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Medical Forum / General / Vision / July 2006Optometric Study Center: April, 2001 Can We Conquer Myopia? Plus ways to slow myopia
http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/apr01/lesson_0401.htm Excerpt below: Fortunately, a larger NEI-funded study of bifocals is ongoing. The Correction of Myopia Evaluation Trial (COMET) is studying more than 400 children who have been randomized to two groups: those wearing progressive addition lenses with a +2.00D add and those wearing single-vision spectacles for at least three years. A preliminary study in Hong Kong found that the PALs not only cut the progression of myopia by half; they helped slow the growth in axial length. This will be of interest to optometrists! Reserch is underway to control myopia and bifocals have been proven to slow down myopia progression! Otis stands correct preaching the merits of the plus lens as an aid to help control myopia. I wish I had been given bifocals, I would be much less myopic to this day! http://members.aol.com/myopiaprev/prv1.htm Let's get straight to the point: Nearsightedness is caused by nearwork. "Nearwork" means any lengthy task performed at a range of 6 feet (2m) or less. You can avoid the worst effects of nearwork by doing it intelligently (i.e. adopting good visual habits), and by wearing "plus" lenses such as one finds in drug-store type reading glasses.(see link for full story) - Correspondingly, negative lenses and overcorrection with negative lenses increase esophoria139. - According to the generally and scientifically agreed fact of emmetropization (section 3.3.5), accommodation (section 3.2), accommodation induced elevated IOP (section 3.6.2) and artificially negative lens induced myopia (section 3.3) the positive effect of adding of plus power for near work is convincing. - As there were no negative results published for the use of simply adding some plus power for extensive near work, the recommendation should be: Try it! 1. Myopia Progression--Effect of Bifocal vs. Single Lenses In a small preliminary study researchers have found that children who wore bifocal eyeglasses had a slightly slower progression of myopia, or nearsightedness, than children who wore traditional single-vision eyeglasses. These findings appear in the August 2000 issue of Optometry and Vision Science. http://www.agingeye.net/myopia/3.2.2.php hello aceman I would like to ask a couple of questions: 1) how many chicks, primates and shrews used were 'genetically predisposed' to myopia? did the experiments make them permanently myopic? 2) how many humans are subjected to similar thorough, inhumane conditions to get myopia? why would any parent allow '...suturing the eyelid....' or '....putting blurring glasses...' on his/her child? or '...severely restrict the vision to near.....' 3) what 5 yr old would follow 'instructions'? what does this disparity in human and animal experiments say about the validity of statistics collected (either FOR or AGAINST a given myopia theory [whether accepted by the scientific community or not]')? > http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/apr01/lesson_0401.htm > [quoted text clipped - 43 lines] > > http://www.agingeye.net/myopia/3.2.2.php > http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/apr01/lesson_0401.htm > > Excerpt below: > > Fortunately, a larger NEI-funded study of bifocals is ongoing. Actually, the study is finished now. Here is the conclusion: CONCLUSIONS: Use of PALs compared with SVLs slowed the progression of myopia in COMET children by a small, statistically significant amount only during the first year. The size of the treatment effect remained similar and significant for the next 2 years. The results provide some support for the COMET rationale-that is, a role for defocus in progression of myopia. The small magnitude of the effect does not warrant a change in clinical practice. In other words, myopia progression was very slightly slowed, not enough to make much difference. A subset of young myopes with esophoria at near showed the most benefit and there may be some benefit to using plus at near with them. snip > Let's get straight to the point: Nearsightedness is caused by > nearwork. This is not a true statement. Although near work is associated with myopia, there is no evidence that is the cause; it is just as likely that myopia causes increased near work or that a third factor causes both increased near work and myopia. Finally, there is a much larger correlation between family history and myopia then there is between near work and myopia. snip Dr Judy On 7/25/06 1:15 PM, in article 1153858513.530206.244420@m73g2000cwd.googlegroups.com, "Dr Judy" <mpace99@rogers.com> wrote: >> http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/apr01/lesson_ >> 0401.htm [quoted text clipped - 12 lines] > progression of myopia. The small magnitude of the effect does not > warrant a change in clinical practice. This is what I mean by obfuscation. To be understood by scientifically savvy but non-specialist people, the author should at least translate PAL, SVL, and COMET. The following paragraph gives some explanation, but introduces new obfuscation with the term "esophoria." Do OD's wish to be understood only by members of their own guild? > In other words, myopia progression was very slightly slowed, not enough > to make much difference. A subset of young myopes with esophoria at [quoted text clipped - 17 lines] > > Dr Judy This whole business will never be settled until the science is carried out that will provide the biological basis for why eyeballs do or do not elongate because of near work. While I am skeptical of the optometric party line, I do not see any real attempt to justify the party line. Bill -- Ferme le Bush > This is what I mean by obfuscation. To be understood by scientifically > savvy but non-specialist people, the author should at least translate > PAL, SVL, and COMET. The following paragraph gives some explanation, > but introduces new obfuscation with the term "esophoria." Do OD's wish > to be understood only by members of their own guild? All abbreviations are defined in the paper at their first use. You don't type the whole thing out each time--it would be counterproductive to the idea of using abbreviations.  SignatureScott Reverse name to reply >> This is what I mean by obfuscation. To be understood by >> scientifically savvy but non-specialist people, the [quoted text clipped - 8 lines] > would be counterproductive to the idea of using > abbreviations. The Cliff notes didn't include that part... -Quick > This is what I mean by obfuscation. To be understood by scientifically savvy > but non-specialist people, the author should at least translate PAL, SVL, > and COMET. The following paragraph gives some explanation, but introduces > new obfuscation with the term "esophoria." Do OD's wish to be understood > only by members of their own guild? Bill, this was meant for professionals in the eye care field and not for amatuers; there is absolutely no intent for obfuscation (and I use the accepted definition: "To make so confused or opaque as to be difficult to perceive or understand"). It is incumbent on the person reading the information to understand the terminology in journal articles ( this is not "Entertainment Weekly"!). It would be my responsibility, for instance, to become versed in terms of electrical engineers- I would not accuse the field of "obfuscation" because of their lingo and terminology especially if I was challenging their studies. > This whole business will never be settled until the science is carried out > that will provide the biological basis for why eyeballs do or do not > elongate because of near work. Axial length is developmental- the eye does not "become" longer with just near work no matter what some cultists believe. frank On 7/25/06 2:43 PM, in article 1153863825.327079.248760@b28g2000cwb.googlegroups.com, "drfrank21@gmail.com" >> This is what I mean by obfuscation. To be understood by scientifically savvy >> but non-specialist people, the author should at least translate PAL, SVL, [quoted text clipped - 21 lines] > > frank I think it should be the duty of the poster who is ostensibly trying to educate, to add that little bit of glossary. I could not find esophoria in my unabridged dictionary. I did not Google or go to a medical dictionary. I rail just as strongly against obfuscation when I see it in my own field. I boggles my mind as to how obscure acronyms can get. Saying that "Axial length is developmental" is evasive at best. What are the enzymes, hormones, neurotransmitters or anything else that determines how and when elongation takes place. It is not a matter that God waves a magic wand. While there may be no money in discovering such detail, the answers are of significant scientific interest, Bill -- Ferme le Bush > I think it should be the duty of the poster who is ostensibly trying to > educate, to add that little bit of glossary. I could not find esophoria in > my unabridged dictionary. I did not Google or go to a medical dictionary. I > rail just as strongly against obfuscation when I see it in my own field. I > boggles my mind as to how obscure acronyms can get. I don't agree. This audience is far too diverse. While I don't try to be obscure, neither do I attempt to define every term. I run across terms and expressions that require research from me on a daily basis. With a Ph.D. yet, why do you insist on being spoon fed? > Saying that "Axial length is developmental" is evasive at best. What are the > enzymes, hormones, neurotransmitters or anything else that determines how > and when elongation takes place. It is not a matter that God waves a magic > wand. While there may be no money in discovering such detail, the answers > are of significant scientific interest, The answers to your questions are already in the scientific literature. Perhaps not *all* of the pathways have been fully elucidated, but we know that they are mediated by at least one transmitter, and that is acetylcholine. DrG > Saying that "Axial length is developmental" is evasive at best. What > are the enzymes, hormones, neurotransmitters or anything else that > determines how and when elongation takes place. So, in short, you'd like nonexperts in the field to bring you up to the level of an expert in the field, simply because you post the request to a newsgroup. SignatureScott Reverse name to reply Bill had a Ph.D. (I think in optics or E.E.) I think he has enough expertise to understand technical arguments and discussions about the dynamic behavior of the fundamental eye. The jargon is exactly that -- an out-growth of misconceptions about the behavior of the natural eye as a dynamic system. Using basic language, i.e., refractve STATE, could clear the air to a considerable extent, rather than the jargon of ASSUMED box-camera THEORY used to represent the natural eye's behavior. Otis Best, Otis So, in short, you'd like nonexperts in the field to bring you up to the level of an expert in the field, simply because you post the request to a newsgroup. -- Scott > > Saying that "Axial length is developmental" is evasive at best. What > > are the enzymes, hormones, neurotransmitters or anything else that [quoted text clipped - 3 lines] > level of an expert in the field, simply because you post the request to a > newsgroup. > Bill had a Ph.D. (I think in optics or E.E.) > > I think he has enough expertise to understand technical arguments > and discussions about the dynamic behavior of the > fundamental eye. More to the point--he should know enough to spend a few hours familiarizing himself with the field. If Bill expects to learn what's going on, instead of complaining about the use of the jargon of the field, he could spend a few hours learning it. The google search "comet myopia PAL SVL" sends you right to the NEI summary of the COMET study ---first hit in the results-- and all those abbreviations are readily defined, and a link to the full text of the report is provided as well. If Bill isn't willing to spend 45 seconds educating himself, why should anybody else? SignatureScott Reverse name to reply On 7/26/06 5:16 AM, in article Xns980C541C8387Fscottseidmanmindspri@130.133.1.4, "Scott Seidman" <namdiesttocs@mindspring.com> wrote: >> Saying that "Axial length is developmental" is evasive at best. What >> are the enzymes, hormones, neurotransmitters or anything else that [quoted text clipped - 3 lines] > level of an expert in the field, simply because you post the request to a > newsgroup. What I am trying to bring out is that there is a true scientific puzzle. 1. Some eyeballs elongate. True? 2. What are the microscopic processes by which this elongation takes place? Are the answers to these questions known by either experts or others? Are those questions stupid questions? Would discovery of the answers be of scientific interest? Once such answers are obtained, there would be additional questions. 3. Are these changes mediated by various biochemical substances? What are they? 4. What produces such substances? Is there any merit to such inquiry? Will any new facts change any old minds? Bill -- Ferme le Bush > Is there any merit to such inquiry? Enought such that it is specifically in the National Eye Institute's Strategic Plan: from http://www.nei.nih.gov/strategicplanning/np_strab.asp "After evaluating the Program, the Strabismus, Amblyopia, and Visual Processing Panel recommends the following goals for the next 5-year period: * Determine the etiology of myopia in humans, identify the risk factors associated with myopia and other refractive errors, and identify the biochemical pathways associated with the control of eye growth." The NEI also mentions recent progress and ongoing studies: (from the same page as above) "Progress continues to be made in myopia research, including a refinement in the understanding of visual and biochemical cues and genes involved in the regulation of eye growth and refractive states. Experimental studies have shown, for example, that quality, quantity, and timing of visual stimuli can affect ocular growth, which could influence the development of new treatments. Discovery of the role of circadian rhythms and of the molecular changes in the sclera driven by signals from the retina has increased understanding of eye growth. Clinical studies are examining whether certain optical or pharmacological treatments can slow the progression of myopia in children, while epidemiological studies are identifying risk factors, both environmental and genetic, and are determining the incidence of myopia in the United States and elsewhere." It's not like the problem is being ignored, and a day or two in a medical library would convince you of that. > Will any new facts change any old minds? As facts come in, sure. But we should place a high threshold on what we hold to be fact. SignatureScott Reverse name to reply > What I am trying to bring out is that there is a true scientific puzzle. > > 1. Some eyeballs elongate. True? Yes. Myopes elongate more than non-myopes. > 2. What are the microscopic processes by which this elongation takes > place? I don't know of any answer. It would be hard to tell any difference under the microscope. > Are the answers to these questions known by either experts or others? Are > those questions stupid questions? The first one is answered. The second might be unanswerable with current technology. > Would discovery of the answers be of > scientific interest? Once such answers are obtained, there would be > additional questions. You'll find lots of studies that incorporate axial length as one of the parameters. > 3. Are these changes mediated by various biochemical substances? What are > they? So far, it seems to be M3 and/or M4 muscarinic acetylcholine receptors. We know this because atropine affects M1 through M4, while pirenzipine affects mostly M3 and M4. Both meds are known to slow the progress of myopia, at least temporarily. > 4. What produces such substances? What produces acetylcholine? Nerve endings. > Is there any merit to such inquiry? Will any new facts change any old > minds? If it were suddenly shown that atropine had NO effect in slowing myopia, the explanations would have to change. But in fact it's been demonstrated as a consistent and predictable effect. -MT > This whole business will never be settled until the science is carried out > that will provide the biological basis for why eyeballs do or do not > elongate because of near work. The reason this topic is so unproductive in this newsgroup is because of the presence of a persistent troll who uses intellectually dishonest arguments and obfuscation in order to drag the discussion back into the dark ages of accommodation as the cause of all myopia and the use of reading glasses as the only cure. Many people seem to be comfortable with that explanation because it is so simplistic. > While I am skeptical of the optometric party line, I do not see any real > attempt to justify the party line. I'm not sure what you mean by "party line." DrG all specialists, when they talk with one another as they do when they publish papers in specialty journals, etc. use jargon. they all do. now why you seem to think that we need to spell things out so clearly and on such an elementary level as to make them obvious to you i don't understand. sorry if you don't understand every word of whats being said and what every abbreviation is, but I don't feel like I have to make you understand. suffice it to say that much larger minds than yours (and mine) have researched this topic and are continuing to research this topic. most of what Otis believes, i.e. that accommodation causes myopia, has long been disproven. if you can't accept it at that, then wait forever for your Scientific American article. or perhaps you would like to claim there is some kind of conspiracy. ============= > On 7/25/06 1:15 PM, in article > 1153858513.530206.244420@m73g2000cwd.googlegroups.com, "Dr Judy" [quoted text clipped - 54 lines] > Bill > -- Ferme le Bush On 7/25/06 4:32 PM, in article 1153870329.252465.327180@75g2000cwc.googlegroups.com, "p.clarkii@gmail.com" > all specialists, when they talk with one another as they do when they > publish papers in specialty journals, etc. use jargon. they all do. [quoted text clipped - 7 lines] > research this topic. most of what Otis believes, i.e. that > accommodation causes myopia, has long been disproven. You certainly do not have to make me understand. That is not your duty unless you take in onto yourself. You have been very successful in not providing an explanation. Bill Dear Bill, Therea are some issues that need to be addressed: 1. The minus is very easy to apply -- and the public LOVES that minus lens. 2. Any use of the plus (for prevention) must START before that minus lens is applied. THAT would require an intelligent scientist, or WISE parent to understand the REASON why prevention must start at that time. 3. It truly is impossible to expect BOTH, extremely sharp vision instantly (i.e., BVA for 20/18, 20/15, and 20/10 -- from a strong minus) and ALSO prevention with a plus. 4. At the threshold -- is must be one -- or the other. 5. The Oakley-Young study shows that a +1.5 diopter (high) and a under-prescribed minus -- stopped the eye's adaptation to its NEAR enviroment. The full-strength minus group went down by -2 diopers per 4 years, while the "plus" group went down by approximatley 0 diopters in those 4 years. Obviously the M.O. ODs on sci.med.vision are going to fight like crazy against that scientific results -- but that is the reality of it. 6. Any further work should be the use of the plus, when the refractive state is zero for that person (and Snellen 20/20). That WOULD require an fully informed person to understand the nature of this preventive work. 7. The public itself will block any effort of prevention -- that a S.O. OD might attempt. That is a tough reality of these discussions, and must be considered a serious scientific subject. I will post some remarks by a S.O. OD, and the response the "public" had to his preventive advocacy. As always, enjoy our pleasant analysis of the natural eye as a dynamic sytem (dynamic eye paradigm, versus optical box-camera paradigm). The issue of true-prevention AT THE THRESHOLD is still open, and will remain so. But some second-opinion ODs have their own CHILDREN in a plus (at 20/20 and a refractive state of zero). That is real "leadership" in that person. We should learn from that optometrist. www.chinamyopia.org Neither M.O. OD nor the S.O. OD is wrong. It is just that they have a diffent concept for preventing the deveopment of a negative refractive STATE for the fundamental eye. Best, Otis +++++++ > On 7/25/06 4:32 PM, in article > 1153870329.252465.327180@75g2000cwc.googlegroups.com, "p.clarkii@gmail.com" [quoted text clipped - 16 lines] > > Bill > Neither M.O. OD nor the S.O. OD is wrong. It is just > that they have a diffent concept for preventing the deveopment > of a negative refractive STATE for the fundamental eye. Your classification scheme of OD's is totally artificial, and is frankly wearing quite thin. There is no clinically effective preventive technique that either can offer aside from atropine at this time. Plus lenses, indeed. DrG Dear L, This is CLASSIC. The MAJORITY OPINION will ALWAYS DENY THE VALIDITY OF THE SECOND OPINION -- and that is EXACTLY what you are doing. I can certainly agree to the difficulties of prevention -- but they are not IMPOSSIBILITIES -- as you insist. You just wish to BELIEVE that preventing a negative refractive STATE for the natural eye is IMPOSSIBLE -- and so you believe it. That is not science -- that is just your own bias. ipso-facto. Otis > > Neither M.O. OD nor the S.O. OD is wrong. It is just > > that they have a diffent concept for preventing the deveopment [quoted text clipped - 8 lines] > > DrG > Dear L, > > This is CLASSIC. The MAJORITY OPINION will ALWAYS > DENY THE VALIDITY OF THE SECOND OPINION -- and > that is EXACTLY what you are doing. the "second opinion" has no validity because it has no proof that it works. show me some scientific proof in humans that minus lenses cause myopia and that plus lenses reverse that effect. studies in humans do indeed exist, its just that they all prove the opposite of what you say. show me some studies, and i don't require that they be published in Scientific American. and don't bother with posting the results of your "thought experiments". > This is CLASSIC. The MAJORITY OPINION will ALWAYS > DENY THE VALIDITY OF THE SECOND OPINION -- and > that is EXACTLY what you are doing. The so-called *second opinion* is something that you have conjured up in order to dress up your arguments. You and two or three other people do not constitute a *second opinion.* Rather, you constitute a fringe group. >From now on, I shall refer to you as the FG, for *fringe group*. That is a much more accurate description. DrG On 7/25/06 7:23 PM, in article 1153880599.164726.263060@m79g2000cwm.googlegroups.com, "otisbrown@pa.net" > 5. The Oakley-Young study shows that a +1.5 diopter (high) and > a under-prescribed minus -- stopped the eye's adaptation to [quoted text clipped - 4 lines] > are going to fight like crazy against that scientific results -- but > that is the reality of it. As I said to your opposition, the case (either way) will not be clinched until the mechanisms controlling elongation are explained. The theory and the measurements must develop simultaneously. Bill -- Ferme le Bush Dear Bill, Subject: How the experimental facts are evaluated. It is clear that the M.O. OD, and the S.O. OD see the dynamic natural eye DIFFERENTLY. The M.O. OD is trained to BELIEVE that pure optics DEFINES all eyes. Thus they wind up BELINING that you can represent the eye as a PASSIVE system. But the experimtal data simply does not support their concept that the living eye is a frozen optical device, and that THE LIVING EYE WILL NOT CHANGE ITS REFRACTIVE STATE -- WHEN YOU PLACE A -3 DIOPTER LENS ON IT. In fact, what will happen if you do this to the living eye, is that the NATURAL EYE will change its refractive STATE by -2 diopters in 12 months, relative to a control group that has no -3 diopter lens on it. This type of testing PROVES that the LIVING EYE is a dynamic system, and not a frozen box camera -- that was the previous paradigm. But the JUDGMENT of instituting a PREVENTIVE method, will START with a parent (WHO IS AN OPTOMETRIST) and RESPECTS this type of scientific proof an understanding. Thus, it is the parent who can guide his child in the correct use of a PREVENTIVE PLUS, and help his child keep his distant vision clear (positive refractive state from zero to +0.5 diopters) through the school years). This is CONFIRMED by the Oakley-Young study. But the implications are that a STRONGER PLUS, (not +1.5, but +2.5 -- adjusted for the child's habitual reading distance) must be used. Further, the child should NOT be prescribed for 'BEST VISUAL ACUITY" at all -- and if the child has DMV level vision (as first-myopes have) no minus should be used at all. But all of this DEPENDS on making a preventive decision or "choice" before that first minus is applied. Clearly SOME ODs have this preventive concept -- and can use it CORRECTLY on their own children. Attempting to deal with the "public" is a completely different story. But that is how a preveventive second-opinion can develop. Best, Otis > On 7/25/06 7:23 PM, in article > 1153880599.164726.263060@m79g2000cwm.googlegroups.com, "otisbrown@pa.net" [quoted text clipped - 15 lines] > Bill > -- Ferme le Bush > The M.O. OD is trained to BELIEVE that pure optics DEFINES > all eyes. Thus they wind up BELINING that you can represent > the eye as a PASSIVE system. Yet another STRAWMAN argument from the leader of the FG (Fringe Group). DrG > On 7/25/06 1:15 PM, in article > 1153858513.530206.244420@m73g2000cwd.googlegroups.com, "Dr Judy" [quoted text clipped - 22 lines] > new obfuscation with the term "esophoria." Do OD's wish to be understood > only by members of their own guild? I quoted directly from the published paper, those terms has been explained in the paper. I would think however, that anyone who had spent some time on this group would know that PAL is progressive lens and SVL is single vision lens. Also Ace had mentioned that the study was about the use of bifocals. Esophoria has been described many times as well. > > In other words, myopia progression was very slightly slowed, not enough > > to make much difference. A subset of young myopes with esophoria at [quoted text clipped - 21 lines] > that will provide the biological basis for why eyeballs do or do not > elongate because of near work. As you should know, science is never "settled". Our explanations of why stuff happens is based on the total knowledge available at the time and that knowledge is always increasing and being refined. If you care to search the scientific literature (available on line via PubMED) you will find hundreds and hundreds of papers about the physiology controlling the various paramenters of the eye that contribute to refractive error. You will need a expert background in biochemisty and physiology to understand them. Dr Judy On 7/26/06 6:40 AM, in article 1153921225.948150.19990@75g2000cwc.googlegroups.com, "Dr Judy" <mpace99@rogers.com> wrote: > If you care to search the scientific literature (available on line via > PubMED) you will find hundreds and hundreds of papers about the > physiology controlling the various paramenters of the eye that > contribute to refractive error. You will need a expert background in > biochemisty and physiology to understand them. How about giving me three links to pertinent papers. I promise that I will look them up. Bill -- Ferme le Bush > On 7/26/06 6:40 AM, in article > 1153921225.948150.19990@75g2000cwc.googlegroups.com, "Dr Judy" [quoted text clipped - 11 lines] > Bill > -- Ferme le Bush The COMET STUDY http://www.nei.nih.gov/news/statements/comet.pdf Wallman and Winawer http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WSS-4D3WBX7-5 &_coverDate=08%2F19%2F2004&_alid=428705455&_rdoc=1 &_fmt=&_orig=search&_qd=1&_cdi=7054&_sort=d&view=c&_acct=C000022660 &_version=1&_urlVersion=0&_userid=483663&md5= 835f87846d7f8f79c76396be4d4b78d1 You should be able to find plenty of papers given the COMET study and that fine review. SignatureScott Reverse name to reply Hak mir nisht ken tshaynik On 7/26/06 3:37 PM, in article Xns980CBD6B66A48scottseidmanmindspri@130.133.1.4, "Scott Seidman" <namdiesttocs@mindspring.com> wrote: >> How about giving me three links to pertinent papers. I promise that I >> will look them up. [quoted text clipped - 11 lines] > &_version=1&_urlVersion=0&_userid=483663&md5= > 835f87846d7f8f79c76396be4d4b78d1 Thank you for the links. I saved your post and am starting to look at the links. Bill -- Ferme le Bush |
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