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Medical Forum / General / Vision / July 2006The Limits of Optometry -- and why.
Dear Bill, Subject: The scientific secoind-opinion Some remarks: 1. Optometry REACTS to people -- with a minus lens. (Completely understandable and reasonable.) 2. The minus lens is EASY to apply. You just sit a person in a chair, put up a Snellen, and show that a minus lens "sharpens" the Snellen. 3. There is some check for "medical" issues (like RP and glaucoma) but the minus is indeed impressive, and if you only have 10 minutes with a person, and the person EXPECTS the minus lens -- what else can you do? The minus requires no discussion, no review, no decision or choice by the person. Just the obvious fact that the minus "works" -- and that is it. ++++++++++ I think that is a fair argument FOR THE MINUS. The ODs can and SHOULD make that argument -- that they are LIMITED by what the public expects, and indeed what works INSTANTLY -- and that is the only thing that the public will understand and ACCEPT. But the larger issue is this -- does the FUNDAMENTAL EYE change its refractive STATE from a positive value to a negative value -- when there is a negative change in the eye's average visual environmet? This is were these ODs go into a profound DENIAL state of all objective science and facts. I RESPECT (and expect) a population of fundamental eyes -- to be dynamic systems. (i.e., control systems) So I test the entire population of eyes, to find out if the refractive STATE of these eyes will CHANGE their refractive STATE when a -3 diopter lens is applied. From a review of that type of "direct-science", you can pose the following test, of the OD's "majority-opinion", and call it the "null" hypothesis -- which is that the fundamental eye is NOT DYANMIC (in the above sense) and THEREFORE MUST NOT CHANGE ITS REFRECTIVE STATE -- WHEN YOU PLACE A -3 DIOPTER LENS ON IT. Retinula has insisted MANY TIMES that the natural eye is NOT DYNAMIC, and that there will be NO CHANGE in refractive state of the -3 diotper test group. From long review of this type of scientific testing of the natural eye -- it is virtually certain that the -3 diopter group will change its refractive STATE by greater-than -2 diopters in one year. If you are a scientist -- you should take the results of this OBJECTIVE, TESTING SERIOUSLY. The only request I have is this -- please use the term refractive STATE, where the test is to determine IF THE FUNDAMENTAL EYE IS DYNAMIC -- OR NOT. Retinula does not like the IMPLICATIONS of this test -- so he denies the science of it. As far as I am concerned -- that resolves the scientific issues -- and answers the question of "The Printer's Son". There is a profound difference between dealing with the public (off the street) where ONLY A MINUS LENS "WORKS", versus dealing with the scientific issue of determining if the fundamental eye IS, and PERFORMS as a dynamic system. The descriptive words we use concerning the SCIENTIFIC experiment are critical. DO not use the word ORGANIC DEFECT to describe what is characteristic and natural behavior for the fundamental eye. Maybe this is too abstract for the M.O. ODs on sci.med.vision. They obviously do not understand the concept at all. Some more commentary: Bill> Has such behavior been factored into the various experiments? Otis> No, the M.O. ODs ignore both the question, and the scientific testing -- and results. They are only interested in finding a quick-fix that impresses the public instantly -- and nothing beyond that point. Bill> The way kids, with or without glasses, are not observed during a refraction session. Otis> NO M.O. OD PAYS ANY ATTENTION TO HOW THE KIDS USE THEIR EYES. I perceive that issue as critical. The NATURAL EYE will in fact change its refractive STATE to REFLECT its average visual environment. Because they do not wish to get involved in that type of SCIENTIFIC REVIEW AND DISCUSSION of the objective facts -- proving THAH type of typical behavior for the natural eye. That is why we are having this impasse. That alse explains the need for a second-opinion -- and your knowledge of it. Bill> There is more to good visual hygiene than merely telling a kid to use glasses only for seeing the blackboard. Otis> You bet there is. But the real issue is this. Who is going to discipline the kids, to follow the instructions? The ODs are not going to do it -- it's not their job. The "control" would be the responsibility of the parents to INSTRUCT the kids in these preventive methods -- to include the "plus" when necessary. Bill> Moreover, is a kid going to remove his/her glasses when going from reading the blackboard to writing into a notebook. Otis> Assuming the kid still has 20/40 to 20/50, the real question is this -- will the kid put on a +2.5 diopter for all reading -- and WAIT for his Snellen to clear to better than 20/40 -- as parent of a visual hygiene process. Obviously some engineer-parents have INSISTED their kids do EXACTLY THAT -- and the kids refractive STATE does not go from plus to minus. i.e., they avoid entry into myopia.; Bill> If you think so, you do not know kids and have forgotten your own childhood. Otis> I certainly remember doing it as kid. But I was told that "environment" had not connection with the refractive STATE of the eye. So I kept on doing it. Otis> Only as an engineer did I find out that it was established that the refractive STATE of the fundamental eye FOLLOWS that applied minus lens. So for PREVENTION to develop -- we must first RESPECT the fact that the fundamental eye is proven to be dynamic, and that a slight negative refractive state -- can be prevented if a plus is aggressively used at the critical 20/50 to 20/60 level. Just one man's opinion. Otis Bill The only limits on optometry are the current state of knowledge, the technology, and the ability of the curriculum to squeeze it all in. I think everybody knows what your limitations are. DrG > Dear Bill, > [quoted text clipped - 138 lines] > > Bill Yes, "L", in your office, and in the 10 minutes you have with a person the minus works PERFECLY. And, yes, for the reason I state -- the pluis does not work instantly -- so insist that "prevention" (which you can never offer -- for obvious reason), "is not effective". And you are right. You can NEVER DO IT -- and it must rest with the parents to make that type of prevetive choice or decision. You have stated your majority-opinion many times -- to that effect. But then I can NEVER expect anything from you -- for the reasons I state -- and agree to. But prevention will require an educated parent who is willing to guide his child in plus prevention -- buit NEVER WITH YOU INVOLVED -- for the reasons you state. But fortunatly there are second-opinion ODs who recognize these issues, and provided the parents will make that critical "choice", the the preventive parent -- and preventive OPTOMETRIST can TOGETHER maintain clear distant vision for that child -- PROVIDED that the "plus" is STARTED before the minus is applied. See: www.chinamyopia.org to verify the judgment of a second-opinion OD about the effect that a minus has on the refractive STATE of the eye -- in pure science. Make your choice wisely. Best, Otis ++++++++ > The only limits on optometry are the current state of knowledge, the > technology, and the ability of the curriculum to squeeze it all in. [quoted text clipped - 145 lines] > > > > Bill > Yes, "L", in your office, and in the 10 minutes you have > with a person the minus works PERFECLY. Your knowledge of what I do in my practice is about as outdated as your knowledge of myopia. DrG Yes, "L", I understand you quite well. And I think this describes your "vision" of yourself and what you think and do: If you just admit that the public will REJECT the preventive plus -- if you were to attempt to offer it -- that would be a major step forward. Every man takes the limits of his own field of vision for the limits of the world. Arthur Schopenhauer "I know that most men ... can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the very fabric of their lives." Leo Tolstoy Men live by their routines; and when these are called into question, they lose all power of normal judgment. They will listen to nothing save the echo of their own voices; all else becomes dangerous thoughts. Harold Laski Imagination is more important that knowledge...knowledge is limited but imagination circles the world. To see with one's own eyes, to feel and judge without succumbing to the suggestive power of the fashion of the day, to be able to express what one has seen and felt in a trim sentence or even a cunningly wrought word...is that not glorious? When I examine myself and my methods of thought, I come close to the conclusion that the gift of imagination has meant more to me than my talent for absorbing absolute knowledge. Albert Einstein As always, enjoy our discussion of an accurate analytical model for the proven behavior of all fundamental eyes. Best, Otis ++++++++ > The only limits on optometry are the current state of knowledge, the > technology, and the ability of the curriculum to squeeze it all in. [quoted text clipped - 145 lines] > > > > Bill > Every man takes the limits of his own field of vision for the > limits of the world. Pot, meet kettle. -MT I agree totally, Otis! The responsability rests on the parents and ultimately on the child. Had I been told about the plus lens, I would have chosen it. I had no knowlege, no one told me. So I wore the minus lens and developed stair-case myopia. To this day, most people have no knowlege of myopia prevention so they fall victim to the wretched minus lens then get stuck with it for life(unless they risk their eyes with lasik) Gadfly. DrG > I agree totally, Otis! The responsability rests on the parents and > ultimately on the child. Had I been told about the plus lens, I would [quoted text clipped - 3 lines] > lens then get stuck with it for life(unless they risk their eyes with > lasik) > Had I been told about the plus lens, I would > have chosen it. I had no knowlege, no one told me. So I wore the minus > lens and developed stair-case myopia. To this day, most people have no > knowlege of myopia prevention so they fall victim to the wretched minus > lens then get stuck with it for life(unless they risk their eyes with > lasik) You weren't told about the plus lens because it doesn't work. "Stair case myopia" is not caused by wearing a minus lens. Since you like anecdotal stories; here is the story of one of my patients. I first saw him when he was four years old and his mother had noticed one eye turning in. He turned out to be quite far sighted with an accommodative esotropia (one eye turning in). With plus lenses, he was no longer esotropic but did still have a large esophoria. So I prescribed bifocals for him, plus for far and more plus at near. Now you should know that he is of Chinese heritage and both parents are myopes. At about age 12 when he came in for his annual check, his mother was upset with him as he no longer wanted to wear his glasses. Mom was insistent and he kept them on. On that visit I found that he was no longer far sighted, but still had the esophoria. So we changed him to bifocals, clear for far, plus for near. AT age 13 he complained about distance blur. Sure enough, he was now myopic so the bifocals were changed to minus for distance, less minus for near. Myopia progressed a little bit over the next few years. Now 22, his myopia has not changed since age 18. So here is anecdotal "proof" that myopia will develop despite the use of plus (myopia developed while wearing plus) and that wearing minus does not lead to stair case myopia (note that myopia is stable after age 18 despite continued use of minus). Don't beat yourself up for wearing minus and quit blaming your parents/eye doctor for not telling you about plus. Had you not worn minus and worn plus, you would likely have the same refractive error. Dr Judy Dr Judy said: > You weren't told about the plus lens because it doesn't work. "Stair > case myopia" is not caused by wearing a minus lens. Then it wouldnt have mattered if I wore the minus lens or didnt use the plus. But some people insist it did matter and they have shown evidence. I would have tried the plus and avoided the minus anyway as there is *no* harm in trying this approach. If it works, good. If it doesnt work like you say, ill become myopic either way. > So here is anecdotal "proof" that myopia will develop despite the use > of plus (myopia developed while wearing plus) and that wearing minus > does not lead to stair case myopia (note that myopia is stable after > age 18 despite continued use of minus). Very strange. Maybe his accommodative esotropia had something to do with it? Also he was forced to go in a blur with plus glasses after he became emmetropic, this could have caused so much stress that it affected his vision and caused it to blur into myopia? Genes did play a part, but im wondering about the other factors. > Don't beat yourself up for wearing minus and quit blaming your > parents/eye doctor for not telling you about plus. Had you not worn > minus and worn plus, you would likely have the same refractive error. > > Dr Judy The only evidence I have is my brother did what I should have done and he is only -1 to this day while I am in the -4 range. At least some optometrists admit atropine or anticholergenic cycloplegic agents may slow or halt myopia progression. I would have been happy to use it short term during my years where myopia progresses most rapidly. I know ill need readers and sunglasses while cycloplegized but the reward at the end will be worth being much less myopic. Trust me, -4 diopters sucks! -3 is considerabily better and -2 would keep me out of glasses most of the time, including for computer use and around the house. I am getting atropine on Friday to see how much of my myopia is axial and do away with pseudomyopia. I am really hoping I have mild myopia which is less than -3 diopters. Retinula said: "you were not told about it because it doesn't work. doctors do not usually recommend worthless therapies to their patients." Then anticholergenic cycloplegic agents along with the plus would have done the trick and this is something even some majority opinion optometrists believe in. Long term use may harm the cornea and eye, but even short term would work and I can use it a month, take three month break, use it another month. I would be much happier as a -2 than -4! "well you may have gotten more myopic, but you would have anyway. your glasses had nothing to do with it. when a kid gets a cavity, goes to the dentist to get it filled, and then later gets more cavities, do you blame the dentist who filled the first one?" blame the sweets. I understand the analogy and would put the blame at my glasses or whatever caused my myopia. "start thinking-- your reasoning ability is obviously defective. and you claim to be such a genious. you let old man Otis tell you a few stories and show you a biased website and you became a converted fringe-group member." You have gotta give that nice guy a little credit, he is concerned about the young one's eyes and would like to see an end to the myopia epidemic. The stories he shows is evidence, even if you chose not to believe it, at least it *has* worked before. They had nothing to lose by trying! "there is no prevention scheme that works-- they have all been tested in large statistical studies and found to be ineffective. and minus lenses do not induce progression of myopia-- i see patients in my practice all the time whose myopia becomes reduced without any NVI and without any prevention therapies." Thats because of either the pseudomyopia they had or the hyperopic shift they experience in old age. I am doing NVI to purposely eliminate any tonic accomodation I have. I am getting atropine on Friday to reveal the difference between my cycloplegic and manifest. "really Ace, your understanding of what is happening with the physiology of the human eye is quite low and someday you'll be embarrassed by all the stupid things you keep saying in this newsgroup." I am always learning! Would you optometrists be happy to see the end of the myopia epidemic even if it means most of you would be out of a job? " but of course you won't believe me because you think you are "gifted". to get dupped by Otis is pretty pathetic and seems to prove your quite gullible. you give yourself too much credit." Otis is the one who deserves credit. He is the teacher. By the way, you optometrists have a good idea of the correlation between diopters and 20/something vision. I have done much research on this. Isnt -2 20/100 on average, -3 20/200 on average and -4 20/400? Dear Aceman, If you ask the question -- is the fundamental eye DYNAMIC, then Retinula is WRONG is the sens of pure-science. Because he INSISTS with no proof, that the fundamental eye IS NOT DYNAMIC, and WILL NOT CHANGE ITS REFRACITVE STATE WHEN YOU PLACE A -3 DIOTPER LENS ON IT. But, let us just say that his concept is the "majority-opinion". But let us analyize what Retinula has said: Retinula said: "you were not told about it because it doesn't work. doctors do not usually recommend worthless therapies to their patients." Otis> That is Retinula OPINION. What Retinula means is that a minus lens works INSTANTLY, and impresses everryone -- and the "plus" is not instant. And I AGREE with Retinula on that point. And I will further state (the lead-in of this thread) that PREVENTION must be a matter of review and CHOICE for the parents -- at the threshold -- AS THE SECOND-OPINION. Otis> But is is obvious that a "doctor" can NEVER prescribe plus-prevention. That HAS TO BE AN ISSUE FOR YOU TO DECIDE FOR YOUR CHILDREN. If you want a "snappy" quick-fix, then got to Retinula and get it. But you may rue the consequences of the minus, which will be stair-case myopia --as the SECONDARY consequence. Otis> But when your kids start getting into it -- you will at least have the benfit of proof the the fundamental eye is dynamic, and Retinula' argument (for the convenience of practice) that the plus does not work "instantly", and therefore must be "wrong". Best, Otis acema...@yahoo.com wrote: > Dr Judy said: > [quoted text clipped - 98 lines] > between diopters and 20/something vision. I have done much research on > this. Isnt -2 20/100 on average, -3 20/200 on average and -4 20/400? > Dear Aceman, > [quoted text clipped - 5 lines] > let us just say that his concept is the "majority-opinion". But > let us analyize what Retinula has said: He insists nothing of the kind. None of us have. In fact, I challenge you to provide a link to such a message in any NG. > Retinula said: > [quoted text clipped - 7 lines] > PREVENTION must be a matter of review and CHOICE for > the parents -- at the threshold -- AS THE SECOND-OPINION. DrG> Retinula is correct. There is no proof that the "prevention" Otis recommends works at all. Outside of the Young-Oakley study -- which Otis misinterprets -- there is no scientific proof. Prevention is not a matter of choice, because there is no choice. What Otis offers is a blatantly false choice. > Otis> But is is obvious that a "doctor" can NEVER prescribe > plus-prevention. That HAS TO BE AN ISSUE FOR YOU > TO DECIDE FOR YOUR CHILDREN. If you want > a "snappy" quick-fix, then got to Retinula and get it. > But you may rue the consequences of the minus, which > will be stair-case myopia --as the SECONDARY consequence. DrG> A "doctor" can legally employ lenses and prisms for therapeutic purposes. If lenses and prisms could prevent myopia, then all doctors would be employing lenses and prisms in their practice and helping their patients to use them. > Otis> But when your kids start getting into it -- you will > at least have the benfit of proof the the fundamental eye is > dynamic, and Retinula' argument (for the convenience of practice) > that the plus does not work "instantly", and therefore must > be "wrong". DrG> In other words, Otis recommends that you experiment on your own children and see what happens. If the child does not get myopic, then Otis will claim "proof" of efficacy. If the child gets more myopic, then Otis will claim that the child did not do it properly. Best, DrG > Then it wouldnt have mattered if I wore the minus lens or didnt use the > plus. But some people insist it did matter and they have shown > evidence. Anecdotes aren't evidence because so many myopes get better on their own, without any NVI or special lenses. You did. If that didn't happen, it would be easy to see what caused the special cases. Since it does happen, you need at least freshman statistics to determine efficacy. After you pass one statistics course, anecdotes become less meaningful. > I would have tried the plus and avoided the minus anyway as > there is *no* harm in trying this approach. If it works, good. If it > doesnt work like you say, ill become myopic either way. That's what we say. We only argue with those who claim efficacy, because tests of efficacy have been virtually all negative. > Also he was forced to go in a blur with plus glasses after he > became emmetropic, this could have caused so much stress that it > affected his vision and caused it to blur into myopia? So why is Otis recommending it? > Genes did play a > part, but im wondering about the other factors. 80% genetic, 20% environment is about what the authorities tell us, except with very high myopia it's roughly 99% genes. And remember that's axial myopia, verified by cycloplegic and unclouded by pseudomyopia. But accommodative habits almost always influence prescriptions in the young, nearsighted or farsighted. > The only evidence I have is my brother did what I should have done and > he is only -1 to this day while I am in the -4 range. So you base your entire opinion on a sample with n=2. That level of understanding doesn't deserve much respect. Telling stories doesn't determine efficacy. A hypothesis without convincing proof is called "wishful thinking." > At least some > optometrists admit atropine or anticholergenic cycloplegic agents may > slow or halt myopia progression. Absolutely. Because there are efficacy studies to back it up. I'm personally interested in the effect of low-dose atropine, because it's been shown to work, if not to last. > I would have been happy to use it > short term during my years where myopia progresses most rapidly. There's a tendency to "catch up" after you quit using the drop. That's why everyone isn't jumping on it. > I know > ill need readers and sunglasses while cycloplegized but the reward at > the end will be worth being much less myopic. Atropine isn't used to "reverse" myopia. You'll find no doctor willing to keep you on it for any length of time, particularly since you've already begun to reverse naturally, usually a signal that your axial length has stopped changing. > Trust me, -4 diopters > sucks! -3 is considerabily better and -2 would keep me out of glasses > most of the time, including for computer use and around the house. I am > getting atropine on Friday to see how much of my myopia is axial and do > away with pseudomyopia. I am really hoping I have mild myopia which is > less than -3 diopters. I doubt you'll measure better than -300, but it is what it is. Your anatomy and the chemistry of your lens will change in the 4th and 5th decades in a way that tends to lessen it a little further. You might get to -2.50 or -2.00. I believe I told you that about three months ago. > blame the sweets. I understand the analogy and would put the blame at > my glasses or whatever caused my myopia. You only blame glasses if you believe Otis. Reading and close work might have contributed say 20% to your myopia, the rest is genetic. Otis wants you to take the blame yourself, because it makes him feel better when people wallow in despair over their myopia, like he did. > You have gotta give that nice guy a little credit, he is concerned > about the young one's eyes and would like to see an end to the myopia > epidemic. How is that different from someone who actually goes to school and studies myopia to learn what works and what doesn't? > I am always learning! Would you optometrists be happy to see the end of > the myopia epidemic even if it means most of you would be out of a job? It didn't put many dentists out of business when cavities declined dramatically because people started brushing their teeth. They still get you every six months. > Otis is the one who deserves credit. He is the teacher. You need to find a teacher with better credentials. One who's actually been to some school where they teach about eyes. The argument is between Otis and the textbooks. You've chosen Otis. See anything wrong? > By the way, you optometrists have a good idea of the correlation > between diopters and 20/something vision. I have done much research on > this. Isnt -2 20/100 on average, -3 20/200 on average and -4 20/400? It depends. -MT Mike Tyner said: > Anecdotes aren't evidence because so many myopes get better on their own, > without any NVI or special lenses. You did. If that didn't happen, it would > be easy to see what caused the special cases. Since it does happen, you need > at least freshman statistics to determine efficacy. After you pass one > statistics course, anecdotes become less meaningful. I improved only because of NVI which in reality addresses my tonic accomodation. Older people experience changes in their lens and elimination of all stuck accomodation due to presbyopia. > That's what we say. We only argue with those who claim efficacy, because > tests of efficacy have been virtually all negative. Otis speaks of experience in the efficacy of the plus lens. If testing does not agree then we can consider it "anticedotal evidence" and that alone is enough to give the plus lens a shot, dont let myopia get you without a fight! > So why is Otis recommending it? plus for near, no correction for distance. > 80% genetic, 20% environment is about what the authorities tell us, except > with very high myopia it's roughly 99% genes. Then the 20% environmental influence by using a plus lens can save some myopes if they dont have a strong genetic code, especially for high myopia. If no one in your family is myopic and your distance vision starts dropping, its likley environment is the cause and a plus lens would be effecient. But if everyone in your family has plenty of myopia, you probably will fall victim too anyway. > So you base your entire opinion on a sample with n=2. That level of > understanding doesn't deserve much respect. Telling stories doesn't > determine efficacy. A hypothesis without convincing proof is called "wishful > thinking." Its an example, not a total sample.(hey it rhymes!) > Absolutely. Because there are efficacy studies to back it up. I'm personally > interested in the effect of low-dose atropine, because it's been shown to > work, if not to last. Any slowdowns in myopia is good. High myopia is hard on the retina and of course makes the victim helpless without cokebottles. > There's a tendency to "catch up" after you quit using the drop. That's why > everyone isn't jumping on it. Myopia progression would slow anyway at around 18. Maybe a half or one diopter may be forthcomming but you starved off stair-case myopia as a child and can look forward to mild myopia as an adult. I think the real reason why drops arent so popular is they cause high dependancy on plus lens, very poor uncorrected near vision, mydrisis, photophobia and long term use is bad on the eyes. It can be useful for out of control myopia, but for gradually increasing myopia it may not be worth the trouble of drops. Also once someone is myopic and needs minus, he may feel discouraged and just give up and look into lasik in the near future. > Atropine isn't used to "reverse" myopia. You'll find no doctor willing to > keep you on it for any length of time, particularly since you've already > begun to reverse naturally, usually a signal that your axial length has > stopped changing. You misunderstood. I meant in the past when I was 12 and -1, id be happy to still be a -1 or -2 to this day. My axial myopia likley stopped progressing around age 18, ill be getting atropine on Friday to see how much of my manifest prescription is just pseudomyopia and also to do away with pseudomyopia. Im hoping theres at least 1.5 diopter improvement :) > I doubt you'll measure better than -300, but it is what it is. Three hundred diopters? Or you forgot the decimal ;) > Your anatomy and the chemistry of your lens will change in the 4th and 5th > decades in a way that tends to lessen it a little further. You might get > to -2.50 or -2.00. I believe I told you that about three months ago. One good thing to look forward to getting old, my vision will improve instead of worsen like it is the case for some. However I do want less myopia NOW!(without any refractive surgury) im looking into orthoK and whatever other safe, reversable alternatives the future brings > You only blame glasses if you believe Otis. Reading and close work might > have contributed say 20% to your myopia, the rest is genetic. Otis wants you > to take the blame yourself, because it makes him feel better when people > wallow in despair over their myopia, like he did. I wish it were the case but my brother is -1, I am -4, this is 300% so obviously our environments were different enough for this disperency. I would be blaming myself alot less if my brother was a -3 or -4. Otis has high myopia, even worse than mine so I am emphathic and symphathic to his poor vision. His dreams of being a pilot became as negetive as his refractive state. > How is that different from someone who actually goes to school and studies > myopia to learn what works and what doesn't? Otis is an engineer and I study the facts on the wonderful internet > It didn't put many dentists out of business when cavities declined > dramatically because people started brushing their teeth. They still get you > every six months. Just for regular checkups and a through cleaning of your teeth. I guess optometrists can get you yearly for regular eye checkups but the glasses business will shrink as more and more people prevent myopia or "fix" it with refractive surgury. > You need to find a teacher with better credentials. One who's actually been > to some school where they teach about eyes. Otis knowlege of the eye is based on a purely scientific level of the natural dynamic eye, not medical but science. > The argument is between Otis and the textbooks. You've chosen Otis. See > anything wrong? Have you read Dr. Bates? Very interesting :) > > By the way, you optometrists have a good idea of the correlation > > between diopters and 20/something vision. I have done much research on [quoted text clipped - 3 lines] > > -MT Your the one with a good idea after doing thousands of refractions. I know that BCVA is the biggest factor. Squinting is cheating and doesnt count. Pinholes and constricted pupils in bright light dont count either. Guessing and memorization doesnt count. I read around and several websites and optometrists say -2=20/200 and -3=20/400 but its not this bad, youd agree. Why do they think so then? Ace> By the way, you optometrists have a good idea of the correlation between diopters and 20/something vision. I have done much research on this. Isnt -2 20/100 on average, -3 20/200 on average and -4 20/400? Otis> There is no exact answer. But on the average 20/40 will required about a -1.25 to -1.5 diopters if PRESCRIBED for Best-Visual-Acuity (say 20/15 to 20/13). But if 20/40 is acceptable, the 0.0 diopters would the choice. Otis> But assuming prescription for BVA, the relationship would be roughly: 20/70 -1.5 D 20/140 -3 D 20/210 -4.5 D Otis> But it all depends on the subjective judmgent of the OD doing the perscribing. Otis> In one case a 3 year-old had 20/50 vision, so they prescribed a -10 diopter lens. Therefore: 20/50 -10 DIopters Again for subjective reasons. That is why no relationship can be established. Otis > Dr Judy said: > [quoted text clipped - 98 lines] > between diopters and 20/something vision. I have done much research on > this. Isnt -2 20/100 on average, -3 20/200 on average and -4 20/400? otisbrown@pa.net said: > Otis> There is no exact answer. But on the average > 20/40 will required about a -1.25 to -1.5 diopters if PRESCRIBED > for Best-Visual-Acuity (say 20/15 to 20/13). But if 20/40 is > acceptable, the 0.0 diopters would the choice. Yea that makes sense. However optometrists need to be careful and not overprescribe. One of the most important factors is BCVA. Two people may have 20/40 but if one corrects better, he needs more minus. You have warned of gross overminusing of -2 to -3 for 20/40 UCVA when rarely is even -1.5 needed. > Otis> But assuming prescription for BVA, the relationship would be > roughly: [quoted text clipped - 7 lines] > Otis> But it all depends on the subjective judmgent of the OD doing > the perscribing. Its not linear like that but expotentional. -3 is much worse than -1.5, well more than twice. No one needs this much minus if they see 20/200, its probably going to be -2.5 to -3 usually. > Otis> In one case a 3 year-old had 20/50 vision, so they > prescribed a -10 diopter lens. Therefore: [quoted text clipped - 3 lines] > Again for subjective reasons. That is why no relationship > can be established. Thats because she had a strange myopic distortion in her lens but could see 20/50 thru the less distorted areas of her lens. Normally, axial myopia of -10 is so bad youd only be able to count fingers like 2 feet from your face! It needs no explanation. DrG > I agree totally, Otis! The responsability rests on the parents and > ultimately on the child. Had I been told about the plus lens, I would [quoted text clipped - 3 lines] > lens then get stuck with it for life(unless they risk their eyes with > lasik) Dear AceMan, Thanks for the "vote of confidence". It is clear, from the statement of Jacob Raphaeson (The Printer's Son) that even the most dedicated optometrist could not help the public with true-prevention with the plus. Thus the rather violent "turn down" of the plus by the parent ensured that the child could get NO PROTECTION OF HIS DISTANT VISION FOR LIFE. It is clear from the Oakley-Young study, that if PREVENTION is desired, then the "plus" must start no later than the 20/60 stage (-1.25 diopters). Clearly this must be considered an "either-or" choice, again given the objective facts of the Oakley-Young study. But, given "The Printer's Son", and the fact that a strong minus works "instantly" it is hard to see how plus-prevention could ever be implemented -- except by a parent who is "educated" in this matter (as the second-opinion) and is willing to help his child in the use of the preventive-plus. In any event, at least you will be prepared to work with second-opinion (preventive) ODs like Steve Leung when your child's vision starts going below 20/50 on the Snellen. www.chinamyopia.org Best, Otis > It is clear, from the statement of Jacob Raphaeson (The Printer's Son) > that even the most dedicated optometrist could not help the > public with true-prevention with the plus. none of us could blame Raphaelson for being wrong. all the research that has accummulated wasn't available when he wrote what he did. > It is clear from the Oakley-Young study, that if PREVENTION > is desired, then the "plus" must start no later than the > 20/60 stage (-1.25 diopters). > > Clearly this must be considered an "either-or" choice, again > given the objective facts of the Oakley-Young study. really? how do you think the Oakley-Young study says anything about that. the OY study compared using bifocals to using single-vision spectacles in a population of children who were mostly near-point esophores. it didn't test "the plus". it didn't prove anything about "the wretched minus" causing staircase myopia. it just tested using bifocal adds in the kids glasses or not. why do you keep over-interpreting the results of the OY study? have you read it? is your mind not able to access valid conclusions that can be drawn from such a study? > In any event, at least you will be prepared to work with > second-opinion (preventive) ODs like Steve Leung > when your child's vision starts going below 20/50 on > the Snellen. > > www.chinamyopia.org is this the closest second-opinion optometrist to wear i live? there must not be very many SO optometrists. i've never met one. do they all live in china or something? > Had I been told about the plus lens, I would > have chosen it. I had no knowlege, no one told me. you were not told about it because it doesn't work. doctors do not usually recommend worthless therapies to their patients. > So I wore the minus > lens and developed stair-case myopia. well you may have gotten more myopic, but you would have anyway. your glasses had nothing to do with it. when a kid gets a cavity, goes to the dentist to get it filled, and then later gets more cavities, do you blame the dentist who filled the first one? start thinking-- your reasoning ability is obviously defective. and you claim to be such a genious. you let old man Otis tell you a few stories and show you a biased website and you became a converted fringe-group member. > To this day, most people have no > knowlege of myopia prevention so they fall victim to the wretched minus > lens then get stuck with it for life(unless they risk their eyes with > lasik) there is no prevention scheme that works-- they have all been tested in large statistical studies and found to be ineffective. and minus lenses do not induce progression of myopia-- i see patients in my practice all the time whose myopia becomes reduced without any NVI and without any prevention therapies. really Ace, your understanding of what is happening with the physiology of the human eye is quite low and someday you'll be embarrassed by all the stupid things you keep saying in this newsgroup. but of course you won't believe me because you think you are "gifted". to get dupped by Otis is pretty pathetic and seems to prove your quite gullible. you give yourself too much credit. > Just one man's opinion. Yes, you already posted that. So give us your opinion on why Ace isn't getting more nearsighted. -MT
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