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Medical Forum / General / Vision / August 2006For Pat -- Thg PROFESSIONAL second-opinion on the plus.
Dear Pat, Here is the professional second-opinion, supporting the recommendations of the ophthamologists. Best, Otis +++++++++++++++++++++++ How to Eliminate Hyperopia (A HIGH positive refractive STATE of the fundamental eye.) by Merrill Allen, OD, PhD, FAAO, FCOVD PROFESSOR of OPTOMETRY Indiana University. Summary: The young eye should be given time to move towards zero diopters refractive state (emmetropiia). A strong plus lens will interfere with the "normalization" process. (i.e,, interfere with "emmetropization".) This statement is the "second-opinion" by a highly qualified expert. Re: When I'm in the mall, I see thick glasses on small children and I have to control myself. I know that wearing those glasses blocks emmetropization. (i.e., blocks the process of normal vision growth. Subsequently, a proven characteristic of the primate eye. OSB) If Mom would put the glasses on the child only in the afternoon, the child would grow out of his/her hyperopia and require several spectacle power reductions. If the child's correction is less than the refractive error, he/she will grow out of the need for those glasses and soon weaker lenses will be needed. Dr. M. Allen __________________________________ Humans are adaptable. The refractive error distribution in the population of newborns is almost a normal curve. By the first grade the distribution has become leptokurtic with the great majority of the population falling within -0.5 and +2.00 diopters of error. The babies have grown out of their refractive errors! Graduate Students at Indiana University did a study of babies at 2 weeks of age who performed as well on focusing tests as college students. The one baby who did not was about 5 D hyperopic. After 6 weeks or so it was clearly withdrawn and abnormal in personality. The baby could not respond to the test. Application of +4 D glasses changed the baby's personality overnight! Regarding the overcoming of hyperopia by optometric intervention, the baby above was not followed, but if the baby continued to wear those glasses, now as an adult, he/she will still be +4 hyperopic. I worked with an 18 month old esotropic girl whose eyes were so crossed I thought she had convergence fixus. However when I held her at arms length and turned my body through 360 degrees her vestibulars took over and her eyes straightened and she showed nystagmus. At each of the three visits I increased the plus to take home. Her eyes straightened with +11D. Then at the age of three years while moving to another city she lost her glasses and went without them for 3 months. The new eye examination showed her Rx to be +4. She had lost 7 diopters in three months! I did not realize the significance and was not smart enough to say to Mom: "Let's leave the glasses off for another 3 months," or "Let's wear plano glasses with binasal occluders for 3 months." The last checkup of this patient was at age 18 years when she was wearing +4D contact lenses! We cured her of esotropia and reduced 7 diopters of hyperopia! She has of course continued to be straight eyed. Wild monkeys have low hyperopia or emmetropia and no myopia. Caged monkeys have less hyperopia and much more myopia. Because the evidence for emmetropization is so strong, I suggest a couple of approaches on how to emmetropize young hyperopes. Only prescribe as much plus as needed to keep the eyes straight. (In the case of our baby that couldn't focus and had personality problems, the plus probably wouldn't be needed for more than a week or two as the child figured out how to use his eyes. At most the Rx should only be about half of the retinoscopic Rx and then reduced in power as the eyes change. With esotropia, more plus power may be needed at first to establish normal binocular vision, after which treatment of hyperopia may proceed. Alternatively for esotropia, the no Rx, binasal approach, see below, is highly recommended. Use no lens power but provide binasal occluders such as frosty Scotch tape applied with the outer edges placed at the distance apart of the centers of the pupils, minus 4mm. A growing child will require frequent occluder adjustments as his/her pupillary distance increases. The binasals will straighten crossed or exotropic eyes as well as cause emmetropization. Within 6 months the occluders can be removed. Strabismus and refractive error should be cured in that time! if you or the parents forget, the child will grow out of the binasals [they will cover less and less of the visual field] and will be cured. We know that older people grow into myopia, so I would not put an upper age on when a person can grow out of hyperopia. The important condition is that they be able to intensively pursue visual tasks requiring accommodation. If they are not visually involved, and if we eliminate the need to emmetropize, they will not emmetropize! When I'm in the mall, I see thick glasses on small children and I have to control myself. I know that wearing those glasses blocks emmetropization. If Mom would put the glasses on the child only in the afternoon, the child would grow out of his/her hyperopia and require several spectacle power reductions. If the child's correction is less than the refractive error, he/she will grow out of the need for those glasses and soon weaker lenses will be needed. The doctors that wrote this article are geniuses! The plus lens can also be "evil" if used incorrectly for high hyperopes. My dad's eyes got ruined when he wore a strong plus at age 5 which prevented proper emmetropization! If he could not function without correction, use a reduced strength plus and encourage lots and lots of near work to take care of the hyperopia. Be careful not to go overboard or myopia will begin. In my case, the wretched minus lens caused stair-case myopia. Genes played a small part in that, but I know the minus was mostly responsable as well as my near work environment. My eyes got worse *faster* once I wore that wretched minus! Majority opinion optometrists of course will deny this, they do not believe in the eye being dynamic. Dear Ace, In this specific case -- a young child's eyes with a refractive STATE of +1.75 diopters -- a plus should NOT BE USED. But equally, there is a time when a PLUS SHOULD BE USED -- for prevention. And, in my judgment, that would be when the child has a refractive STATE of +1/2 to zeros diopters. Remember a good and valuable refractive STATE is about +3/4 dipoters. (From the primate studies -- in an "open" enviroment.) Thus, before the child fails the "Snellen", a plus COULD BE USED to maintain a refractive a NORMAL refractive STATE of +1/2 to one diopters. That way a negtive refractive STATE would never develop. Best, Otis > The doctors that wrote this article are geniuses! The plus lens can > also be "evil" if used incorrectly for high hyperopes. My dad's eyes [quoted text clipped - 9 lines] > *faster* once I wore that wretched minus! Majority opinion optometrists > of course will deny this, they do not believe in the eye being dynamic. Dear Ace, Subject: Second-opinion optometrists. It may be in your lifetime. The optometrist checks your kid's eyes at age 5, and says, "I measure them with a refractive STATE of +1/4, and 20/20". At this point, I would RECOMMEND that your child BEGIN the use of a plus, with the goal of "improving" this childs refractive STATE towards +3/4 diopters. This is a protective, or preventive measure. That would take some understanding on your part -- but that is indeed the second-opinion. You can of course do nothing, and as the Oakley-Young study shows, the eye in a "school" enviroment will go "DOWN" at a rate of -1/2 diotper per year. So two years later, when the child is at 20/40 to 20/50, you get the next "chance" at vision-clearing. It that level it does become important to make that "either-or" choice. Ace, you have spent a huge amount of time on sci.med.vision. I believe that you have learned a great deal about these issues. But the real "test" of your knowlege will be when you have your own children, and their eyes begin to "adapt" to that school environment as a "natural process". By learing this -- you could save them -- with your leadership and knowledge -- of this preventive second-opinion. It is valid as science, and works on the threshold. But it certainly is never easy. Best, Otis > The doctors that wrote this article are geniuses! The plus lens can > also be "evil" if used incorrectly for high hyperopes. My dad's eyes [quoted text clipped - 9 lines] > *faster* once I wore that wretched minus! Majority opinion optometrists > of course will deny this, they do not believe in the eye being dynamic. Thats correct, teacher Otis. On the other hand, if they are high plus, let a S.O optometrist underprescribe them +1 to +1.5 less than their positive refractive state. If they are +2 or less, no correction is needed. Dear Ace, I consider that a substantial "educational process" must exist for the parent and child BEFORE a plus is used. In this sense, you can not help a person -- unless, or until -- the person is williing to help himself. That is the true difficulty of plus-prevention. The real nature of plus-prevention, or the second-opinion, is NOT what an optometrist does for the public, but rather, what he is prepared to do for his own children. Because he does not want THEM to develop stair-case myopia from that minus. Avoiding or "preventing" are always very difficult -- as we discussed. That is the "correct way" to define the second opinion. That is what an expert has concluded, and is prepared to apply TO HIS OWN CHILDREN. Thus the two ophthalmologists who recommended no +1.75 diopter for the twins -- WOULD NOT PUT THAT MUCH PLUS ON THEIR OWN CHILDREN AND GRAND CHILDREN. Were, no doubt, the optometrist would. That does not make EITHER METHOD RIGHT OR WRONG. It just says that their is profound conflict in concept and method -- and Pat should be aware of this conflict. But, now that she is, she can decide to put her children in a plus, or follow the recommendations of an ophthamologist, and do nothing, and allow their refractive state to move towards zero (as a natural process). Best, Otis > Thats correct, teacher Otis. On the other hand, if they are high plus, > let a S.O optometrist underprescribe them +1 to +1.5 less than their > positive refractive state. If they are +2 or less, no correction is > needed. > I consider that a substantial "educational process" must exist for > the parent and child BEFORE a plus is used. I consider that a "substantial educational process" must exist before you go offering your opinions to strangers. -MT Look you stupid moron, stop ranting on about things you know nothing about. These kids may require plus, they may not, but you are not an expert, you are not remotely experienced to advise on any form of vision correction. Kindly bugger of and post your crap somewhere else. dr grant I consider a substantial educational process -- to study the behavior of all fundamental eyes as dynamic sytems. I consider that process a matter of reviewing the judgment of second-opinion optometrists like Steve Leung OD at: www.chinamyopia.org So that the reader understand the nature of the PREVENTIVE second-opinion, and the scientific proof that supports it. I am sorry you have your head in a place where the sun does not shine -- but that is aparently how you formulate your majority-opinion. Otis > > I consider that a substantial "educational process" must exist for > > the parent and child BEFORE a plus is used. [quoted text clipped - 3 lines] > > -MT Sorry Cletis, but I am the second opinion doctor. My opinion is that you are an idiot. My second opinion is that you are a demented idiot. Steven Leung is no expert, has never been and will never been. He has not been peer assessed to have higher and better skills and knowledge. It is time you stopped promoting this rubbish and started to actually do some research into the subject. dr grant BScOptom MOptom FCOVD FACBO GCOT An accredited second opinion expert Did you gain your foul mouth at an OD school??? You you are the OD who is grossly over-prescribing the plus and creating stair-case "hyperopia". You are the person that Professor Allen was talking about. Yes a foul mouth and limited understanding seem to go together. It is too bad you are not furrther identified. I have NEVER head a MEDICAL professional talk the way that you do. But then, the medical people do not consider you a MEDICAL person at all -- only a lens-fitter. And I can see why. Otis > Sorry Cletis, but I am the second opinion doctor. > [quoted text clipped - 10 lines] > BScOptom MOptom FCOVD FACBO GCOT > An accredited second opinion expert > Did you gain your foul mouth at an OD school??? > [quoted text clipped - 14 lines] > > Otis "doctor" Grant needs to take some manners and anger management classes. I also have never seen a "doctor" as foul as Grant. Otis understands the dynamic eye more than M.O optometrists. He does not prescribe glasses/contacts because hes not a doctor, hes an engineer and thinks like an engineer > "doctor" Grant needs to take some manners and anger management classes. > I also have never seen a "doctor" as foul as Grant. Dr grant is entirely lucid. He knows exactly what he says. Nancy you are a f.cking stupid moron. My annoyance comes from dealing with someone so totally inept of any intellegence whatsoever. > Otis understands the dynamic eye more than M.O optometrists. He does > not prescribe glasses/contacts because hes not a doctor, hes an > engineer and thinks like an engineer Engineers are pedantic little twirps. Cletis thinks like a pedantic little twirp because he is a pedantic little twirp. Cletis does not know about the eye, you do not know about the eye and I am the second opinion doctor Cletis keeps talking about. My first opinion is you and Cletis are stupid morons, my second opinion is you are really stupid morons. dr grant Board Certified Second Opinion Specialist CatmanX schreef: > Engineers are pedantic little twirps. Cletis thinks like a pedantic > little twirp because he is a pedantic little twirp. Cletis does not [quoted text clipped - 5 lines] > dr grant > Board Certified Second Opinion Specialist As the Pope and chief in command off all Second Opinion Specialist's worldwide, I'll confirm the statement made by Catman X also known, for inti mi, as "terrible Grant" The Pope (normally Latin spoken) > "doctor" Grant needs to take some manners and anger management classes. > I also have never seen a "doctor" as foul as Grant. > > Otis understands the dynamic eye more than M.O optometrists. He does > not prescribe glasses/contacts because hes not a doctor, hes an > engineer and thinks like an engineer What is this? Otis and Ace spout crap, play their doctors games, back up their opinions from ridiculed, and dead docs, half truths chicken and monkey experiments, can't get rid of the freaks and their dangerous and often wrong games, when someone objects, oh it's their fault. Otis understands the eye because hes not a doctor???? He's not a doctor, nor are you, but you still insist pretending to be don't you? Im sure newcomers probably think you do. Maybe if you guys could start off your posts to newcomers with "Im not a doctor and have no qualifications, but as an engineer, here's my opinion... check this out with your optician... etc" it maybe wouldn't be so bad? Cya Simon > Maybe if you guys could start off your posts to newcomers > with "Im not a doctor and have no qualifications, but as > an engineer, here's my opinion... check this out with > your optician... etc" it maybe wouldn't be so bad? Wait a minute... What qualifies Otis as an engineer? -Quick Dear Ace, If I see a person with a pistol aimed at his foot -- (or starting to wear an over-prescribed minus) -- I suggest (as an engineer) that he not pull the trigger. But he does anyway. So who is to blame for the hole-in-the-foot? And stair-case myopia from the minus? Take care that you do not repeat this mistake with your own children. Again, people do not get what they want -- they get what they "deserve" or will "accept". Best, Otis > > Did you gain your foul mouth at an OD school??? > > [quoted text clipped - 21 lines] > not prescribe glasses/contacts because hes not a doctor, hes an > engineer and thinks like an engineer otisbrown@pa.net schreef: > Dear Ace, > [quoted text clipped - 14 lines] > > Otis Spectacles with a trigger, a new type of gun? What a charlatan you are Otis, comparing a pointed gun with a prescription for glasses. Free to Marcus Porcius Cato's "Ceterum censeo Carthaginem esse delendam" In conclusion, I think that the "old plus lens junk recovered by Otis" should be destroyed. Jan (normally Dutch spoken) >Dear Ace, > [quoted text clipped - 10 lines] >Again, people do not get what they want -- they get >what they "deserve" or will "accept". Luckily Ace will not have any children because he has Asperger's syndrome and can't get a job and therefore doesn't meet any women. If it does happen that he has children, god help them. Dear Ace, Also the "advice" is supply is almost always supported AS THE SECOND-OPINION. And further, I wish that I personally had received SECOND-OPINION support when my refractive STATE was between zero to +1/4 diopters. (i e., 20/20 but on the THRESHOLD of a negative refractive STATE). At that point, the use of the plus (properly understood as the SECOND-OPINION) could have the capability of changing the child's refractive STATE in a positive direction, like IMPROVING to a refractive STATE of +1/2, +3/4 to +1.0 diopters. Refractive STATES of these numbers were considered of value to midshipmen entering Annapolis, because of the known-fact that the refractive STATE moved negative at a rate of -1/3 diopter in a four year college. The "improvoing" your refractive STATE could be of considerable value in AVOIDING entry into a negative refracitve STATE. Best, Otis > > Did you gain your foul mouth at an OD school??? > > [quoted text clipped - 21 lines] > not prescribe glasses/contacts because hes not a doctor, hes an > engineer and thinks like an engineer > At that point, the use of the plus (properly understood as the > SECOND-OPINION) could have the capability of changing > the child's refractive STATE in a positive direction, like IMPROVING > to a refractive STATE of +1/2, +3/4 to +1.0 diopters. "Could have" means you're substituting imagination for evidence. Never mind that it doesn't happen after age 3. > Refractive STATES of these numbers were considered of > value to midshipmen entering Annapolis, because of the > known-fact that the refractive STATE moved negative > at a rate of -1/3 diopter in a four year college. Didn't Shotwell test Annapolis students? Was he able to modify the course of their myopia? Was he able to show that wearing glasses accellerated myopia? Imagine an answer for us, then call it a fact. -MT Grant, What I suggest to Pat was that there were TWO professional opinions. One by: Merrill Allen, OD, PhD, FAAO, FCOVD PROFESSOR of OPTOMETRY An accredited MAJORITY opinion expert And the other by you. > Sorry Cletis, but I am the second opinion doctor. > [quoted text clipped - 10 lines] > BScOptom MOptom FCOVD FACBO FOUL GCOT MOUTH > An accredited second opinion expert > Grant, > [quoted text clipped - 3 lines] > Merrill Allen, OD, PhD, FAAO, FCOVD PROFESSOR of OPTOMETRY > An accredited MAJORITY opinion expert He's dead, his theories were old, and the university doesn't follow his work anymore. That not tell you anything? > I consider a substantial educational process -- to study the > behavior of all fundamental eyes as dynamic sytems. So did Ong, Shotwell, Grosvenor and Parssinen. > I consider that process a matter of reviewing the judgment > of second-opinion optometrists like Steve Leung OD at: Oh. Well, those others were only published in BJO, AJOPO, JAOA, y'know, the peer reviewed journals. > I am sorry you have your head in a place where the > sun does not shine -- but that is aparently how you > formulate your majority-opinion. Nah. I get mine from those journals you never read. -MT
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