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Medical Forum / General / Vision / July 2006I have a few questions for you guys and optometrists
1. What is the minimum prescription someone has to be for you to prescribe glasses? 2. Do you double check the subjective manifast refraction to be sure its correct, accurate and repeatable? 3. How often do you administer cycloplegic refractions? 4. http://www.tc.umn.edu/~schw0709/stories/VisionTherapy.html Need I say more? *why* was he prescribed a minus lens? *Why* was I prescribed a minus lens? Why wasnt I told about the plus lens which could have cleared my vision like it worked for him???????? > 1. What is the minimum prescription someone has to be for you to > prescribe glasses? There is no fixed limit as it depends on the individual and his/her personality and symptoms. Some people appreciate a correction of, say -0.25sph (I know you are obsessed with myopia so I'll make it easy for you). Other people with larger refractive errors are quite happy uncorrected. In my opinion, and as a generalisation with plenty of exceptions, more intelligent people have more exacting visual requirements. > 2. Do you double check the subjective manifast refraction to be sure > its correct, accurate and repeatable? As in 'start the entire process from scratch & do it again'? No. But inherent in the refractive process is a system of confirming & verifying the patient's answers so that any inconsistencies are picked up and corrected along the way. The final refraction does not rely upon any single patient response. P.S. It is manifest, not manifast. > 3. How often do you administer cycloplegic refractions? Personally not very often as I feel I can get good information using other techniques. But different optometrists have different preferences. Certainly there are times when it's definitely indicated and therefore is definitely used. > 4. http://www.tc.umn.edu/~schw0709/stories/VisionTherapy.html > > Need I say more? *why* was he prescribed a minus lens? *Why* was I > prescribed a minus lens? Why wasnt I told about the plus lens which > could have cleared my vision like it worked for him???????? I didn't even bother trying to read this... if you want to know why, google 'protanomal'. But it appears to be what is known as 'anecdotal evidence' (again, google it). Therefore, interesting to some, but not really relevant when it comes to patient care. Dom > There is no fixed limit as it depends on the individual and his/her > personality and symptoms. Some people appreciate a correction of, say > -0.25sph (I know you are obsessed with myopia so I'll make it easy for > you). Other people with larger refractive errors are quite happy > uncorrected. In my opinion, and as a generalisation with plenty of > exceptions, more intelligent people have more exacting visual requirements. Thats crazy if anyone insists on bothering you or another optometrist to fill out a prescription form and record it in paperwork for -.25 which blurs so little, it costs about half a line(instead of 20/20, may be 20/20-) The hassles of glasses would be far more than a minimal difference in vision(no difference less than 4 meters at that) I am betting once they try the glasses and see how it makes vitrually no difference, they probably put the glasses away and forget about them. I had a friend who was -.25, he tried the glasses for a week and was wondering what good were they as the difference was very neglectable. He ended up breaking them by "accident" and throwing them out. His parents just shrugged and said they wasted money buying him glasses when he didnt need them anyway. You are correct about others(which means majority from what ive seen) are happy to go uncorrected with refractive errors of -.75, -1, -1.25 and sometimes higher even. At -2, not many people forgo glasses except for near work. > As in 'start the entire process from scratch & do it again'? No. But > inherent in the refractive process is a system of confirming & verifying > the patient's answers so that any inconsistencies are picked up and > corrected along the way. The final refraction does not rely upon any > single patient response. I ask this question because when I got a manifest refraction, it got to a point where I couldnt tell the difference between two lenses so I just chose one at random. Should I have said "no difference" or "same?" Maybe the optometrist just gave me the stronger lens anyway when I didnt need this much minus. Do you ever find it tricky what to give exactly if the patient cant tell the difference between two values of a quarter diopter apart? > Personally not very often as I feel I can get good information using > other techniques. But different optometrists have different preferences. > Certainly there are times when it's definitely indicated and therefore > is definitely used. How would you then know how much plus to give a hyperopic child who can accomodate around most or all of it? How do you know when a child is "eating up" excess minus or has tonic accomodation/ciliary spasms, accomodative excess? > I didn't even bother trying to read this... if you want to know why, > google 'protanomal'. But it appears to be what is known as 'anecdotal > evidence' (again, google it). Therefore, interesting to some, but not > really relevant when it comes to patient care. > > Dom protanomal means colorblind in the red spectum, has nothing to do with manifest refractions. Anecdotal evidence does matter. In the link, his optometrist gave him a -1 when he was not really myopic and just had what can be known as tonic accomodation/ciliary spasms, accomodative excess? He figured it out on his own and relaxed his ciliary muscles with a plus lens and not filling out his prescription for -1. I feel alot of people are presribed more minus than their cycloplegic refraction(for hyperopes, less plus) and this can cause problems like eyestrain, blurred near vision, worsening of ciliary spasms, increase in both pseudomyopia and axial myopia. >> There is no fixed limit as it depends on the individual and his/her >> personality and symptoms. Some people appreciate a correction of, say [quoted text clipped - 8 lines] > be 20/20-) The hassles of glasses would be far more than a minimal > difference in vision(no difference less than 4 meters at that) Well ace when you eventually get your drivers licence you will realise that driving a car (and many other activities that people 'with a life' participate in) involve seeing objects at a distance of more than 4 metres. Some people, not all but some, would argue that it's well worth it. Just because it's not worth it for you doesn't mean it's not worth it for someone else. Again you are expecting others to share your opinion & perceptions - not everyone is the same as you. "Hassles of glasses" - what hassle? I am > betting once they try the glasses and see how it makes vitrually no > difference, they probably put the glasses away and forget about them. I [quoted text clipped - 3 lines] > parents just shrugged and said they wasted money buying him glasses > when he didnt need them anyway. If patients don't want the glasses then they don't order them in the first place. You seem to think that we optometrists tell people that they *must* get glasses if we find more than about 0.12D of myopia. You may be surprised to hear that the patient actually gets to choose whether or not to get them. This way we cater for different personalities and the different visual requirements of various individuals. Why on earth did your friend buy the glasses if he was not having any visual problems in the first place? You are correct about others(which > means majority from what ive seen) are happy to go uncorrected with > refractive errors of -.75, -1, -1.25 and sometimes higher even. At -2, > not many people forgo glasses except for near work. I'm so relieved that you have endorsed my statements about uncorrected refractive errors. >> As in 'start the entire process from scratch & do it again'? No. But >> inherent in the refractive process is a system of confirming & verifying [quoted text clipped - 5 lines] > a point where I couldnt tell the difference between two lenses so I > just chose one at random. Should I have said "no difference" or "same?" If two choices look the same then of course yes you should say 'the same'. If you choose one at random then you can expect a random prescription. > Maybe the optometrist just gave me the stronger lens anyway when I > didnt need this much minus. Do you ever find it tricky what to give > exactly if the patient cant tell the difference between two values of a > quarter diopter apart? It's not the most challenging part of an optometrist's day. >> Personally not very often as I feel I can get good information using >> other techniques. But different optometrists have different preferences. [quoted text clipped - 5 lines] > "eating up" excess minus or has tonic accomodation/ciliary spasms, > accomodative excess? Exactly how much plus to give a young hyperopic child is not a simple subject and I'm not about to answer that question in just a few lines. But rest assured there are ways of telling... cycloplegic refraction being one of those ways. I didn't say I don't use it, but there are other tests & techniques besides cycloplegic refraction. >> I didn't even bother trying to read this... if you want to know why, >> google 'protanomal'. But it appears to be what is known as 'anecdotal [quoted text clipped - 5 lines] > protanomal means colorblind in the red spectum, has nothing to do with > manifest refractions. But plenty to do with why I couldn't be bothered reading it. Anecdotal evidence does matter. Anecdotal evidence may be interesting, and it may be a pointer towards future research, but it doesn't matter when it comes to patient care. From http://en.wikipedia.org/wiki/Anecdotal_evidence: "Misuse of anecdotal evidence is a logical fallacy and is sometimes informally referred to as the "person who" fallacy ("I know a person who..."; "I know of a case where..." etc.) The problem with arguing based on anecdotal evidence is that anecdotal evidence is not necessarily typical; only statistical evidence can determine how typical something is." In the link, his > optometrist gave him a -1 when he was not really myopic and just had > what can be known as tonic accomodation/ciliary spasms, accomodative [quoted text clipped - 4 lines] > eyestrain, blurred near vision, worsening of ciliary spasms, increase > in both pseudomyopia and axial myopia. Then I look forward to your campaign to eradicate worldwide uncorrected hyperopia - there are plenty of uncorrected +050's running around without glasses on who need someone to save them from staircase myopia. If you approach one of the big lens labs they may supply you with free pairs of +3.00's to give to all these potential myopes. If the wearers complain that +3.00 seems a little strong you can reassure them that it's OK because you feel there would probably be more plus under cycloplegia. Dom Dom said: > Well ace when you eventually get your drivers licence you will realise > that driving a car (and many other activities that people 'with a life' [quoted text clipped - 3 lines] > it for someone else. Again you are expecting others to share your > opinion & perceptions - not everyone is the same as you. The DMV is 20/40 almost everywhere. In florida its 20/70. I will wear glasses that fully correct me for distance to drive, but for anything else, full correction is not neccessary, especially for near. Everyone should have a seperate pair of glasses for the computer that corrects them just enough so they dont have to accomodate and strain their eyes. > "Hassles of glasses" - what hassle? Just ask all those people who chose to get lasik instead or those with very low prescriptions who would rather go uncorrected than deal with glasses. > If patients don't want the glasses then they don't order them in the > first place. You seem to think that we optometrists tell people that [quoted text clipped - 4 lines] > individuals. Why on earth did your friend buy the glasses if he was not > having any visual problems in the first place? I was under the impression the optometrist can decide if the patient doesnt need glasses. Some optometrists wont prescribe myopes that see 20/40 or better because their vision is not bad enough to need glasses and besides they fear glasses will quickly worsen their vision. I had a friend who had to argue and insist his optometrist to prescribe him glasses even though he was 20/20 UCVA. He sees like 20/13 BCVA. His fault because now his eyes have gotten much worse ever since he first wore glasses. He should have listened to his doctor, something people have a bad habit of not! > I'm so relieved that you have endorsed my statements about uncorrected > refractive errors. You are welcome! > If two choices look the same then of course yes you should say 'the > same'. If you choose one at random then you can expect a random > prescription. Well he had it narrowed down to two lenses and only the pickiest person is gonna complain about 1/4 diopter. Anyone with a moderate or high prescription can just simply slide their glasses half a milimeter closer or further from their nose. I slide my full power glasses way down my nose when I view something close or I take them off alltogether. > Anecdotal evidence may be interesting, and it may be a pointer towards > future research, but it doesn't matter when it comes to patient care. [quoted text clipped - 5 lines] > necessarily typical; only statistical evidence can determine how typical > something is." If someone is not myopic, but has whats known as pseudomyopia, prescribe him a plus lens to fix that. A minus lens wont solve pseudomyopia and make things worse. > > There is no fixed limit as it depends on the individual and his/her > > personality and symptoms. Some people appreciate a correction of, [quoted text clipped - 11 lines] > betting once they try the glasses and see how it makes vitrually no > difference, they probably put the glasses away and forget about them. How many times do we need to tell you that some people like to be able to see? Personally, I find 0.25 to be a very noticeable difference. I actually happen to have two pairs of glasses, one which has an extra +0.25 in it (too much), and the difference is night and day to me when I look far away. Having said that, it would be a tough choice if all I had was -0.25 in each eye. I might go without in hopes that my eyes would somehow adapt or something. If they didn't do anything in a year or so though, I think I'd get some Rx glasses and wear them for driving and other outdoor activities (e.g. sightseeing on vacation). Here's a question for the eye docs though. Have you seen patients with an Rx like +0.5 in one eye and PL in the other? Does the non-independence of the focus mechanism make this situation annoying, such that most patients would choose to wear a weak plus in one eye to even things up? -- Charles said: > How many times do we need to tell you that some people like to be able > to see? Personally, I find 0.25 to be a very noticeable difference. I > actually happen to have two pairs of glasses, one which has an extra > +0.25 in it (too much), and the difference is night and day to me when > I look far away. Well, theres a difference between wearing the wrong prescription glasses and having near perfect uncorrected vision with a prescription too small to spend money and time dealing with correction. If I saw 20/40 with glasses then yes id get new glasees. If I saw 20/40 without glasses, I would not need glasses. .25 diopters is neglecable difference. Even half diopter is a very small difference and just big enough for people to start to notice. I have a 2nd pair thats half a diopter weaker and I barely notice, its still so much clearer compared to my *uncorrected* vision and not only that, the slightly weaker glasses are easier on the eyes when viewing things at half to two meters away. So in a way, I see better with the half diopter undercorrection. > Having said that, it would be a tough choice if all I had was -0.25 in > each eye. I might go without in hopes that my eyes would somehow adapt > or something. If they didn't do anything in a year or so though, I > think I'd get some Rx glasses and wear them for driving and other > outdoor activities (e.g. sightseeing on vacation). If you arent a picky perfectionist, youll adapt in a few hours to 20/25 uncorrected vision instead of 20/20(.25 to .5 diopter refractive error) Im sorry, but I laugh at anyone that says they cant "see" when their eyes without glasses is as good as mine *with* glasses! If they want to know what *not* seeing is, I suggest they put on two pairs of strong reading glasses. This is how bad I see without correction(-4 with cylindar) You should *never* get lasik even if they paid you big money. Youll complain nonstop how much worse you see. Picky perfectionists should realize lasik is the biggest mistake and to never consider lasik or even think about it. I know people as picky as you who ended up 20/25 after lasik and werent happy, nevermind they see 20 times better without correction than they did before lasik! Another couple questions for you optometrists: 1. Have you heard of adaptive optics? (ill make a thread on this) But when you test people's vision, what % have a BCVA of worse than 20/40, 20/40, 20/30, 20/25, 20/20, 20/15, 20/13, 20/10, better than 20/10? One optometrist said 20/10 is so rare, less than 2% see it with conventional glasses/contacts, lasik or uncorrected. 2. You optometrists, including Dom would know the relationship between diopters of myopic defocus and snellen acuity. This question comes up all the time and dozens of others have asked this too. Your answer here would provide insight to everyone reading this. How bad is -.5, -1, -1.5, -2, -3, -4, etc? I think being +0.25D off from the correct Rx is the same regardless of baseline. If your correct Rx is -0.25 and you wear nothing, you'll see the same as someone who has a -3.25 Rx and wears -3 - assuming the properly Rx'd corrected vision is 20/20 in both cases (or 20/15, or whatever). > Charles said: > [quoted text clipped - 36 lines] > after lasik and werent happy, nevermind they see 20 times better > without correction than they did before lasik! -- > I think being +0.25D off from the correct Rx is the same regardless of > baseline. If your correct Rx is -0.25 and you wear nothing, you'll see > the same as someone who has a -3.25 Rx and wears -3 - assuming the > properly Rx'd corrected vision is 20/20 in both cases (or 20/15, or > whatever). Like I said, if someone already has bad vision and needs correction, it will make no difference if the glasses are a fraction thicker. Might as well get the right prescription that gives you BCVA for distance. But if someone had such a low refractive error, glasses arent worth the hassle for the tiny difference you see. Glasses cost money, they scratch, they smear, they get dusty, they slide down your nose, they reflect light causing glare, etc. All those problems alone is going to be much worse than going around with -.25 or -.5 uncorrected vision. In fact, most people I know choose to go without correction for -1 prescriptions! They arent picky perfectionists like you. Lots of people after lasik do NOT end up exactly plano, yet their dependancy on glasses is greatly reduced! Aceman If you had a -0.50 difference between the eyes like I have and you tried to go without you'd notice it I swear you would. Maybe not at 0.00 and -0.50 but when you get up to -2.25 and -2.75 like me you can tell the difference. > Aceman > If you had a -0.50 difference between the eyes like I have and you tried to [quoted text clipped - 4 lines] > Message posted via MedKB.com > http://www.medkb.com/Uwe/Forums.aspx/vision/200607/1 Ive tried monovision and cant tolerate it, but something as small as half diopter difference, I barely even notice and im used to it over the years. Most people in fact have a small difference between their eyes. I rarely see someone with the exact same prescription in both eyes! I agree with Otis there. The M.O optometrists just dont care and I didnt have internet back then. By the time I got internet my eyes were getting bad and it was too late. The minus lens has made me permanently myopic(as has lots of near work) but I will take every effort to warn future family generations(children, nephew, neice, cousins) about the wretched minus lens and get them into a plus with the approval of a second opinion optometrist. Ill also try to warn my friend's children and show them a second opinion optometrist that will help them stay out of myopia. > I agree with Otis there. The M.O optometrists just dont care and I > didnt have internet back then. By the time I got internet my eyes were [quoted text clipped - 5 lines] > and show them a second opinion optometrist that will help them stay out > of myopia. Let me get this straight. You assert that when you first went to the optometrist, there was nothing wrong with you, but s/he gave you minus lenses. And, each and every time you visited your optometrist, s/he gave you stronger and stronger lenses, even though you didn't need them. As a result of this malpractice by one or more optometrists, you now have myopia that is permanent. Now, look out into the backyard. Are there men in black helicopters landing yet? DrG Dr. Leukoma frowned: > Let me get this straight. You assert that when you first went to the > optometrist, there was nothing wrong with you, but s/he gave you minus > lenses. I likley just had a little accomodative spasm from all the reading and computer I did. >And, each and every time you visited your optometrist, s/he > gave you stronger and stronger lenses, even though you didn't need > them. Back then, I did not need them but I developed stair-case myopia. Where was Otis when I was 12 and got my first -1 glasses? >As a result of this malpractice by one or more optometrists, you > now have myopia that is permanent. In this case I am not pointing fingers at anyone, no one did anything wrong, they just did not do the right thing and inform me that I had a second option which was likley to stop my myopia and reverse my pseudomyopia. It may be possible the optometrist himself does not believe in anything except myopia goes in one direction...worse, worse, worse. I guess maybe in a way its my fault for being oblivious to the fact, but at 12 and with no internet, I thought nothing of it. Malpractice is when an optometrist KNOWS someone is NOT actually myopic YET he prescribes minus glasses anyway! My optometrist had no knowlege and just assumed I was myopic, which I may or may not have been at that time. I never got the chance to try atropine back then or give the plus lens a try and see where that takes me. Others have tried it and this guy(see link below) to his delight found out he was NOT myopic. Maybe the optometrist did NOT know, but now he DOES and has gotta be CAREFUL from now on! *******Make sure someone is actually myopic and not just tonic accomodation before prescribing minus glasses! Also warn him minus glasses will make vision worse, especially if overworn or worn for near******** http://www.tc.umn.edu/~schw0709/stories/VisionTherapy.html > Dr. Leukoma frowned: > [quoted text clipped - 4 lines] > I likley just had a little accomodative spasm from all the reading and > computer I did. Hindsight is 20/20, and we don't have the benefit of your exam results, and you cannot prove it, and so I can discount this comment. > >And, each and every time you visited your optometrist, s/he > > gave you stronger and stronger lenses, even though you didn't need > > them. > > Back then, I did not need them but I developed stair-case myopia. Where > was Otis when I was 12 and got my first -1 glasses? You didn't "need" them? Did somebody put a gun to your head and make you wear them? I find that children with that prescription maybe wear them 50% of the time. > >As a result of this malpractice by one or more optometrists, you > > now have myopia that is permanent. [quoted text clipped - 14 lines] > the optometrist did NOT know, but now he DOES and has gotta be CAREFUL > from now on! Atropine eye exams are NOT the standard of care, my friend. DrG Dr. Leukoma answered: > Hindsight is 20/20, and we don't have the benefit of your exam results, > and you cannot prove it, and so I can discount this comment. True, but even still, I would be happy to be a -1 or -2 to this day. No one told me I could have slowed or halted myopia progression with plus lens and bifocals and limiting use of the minus lens as much as possible. > You didn't "need" them? Did somebody put a gun to your head and make > you wear them? I find that children with that prescription maybe wear > them 50% of the time. I wore my -1 lenses like 20% of the time so my eyes didnt get much worse, they actually got worse faster when I was at -1.5 and wore them 50% of the time then became full time wearer at -2 and stair-case myopia took off from there. > Atropine eye exams are NOT the standard of care, my friend. > > DrG Id be happy with cyclogyl and if theres *any* difference in my cycloplegic, no minus lens for me, plus lens for me to clear my "myopia" that isnt really there. > No > one told me I could have slowed or halted myopia progression with plus > lens and bifocals and limiting use of the minus lens as much as > possible. you can't. it doesn't work when tested statistically in large groups of people (as any test for efficacy should be done). i guess you just don't accept the published scientific results and instead prefer to believe your own "data" from your own "thought experiments" like otis does. do the thought experiments work a little better after eating some mushrooms? > True, but even still, I would be happy to be a -1 or -2 to this day. No > one told me I could have slowed or halted myopia progression with plus > lens and bifocals and limiting use of the minus lens as much as > possible. Many have tried those methods. In fact, I did as well. These theories had some popularity back when I attended optometry school more than a quarter of a century ago. Unfortunately, those trials tended to backfire in the clinic. Furthermore, there were absolutely no controlled studies to indicate the efficacy of those ideas...just opinions and anecdotal reports from the "behavioral/developmental" optometrists. Eventually, serious people began to publish studies leading up to the recent COMET study. The cutting edge research is now going in a different direction, using the concept of retinal blur, rather than accommodation. > I wore my -1 lenses like 20% of the time so my eyes didnt get much > worse, they actually got worse faster when I was at -1.5 and wore them > 50% of the time then became full time wearer at -2 and stair-case > myopia took off from there. Kind of proves my point: You got 50% worse when wearing your -1.00 D prescription only 20% of the time. Before that, you had no glasses, but got nearsighted anyway. Again, you confuse effect with cause. At one diopter, you could function in more situations without your glasses. At 2 diopters, you needed to wear them more to function. Instead, you have let Otis muddle your thinking. > Id be happy with cyclogyl and if theres *any* difference in my > cycloplegic, no minus lens for me, plus lens for me to clear my > "myopia" that isnt really there. Now, you don't make any sense. You have axial myopia, alright. You probably also have some pseudomyopia as well. DrG > Ill also try to warn my friend's children > and show them a second opinion optometrist > that will help them stay out of myopia. Do you find those in the yellow pages under "O" or is it "S"? -MT Dear AceMan, Subject: Giving "candy" (minus) to a child. I is profoundly EASY to put a -1.25 diopter on a child. The child LOVES that minus lens -- and the parents are impressed with how EXPERT that majority-opinion OD is. So what is the problem. To "change" this situation, you must "buck": 1. The M.O. OD 2. The parents. and 3. The child. There is no "percentage" in "bucking" this sytem -- now is there. Why DENY the child the "candy" that he loves? But some issues are "not so simple". When you begin to understand this "preventive" issue -- then you will be in a position to help your kids with prevention. The second-opinion ODs have FINALLY WOKEN UP to the necessity of helping -- EXCLUSIVELY THEIR ON CHILDREN -- because of the three items stated above. When you realize how POWERFUL those three items are in DESTROYING any concept of prevention -- they you will BEGIN TO UNDERSTAND THE TRUE ISSUES OF PLUS-PREVENTION. Profoundly arrogant (and ignorant) people like Retinula must be avoided -- in my humble opinion. The above issues MUST BE UNDERSTOOD. Only AFTER they are understood -- is it possible to have an intelligent discussion of plus-prevention. Just one man's opinion. Best, Otis ++++++++++ > > There is no fixed limit as it depends on the individual and his/her > > personality and symptoms. Some people appreciate a correction of, say [quoted text clipped - 60 lines] > eyestrain, blurred near vision, worsening of ciliary spasms, increase > in both pseudomyopia and axial myopia. On 7/22/06 11:03 AM, in article 1153591397.272673.308170@h48g2000cwc.googlegroups.com, "otisbrown@pa.net" > So what is the problem. > [quoted text clipped - 5 lines] > > 3. The child. You forgot the school system and child protection people. Bill -- Ferme le Bush You are right, Bill. That truly "pushes" the issue onto the parents. You can never "help" a person with plus-prevention -- until the person himself -- FIRST understands these issues. But there are ODs who "support" plus-prevention -- and maybe, as the years go by, these issues can be addressed. There is nothing "easy" about prevention -- I think we all recognize that fact. Best, Otis > On 7/22/06 11:03 AM, in article > 1153591397.272673.308170@h48g2000cwc.googlegroups.com, "otisbrown@pa.net" [quoted text clipped - 13 lines] > Bill > -- Ferme le Bush Dear Bill, And indeed -- I have not forgotten myself -- either. As a child -- I did this "nose on book" routine -- because I BELIEVED that doing so had NO EFFECT ON THE REFRACTIVE STATE OF ALL EYES. As an engineer, respecting the natural eye as a dynamic system, science determines that the natural eye will move from "plus" to "minus" (in terms of refractive STATE) if you do this. Thus, in retrospect, I must acknowlege that I INDUCED a negative refractive STATE in my natural eyes -- and that further, I should have been OFFERED the use of the plus when my refractive STATE was at -3/4 diopters. This would have required a change of "attitude" on BOTH my part -- and the part of my parents to SUPPORT IT. But, I judge that is the ONLY WAY POSSIBLE TO PREVENT THE DEVELOPMENT OF NEARSIGHEDNESS -- a negative refractive STATE of the natural eye. Obviously, I know that once you START with the minus, your refractive STATE can only go DOWN from that point onwards, i.e., can NOT BE REVERSED -- once you start with the minus. Thus the education of the parents -- and their need to know of the preventive choice becomes critical. Just one man's opinion. Best, Otis > On 7/22/06 11:03 AM, in article > 1153591397.272673.308170@h48g2000cwc.googlegroups.com, "otisbrown@pa.net" [quoted text clipped - 13 lines] > Bill > -- Ferme le Bush >http://www.tc.umn.edu/~schw0709/stories/VisionTherapy.html > > Need I say more? *why* was he prescribed a minus lens? *Why* was I > prescribed a minus lens? Why wasnt I told about the plus lens which > could have cleared my vision like it worked for him???????? ace you idiot. the guy got glasses because he went to the doctor and complained of blurry vision. it was bothering him in his day to day life. he couldn't see clearly in class and he likely had problems driving too. the eye doctor gave him a -1.00 Rx which is reasonable for a 20/40 acuity assuming he is a simple myope. the cause of his distance blur is what confuses the situation for you and other idiots like Otis. in his case the problem is likely accommodative dysfunction (aka pseudomyopia). because so much of his visual world reqiures near work his ciliary muscle mainains some contraction and doesn't completely relax. this is not typical myopia but it nonetheless causes real symptoms. he was treated entirely appropriately. you give such a person a weak minus Rx and tell them to wear them only when they need them at school and when driving and don't use them otherwise. you should also tell them to take frequent breaks from prolonged near work. GIVING PEOPLE MINUS LENSES DOES NOT INDUCE "STAIRCASE MYOPIA" AND DOESN'T MAKE ANYONES PSEUDOMYOPIA PERMANENT OR WORSE. did you want the eye doctor to tell him to go away and "tough it out"? > >http://www.tc.umn.edu/~schw0709/stories/VisionTherapy.html > > [quoted text clipped - 22 lines] > > did you want the eye doctor to tell him to go away and "tough it out"? Hey take it easy. Dont be rude, kind old optometrist. You are making asumptions why he got glasses which he didnt, he went strait to the plus to "fix" his blurry vision. He was NOT a myope yet, something you and his optometrist failed to realize. All he had to do was use the plus lens to clear his vision to 20/20. Wearing a minus lens would do NO good at best and likley harm. Optometrists are too quick to push the minus when all he needed to do was relax his ciliary spasms. He did NOT need glasses, he did NOT have to wear glasses. It was likley he would have developed axial myopia like I did when I wore my first minus lens and didnt do anything about the near work stress. Dear AceMan, The difference was that August figured out that a "minus" was not a good idea. The minus is knee-jerk simple. No discussion is required. It is like candy for a baby. Agust "read" aroung the "net" and discovered that the minus was not "a good idea". He recognized that he MUST pass the DMV (to avoid any use of a minus). He personally made the decision to use the "plus" and monitor his Snellen. In as much as the "un-protected" natural eye will go "down" at a rate of -1/2 diopter per year, so also, an eye that has the "near" environment elliminated (optically) with a plus will SLOWLY change its refractive STATE in a positive direction at a rate of +1/2 diopter per year. In the case of August, this plus-vision-clearing seems to have been faster that that. As long as August takes the responsibility to check his Snellen and PASS the DMV (when required) there is no good reason for him to be wearing a minus lens. But some people do prefer the easy quick-fix of the minus. But that becomes a matter of personal choice. i.e., Clear your vision with the plus (at the threshold) or get stair-case myopia from the minus. Tough choice. Best, Otis > > >http://www.tc.umn.edu/~schw0709/stories/VisionTherapy.html > > > [quoted text clipped - 33 lines] > have developed axial myopia like I did when I wore my first minus lens > and didnt do anything about the near work stress. Otis is just making up data again! ======================= > In as much as the "un-protected" natural eye will go "down" at > a rate of -1/2 diopter per year, so also, an eye that has the > "near" environment elliminated (optically) with a plus will > SLOWLY change its refractive STATE in a positive direction > at a rate of +1/2 diopter per year. No, P.Clark, I got it from a SECOND-OPINION scientific paper, prepared, peer-reviewed and published in Vision Science. Otis > Otis is just making up data again! > [quoted text clipped - 5 lines] > > SLOWLY change its refractive STATE in a positive direction > > at a rate of +1/2 diopter per year. is that the Flitcroft paper you talked about in another thread? Otis you are so ridiculous. Do you ever actually READ these scientific papers? Flitcroft doesn't say anything about what you are talking about. this is just like the Oakley Young paper that you have a strange interpretation of. your mind seems to work a lot different from everyone elses. you are an illogical man. ========== > No, P.Clark, I got it from a SECOND-OPINION scientific > paper, prepared, peer-reviewed and published in > Vision Science. > > Otis > is that the Flitcroft paper you talked about in another thread? Otis > you are so ridiculous. Do you ever actually READ these scientific [quoted text clipped - 4 lines] > your mind seems to work a lot different from everyone elses. you are > an illogical man. Amen to that. DrG Dear AceMan, Subject: Your child, and his right of decision and choice. AceMan> Need I say more? *why* was he prescribed a minus lens? Otis> Because these M.O. ODs BELIEVE that: 1. They should give you BVA, or a very strong minus, producing 20/18, 20/15, 20/12, and 20/10 -- on the assumption that the minus has NO EFFECT ON THE REFRACTIVE STATE OF ALL EYES. Tragically, in pure science -- this is simply not true. But that is what the M.O. ODs do. If you checked your child's vision on HIS SNELLEN, you might well find that the child has 20/40, and would pass the DMV, and yet, winds up with a -1.5 to -2.0 diopter "prescription" -- based on the BELIEF that a minus lens has NO EFFECT ON THE REFRACTIVE STATE OF ALL FUNDAMENTAL EYE. It is very hard to talk to a parent about this specific issues, and if you have only 10 minutes with a person -- no conversation of these issues will ever develop -- nor should you expect it to. You can learn and understand the factors that DRIVE a M.O. OD to PRESCRIBE, since the minus is so easy. But August, managed to "break" this cycle, got a plus, and cleared to PASS the DMV -- and much better -- 20/20. AceMan> *Why* was I prescribed a minus lens? Otis> Because the M.O. OD who "prescribed" a minus lens for you -- did not have time to discuss these issues with you, or the need for you to "take forcefull control" with the plus, and under YOUR control with the plus -- clear to pass the DMV, and always maintain your distant vision at better-than 20/40. That would make the issue YOUR RESPONSIBILITY -- and NOT the responsibility of any M.O. OD. Ace> Why wasnt I told about the plus lens which could have cleared my vision like it worked for him???????? Otis> Because of the "myth" these M.O. ODs have about the eye -- believeing that the fundamental eye is NOT DYNAMIC, and therefore (with no scientific proof) will over-prescribe a minus lens -- with rather bad long-term consequences for your distant vision. Otis> I would suggest that when you have kids, you provide them with this type of information -- and if you can find one, work with a plus-preventive second-opinion optometrist. Failing that, you will have to help your kids yourself. best, otis > 1. What is the minimum prescription someone has to be for you to > prescribe glasses? [quoted text clipped - 9 lines] > prescribed a minus lens? Why wasnt I told about the plus lens which > could have cleared my vision like it worked for him???????? |
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