the local OD Board. d. After you get stair-case myopia from the minus -- would you go back the the second-opinion OD and appoligize for tuning him it to the OD Board? Best, Otis > 1. What is the biggest block to > preventing the development > of a negative refractive state? > > The optometrist or, > The patient? I've tried to resist but I can't help myself. I must ask you a question using exactly the same logic: After you molest children, do you a) pop open a beer and turn on the TV or b) turn yourself in for psychological evaluation and treatment? -MT >> 1. What is the biggest block to >> preventing the development [quoted text clipped - 8 lines] >After you molest children, do you a) pop open a beer and turn on the TV or >b) turn yourself in for psychological evaluation and treatment? Uh-uh, Mike. Trick question. Your question *assumes* that he ever takes a break from molesting children.... [Too smart for /that/ one] SignatureLive simply so that others may simply live Dear Mike, Thanks for your "flip" remark. Perhaps I should ask the question: Who is more responsible for child obesity: 1. The doctor or, 2. The parents and child. [Please consider the law of conversation of energy in your answer -- i.e., physics.] and Who is ultimately responsible? Best, Otis > > 1. What is the biggest block to > > preventing the development [quoted text clipped - 10 lines] > > -MT > Perhaps I should ask the question: > > Who is more responsible for child obesity: We can always rely on you to miss the point. Whoosh! -MT > Dear Dicky, > [quoted text clipped - 3 lines] > preventing the development > of a negative refractive state? Do you mean to ask, what is the main reason that people do not make some effort to avoid becoming myopic? The answer is that nobody knows for sure how to prevent myopia. So if you are a kid, and you would like to try to avoid becoming progressively myopic, you can't really get any good answers. > 2. If an second-opinion offered > you the preventive alternative what > would you do? How can a second opinion offer an opinion? An opinion comes from a person, not from an opinion. > d. After you get stair-case > myopia from the minus -- would > you go back the the second-opinion > OD and appoligize for tuning > him it to the OD Board? Me, I got implants. I am quite fine for now. But you have to wait until you are old for those if you expect Medicare to pay for them. But I really think that my life would have been better if I had been able to read print for more than 20 minutes at a time, see the blackboard in classes, and recognize people on the other side of the street. That I can see the 20/15 line with implants and mild eyeglasses suggests that my vision care over the years could have been better. I guess I know what you mean by "the second-opinion OD" but it is a dumb way to refer to yourself, if that is what you are doing, because, if we can believe you, you are an engineer and not an optometrist. I don't think turning some one over to some OD Board would do much good because it is doubtful that ODs can make trouble for people who are not ODs, and maybe not for those, either. It takes somebody like the President to misuse power he is not accorded. -- Dicky >> Dear Dicky, >> [quoted text clipped - 3 lines] >> preventing the development >> of a negative refractive state? >Do you mean to ask, what is the main reason that people do not make >some effort to avoid becoming myopic? >The answer is that nobody knows for sure how to prevent myopia. Ding ding ding ding! Dicky, you get a gold star. This is the point Otis doesn't get. Everybody would like to prevent myopia. Trouble is, nobody knows how to do it! Plus doesn't work, bifocals don't work, RGPs don't work. Otis thinks that if you just try hard enough, you can do it. Ready, fire, aim right Otis. >I guess I know what you mean by "the second-opinion OD" but it is a dumb >way to refer to yourself, if that is what you are doing, because, if we can >believe >you, you are an engineer and not an optometrist. You're getting smarter still. >It takes somebody like the President to misuse >power he is not accorded. Bingo. Excellent. Dicky, you are my hero of the day. Dear Dicky, 1. Bush had exceeded his authority -- but a wide margin. The worst part is holding people with out charges, and without trial. That is what the Frech Revolution was about. Were is the constitution? Were is the bill of rights? Were is the American Civil Liberties? Out to lunch? 2. The constitution requires a DECLARATION OF WAR -- if that is what we want. Were it is? Since we are not at war, then how in the word does Bush claime "War Powers"? Where are the bill of particularls about how greviously Iraq attacked us -- so we were FORCED to declare war? Sorry for the political statement -- but some one kicked it off. Our arguments about the eyes mean nothing --- compared to this political problem. Have you written your senator yet? Sorry -- I can not talk about the eyes. Do you think the CIA and NSA monitor our conversations? Oops -- I hear a knock at the door....... ============ > > Dear Dicky, > > [quoted text clipped - 42 lines] > -- > Dicky otis, i like your politics... finally we've found common ground > otis, > i like your politics... > finally we've found common ground Me too. I think we should adjourn to the local coffee shop. bill Otis: I can't believe even you had the temerity and audacity to make those kinds of threats. Given the post-9/11 era, and the current state of wiretapping/monitoring by the government, I'd strongly caution you that threats of that sort can only lead to trouble. I'm advising you to cease and desist, and will not discuss this subject with you any further. SignatureLive simply so that others may simply live Is this some kind of joke?? Not very funny. It's worse though, if not intended as a joke, if you really intend to ask those questions at your eye exam, and take them seriously. I will appreciate some help on this. I am trying to work out a series of simple questions to ask during a refraction to assess the competency of the refractor. So far I am up to here: 1. What is a diopter? 2. What is a prism diopter? 3. If not glass, what are my eyeglasses to be made of? 4. What is meant by 20/20 vision? 5. How can there be a 20/20 line on this chart 20 inches from my face? 6. What about my eyes makes me nearsighted (farsighted)? 7. How did my eyes get that way? 8. One of my eyes is an OD and you are an OD -- how do you explain that? 9. If I happened to be simply 2 spherical diopters nearsighted in each eye, thus to see print sharply at ~20 inches, should I read without my eyeglasses? 10. Isn't there a machine that figures out my required correction automatically? Why don't you have one of those? 11. If you are not the OD, is he the one who trained you to do OD stuff? 12. How do you expect me to drive home in bright sunshine with my pupils the size of poker chips? Please understand I am not asking for answers. What I want is more questions. Let's start with simple eyeglasses, and work our way up, if thats OK with you. Thanks, -- Dicky > Is this some kind of joke?? Not very funny. Some of my experience over the last several decades has been with HMO doctors who train their own phoropter flipper-floppers. I started naive about this, and trusting. But there seem to be at least as many theories about how eyes work and what's the best way to correct them as there are home-grown eye techs. I suppose one could ask for evidence of professional training, but the test is quick and kind of fun, in a macabre way. For instance, most techs around here, and some OD's do not know how a diopter is defined, or what "add" it takes for presbyopic eyes to focus a CRT screen at say 27 inches. Almost no one any more knows how a prism diopter is defined. The stupidity of wraparound eyeglasses is another example -- I had a big argument with an OD about getting new a frame flattened, and recently needed to flatten a mail-order pair (preferable to arguing with an "expert"). It is not funny to find a 50% chance that prescription eyeglasses need redoing, particularly when one made to feel argumentative and unreasonable, and required to pay for the rework. Frankly, it seems to me that the prescribing and making of simple eyeglasses is getting to be a lost art. -- Dicky Dick(less) Adams" wrote: >I will appreciate some help on this. I am trying to work out a series of >simple questions to ask during a refraction to assess the competency [quoted text clipped - 21 lines] >Let's start with simple eyeglasses, and work our way up, if thats OK with >you. "MS" replied: >Is this some kind of joke?? Not very funny. It's worse though, if not >intended as a joke, if you really intend to ask those questions at your eye >exam, and take them seriously. Add Dick(less) Adams to your killfile. You'll sleep better. SignatureLive simply so that others may simply live In news:rqnpt1pkss47km6qqobb14766dkh5j4833@4ax.com "Neil Brooks" <neil0502@yahoo.com> under a full requote of this thread, tersely added: > Add Dick(less) Adams to your killfile. You'll sleep better. Have you got any imagination at all, you empty-headed, brown- nosing dolt? Ace and Otis have better style and do much snappier posts than you. -- Dicky
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