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Medical Forum / General / Vision / February 2006

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Diopters to 20/something conversion. The math and science behind this!

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acemanvx@yahoo.com - 10 Jan 2006 11:13 GMT
Hello everyone, post your dioptric pescription(how bad are your eyes),
your UCVA(uncorrected) and BSCVA(corrected by glasses) Also if you know
anyone's vision, post that too. I have done much research on the
correlation of diopters and 20/xxx and have compiled several charts,
formulae, tables and comments on the results obtained thus far. To test
for this, do it in room light or dim light. Make sure the eyechart is
well illuminated and your not squinting at all or recalling from memory
or guessing. Blur preception is of course allowed.

I and most optometrists have found that -.25 diopters doesnt cost you a
single line but makes the existing line blurry but still readable. Some
say it costs half a line. Such as if you can see half of 20/15 with a
-.25 lens, youll be a full 20/20 but wont be able to see better than
that uncorrected. Another example is if your seeing all of 20/20, you
may miss half of the 20/20 with -.25 diopters. Others have said it
didnt affect their ability to read a line, just made it harder to do
so.

Minus half diopter(-.5) is generally accepted as resulting in one full
line loss. This means 20/15 becomes 20/20 and 20/20 becomes 20/25. If
you can see half of 20/15 youll be seeing half of 20/20.

Minus one diopter(-1) generally gives you half visual accuracy. My
friends who see 20/20 with glasses see 20/40 without their -1 glasses.
Ditto for 20/15 with -1, 20/30 uncorrected. I was 20/50 corrected to
20/25 with a -1 lens years ago.

Higher dioptric values become harder to calculate and predict,
especially when you get to -6 and up. Someone could be -4.5 another
-5.25 and both see 20/400 UCVA. The -5.25 probably will see a much
blurrier 20/400 than the -4.5 but generally, 20/400 represents a
moderate of myopia around -5 diopters. One website said the range was
-4 to -6 for 20/400 and your best corrected vision played a big factor.
Someone whos 20/15 corrected needs more diopters to see the same blur
as another with 20/30 corrected. For me, my left eye at -5 or so
couldnt see 20/400 while my right eye at -4.5 or so just barely, barely
saw 20/400. I know two people who passed V3 requirement which states
you have to be 20/400 or better uncorrected and both were barely 20/400
with -5.5 pescriptions with 20/15 corrected. Those two guys said they
dont know anyone else -5.5 or more who passed V3 which requires 20/400.
They probably didnt have the great 20/15 corrected vision with glasses
so for them, -5 was the limit(20/20 corrected) I am not correctable to
20/20 so my limit is even less.

Few eyecharts go beyond 20/400 so info is scarce past this. I have a
solid grasp on dioptric values below -6(mild to moderate myopia), but
for -6 and up which is high myopia I am less certain how this converts
to diopters. I do know high myopes are worse than 20/400 but how bad
exactly? Also theres much fewer high myopes than low and moderate
myopes so much of my info is on low(er) myopes and their diopters to
snellen accuracy.

One could stand closer but then accomodation needs to be taken into
account. I can see the 20/200 E from 10 feet less blurry than the
20/400 E from 20 feet. At 5 feet I see the 20/70 line but im certainly
worse than 20/280. I experienced .67 diopter accomodation from the 5
feet mark.

If any of you have charts and formulae, on what expotentional scale
does this equal to? I know that going from -1 to -2 is only twice as
bad(20/40 and 20/80), but going from -3 to -6 is definately more than
twice as bad(20/150 and 20/500?), blurs much more than twice. Does this
gap become even larger still at -6 to -12(20/500? and 20/????) where
the number of times more blurry increases expotentionally?

Me and many others are curious about this and this topic has been
posted before many years ago. Its also useful for some occupations such
as pilot, soldier, law enforcement, etc where they have a requirement
for both corrected(BCVA) and uncorrected(UCVA) vision and people ask
all the time if their UCVA is good enough to make the cut.
acemanvx@yahoo.com - 10 Jan 2006 11:16 GMT
Let me attempt to re-arrange the paragraphs to make reading easier. It
didnt show up right

Hello everyone, post your dioptric pescription(how bad are your eyes),
your UCVA(uncorrected) and BSCVA(corrected by glasses) Also if you know
anyone's vision, post that too. I have done much research on the
correlation of diopters and 20/xxx and have compiled several charts,
formulae, tables and comments on the results obtained thus far. To test
for this, do it in room light or dim light. Make sure the eyechart is
well illuminated and your not squinting at all or recalling from memory
or guessing. Blur preception is of course allowed.

I and most optometrists have found that -.25 diopters doesnt cost you a
single line but makes the existing line blurry but still readable. Some
say it costs half a line. Such as if you can see half of 20/15 with a
-.25 lens, youll be a full 20/20 but wont be able to see better than
that uncorrected. Another example is if your seeing all of 20/20, you
may miss half of the 20/20 with -.25 diopters. Others have said it
didnt affect their ability to read a line, just made it harder to do
so.

Minus half diopter(-.5) is generally accepted as resulting in one full
line loss. This means 20/15 becomes 20/20 and 20/20 becomes 20/25. If
you can see half of 20/15 youll be seeing half of 20/20.

Minus one diopter(-1) generally gives you half visual accuracy. My
friends who see 20/20 with glasses see 20/40 without their -1 glasses.
Ditto for 20/15 with -1, 20/30 uncorrected. I was 20/50 corrected to
20/25 with a -1 lens years ago.

Higher dioptric values become harder to calculate and predict,
especially when you get to -6 and up. Someone could be -4.5 another
-5.25 and both see 20/400 UCVA. The -5.25 probably will see a much
blurrier 20/400 than the -4.5 but generally, 20/400 represents a
moderate of myopia around -5 diopters. One website said the range was
-4 to -6 for 20/400 and your best corrected vision played a big factor.
Someone whos 20/15 corrected needs more diopters to see the same blur
as another with 20/30 corrected. For me, my left eye at -5 or so
couldnt see 20/400 while my right eye at -4.5 or so just barely, barely
saw 20/400. I know two people who passed V3 requirement which states
you have to be 20/400 or better uncorrected and both were barely 20/400
with -5.5 pescriptions with 20/15 corrected. Those two guys said they
dont know anyone else -5.5 or more who passed V3 which requires 20/400.
They probably didnt have the great 20/15 corrected vision with glasses
so for them, -5 was the limit(20/20 corrected) I am not correctable to
20/20 so my limit is even less.

Few eyecharts go beyond 20/400 so info is scarce past this. I have a
solid grasp on dioptric values below -6(mild to moderate myopia), but
for -6 and up which is high myopia I am less certain how this converts
to diopters. I do know high myopes are worse than 20/400 but how bad
exactly? Also theres much fewer high myopes than low and moderate
myopes so much of my info is on low(er) myopes and their diopters to
snellen accuracy.

One could stand closer but then accomodation needs to be taken into
account. I can see the 20/200 E from 10 feet less blurry than the
20/400 E from 20 feet. At 5 feet I see the 20/70 line but im certainly
worse than 20/280. I experienced .67 diopter accomodation from the 5
feet mark.

If any of you have charts and formulae, on what expotentional scale
does this equal to? I know that going from -1 to -2 is only twice as
bad(20/40 and 20/80), but going from -3 to -6 is definately more than
twice as bad(20/150 and 20/500?), blurs much more than twice. Does this
gap become even larger still at -6 to -12(20/500? and 20/????) where
the number of times more blurry increases expotentionally?

Me and many others are curious about this and this topic has been
posted before many years ago. Its also useful for some occupations such
as pilot, soldier, law enforcement, etc where they have a requirement
for both corrected(BCVA) and uncorrected(UCVA) vision and people ask
all the time if their UCVA is good enough to make the cut.
Dom - 10 Jan 2006 11:50 GMT
Aceman this is an amazing question, not least because of its length. I
really am curious about you... how does one develop such an interest
(obsession) with vision and vision correction? Even optometry students
don't have your keen level of amateur enthusiasm. Do you have other
interests? What is your age? Do you work or study (I'm guessing not, as
you clearly spend a great deal of time on the internet researching these
topics - maybe too much time).

This is a genuine question to find out how a person can be so obsessed
with something (the process of prescribing glasses and other vision
correction) that most people just don't find that interesting!

You are obviously a thinker but remember the old expression, "a little
knowledge is a dangerous thing".

Dom

> Hello everyone, post your dioptric pescription(how bad are your eyes),
> your UCVA(uncorrected) and BSCVA(corrected by glasses) Also if you know
[quoted text clipped - 66 lines]
> for both corrected(BCVA) and uncorrected(UCVA) vision and people ask
> all the time if their UCVA is good enough to make the cut.
Don W - 10 Jan 2006 17:53 GMT
> Aceman this is an amazing question, not least because of its length. I
> really am curious about you... how does one develop such an interest
[quoted text clipped - 12 lines]
>
> Dom

Just wondering, what limits the amount of interest one may have in certain
areas?
Scott Seidman - 10 Jan 2006 18:12 GMT
> Just wondering, what limits the amount of interest one may have in
> certain areas?

An absence of OCD?

Signature

Scott
Reverse name to reply

acemanvx@yahoo.com - 10 Jan 2006 19:33 GMT
As to what Otis said, since most are myopes, the minus lens is tried
first, if this makes things blurrier the person could be a hyperope and
a high one at that if hes young. Test with plus lenses then. Then
theres the cylindar component which is tricky and many optometrists
tend to give spherical equivalent with more minus or less plus. The
pinhole test is a quick diagnosis to check for refractive error or
occular pathalogy.

someone said:

"the real answer depends on the optics of corneal curvature vs axial
length
- an eye with steep cornea and average length can be equally
nearsighted
with an eye with a flat cornea that is very long - but they may not
have
the same uncorrected acuity."

I dont see how this makes a difference be it the cornea, lens, axial
length or even giving someone a plus lens(other than magnificarion) all
refractive error is expressed in units and blur equally. I never heard
of different types of components resulting in refractive error to
affect the final outcome.

"d=log(20/xxx)/.27"

This formula only works somewhat for a narrow range. I havent composed
my own formula, but just a table with the values.

You also have a database with 150 results and said It looks to me like
the only people this works well for have 20/20 uncorrected acuity.

I really, really question all those -.25 guys with 20/40, 20/50, 20/70
or even 20/100 accuracy who "magically" see 20/20 or 20/25 with minus
one quarter diopter! Sorry but this is not possible. I have seen the
differences of quarter diopters with trial lens and when I got my eye
exam thru phororapter. The differences is very small, sometimes I have
to ask the optometrist to try two, three, four times flipping between
quarter diopters to determine which is better. My mom has tried -7.5
and -8 contacts and said there wasnt a difference between the two! She
of course wears -7.5 now since more minus doesnt help.

I also question some of the seemely poor vision with very low dioptric
values(see above) and seemly good accuracy with high diopters.
Squinting perhaps? Overminus? -3 diopters is going to be alot worse
than 20/80 if BCVA is 20/20.

Anyway I already saw those threads from years ago. This thread will be
like a countinuation and add new results. You optometrists get to know
results everyday when doing eye exams. Im sure youve noticed a pattern
by now excluding the odd ones which dont make sense like -.25 and 20/70
or -4 and 20/70 for example.
William Stacy - 10 Jan 2006 21:59 GMT
>As to what Otis said, since most are myopes, the minus lens is tried
>first
>  

We have shown you that most people ARE NOT myopes, or did you forget that?

w.stacy, o.d.
acemanvx@yahoo.com - 10 Jan 2006 22:48 GMT
Reguardless, the minus lens is tried first by default then the plus. I
do see more old people being farsighted but much more young people are
nearsighted. low hyperopia is asymptomic for young people so if a young
person had 20/60 vision, its much liklier that hes myopic.
William Stacy - 10 Jan 2006 22:58 GMT
>Reguardless, the minus lens is tried first by default then the plus.

It's obvious that in your wide ranging reading about myopia etc you
never ran across a book on refraction techniques.  NONE OF THEM, NOT ONE
recommend that.  Based on physiological optics, it is EXACTLY THE WRONG
THING TO DO. All experts start with at least +1.50 or +2.00 and go from
there (usually with a retinoscope).

You're recommending the stupidest thing I've ever heard in refraction
technique, but then that's why I have the license and you don't, thankfully.

w.stacy, o.d.
Jan - 10 Jan 2006 23:34 GMT
> Reguardless, the minus lens is tried first by default then the plus.

Nonsence, layman talk.

> low hyperopia is asymptomic for young people

If this was true , you did not have vision problems ace.
Overminusing works the same way as low hyperopia as you already find out.
Think about headaches, total fatigue, lack of concentration power etc.
Speaking of concentration ace, hands above the sheets!

And ace, whenever you respond it is internet etiquette to show to whom you
respond (see the top of this message)

Signature

Free to  Marcus Porcius Cato: ''Ceterum censeo Carthaginem esse delendam"

In conclusion, I think that the "Otis therapy" should be destroyed

Jan (normally Dutch spoken)

otisbrown@pa.net - 11 Jan 2006 04:15 GMT
Dear William,

Subject:  Refractive state of the natural eye -- in the open.

Re: Refractive states dependent on the average visual enviroment --
measured
directly and objectively -- by Francis Young.

It is true that the natural eye -- in the wild will have
positive refractive states running from zero to plus-2 diotpers.

Measured with a Snellen and Trial-lens frame.  Measurement
as previously described.

For the primates, these refractive states form a gaussian
distribution with an average value of about +0.75 diopters.

Best,

Otis
acemanvx@yahoo.com - 11 Jan 2006 09:22 GMT
My pre-op Rx and post-op results are:

                       OS (left)                       OD (right)

Pre-op          -9.00 sph       +1.00 cyl       -8.75 sph       +1.75
cyl

2 weeks post-op -2.25 sph        0 cyl          -1.75 sph        0 cyl

6 weeks post-op -3.25 sph        0 cyl          -2.75 sph        0 cyl

The surgery only took about 10 minutes and was relatively painless.
The
worst part was when they examine the cornea afterword with a VERY
BRIGHT
light. You can't blink and the light is painfully bright, but it
doesn't
last too long.  The days and hours of anxious waiting before the
surgery
is far worse than the actual procedure.

I had absolutely no post-op discomfort and haven't since, except for an

occasional dry burning sensation that goes away with eye drops.  As you

can see from my results, I didn't get 20/20 vision on the first try.  I

saw 20/70 the next day and have slowly regressed to about 20/100 or so.

Note to all you high myopes: 20/70 is damn good compared to whatever we

are at -9 or worse! Before, I couldn't read the big E on the eye chart.

Now, even with -3 d of nearsightness I can function without glasses,
which is something I could not do before, so it is a big improvement.

My comments: Hes giving the correlation between diopters and 20/xxx
notice
hes seeing 20/70, presumbly with the better -1.75 eye. Also notice he
regressed
to 20/100 then a little worse, perhaps 20/150 at -2.75
also notice at -9 theres no way he will see any snellen eyechart
letters
not even the 20/800 E! -3 is a very, very big improvement when you used
to be
a -9! Hes probably going to leave things well enough alone and not go
for
a lasik enhancement due to his presbyopia and keeping his near vision
intact.
Its not as much improvement for me where im a -4.5 and using a -1.5
trial lens gets me down to -3 but enough improvement to be noticable
but not quite enough to go "wow!" Give me a -3 trial lens and were
talking
a significent improvement and I wish I were only -1.5 diopters! This
would be good enough to almost never need distance glasses, yet not
need
reading glasses except for fine print.
acemanvx@yahoo.com - 01 Feb 2006 20:01 GMT
Mike and others can share their experiences here. You optometrists,
what correlation have you learned?
Dom - 11 Jan 2006 09:20 GMT
 Then theres the cylindar component which is tricky and many optometrists
> tend to give spherical equivalent with more minus or less plus.

No we don't. We tend to find the cylinder. It's not tricky at all if
you're an optometrist.

> I really, really question all those -.25 guys with 20/40, 20/50, 20/70
> or even 20/100 accuracy who "magically" see 20/20 or 20/25 with minus
> one quarter diopter!

Who are the "-.25 guys with 20/40 [to] 20/100"? Where have you heard or
read about them? I haven't come across these people.

Remember, Ace, a little knowledge is a dangerous thing. You have a
little knowledge. Be careful that you don't present yourself as having a
comprehensive knowledge.

Dom
acemanvx@yahoo.com - 11 Jan 2006 09:39 GMT
"No we don't. We tend to find the cylinder. It's not tricky at all if
you're an optometrist."

Youd be supprised how many times I get just the sphere without
cylindar. Last eye exam nearly a year ago he gave me -5.5x-.5(left) and
-5(right) but this isnt right and is even more off now that my eyes
have gotten slightly less nearsighted(reduction of the pseudomyopia
component) My right eye has a sphere closer to -4 with -.75 cylinder.

"Who are the "-.25 guys with 20/40 [to] 20/100"? Where have you heard
or
read about them? I haven't come across these people."

It was in William's spreadsheet in previous posts from years ago when
he tested diopters vs. 20/xxx

"Remember, Ace, a little knowledge is a dangerous thing. You have a
little knowledge. Be careful that you don't present yourself as having
a
comprehensive knowledge."

Just a young man learning about vision and optics =) :) :D

so anyway do you have any experience on diopters and 20/xxx?
Dom - 11 Jan 2006 10:42 GMT
> "No we don't. We tend to find the cylinder. It's not tricky at all if
> you're an optometrist."
[quoted text clipped - 4 lines]
> have gotten slightly less nearsighted(reduction of the pseudomyopia
> component) My right eye has a sphere closer to -4 with -.75 cylinder.

If your cylinder result varies from test to test, it's more likely due
to variations in your tear film, your accommodation, or your responses,
rather than the optometrist not being capable or willing to find the
cylinder. In my experience, those patients who are the most concerned
about giving all correct answers, analysing each choice carefully,
viewing the alternatives multiple times, and not making any mistakes,
are those the most likely to end up with a *less* accurate refraction as
a result. Perhaps this could have been your experience.

> "Who are the "-.25 guys with 20/40 [to] 20/100"? Where have you heard
> or
> read about them? I haven't come across these people."
>
> It was in William's spreadsheet in previous posts from years ago when
> he tested diopters vs. 20/xxx

I don't know what spreadsheet you're referring to... does this
spreadsheet really claim to record eyes with UCVA of 20/100 and
sphero-cylindrical refraction of -0.25sph, giving BCVA of 20/20? Or is
there more to it than that?

> "Remember, Ace, a little knowledge is a dangerous thing. You have a
> little knowledge. Be careful that you don't present yourself as having
> a
> comprehensive knowledge."
>
> Just a young man learning about vision and optics =) :) :D

Yes it's great to ask questions and learn, and all the optometrists on
this newsgroup will happily answer reasonable questions BUT be careful
you don't present yourself as an expert or bore people with long-winded
rambling posts, or you risk being thought of as a "know it all" who
really knows very little.

> so anyway do you have any experience on diopters and 20/xxx?

Yes plenty. But I haven't recorded it or worked out any formulae. That's
because the value of any such formula would be extremely limited to say
the least. Here are a few clues as to why: "pupil size; hyperopia;
astigmatism; accommodation; lens opacities; tear film quality;
motivation; pathology".

Dom
William Stacy - 11 Jan 2006 14:09 GMT
> I don't know what spreadsheet you're referring to... does this
> spreadsheet really claim to record eyes with UCVA of 20/100 and
> sphero-cylindrical refraction of -0.25sph, giving BCVA of 20/20? Or is
> there more to it than that?

Years ago on this n.g. the subject line above question had come up and
had been argued for so long that I decided to query my database (I was
kindof a pioneer in recording refractions and acuities directly into my
PC as I did the exam), and tallied refractions against unaided acuities.
I haven't seen that particular tally lately, but I know it got
manipulated a few times as some of the other contributers fit the
equation to the curve.  I called it the "Dead Horse Equation" because
the subject was posted so many times that I thought we were kicking a
dead horse around, trying to get it to work.  Anyway, it was an
interesting exercise, and I must say most contributors at that time
agreed that it was a valiant attempt to make the corellation, there are
so many variables in real life, it was not a very useful thing, and I
don't think it ever made it into the curricula of any optometry
schools... Anyway, if there were any 20/100 -.25 people, they certainly
had eye disease or large astigmatism.

w.stacy, o.d.
acemanvx@yahoo.com - 13 Jan 2006 09:55 GMT
Your spreadsheet showed many people being corrected to 20/20 or 20/25
and I dont think anyone worse than 20/40 as I recalled. Curiously, none
corrected better than 20/20 despite you now saying otherwise. In that
spreadsheet, it showed some -.25 guys with 20/40 to 20/100 UCVA and
20/20 or 20/25 BCVA. This sounds like an error or something. Perhaps I
am confused when reading your spreadsheet. In reality, I would think
-.25 diopters shouldnt cost even one line, lots of people are still
20/20 with -.25 and some at -.5 for the matter. How do you find
someone's UCVA if they cant see the 20/400 E on the projection
eyechart? in your experience(and the experience of any other
optometrists here), what diopter values corresponded with what visual
accuracies?

such as:

-1
-1.5
-2
-3
-4
-5
worse than -5
William Stacy - 13 Jan 2006 20:36 GMT
> Your spreadsheet showed many people being corrected to 20/20 or 20/25
> and I dont think anyone worse than 20/40 as I recalled. Curiously, none
> corrected better than 20/20 despite you now saying otherwise.

I think my habit at the time was only to test to 20/20.  That was over
10 years ago.  The projectors I now use are very convenient to test
20/15 or 20/10.

By the way, I looked at some of those on line charts you can print
yourself, and some if not most are very crude and have letters that
don't conform to the snellen standard construction.  If you use those,
esp. in improper lighting, you will get incorrect acuities.

In reality, I would think
> -.25 diopters shouldnt cost even one line, lots of people are still
> 20/20 with -.25 and some at -.5 for the matter.

It may or may not, and you are not in a position to determine any cause
and effect relationships on individuals.  You don't have the knowledge
or the equipment or the skills.

 How do you find
> someone's UCVA if they cant see the 20/400 E on the projection
> eyechart?

It's very easy, but I'm not going to tell you.  Find out yourself.
acemanvx@yahoo.com - 15 Jan 2006 05:57 GMT
"I think my habit at the time was only to test to 20/20.  That was over

10 years ago.  The projectors I now use are very convenient to test
20/15 or 20/10."

Even when you only had 20/20 as the bottom line, I noticed alot had
minus sign in front meaning they missed some on that line. This means
they werent fully 20/20. willingness to guessing can change the results
from 20/25 to 20/20- easy.

"By the way, I looked at some of those on line charts you can print
yourself, and some if not most are very crude and have letters that
don't conform to the snellen standard construction."

I make sure the ones I print do confirm. Theres one that confirms
perfectly to the cardbord type snellen chart. In fact I also have a
photocopy of the actual snellen chart and the printed one is identical
size, identical font, identical in everyway. Other snellen charts I
print out or make myself are accurate as ive confirmed. Just measure
the size of the letters. The 20/200 letters should be 3.4 inches,
simple as that.

"It may or may not, and you are not in a position to determine any
cause
and effect relationships on individuals.  You don't have the knowledge
or the equipment or the skills."

Thats what im learning and your the expert, see? Another optometrist
did post some time back that hes never seen anyone lose a line from
-.25 diopters. You also posted in another thread where this guy got
IOLs that undercorrected him to -.5 and 20/25, corrected to 20/20 with
-.5 glasses.

"It's very easy, but I'm not going to tell you.  Find out yourself."

count fingers, even larger than 20/400 letters, moving closer so your
say 10/400.

Anyway I got more info. This guy ive talked to is about -2 diopters, at
least thats what his contact lens pescription was. He always thought he
was 20/80 to 20/100 but I told him hes probably closer to 20/50 or
20/60 since hes corrected better than 20/20, this namely being 20/15! I
was correct and it shows I have a good grasp on diopters to
20/something. Turns out he measured as 20/50 in one eye, 20/70 in the
other and was told hes -2. He probably has some astigmastim that
reduced the other eye to 20/70. To all those saying -2 corresponds to
20/200, sorry you are dead wrong!(I see much better than 20/200 with a
-2 undercorrection and im not even corrected to 20/20) Youd be within
correct approximation if you said -4 is 20/200. -2 is usually better
than 20/100 and those who correct better than 20/20(such as 20/15) see
20/50 or therebouts at -2

However you are the expert and you test people all the time. You
probably have a firm grasp on a very close approximation to how the two
correlate. I on the other hand am still learning and obtaining results.
You probably find that 20/200 correlates between -3 and -4.5 with your
testing.
RT - 15 Jan 2006 17:55 GMT
> However you are the expert and you test people all the time. You
> probably have a firm grasp on a very close approximation to how the two
> correlate. I on the other hand am still learning and obtaining results.
> You probably find that 20/200 correlates between -3 and -4.5 with your
> testing.

GIL Instead of telling the experts what they are probably finding, why
don't you research it.  You're FRIED, MAN.

Signature

~RT

Don W - 15 Jan 2006 09:33 GMT
> By the way, I looked at some of those on line charts you can print
> yourself, and some if not most are very crude and have letters that don't
> conform to the snellen standard construction.  If you use those, esp. in
> improper lighting, you will get incorrect acuities.

What might be the increase in acuity with brighter than standard light?

Don W.
William Stacy - 15 Jan 2006 16:35 GMT
>>By the way, I looked at some of those on line charts you can print
>>yourself, and some if not most are very crude and have letters that don't
>>conform to the snellen standard construction.  If you use those, esp. in
>>improper lighting, you will get incorrect acuities.
>
> What might be the increase in acuity with brighter than standard light?

I don't think just increasing the lighting will always increase acuity.
 I could decrease it as well, due to glare factors.  I have a paper
chart in my office as well as my 2 projectors in the exam rooms, and the
projected images seem to have better contrast than the paper one, no
matter what lighting I use on the paper one.  Obviously the projected
charts are used in a dimly lit room because bright overheads tend to
wash out projected images (just like in a theater).

w.stacy, o.d.
Dick Adams - 16 Jan 2006 14:30 GMT
> [ ... ]

> I don't think just increasing the lighting will always increase acuity.

Several years ago, I went through a phase where my best correction
for daylight was about 0.5D too mild for dim light.  Corrected vision
was noticeably sharper in dim light.  When I tried to discuss it with the
practitioners, they thought I was nuts.  The distance correction for night
vision was ~-0.5D greater than the best correction for day vision, and
corrected night-vision acuity was better.  Finally I figured it out.

--
Dicky
William Stacy - 16 Jan 2006 15:25 GMT
> Several years ago, I went through a phase where my best correction
> for daylight was about 0.5D too mild for dim light.  Corrected vision
> was noticeably sharper in dim light.  When I tried to discuss it with the
> practitioners, they thought I was nuts.  The distance correction for night
> vision was ~-0.5D greater than the best correction for day vision, and
> corrected night-vision acuity was better.  Finally I figured it out.

You must have gone to the wrong practitioners, because the myopic shift
secondary to dark adaptatation is such a well known phenomenon that
whoever they are, they are incompetent, or else there was a
communications breakdown.  As you dark adapt, your retinal pigment
epithelium migrates posteriorly, shifting the focus to slightly more myopia.

w.stacy, o.d.
Mike Tyner - 16 Jan 2006 17:52 GMT
> communications breakdown.  As you dark adapt, your retinal pigment
> epithelium migrates posteriorly, shifting the focus to slightly more
> myopia.

I never heard that one, but it's been 20 years since school. Any source
information you can point me to?

-MT
William Stacy - 16 Jan 2006 21:56 GMT
>>communications breakdown.  As you dark adapt, your retinal pigment
>>epithelium migrates posteriorly, shifting the focus to slightly more
>>myopia.
>
> I never heard that one, but it's been 20 years since school. Any source
> information you can point me to?

It's been longer for me, and maybe I am confused.  Doing a quick search
and I only come up with stuff about fruit flies, squids and other fauna.
  I may have been taking comparative anatomy too far...

Anyway, I kind of like Jan's explanation which makes more sense anyway...

w.stacy, o.d.
David Robins, MD - 18 Jan 2006 02:52 GMT
On 1/16/06 9:52 AM, in article
U3Ryf.192$rH5.25@newsread2.news.atl.earthlink.net, "Mike Tyner"
<mtyner@mindspring.com> wrote:

>> communications breakdown.  As you dark adapt, your retinal pigment
>> epithelium migrates posteriorly, shifting the focus to slightly more
[quoted text clipped - 4 lines]
>
> -MT

I (think I) remember that the myopic shift is at least partially due to the
larger pupil in the dark. The peripheral lens power is different (more
plus), and results in the need for more monus to compensate..
Dr. Leukoma - 18 Jan 2006 03:43 GMT
I'm sure this that positive spherical aberration accounts for the
paradoxical myopic shift sometimes found during cycloplegia.

As an aside for Dr. Robbins, today I saw my first pediatric case of
"presumed" congenital stationary night blindness in a two year/old.
History consisted of congenital nystagmus and high myopia (> -7D) first
diagnosed at age 1 year.  Today, the parents coincidentally mentioned
that the child exhibited symptoms of night blindness.  Fundus appeared
normal, except for lots of retinal pigment and a tigroid.  Nystagmus is
no longer apparent.

Anything else I should be looking for to clinch the diagnosis?  He just
had an exam at the Retina Foundation of the Southwest to determine the
visual acuity (20/40).  The parents seemed clueless, and never heard
this diagnosis before.

DrG
acemanvx@yahoo.com - 18 Jan 2006 10:41 GMT
"I'm sure this that positive spherical aberration accounts for the
paradoxical myopic shift sometimes found during cycloplegia."

My pescription improved half a diopter under cycloplegia and would have
improved by more like a diopter and a half but the cycloplegia was
incomplete and didnt fully relax my tonic accomodation. However you are
right, I do see worse in low light due to my high order aberrations.
Letters appear somewhat grayish and indistinct. In normal room light I
see normally and in bright light my vision is much improved due to
pinhole effect
Scott Seidman - 18 Jan 2006 13:37 GMT
"Dr. Leukoma" <drg@leukoma.com> wrote in news:1137555800.684084.41910
@z14g2000cwz.googlegroups.com:

>  Nystagmus is
> no longer apparent.

I don't think I've ever heard of congenital nystagmus just going away.  
Could it have been Spasmus Nutans?  The -7D story is consistant with CN,
but still, CN doesn't just go away.  Maybe the high myopia is just a
coincidence.

FWIW, CN and Spasmus Nutans are fairly difficult to differentially diagnose
without precise binocular eye movement recordings to determine if the
oscillations are disconjugate (at least part of the time), which points to
Spasmus Nutans.  Of course, if it goes away, that's a big clue pointing
away from CN.  If you see no evidence of nystagmus at any head posture and
with fixation broken, and you don't see anything wierd like nystagmus
blockage, Spasmus Nutans is probably more likely.

With the night blindness sitting on top of this, perhaps you should kick it
to a neurologist, if the child hasn't seen one already.  Leigh and Zee
(Neurology of Eye Movements) recommends imaging for Spasmus Nutans to rule
out structural lesions in the visual pathway.

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Scott
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Dr. Leukoma - 18 Jan 2006 14:23 GMT
I appreciate the suggestion of Spasmus Nutans.  No, I could not elicit
any nystagmus in any field of gaze.  His parents noted that it appears
to have improved since he got his glasses from the pediatric
ophthalmologist one year ago.  They described the nystagmus as worse in
superior gaze, with the null point being in downgaze with the head
tilted back.

In view of the much improved status, does a lesion make any sense?

DrG
Scott Seidman - 18 Jan 2006 15:21 GMT
"Dr. Leukoma" <drg@leukoma.com> wrote in news:1137594218.661047.17680
@g14g2000cwa.googlegroups.com:

> I appreciate the suggestion of Spasmus Nutans.  No, I could not elicit
> any nystagmus in any field of gaze.  His parents noted that it appears
[quoted text clipped - 6 lines]
>
> DrG

Actually, do a search for "spasmus nutans night blindness".  

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=8351022&dopt=Abstract

"Two children with congenital stationary night blindness were originally
diagnosed as having spasmus nutans. Both children had the typical
features of spasmus nutans including asymmetric nystagmus, head shaking,
and torticollis. The diagnosis of congenital stationary night blindness
was established only after each child underwent electroretinography. The
nystagmus associated with retinal disease can mimic many of the features
of spasmus nutans. Children suspected of having spasmus nutans should
undergo complete ophthalmologic examination and electroretinography if
they are myopic."

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=7872404&dopt=Abstract

"Quantitative eye and head movement recordings of retinal disease
mimicking spasmus nutans.

Gottlob I, Wizov SS, Reinecke RD.

Wills Eye Hospital, Foerderer Eye Movement Center for Children,
Philadelphia, PA 19107.

PURPOSE/METHODS: To investigate whether quantitative head and eye
movement recordings can distinguish patients with spasmus nutans from
patients with retinal diseases mimicking spasmus nutans. A patient with
congenital stationary night blindness was followed up for seven years
with electro-oculographic eye movement recordings. RESULTS/CONCLUSIONS:
Rhythmic head movements and fine, intermittent, asymmetric, disconjugate,
high-frequency, out-of-phase pendular nystagmus were recorded. Eye and
head movement recordings of patients with congenital stationary night
blindness can mimic spasmus nutans."

http://www.audio-
digest.org/pages/htmlos/06245.27.3142808734122564427/OP4321

"Asymptomatic retinal disorders: Leber’s amaurosis, cone dystrophies, and
x-linked recessive stationary night blindness and myopia not associated
with ophthalmic abnormalities in young patients; important to consider
retinal disease in children with nystagmus; ERG or MRI often recommended"

(you'll need to pop the full links onto one line, unfortunately)

The more you pop around in these search results, the more you'll that the
underlying retinal disease (the night blindness??) mimiced SN (which is a
little strange, since the etiology of SN is a mystery!).   Some of the
papers recommend ERG and MRI.  You seem to have stumbled onto a situation
that gets written up in case reports!  

These abstracts suggest that SN patients be screened for retinal disease.  
Now, you seem to have already found the retinal disease by independent
means. The entire syndrome was likely caused by the night blindness, and
the extremely observant parents might have helped pin this down.  If you
want confirmation, ERG will do it.  It might be helpful to hunt down the
papers just to make sure nobody mentions anything more insidious to rule
out, but at least the abstracts of the published case reports seem
comforting.

Keep in mind, I'm no doctor, but have some experience with ocular motor
disorders.  I have no experience with retinal diseases.

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Scott
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Dr. Leukoma - 18 Jan 2006 17:30 GMT
Well, first of all I did not see any visible signs of retinal disease,
and macular reflexes were present.  According the little information I
can find in my ophthalmic texts, there are no abnormal visible retinal
findings in congenital stationary night blindness.  His older sister
(who is farsighted) has a similar appearance to her fundi, except for
the peripheral thinning.  The patient simply did not exhibit any
unusual head or eye movements despite the fact that his parents
indicated that he had had nystagmus.  In fact, I begged the question.
It was only at the end of the exam when the father mentioned his
apparent night blindness that I considered the diagnosis of congenital
stationary night blindness.

If you think this is the stuff of a case study, I will gather records
to see what tests have been done.  I had planned to follow-up in three
months.  Thanks for the info.

DrG
Scott Seidman - 18 Jan 2006 17:42 GMT
"Dr. Leukoma" <drg@leukoma.com> wrote in news:1137605442.851772.98840
@z14g2000cwz.googlegroups.com:

> Well, first of all I did not see any visible signs of retinal disease,
> and macular reflexes were present.  According the little information I
> can find in my ophthalmic texts, there are no abnormal visible retinal
> findings in congenital stationary night blindness.  

Oops-- pardon the ignorance.  I thought the congenital stationary night
blindness WAS considered a retinal disease :(

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Scott
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Dr. Leukoma - 18 Jan 2006 18:03 GMT
> "Dr. Leukoma" <drg@leukoma.com> wrote in news:1137605442.851772.98840
> @z14g2000cwz.googlegroups.com:
[quoted text clipped - 6 lines]
> Oops-- pardon the ignorance.  I thought the congenital stationary night
> blindness WAS considered a retinal disease :(

Well, I think it IS considered a retinal disease, but with negative
findings on ophthalmoscopy.  Perhaps an ERG would show something, and
one may have been done fairly recently.  Obviously I'm not a retinal
specialist, either.  In hindsight, Spasmus Nutans might be the correct
conclusion.  It would be interesting to see what the pedOMD had to say.
I guess I need to dig a little bit more.

DrG
acemanvx@yahoo.com - 27 Jan 2006 14:50 GMT
I am back and here is my results of diopters to 20/something that
applies just for my own eyes. The optometrist had trial lenses used to
find my pescription and along the way I noticed letters gradually
clearing and I told him "better, better" then when there was no more
difference, I said "same"

***My results with left eye***
plano to -.25...........20/30
-.50 diopters...........20/40
-.75 diopters...........20/50
-1.00 diopters..........20/60
-1.25 diopters..........20/70-80
-1.50 diopters..........20/100
-2.25 diopters..........20/150
-2.75 diopters..........20/200
-3.75 diopters..........20/300
-4.50 diopters..........20/400
-4.50 diopters, -.75a...count fingers

***My results with right eye***
plano to -.25...........20/40
-.50 diopters...........20/50
-.75 diopters...........20/60
-1.00 diopters..........20/70-80
-1.25 diopters..........20/100
-2.00 diopters..........20/150
-2.50 diopters..........20/200
-3.50 diopters..........20/300
-3.50 diopters, -1.5a...20/400

My new pescription is:

left eye: -4.5 sphere, -.75 cylindar(140 axis) correctable to 20/30
right eye: -3.5 sphere, -1.5 cylindar(55 axis) correctable to 20/40

Feel free to comment and post your own results. How well do you
correct? Whats your pescription and UCVA?
Quick - 27 Jan 2006 17:44 GMT
> Feel free to comment and post your own results. How well
> do you correct? Whats your pescription and UCVA?

What, it's group hug time?

-Quick
Neil Brooks - 27 Jan 2006 20:28 GMT
>I am back and here is my results of diopters to 20/something that
>applies just for my own eyes.

a) How about starting a new thread (or not), rather than hijacking
this one;

b) W.F. C. (who f***ing cares)?
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acemanvx@yahoo.com - 28 Jan 2006 07:26 GMT
LOL I am the one who started this thread in the first place! People can
learn alot from this info, especially what ive provided. Dont be shy,
step up and provide info, everyone ;)
Scott Seidman - 30 Jan 2006 13:38 GMT
acemanvx@yahoo.com wrote in news:1138433179.241656.281830
@g49g2000cwa.googlegroups.com:

> LOL I am the one who started this thread in the first place! People can
> learn alot from this info, especially what ive provided. Dont be shy,
> step up and provide info, everyone ;)

You've posted on the wrong branch of the thread.

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Jan - 16 Jan 2006 19:21 GMT
Several years ago, I went through a phase where my best correction
for daylight was about 0.5D too mild for dim light.  Corrected vision
was noticeably sharper in dim light.  When I tried to discuss it with the
practitioners, they thought I was nuts.  The distance correction for night
vision was ~-0.5D greater than the best correction for day vision, and
corrected night-vision acuity was better.  Finally I figured it out.

Every eyecare specialist is familiar with this phenomenon you mentioned
above.
The shift from colors to grey is one of the reasons.
The shift is about -0,25 to 0,5 diopter.
An other reason is the location of the rods
Rods are located a little excentric (so further away) from the place where
you  receive your optimum vision acuity when viewing in daylight with the
cones.

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Jan (normally Dutch spoken)

Jan - 16 Jan 2006 19:35 GMT
>Several years ago, I went through a phase where my best correction
>for daylight was about 0.5D too mild for dim light.  Corrected vision
>was noticeably sharper in dim light.  When I tried to discuss it with the
>practitioners, they thought I was nuts.  The distance correction for night
>vision was ~-0.5D greater than the best correction for day vision, and
>corrected night-vision acuity was better.  Finally I figured it out.

Every eyecare specialist is familiar with this phenomenon you mentioned
above.
The shift from colors to grey is one of the reasons. (the change from using
cones to rods)
The shift is about -0,25 to -0,5 diopter. (in needed correction)
An other reason is the location of the rods
Rods are located a little excentric (so further away) from the place where
you  receive your optimum vision acuity when viewing in daylight with the
cones.

Signature

Jan (normally Dutch spoken)

Dick Adams - 16 Jan 2006 20:13 GMT
> >Several years ago, I went through a phase where my best correction
> >for daylight was about 0.5D too mild for dim light.  Corrected vision
[quoted text clipped - 5 lines]
> Every eyecare specialist is familiar with this phenomenon you mentioned
> above.

Finally my eyeglasses guy (optician) referred me to a surgeon.  The surgeon
said I had cataracts and needed implant surgery.  That seemed to make sense
if the cataracts were dead center.  But, then again, cataract surgery is what
eye surgeons mostly do.  It is sometimes hard to know who to believe.

--
Dicky  
Jan - 16 Jan 2006 20:44 GMT
Dick Adams schreef:

>>>Several years ago, I went through a phase where my best correction
>>>for daylight was about 0.5D too mild for dim light.  Corrected vision
[quoted text clipped - 10 lines]
> if the cataracts were dead center.  But, then again, cataract surgery is what
> eye surgeons mostly do.  It is sometimes hard to know who to believe.

And, problems solved?

Now you are mentioning your cataract surgery, was it not Mike Tyner who
already explained the cataract issue to you?
As he did the corneae topography issue and the pupil size?

Jan (normally Dutch spoken)
Dick Adams - 16 Jan 2006 23:11 GMT
> Now you are mentioning your cataract surgery, was it not
> Mike Tyner who already explained the cataract issue to you?

I value his words.  Recently he mentioned that you'd know soon
enough if you had cataracts, as opposed to being periodically studied
by the practitioner.

> As he did the corneae topography issue and the pupil size?

Not specifically, or perhaps I forgot.  People old enough to need
cataract surgery are old enough to be forgetful and easily confused,
as one no doubt assumes.  Anyway, I think my corneas are smooth
and that my pupils are getting larger and smaller in the way that they
should, being larger in under conditions of low light.

The problem I fancied I recognized seemed to be a central opacity
or refractive discontinuity in the lens, not large enough to botch much
of the light path in the dark-adapted eye.  My vision was not really bad,
but strange in the way I described (in news:g6Oyf.1845$h47.1693@trnddc08 ).
Anyway, implants cleared everything up, which is good!  Well, there is
slightly more chromatic aberration and some flare, but what the heck?
Medicare paid it all, and now what eyeglasses I sometimes need are
simple enough so that I can get them from Zenni.

--
Dicky
acemanvx@yahoo.com - 17 Jan 2006 09:07 GMT
update: This lady has an 8 year old son whos -.75(20/30) and
-1.5(20/50)

Another guy ended up -.5 after lasik but is still 20/20!

William himself says -1 correlates to 20/30 or 20/40
What does -2, -3, -4, etc correlate in your testing, sir?
William Stacy - 11 Jan 2006 13:50 GMT
> "Who are the "-.25 guys with 20/40 [to] 20/100"? Where have you heard
> or
> read about them? I haven't come across these people."
>
> It was in William's spreadsheet in previous posts from years ago when
> he tested diopters vs. 20/xxx

I think you misread that tally, or maybe somebody clipped off the
cylinders.  I have never had many -.25 sph patients with 20/40 to 20/100
(there are always a few with macular degeneration, etc.) No healthy eye
with -.25 sph is anywhere near 20/100

w.stacy, o.d.
David Combs - 09 Feb 2006 01:44 GMT
SNIP

>I really, really question all those -.25 guys with 20/40, 20/50, 20/70
>or even 20/100 accuracy who "magically" see 20/20 or 20/25 with minus
[quoted text clipped - 3 lines]
>to ask the optometrist to try two, three, four times flipping between
>quarter diopters to determine which is better. My mom has tried -7.5
...

OK -- but .25 *does* affect the distance from the eyes where
the focus is best.

Especially if older and one's depth-of-field is like only three
or fewer inches (at book-reading distance).  At least for me!

What I have learned to do is after the prescription is
written down is to go out in the waiting room, having borrowed
one or two .25 test-lenses, *and* (of course) the test-frames
filled with the lens-combination that equals the prescription.

THEN I take a magazine, say, and put it at reading distance,
and move it a bit closer and farther away, seeing it the
best focus occurs at the *same* distance for *both* eyes together.

Rarely happens.

Then, I play with the .25's until I get it right, where my
exceedingly-narrow depth-of-field occurs at exactly the same
place for both eyes.

With that result, I modify the prescription, and thereby
get glasses that *work* -- for me, at least.

So, *that* is where .25 *does* make a difference -- a *BIG*
difference: removes eye strain, gives MUCH better vision!

David


acemanvx@yahoo.com - 09 Feb 2006 02:14 GMT
an overcorrection of .25 will caused increased strain at near for a
presbyope. If one carefully measures the near point, one will notice a
.25 diopter difference. I notice .25 in the distance but its very
slight and subtile. If I was only -.25 or even -1 theres no way ill
bother with distance glasses. If someone is already wearing glasses and
his eyes get worse, then yes get stronger glasses or better yet do
natural vision improvement to get your pescription down so your seeing
clearly again with your old glasses.
Dom - 10 Jan 2006 21:26 GMT
> Just wondering, what limits the amount of interest one may have in certain
> areas?

To answer your question: I suppose things like:
The amount of time available to spend reading, learning & talking about it.
Access to resources to further one's interest.
Competing interests, hobbies, and other activities.
Time spent on daily necessities such as work, study, eating, sleeping etc.
I'm sure you can think of others.

... but my original question was trying to find out how or why Aceman
developed such a keen interest in this topic... trying to find out a
little about the person behind all the posts.

Dom
 
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