Dear Judy,

Here is the documentation you requested for
your perusal.

I can accept that children do some things with their eyes that
will induce a negative refractive STATE.

The only goal for me is to ask the right questions, i.e., is the
natural eye a dynamic system -- or not?

As an engineer I expect it to be so.

But in science you must verify it to be so.

After you clear your mind in this way, and "accept" that you will
measure a refractive STATE (using a retinoscope and cyclogel or
equivalent),
you simply place a -3 diopter lens and see if the refractive state of
the
natural or fundamental eye "follows" the -2 diopter lens
(with a time-constant response).

If it does, then the eye is a dynamic system.

If it does not -- then it is not -- and I am wrong, and the preventive
second-opinion is wrong.

But except for a few, that type of clean language and clear-minded
testing does not "work".

For your enjoyment, here are the "majority-opinion" arguments
"against" such clear thinking an questions.

Enjoy,

Otis
++++++++++++++

Re: The Refractive States of the Natural Eye.

"Otis S. Brown" wrote:

Judy> snip

Paper> Title: "Spectacle lenses alter eye growth and the
refractive status of Young monkeys"

Judy> (snip)

Paper> These results indicate that the developing primate visual
system can detect the presence of refractive anomalies and
alter each eye's growth to eliminate these refractive
errors. Moreover, these results support the hypothesis
that spectacle lenses can alter the eye development in
young children.

Otis> My Commentary:

Judy> snip

Otis> (The result was that the refractive STATE "followed" the
applied lens. i.e., the eye is dynamic with respect to the
applied lens. This "following" process is normal and
essential. OSB)

Judy> An interpretation that refractive error "follows" applied
lenses is not one that the study authors made.

Otis> They saturated their analysis with the words "error", and
the like. Just report the measured refractive STATE -- and
save me from the incorrect words with the false
assumptions.

Judy> You didn't provide the date of the study quoted;

Otis> 1994

Judy> hundreds of these kinds of studies have been done with
birds, primates and various other mammals. The point of
these studies is not to investigate whether applied lenses
cause change in eyes but rather to investigate how the eye
copes with congenital refractive error;

Otis> What is important is to prove that the natural eye changes
it refractive STATE by -2 diopters when you place a minus
lens on it. You obviously have your majority-OPINION about
the natural eye's proven behavior. The second-opinion does
not agree with your interpretation.

Judy> lenses are simply of way of simulating refractive error.

Otis> There you go with "refractive ERROR" again. That is not
what was measured, i.e. refractive STATE. It is your
assumptions that lead to false conclusions about the
behavior of the natural eye.

Judy> These studies and what we empirically know about the
distribution of refractive error in new born human babies
and older children all support the concept of
emmetropization.

Otis> Judy has yet to define "emmetropization". The word itself
is an "invention" of the box-camera eye, where the
assumption was that all refractive stated must be exactly
zero to be "normal". All other non-zero refractive STATE
are considered "errors". The natural eye has refractive
STATES, not "errors". And that is the problem with the
ASSUMPTIONS Judy is making. But Judy BELIEVES her theory.
So let us call her statements an OPINION about the behavior
of the natural eye, and the respect for the dynamic eye the
second-opinion.

Judy> Emmetropization is a mechanism whereby an eye with
refractive error somehow recognizes the error and modifies
the growth of eye structures so as to eliminate the error.

Otis> There we go with the "error" problem. There is no "error"
in a dynamic system. The natural eye changes its refractive
STATE when you place a -3 diopter lens on it. This is a
dynamic and natural process -- not an "error" process.

Judy> the consensus know is that retinal defocus during distance
viewing drives this process,

Otis> Yet another assumption. When an eye looks at 13 inches (-3
diopters), the image is in focus on the surface of the
retina. There is a feedback process between the
lens-retina, were the lens is "adjusted" based on
micro-blur on the surface of the retina.

Otis> If you look at 13 inches, or place a -3 diopter lens on the
eye -- the process is identical. Looking in the distance
through a -3 diopter lens will NOT create "defocus" as
implied by Judy.

Judy> ...not accommodation and so using plus lenses at near to
prevent myopia does not fit with the experimental data.

Otis> Wow! She has just jumped to the conclusion she wanted to --
without ever understanding that the natural eye changes its
refractive STATE from the application of a -3 diopter lens
to it.

Judy> If Bates type exercises improve the eye's ability to
recognize retinal defocus, then you might be in a position
to argue for a study of Bates type exercises for
preschoolers as a potential preventive method.

Otis> Jeeze, yet again. I have NOT suggested Bates-exercises at
all. Yet another assumption by Judy.

Judy> Emmetropization has been studied for about 15 ot 20 years
now and knowledge of it has influenced how eye doctors
treat refractive error in young children.

Judy> We mostly now take a wait and see approach, holding off on
spectacle correction until it is obvious (usually by age 6)
that emmetropization is not working.

Otis> It is here that we disagree. Emmetropization in this
instance is where Judy "wants" the refractive STATE of the eye
to be EXACTLY ZERO.

Otis> In fact, from the study of the natural primate eye in the
wild, the DESIRED and PROTECTIVE refractive state should be
between +0.75 to +1.25 diopters.

Otis> Thus, by the time the refractive STATE is zero, it is truly
time to START with the preventive plus. But Judy does not
understand the concept at all. But for the parents who
can, the goal would be to START with the plus a zero to
-1/2 diopter.

Otis> This would REQUIRE an educated parent and child to
understand the necessity of it. And that certainly is not
easy.

Judy> The big question remaining unanswered is why emmetropization
does not work in some people -- their eyes do not respond
to the retinal defocus, do not self correct and they end up
with refractive error.

Otis> Judy has no confabulated a series of misconceptions about
the fundamental eye's behavior. But again, error, error,
error of her language.

Judy> In the study you quoted, lenses were used to induce retinal
blur equivalent to a -3 or +3 refractive error

Otis> In this case the micro-blur at the surface of the retina
adjusted the "lens" to +3 diopters. Thus there was no
"retinal-blur". It is an ASSUMPTION. Thus the AVERAGE of
accommodation for one eye was 3 diopters DIFFERENT from the
other eye. The result OBJECTIVELY was that the refractive
STATE changed to the accommodation LEVEL. This is a
NATURAL process, not a "error" process. But let us call
this technical analysis of the natural eye's behavior the
"second-opinion".

Judy> and study how the eye reacts. It is not relevant to using
lenses to correct preexisting error.

Otis> Yet, again, error, error and error. These primates were one
month old and completely normal. The refractive STATES were
all normal.

Otis> These natural eye's simple changed their refractive STATE by
-2 diopters to an applied -3 diopter lens. That is
objective scientific truth. How simple can this be?

++++++++++++++++++++

The argument that Judy SHOULD make, is that she is dealing
with a person in the space of 5 to 20 minutes.

The "public" wants vision made very-sharp in a short period
of time, and has no interest in anything other than that.

Any type of "technical" discussion will be totally lost
on the public, and it is virtually impossible to
have a far-reaching discussion of any issue, other
than to make it "sharp" and the public insists.

If Judy made THAT argument -- then she would
have no disagreement with me.

But then, that is the "argument" that always
"wins" in the context of her office, and
what the public "expects".

I would prefer to have the facts (including the above issue)
presented to me.

Then I could make my own choice based on the
facts, and not on the conditions that "force" the
use of a minus lens.

That is why I so deeply respect the courage of Steve Leung -- to
take this first step towards plus-prevention -- based
on objective science, and not on what impresses
the public in 20 minutes.

Very few people understand how difficult (or
impossible) the public can be on this issue.

Best,

Otis

++++++++++