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Medical Forum / General / Vision / July 2006Plus lenses for myopia
This question is for Otis Brown. My son's myopia prescription is -1.0 on the left and -1.5 on the right. If I want to try plus lenses on him for book reading, what prescription should I go for ? +2.0 on both eyes, or different prescription for the two eyes ? By the way I am the one who brought up the projector for book reading question. After some investigation I have made a projection system by hooking up a regular TV projector to a video camera that I have. Works beautifully. Now my son reads a book by looking at a big screen 15 feet away. Dear BuyWheels, This question is for Otis Brown. My son's myopia prescription is -1.0 on the left and -1.5 on the right. If I want to try plus lenses on him for book reading, what prescription should I go for ? +2.0 on both eyes, or different prescription for the two eyes ? Otis> BEFORE you do that -- I would STRONGLY suggest that you have him read a Snellen. There is one on my site, as EyeChart #2. There can be, and is, considerable variation between a "prescription" and your child's ACTUAL reading. You might be pleasantly surprised to find that is visual-acuity might pass the DMV level. Otis> If you are going to take a larger degree of responsibility for PROTECTING his distant vision, then having him check himself is a major first step. Otis> Only AFTER you (and he) has confirmed his Snellen, should you talk about the plus -- and how to use it correctly. Wheel> By the way I am the one who brought up the projector for book reading question. Otis> The "projector" idea is excellent. That has been suggested many times. I wish all schools did that also. Wheel> After some investigation I have made a projection system by hooking up a regular TV projector to a video camera that I have. Works beautifully. Now my son reads a book by looking at a big screen 15 feet away. Otis> That is excellent -- and a FIRST STEP. Take your time. After you have him reading the Snellen (he might be clever enough to get the right idea), then we should continue this conversation. Otis> There are a lot of majority-opinion ODs on sci.med.vision who are profoundly hostile to you protecting your child's distant vison through the school years. Otis> If it gets excessive, you can contact me at: www.myopiafree.com Best, Otis Dear Wheel, Subject: SUPPORT for plus-prevention -- from a professional. There is profound hostility to plus-prevention on sci.med.vision -- as you have seen. But there are highly-qualified PROFESSIONALS like Steve Leung OD who support it. Here are some remarks about the need to START the plus before you child gets too deep into myopia. Best, Otis +++++++++ Despite the fact that results of studies of children who have been given bifocals are highly equivocal, Theodore Grosvenor of the University of Houston College of Optometry -- a proponent of the role of bifocals in the prevention of myopia -- insists that persistent close work causes myopia. (In what researchers generally consider to be the most carefully performed study to date, the two scientists ** disagree on the results.) Some of the studies have not borne out his hypothesis, he says, because they were conducted too late. "Once the eye has started to stretch, it may be too late to keep it from stretching," he says, explaining that most of the children in the study had already become myopic. "The ultimate study would be to put reading glasses on first-graders before anyone has developed myopia," he says. ** [One of the scientists was Dr. Francis Young. His bifocal study showed that a combination of under-correction and a strong plus stopped the eye's movement into myopia, i.e.,, would help the natural eye maintain clear distant vision if used when the eye was at the 20/40 to 20/50 level. OSB] > This question is for Otis Brown. My son's myopia prescription is -1.0 > on the left and -1.5 on the right. If I want to try plus lenses on him [quoted text clipped - 6 lines] > beautifully. Now my son reads a book by looking at a big screen 15 feet > away. Please also read this. If this guy can clear his -1 vision, so can your son if things are done right. http://www.tc.umn.edu/~schw0709/stories/VisionTherapy.html Dear BuyWheels, Wheels> This question is for Otis Brown. My son's myopia prescription is -1.0 on the left and -1.5 on the right. Otis> That might be over-prescribed. By that, I mean he might have 20/40 vision, which would make the use of a minus un-necessary. As Bates suggested, the natural eye 'ADAPTS' to that minus -- making "clearing" almost impossible. Further, quite a few second-opinion ODs recommend NOT wearing that minus -- unless absolutly necessary. So that is the reason why you should have him look at a Snellen. With that issue understood, then, Wheels> If I want to try plus lenses on him for book reading, what prescription should I go for ? Otis> That will depend on the child's habitual reading distance. For instance, if the child habitually reads at 20 inches (-2 diopters -- approximately) then a +1.75 to +2.0 diopter lens would NEUTRALIZE that "near" environment. Otis> If the child reads at 13 inches (-3 diopters), then a +3 diopter lens would be suggested. Obviously some compromise is required, and a +2.5 dipoter would be reasonable. Wheels> +2.0 on both eyes, or different prescription for the two eyes ? Otis> Judging from the "prescription" the eye are reasonably close -- by the prescription. Reading the Snellen (say 20/50 and 20/40) would confirm this. I would SUGGEST using equal-powers, i.e., +2 diopters for both eyes. Otis> The goal is that your child always keeps his vision in an "acceptable" range, relatigve to his Snellen. As Dr. Grosvenor suggests (and the Oakley-Young demonstrates) prevention with the plus is wise. The real issue is how youi implement it. Best, Otis +++++++ > This question is for Otis Brown. My son's myopia prescription is -1.0 > on the left and -1.5 on the right. If I want to try plus lenses on him [quoted text clipped - 6 lines] > beautifully. Now my son reads a book by looking at a big screen 15 feet > away. > 20/40 vision, which would make the use of a minus un-necessary. As > Bates suggested, the natural eye 'ADAPTS' to that minus -- making > "clearing" almost impossible. So Dr. Bates measured the rate of myopia in children wearing glasses and compared it to children who don't? > Further, quite a few second-opinion ODs > recommend NOT wearing that minus -- unless absolutly necessary. I haven't seen a comparision showing children wearing minus get more nearsighted. Have you? > Wheels> If I want to try plus lenses on him > for book reading, what prescription should I go for ? [quoted text clipped - 3 lines] > approximately) then a +1.75 to +2.0 diopter lens would NEUTRALIZE that > "near" environment. WRONG for a child with -1.50 eyes. > Otis> If the child reads at 13 inches (-3 diopters), then a +3 diopter > lens would be suggested. WRONG for a child with -1.50 eyes. Only +1.50 is required to have the effect of wearing +3.00. > Obviously some compromise is required, and a > +2.5 dipoter would be reasonable. WRONG. With +2.50 lenses, a -1.50 child will be blurry beyond 10 inches. Close working distances are known to cause myopia. You are forcing the child to work at 10 inches or forcing them to read blurry. Which is it? > confirm this. I would SUGGEST using equal-powers, i.e., +2 diopters > for both eyes. So one eye is blurry beyond 13", the other is blurry beyond 11". BuyWheels, in the past, back when actual doctors were using plus for myopia, they found it essential to take the child's existing myopia into account. A child with -2.00 of true myopia is effectively WEARING +2.00 all the time. Adding another +2.00 with "reading glasses" gives him the vision of a -4.00 myope. Everything beyond 25 cm is blurry (1/4.00=0.25m). Back when doctors were doing this, they had every hope that it would work. Otis cites the few authors whose results showed some promise. But several larger studies showed evidence to the contrary (no difference between treated and untreated groups) and mainstream science (medicine, optometry, visual physiology) have virtually all abandoned "the plus". We know that close working distances are associated with the rate of myopia creep. We know that wearing or not wearing correction makes no difference in the rate of myopia creep. We know that adding to the myopia with plus lenses makes no difference in the rate of myopia creep. We know that a child wearing total plus at near of +4.00 will reflexively hold his work at 10 inches OR WILL NOT SEE CLEARLY. So according to what we _know_, wearing excessive plus might well INCREASE the rate of myopia. If you intend for the child to read with an effective +2.00 for near vision, use +0.50 in the -150 eye and +1.00 in the -100 eye. To make it practical so the child could wear drugstore glasses, you'd use +0.75 in both eyes. Drugstores don't sell +0.75, so you'd use +1.00. Or you could let him read without glasses. That's effectively +1.00 in one eye, +1.50 in the other. It won't affect the outcome, but that's how a _doctor_ would "implement it". He might also suggest equal stimulus in both eyes and a more socially acceptable frame. But we know that wearing or not wearing correction makes no difference in the rate of myopia creep. > prevention with the plus > is wise. The real issue is how youi implement it. "Wise" is not the same as "efficacious", except to Otis, our very own myopia creep. -MT, OD I don't follow what is wrong here. If a slightly myopic child normally reads at 10" it is probably the cause for his myopia in the first place. A +2.5D lens would force his eye to focus as if the object was much further away. I thought the whole premise of plus lens theory was to force the eye to focus just at the point of starting to blur. > Obviously some compromise is required, and a > +2.5 dipoter would be reasonable. >> WRONG. With +2.50 lenses, a -1.50 child will be blurry beyond 10 inches. >> Close working distances are known to cause myopia. You are forcing the child >> to work at 10 inches or forcing them to read blurry. Which is it? Might i suggest that you take your direct questions to Otis Brown to his personal e-mail account or one of the holistic vision improvement forums that he frequents. there is his very own forum at http://health.groups.yahoo.com/group/i-see/ and also another forum at http://www.visionimprovementsite.com/cgi-bin/yabb/YaBB.cgi Otis is not well respected here. He gives people medical advise even though he is unlicensed to do so and that has resulted in official investigations in his home state of Pennsylvania. He tells people to try treatment plans that have been totally disproven in numerous scientific studies and in some cases his treatment suggestions can actually do harm to patients. if you want to follow his advise, then do so but you have been forewarned. your posting to him here in this forum is likely to arouse the displeasure of knowledgable people whom are fed up with Otis and would like to see him just go away. spare us your dialog with him please. > This question is for Otis Brown. Dear BuyWheels, Some parents (who are myopic) "wake up" to the need to PROTECT their child's distant vision by use of the plus. This is the same advocacy of Steve Leung OD at: www.chinamyopia.org Here are the details: Subject: Success with Myopter and "plus". In this avalanche of protest against plus-prevention, is it wonderful to hear that some parents have developed the correct idea about the need for prevention -- and the fact that their child is successful with it. But this type of "solution" truly requires parental involvement -- and is very difficult to inspire in BOTH the parents and child. True-prevention can not develop until the parents learn to "accept" this necessary intrusion in the life of their child. But it truly beats the alternative, which is to develop stair-case myopia from the over-prescribed minus. Best, Otis ++++++++++++++++++++++++ Subject: myopia reversal Date: Monday, May 08, 2006 9:54 PM Otis. thought you would like to see this email I just received. Too bad those guys you are fighting with won't pay attention to things like this. Don +++++++++++++++++ Remember me? We purchased the myopter for my daughter when she was 5 and ignored the minus lens prescription from her eye doctor. We visited you in PA a short time after our purchase. She wore the myopter for a year and then on a part time bases for another year. Once in a while she now wears some reading glasses. Through the last five years her eyes went from the 20/50 range and got a little bit better each year. At her 10 year old regular doctor's appointment a couple months ago - Jenna was able to read the 20/20 line for the first time in her life. That was very exciting. Thanks so much for all the great information about NOT getting her nearsightedness glasses when she was only 5. I can only imagine that her prescription would be much stronger now 5 years later. Jenna recently commented to me that she never use to be able to see the spots on the moon that she can now (whatever that means). I just wanted to send you an encouraging testimony. I can't tell you how thrilled I am that she does not need to rely on glasses. Her Dad did get glasses at 5. His eyes are so bad now that he can't do anything without his glasses. By the way, it looks as if you really updated your website. Very nice. +++++++++++ > This question is for Otis Brown. My son's myopia prescription is -1.0 > on the left and -1.5 on the right. If I want to try plus lenses on him [quoted text clipped - 6 lines] > beautifully. Now my son reads a book by looking at a big screen 15 feet > away. Dear BuyWheels, Subject: An engineer helps his children avoid entry in to nearsightedness. Re: The primate eye behaves as expected. Re: It seems the parents must FIRST figure out that there children MUST begin wearing the plus at "zero" diopters -- or else accept the consequences of NOT wearing the plus. Re: There are optometrists who DO NOT WANT THEIR CHILDREN TO ENTER INTO STAIR-CASE MYOPIA. Today that is the second-opinion. If you follow this method -- your children can keep their clear distant vision through the school years. Here is an example of how this preventive work can be accomplished by YOU. Some parents finally "wake up" to the need for prevention at the threshold as an "now or never" choice. The HELP their children make systematic use of the plus to AVOID even entry into myopia. Obviously this type of dedication and support can NEVER be prescribed. Thus do it "yourself" seems to be the only way. Thus making the use of the prevetive plus might seem "tedious" but it is better than the alternative -- in MY OPINION. Here is the discussion for your interest. ++++++++++++++++++++++++++++++++++++++++ Myopia Prevention: Theory and Practic By Denis Alarie, P. Eng. To: Mr. Howard C. Howland W201 Seeley G Mudd Hall Cornell University Ithaca NY 14853 USA Dear Sir: About your ongoing research on the development of the eye. It was with a great deal of interest that I read an article in Discover magazine in the October 1995 Issue concerning your ongoing work on the development of the eye and its relation to bio feedback. I come from a family of 7 where both the parents are with normal vision and where all 5 of the children were nearsigthed and read a lot. I graduated from Queen's University in 1977 with a first class degree in Civil engineering and also graduated with courses in Genetics. This interestingly enough, gave me a background in evolution, genetics, mechanics and physics. I had believed since I was about 15 that their was a causal link between eye development and Myopia and indeed was immensely interested when I read an article supporting that position. At first (around 1972) I had hopes that by carefully managing the use of my eyes I would be able to reverse the myopia about (- 1 dioptre ). This I theorized would be done by using reading glasses to simulate an at rest condition. I experimented with various lenses used while reading and studying ranging from +1.5 dioptre to + 2.5 dioptre, all the while thinking of and studying the structure of the eye to see if I could gain a better understanding of the process. Part 2 Although my eyes never improved they did not get any worse from a refractory point of view. It was relatively easy to experiment since my eyes did not have any astigmatism. I could therefore purchase glasses at the drug store for reading. I also talked my eye doctor into prescribing glasses at -0.75 dioptre that I would wear while attending classes. This did not do anything even though I played around with this concept for years. One thing that it did do was make me more aware of the minor changes which seemed to occur with my eyes due to atmospheric pressure, influence of alcohol and marijuana use, reading, driving, smoking. After I graduated 1977, I married in 1978 and had a family. My wife was a graduate nurse at University of Toronto and was mildly myopic with -0.50 in the right eye and -0.75 in the left eye. She did not wear her glasses which probably helped to prevent her vision from changing further. We have two daughters aged 15 and 11 both of whom have eyes that are almost perfect as far as spherical corrections are concerned they are both at 0 dioptre +/- 0.25. From the time that they were young I have encouraged good eye habits in both of them, ie don't sit too close to the TV, Head up when they walk Etc. When we moved to Timmins in 1987 we went to see an eye doctor by the name of Al MacIvor. He was talked into prescribing reading glasses for both of the kids. My reasoning was that since my eyes had stabilized at about -1.00 to -1.25 dioptre that reading glasses of +1.25 dioptre would probably be about the right level for them. Al said that both of the girls had very little reserve in their eyes and would both be myopic by the time they were 15. He looked at me with a bit of a glazed look in his eyes when I started talking to him about my ideas and probably thought I was talking about pyramid glasses etc. I insisted that the prescription not contain any cylindrical corrections. This now 1995 and the girls are fine. Their eyes basically have not changed in 8 years. They both are avid readers and computer users and they both wear their reading glasses. In a further elaboration to the above I have noticed that in the workplace where I work there is a very high incidence of occupational myopia in office workers. Truck drivers never develop myopia. Similar to your observations about the pilots who have good vision prior to their studies and poor vision after. I am not looking for anything from this. Just trying to help where I can and enjoying the chance to finally be able to transmit my information to someone who takes it seriously and has the professional credentials and interest in pursuing it further . Sincerely Yours Denis Alarie, P. Eng. ++++++++++++++ > This question is for Otis Brown. My son's myopia prescription is -1.0 > on the left and -1.5 on the right. If I want to try plus lenses on him [quoted text clipped - 6 lines] > beautifully. Now my son reads a book by looking at a big screen 15 feet > away. Dear Otis Brown, Please answer the questions that Neil Brooks asked you on your site. They ARE relevant. |
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