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Medical Forum / General / Vision / March 2006why do you make a big deal about undercorrection for myopia?
Why is it so important to fully correct myopia if you have presbyopia or accomodative dysfunction? Its common for people getting cateract surgury to choose to be undercorrected for near or intermediate to the tune of -1 diopters, -1.5 diopters, -2 diopters, sometimes even more! I have seen lasik people choose to be corrected to 20/40, just enough not to ever need distance glasses, not even for driving. Because of the undercorrection, they dont need reading glasses for intermediate, such as spending hours on the computer. I talked about orthoK and undercorrection. I doubt orthoK will fully correct me and I have been telling you guys I do NOT want to be fully corrected. I dont accomodate well and fully correcting me will just make me dependant on reading glasses, defeating the point of orthoK. Ideally, I want to be -1.25 diopters since I sit 80cm from the computer. I will still be able to see the computer monitor clearly enough up to -2.25 diopters. I am only a -4 so it should be easy to get me to a -2 or less and ill see well enough to reduce my dependancy on glasses by 90%. If I were corrected to plano 0 my dependancy on glasses would be higher than at -1.25 because id need reading glasses alot. I use my eyes for near much more than for distance. You guys wouldnt understand unless you see thru my eyes. Why dont you put some tropicamide drops and simulate an incomplete cycloplegia? This will make things from closer range blurry and hard to focus on. Then youll have the idea. > Why is it so important to fully correct myopia if you have presbyopia > or accomodative dysfunction? Because very few people want to be undercorrected. If that is what you want, then more power to you, but don't think that it is very common, especially among the young.  SignatureDan Abel dabel@sonic.net Petaluma, California, USA "Because very few people want to be undercorrected." If they rather wear reading glasses most of the time instead of distance glasses occasionally. My brother is -1.25 and almost never wears distance glasses. Lots of my friends have pescriptions of -1 to -1.5 diopters and go without glasses(except for driving if legally required) "If that is what you want, then more power to you" I dont have a choice for more than one reason. Firstly my dependancy on glasses will *increase* if corrected to plano. This is true for many people. I know about 20 people who got lasik or cateract surgury and were fully corrected by choice of the patient and/or doctor. One lady I know in person is in bifocals afterr cateract surgury. She was quite myopic before so shes not complaining, at least her UCVA is far better and not having cateracts anymore made the surgury worth it. Both her UCVA and BCVA improved. Another guy I know online was like -5 with minimal astigmastim and he wore progressive glasses and also had a pair of -3.5 for the computer. Well for some reason he got lasik. He was expecting to be just about free of glasses and only need reading glasses for fine print. WRONG! He did end about plano but now wears reading glasses much of the time, including the 6-8 hours he spends on the computer in +1.5 readers. He needs and uses +3.5 for reading boooks, newspaper and even his watch! His dependancy on glasses was hardly reduced, he will just spend his life in readers instead of minus lenses. Hes in regret now and says he either should never have bothered with the expenses and risks of lasik or asked to be undercorrected around -1.5 with lasik. My friend's mother got lasik and traded up for reading glasses. She now has like 10 pairs of readers around the house. My friend just shrugged and wondered what was the point of her getting lasik, she did not reduce her dependancy on glasses, but marely traded. Imagine waking up and not clearly seeing your alarm clock until you get out of bed and look at it half way across the room. Then as you go downstairs to eat and read the newspaper, you put on your reading glasses. You take your reading glasses with you upstairs to wear when brushing your teeth and shaving. You put them in your pocket and walk to the car where you reach for your bifocals from under your seat so you can see the steering wheel and speedometer when driving. You get to work and replace the bifocals back in the car. You slap your readers back on for reading and computer work. Work is done and you wear bifocals as you drive shopping. At the store, you put your readers on everytime you look at the prices or ingediants of items. You do it again to read your recipt and count your change. Bifocals again as you drive home. You put on readers as you insert your keys in to open the door of your house. Many other things you do require readers. Most humans use their eyes for near and intermediate much more than for distance unless you are an athlate, pilot or hunter, whatever. For those with high accomodation, enjoy it while it lasts. For those with mild myopia, you are very, very lucky! Enjoy being free of the hassles of reading glasses! "but don't think that it is very common, especially among the young." age doesnt matter, anyone with reduced or low accomodation has that problem. I can still accomodate but attempting to read without taking my glasses off gives me instant eyestrain and headache. Text remains clear if I hold reading material away from my face. Its much easier for me to remove my glasses and read razor sharp text from 10 inches. OrthoK will reduce my myopia and astigmastim. I do not need my pescription shown below: 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 I want to reduce my astigmastim as much as possible or eliminate it all. I want to correct my left eye, which is dormant more than my right eye. I wont mind if the right eye is within half diopter of my left. Below is what I should get after 7mm zone orthoK based on average results of others left eye: -2.0 sphere correctable to 20/25 right eye: -1.5 sphere, -.5 cylindar(55 axis) correctable to 20/30 Notice that I could probably get my right eye down a little further but the anisometropia and non dormant eye being much better would annoy me. I may or may not improve my BCVA but less minification and disortion due to myopia and astigmastim should help. OrthoK is based on RGP contacts, so it may smoothen my high order aberrations in my cornea as well. I will be happy as long as my BCVA remains the same, but my optometrist said an improvement is possible. My UCVA will be good enough to reduce my dependancy on glasses by 75% or more and NOT need reading glasses! > "Because very few people want to be undercorrected." > > If they rather wear reading glasses most of the time instead of > distance glasses occasionally. I, and most of the people I know, do more at distance than close. YMMV. And it sounds like it does. That still doesn't make you "most people". > "If that is what you want, then more power to you" > > I dont have a choice for more than one reason. Of course you have a choice. [snipped stuff about correction making him more myopic] > Imagine waking up and not clearly seeing your alarm clock until you get > out of bed and look at it half way across the room. Ridiculous. I want to know what time it is *without* getting up. I have an LED alarm clock with bright red 2 1/4" digits. It has a setting for "high" or "low" brightness. I keep it on "high". For a small amount of money, you can get a clock that projects the time on the ceiling. > Then as you go > downstairs to eat and read the newspaper, you put on your reading > glasses. You take your reading glasses with you upstairs to wear when > brushing your teeth and shaving. Correct. > You put them in your pocket and walk > to the car where you reach for your bifocals from under your seat so > you can see the steering wheel and speedometer when driving. You know less about driving than you do about vision. > You get to > work and replace the bifocals back in the car. You slap your readers > back on for reading and computer work. I always kept reading glasses at work. I didn't bring them. I kept spare readers in the vehicle in case I needed them while I was out. > Work is done and you wear > bifocals as you drive shopping. At the store, you put your readers on > everytime you look at the prices or ingediants of items. You do it > again to read your recipt and count your change. You forgot using the ATM/credit card machine. I prefer readers for that, although I can get along without them if necessary. > Bifocals again as you > drive home. You put on readers as you insert your keys in to open the > door of your house. Many other things you do require readers. I can find the keyhole and insert the key without readers. > "but don't think that it is very common, > especially among the young." > > age doesnt matter, anyone with reduced or low accomodation has that > problem. It was an over-generalization. Older people tend to get out less than younger people. YMMV, and probably does. SignatureDan Abel dabel@sonic.net Petaluma, California, USA > YMMV ????? Signature~RT >> YMMV > > ????? Your Mileage May Vary. -MT "I, and most of the people I know, do more at distance than close. YMMV. And it sounds like it does. That still doesn't make you "most people"." Id say I use my eyes for near and intermediate about 80% of the time. Therefore I want my eyes to be focused for such. -1.25 to -2 diopters fits the bill perfect. Z"Ridiculous. I want to know what time it is *without* getting up. I have an LED alarm clock with bright red 2 1/4" digits." I can see mine but its faint and blurry due to being -4. Any correction will greatly sharpen it because its big and only 5 feet away. Even presbyopes can see it as 5 feet isnt too close to be illegable if the numbers are big. "I can find the keyhole and insert the key without readers." You have a good sense of touch. Maybe you stand 2 meters back and see the keyhole from there and then make a beeline for it? anyway I have already stated the reasons and advantages for having your eyes focused for near if you use them for near more. WTF are you ranting about? Is there any sense in the rambling? dr grant you are not presbyopic dumbass The problem with talking to psychopaths is that they don't listen, so you don't hear when everyone in the world tells you to f.ck OFF. Anyway, f.ck OFF once again, hopefully your crap will stop. dr grant why should I care what a lunatic like you says? Its already clear you cuss and swear at everyone and never have anything constructive to say. What you say is meaningless You still don't get it do you Nancy? You are sick in the head and have no understanding of logic. I shall put this simply: Research shows that undercorrection makes you go more myopic. Do you understand this????? Why do you then tell people to undercorrect themselves? Do you want to make them more myopic? Do you hate people that much that you want to make their eyes worse to make yourself frrl better?? You are really sick. You should be banned from the net. dr grant > Research shows that undercorrection makes you go more myopic. > [quoted text clipped - 4 lines] > make their eyes worse to make yourself frrl better?? > > dr grant I have at times slightly undercorrected a myope who is also an emerging presbyope (by a quarter or so) to help them with near work. I have not seen any seen any "wild" increases in their myopic posture by this mild undercorrection any more than giving a full correction. Obviously, I'm not going to blur out a patient to 20/40 (or worse) at distance but going conservative isn't the end of the world in any age group. It's amazing how a couple of posters here can sure push your buttons and make you sound more like a raving lunatic than an eye care professional. If they bother so much just kill file them. frank Dear Ace, Why does Grant go balliistic over you? I do not recall that you used foul language on him. You are layman, and can ask questions that are all over the map. I expect that, that is just normal. No one should get upset about it, least of all Grant. Otis you and ace are total idiots. what angers the eye doctors here is that you give advise to people that is totally invalid. undercorrection has been shown in REAL SCIENTIFIC AND STATISTICALLY VALID STUDIES to accelerate myopia. please read: Chung K, Mohidin N, O'Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Res. 2002, 42: 2555-9. i know that you place no weight upon science and instead only upon faith and anecdotal stories, but you are potentially screwing with peoples health here! both of you go away. go eat some mushrooms and surf for girlie websites. you are wrong. Otis can prove that the minus lens accelerates myopia, especially with lots of near work. My brother has been going without glasses and he went from -1.75 to -1.25 so hows that? I have been undercorrecting myself for more than a year now and I went from a -5 to a -4. The point is different optometrist think differently. My ophthamologist actually believes in undercorrection, but not so much to improve vision but more to make things from near clear and relieve eyestrain that full power glasses induce. > you are wrong. Otis can prove that the minus lens accelerates myopia, > especially with lots of near work. Saying "Otis can prove it" doesn't change the textbooks. For a couple of years now, I've been asking Otis to show his proof. Human myopia doesn't accelerate with appropriate correction. -MT Dear Ace, Subject: The Second-opinion ODs recognize the power and effect of the Oakley-Young study, the majority-opinion denies that the natural eye is a dynamic system. Ace, you are seeing intense bias here -- something you must understand. In essense, the Oakley-Young study showed that with 250+ people, the group with a single minus went down at a rate of -1/2 diopter per year, while the "high-plus" segment, stopped further negative movement. You can make your own judgment between the majority-opnion and second-opinion about the dyanmic behavior of all natural eyes. This implies that a negative refractive state could be prevented -- if you had the motivation to do it correctly. Best, Otis Cletis, you must understand that this study has been shown to be wrong. It is not properly controlled and numerous studies have since shown that there is NO slowing of myopia with plus. Time to find a new study to flog as Young does not work. dr grant Dear dr grant, Subject: Your majority opinion. Of course you can state that all facts are wrong, that all the primate data proving that a population of natural primate data is "wrong", and everything else you don't like is "not science", but that is your majority opinion. The second-opinion recognizes the possibility of prevention (or avoidance) at the threshold, PROVIDED the parents concur with the preventive method at the threshold. This is suggested by Steve Leung OD at: www.chinamyopia.org And I am well aware of the difficulties of prevention at the threshold. It something for the parents to consider -- and perhaps reject, but at least they should consider the possibility. I certainly do wonder how AceMan would have reacted to the offer of "help" with prevention at the threshold. In fact, perhaps Aceman can provide his assessment of that theoretical offer. What do you think, Ace? You go to the OD, and he says, you see the Snellen at 20/50. He suggests the possiblity of using the plus to "clear" to 20/40 or better by YOUR personal effort. Would you have taken that challenge seriously and done this prevetive work under YOUR control? Best, Otis You really don't know much, do you Cletis? Plus is only as effective as the visual problem, the wearer and prescriber. Young's work on primates is not people. Young has been shown to be wrong because it is wrong. Not majority opinion, but just plain old wrong. If it were to stand the test of time, it would need to be scientifically valid. It is not and has been disproved. How much more evidence do you need to show you are factually incorrect? You are arguing that a fish can fly through the air. It can't, but you still keep telling us that it does. You have no proof, you just keep stating the rubbish without justifying your position. Nancy would not have worn plus because Nancy knows more than you. She knows more about OK than me and more about Lasik than the surgeons. She would have told you how to prescribe plus. As to your perception of second opinion doctors, I am the second opinion doctor. I am the third, fourth and fifth oinion as well. Steven Leung is a moron who is trying to terrorise parents into buying his lenses. This is easy in Singapore Hong Kong and Taiwan. Parents are very concerned about the worsening of vision. Your problem is that you have an extremely simplistic biew on the genesis of myopia, and your treament strategy is inappropriate. Myopia can be controlled, but not in the way you suggest. Stop regurgitating your rubbish and learn something about what you speak of. dr grant >You really don't know much, do you Cletis? CatmanX: I like the Cletis idea; but as a better nickname, might I recommend "ShortBus"? it's suggestive, and almost sounds like his real name. > Otis can prove that the minus lens accelerates myopia, Surprisingly, Otis doesn't claim this. His claims are limited to a theory about preventing myopia with a plus lens at what he calls the "threshold" before the eye reaches 20/50. Otis keeps answering you Ace by restating this, but you don't read what he says or you fail to comprehend. Signature~RT Dear RT, Thanks for stating my "limited" claims. In fact, a lot of my work was to attempt to verify "Bates" claims. And I give these majority-opnion ODs credit about dealing with the public. They almost have no choice but to do what they do. In fact I take the Oakely-Young study as a statement about the "limits" for ths use of the plus. It comes down to an either-or choice. As you know, I hold myself accountable for the "dumb" things I did with my eyes as a seven year old child -- NOT THE OD!!! Only after a study of the fundamental primate eye did I fully comprehend the effect of my bad-habits on the refractive state of my natural eyes. So I do not argue "under-prescription", but rather, for a child -- a discussion of these issues with the parents. Prevention would require that the parents force chnage in the child's bad habits, and I think that issue exceeds the bounds of "optometry" -- as I would understand it. But I do wonder how Ace would have reacted to an "offer" of the use of the plus at the threshold. Best, Otis > Dear RT, > > Thanks for stating my "limited" claims. > > In fact, a lot of my work was to attempt to verify "Bates" claims. Awww. Whatever happened to Rishi? >> Ace> Otis can prove that the minus lens accelerates myopia, > Surprisingly, Otis doesn't claim this. His claims are limited to a > theory about preventing myopia with a plus lens at what he calls the Otis calls it "staircase myopia," a presumptive property of all fundamental eyes. As he stated it, for each increase in spec Rx there follows a 67% change in myopia within 100 days. -MT Dear Mike, As you know, I take PERSONAL responsibility for the "dumb" things I did with my own eyes as a child. If I "knew better" I would not have done it. Obviously experiments to confirm the dynamic behavior of the NATRUAL human-primate eye are not possible. (i.e., FORCED wearing of a -3 diopter on a human population.) So the next best thing is to run the experiment on natural primate eyes, (Macaca Nemestrina (Pigtail) monkeys, and determine if they are "dynamic" (no error will be found or determined by this test) only a determination if the refractive state (using the classic atropine) changes with a change in the average visual environment. This is NOT at test to determine defect of any sort, only a desire to determine base-line bahvior for all natural eyes. A delta (so-called step-input) in this case was approximagely -0.8 diopters, and the resulting change in REFRACTIVE STATE was very close to the imposed 0.8 diopters change in the average visual enviroment, over the 294 days of this scientific test. The OTHER possibility MIGHT have been that the test-group would show NO CHANGE, thus confirming an "open-loop" system. That possibility can now be excluded for the behavior of all natural primate eyes. The calculated correlation coefficient was very high for the relationship betwee an enviroment "shift" and the resultant change in refractive state of these populations of primates. The time-constant was very close to 100 days -- confirming that this system is a first-order system. But this test says NOTHING about any defect -- thus excluding a medical judgment. As to be honest, it woujld have been difficult to "push" me to use a plus (strongly) as a child. But perhaps that will change in the future. So I do hold myself exclusively responsible, now that I know these facts. A very hard lesson to learn. But none of this reflects on you Mike -- it reflects on me, but it is too late. Best, Otis ==================== > >> Ace> Otis can prove that the minus lens accelerates myopia, > [quoted text clipped - 8 lines] > > -MT > As you know, I take PERSONAL responsibility for > the "dumb" things I did with my own eyes as a That's all fine but it has nothing to do with measuring two groups of human myopes, over time. -MT <otisbr...@pa.net> wrote Otis> As you know, I take PERSONAL responsibility for > the "dumb" things I did with my own eyes as a That's all fine but it has nothing to do with measuring two groups of human myopes, over time. Otis> Mike, I am not "measuring" two groups of "myopes". I am determining how all natural eye change their refractive STATE as the visual enviroment is changed. There is a profound difference in the words we use to understand the behavior of all natural eyes as sophisticated systems. Otis> And this is two groups of PRIMATES, not HUMANS as you have often insisted. Otis> Therefore it is MY CONCLUSION that I induced a negative refractive state in my natural (primate) eyes through my bad visual "habits". If I could lieve life again -- I would not repeat THAT mistake. Best, Otis -MT > Otis> Mike, I am not "measuring" two groups of "myopes". Obviously you aren't. But it's the most reliable way to test for your "staircase myopia." When it's done, the group wearing glasses fulltime gets no more nearsighted. So why won't you tell us how you authenticate your "staircase myopia?" Just saying "Somebody else believes it" is not enough. > Otis> Therefore it is MY CONCLUSION that > I induced a negative refractive state in > my natural (primate) eyes through > my bad visual "habits". I take that seriously, and I pledge to caution each and every emerging myope about the perils of reading with their nose in a book. But wearing glasses doesn't seem to matter, unless you've seen some published studies I haven't seen. That's why I'm questioning you again, about this. I have good reasons for wanting to know whether glasses alter the outcome of myopia. I prescribe for myopes several times a day. If my treatment is accelerating the condition, I want to know. I need to know. Please present the evidence that has you so convinced. Every statistically believable comparison *I've* ever found say that it makes little difference. If you _can't_ produce convincing evidence, why do you insist on perpetrating a myth? Now tell us about the Printer's Son again. -MT Dear Mike, Subject: Preceptions of the natural eye as a dynamic system. (ALL REFRACTIVE STATES BOTH NEGATIVE AND POSITIVE.) Re: The nature of the second-opinion. Obviously "suggeting" that a child NOT put is nose ON A BOOK does not work. The kid goes right back and keeps on doing it. Only a parent with a srong will could foce child to not do that. Be even more so, only a parent could put a child into a plus 1.5 diopter lens -- and keep him in that lens -- thus keeping his refractive state at zero or slightly positive. The parent with the "smarts" to do this -- protects his kids distant vision -- through the school years. But at that point, the kid always passes all legal VA requirements -- and the subject of "nearsighedness" never even develops. Thus prevention is for the parents and smart-kid, and obviously you are not a part of it. But the extrapolation of the Oakley-Young study strongly suggests that this will be the result of a child who begins wearing a strong plus -- before he gets in "deeper" that about 20/50. But that means that the person feels the "empowerment" to do this work correctly. And that means accepting the results of the primate studies -- which you do not seem to comprehend. But when it comes to your opinion, then you do what you feel you must do. But equally, Steve Leung OD looks at this data, and concludes that it would be wise for the parents to be fully informed of this preventive option, with the parents and child ultimately making a choice between these two concepts -- that can not be compromised. It is what an OD finally decides to do with his own children -- that determines the true nature of the second opinion. Best, Otis > Subject: Preceptions of the natural eye as a dynamic system. I'll leave the preceptions to you. I asked a very specific question and I didn't see an answer anywhere. How do you know "staircase myopia" exists? It doesn't happen when we compare kids wearing glasses with kids who don't. I thought you had some new information. -MT > you are wrong. Otis can prove that the minus lens accelerates myopia, > especially with lots of near work. you drug tripping idiot. then have otis prove it! he's been asked to over and over again and all he can do is muster up an old Young reference which has long since been discredited and some baby monkey/chick developmental studies. you are unable to assess scientific validity anyway since you are an untrained undisciplined pimple-faced adolescent who likes porn and hallucinigenic drugs. who cares what you say anyway? > My brother has been going without > glasses and he went from -1.75 to -1.25 so hows that? I have been > undercorrecting myself for more than a year now and I went from a -5 to > a -4. who cares about your stories about your brother and you? what does that prove? how about scientific studies that show statistically significant effects over a large group of people. > The point is different optometrist think differently. My > ophthamologist actually believes in undercorrection, but not so much to > improve vision but more to make things from near clear and relieve > eyestrain that full power glasses induce. if you are a myope and you can't see at near, then undercorrection OBVIOUSLY will make you see an near better. great thinking einstein! but it DOESN'T help slow myopia progression. in fact, the real proof shows it might make it worse. how many times must you embarrass yourself and expose your ignorance before you just go away? |
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