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Medical Forum / General / Vision / April 2007

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vision after lens removal

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cdavis@directflatscreen.tv - 01 Apr 2007 17:37 GMT
If a person were very nearsighted and then had his natural lens
removed, what sort of vision might he have? Could his eye structure
and cornea provide near "normal" distance correction? If not, why not?
otisbrown@pa.net - 01 Apr 2007 19:17 GMT
Dear cda,

Subject:  The power of the lens of the eye.

The power of the eye's lens is about 10 diopters.

If that is removed, the total refractive power of the eye
is changed by that amount.

If the person had a refractive STATE of -5 diopters before
the removal of the lens (say for caterack), then the
eye's power would change to +5 diopters (by
simple optics.

The IOL is normally determined by calculation so
that when the lens is replaced, the eye's refractive
STATE is made approximately zero.

It is a great idea and it WORKS!

Best,

Otis

On Apr 1, 12:37 pm, cda...@directflatscreen.tv wrote:
> If a person were very nearsighted and then had his natural lens
> removed, what sort of vision might he have? Could his eye structure
> and cornea provide near "normal" distance correction? If not, why not?
cdavis@directflatscreen.tv - 01 Apr 2007 22:04 GMT
On Apr 1, 11:17 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> Dear cda,
>
[quoted text clipped - 25 lines]
> > removed, what sort of vision might he have? Could his eye structure
> > and cornea provide near "normal" distance correction? If not, why not?

So if I were +1.5 then I would be +11.5 and if I were -13.5 then I
would be -3.5 without any lens or IOL?
Dr Judy - 01 Apr 2007 22:54 GMT
On Apr 1, 2:17 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> Dear cda,
>
> Subject:  The power of the lens of the eye.
>
> The power of the eye's lens is about 10 diopters.

Actually it is about 14D to 20D.  The model of the average eye has a
total refractive power of about 60D, with 43D from the cornea and 17D
from the lens.

Before intraocular lenses were in use, patients typically had +12 to
+20 refraction after cataract surgery.   A high myope (> -14D) may be
close to no refractive error after cataract surgery.

Dr Judy
cdavis@directflatscreen.tv - 02 Apr 2007 00:32 GMT
> On Apr 1, 2:17 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
>
[quoted text clipped - 13 lines]
>
> Dr Judy

If there were no cataracts and a person was +1.5 before surgery then
an IOL of +20.5 might not be out of line? What if a person was -13.5
and an IOL of +13.5 were put in?
Dr Judy - 02 Apr 2007 02:54 GMT
On Apr 1, 7:32 pm, cda...@directflatscreen.tv wrote:

> > On Apr 1, 2:17 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
>
[quoted text clipped - 16 lines]
> If there were no cataracts and a person was +1.5 before surgery then
> an IOL of +20.5 might not be out of line?

IOLs of that power are used.

What if a person was -13.5
> and an IOL of +13.5 were put in?

Assuming the natural lens was +16 and ignoring some other placement
factors, then the refraction after surgery would be -13.5 - (+16   -
+13.5) = -11.00.

The real answer depends on eye length and corneal curvature.  There is
a formula that uses those numbers and some other eye measurements to
calculate what refraction will result from what power of IOL .

Dr Judy
otisbrown@pa.net - 02 Apr 2007 03:00 GMT
Dear Cda,

This is a matter of calculation before the surgery.

Knowing the refractive state of the eye before the
surgery, and by use of ultra-sound, the replacement
IOL is calculated.

The result, if done correctly is a total refractive state
of approximately zero -- which is the goal.

Since the IOL can not "accommodate", it follows that
the person can have the IOL tailored for "near" or "far",
or an intermediate position.

For instance the "target" could be a refractive STATE of
-1.0 diopters which would allow near vision (with depth-of-focus
of 1 to 2 diopters), and far vision of about 20/60.

Thus a mild minus of about -1 diopter could be used
to pass the DMV, but for most purposes the person
could function with no lens at all.

The person would need a mild plus for restaurants
with low level illumination.

Further, the person could request "mono-vision" where
a DIFFERENCE in refractive state was intentional.

Thus one eye could be close to 20/20, and
the other eye at -1 diopters.

Best,

Otis

On Apr 1, 7:32 pm, cda...@directflatscreen.tv wrote:

> > On Apr 1, 2:17 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
>
[quoted text clipped - 19 lines]
>
> - Show quoted text -
p.clarkii@gmail.com - 02 Apr 2007 03:18 GMT
On Apr 1, 10:00 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> Dear Cda,
>
[quoted text clipped - 57 lines]
>
> > - Show quoted text -

please disregard the poster named otis brown.  as he has demonstrated,
his facts are inaccurate.  he is nothing more than an amateur with a
fetish for issues relating to the human eye, combined with a desire to
see his posts appear on the internet.  the value of his posts is less
than zero.
otisbrown@pa.net - 02 Apr 2007 03:31 GMT
Dear PClar,

Please explain to CDA EXACTLY what statement I made
that was not accurate -- in YOUR judgment.

I am certain he would like to hear YOUR opinion.

All you wish to do is to denounce people -- never
help them at all.

Now, please explain, and an optometrist, how
you understand the use of a replacement lens.

Otis

On Apr 1, 10:18 pm, p.clar...@gmail.com wrote:
> On Apr 1, 10:00 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
>
[quoted text clipped - 67 lines]
>
> - Show quoted text -
p.clarkii@gmail.com - 02 Apr 2007 12:04 GMT
On Apr 1, 10:31 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> Dear PClar,
>
[quoted text clipped - 10 lines]
>
> Otis

that you believe the refractive state of the cornea is about 10
diopters is ridiculuous.  that you believe that a child with
intermittent eso needs to see an "behavioural optometrist" is
ridiculuous.

i have earned two advanced degrees-- vision research and optometry.  i
currently practice optometry in the midwest US.  i have participated
as an in-room observer in multiples types of ocular surgeries included
cataract, lasik, strabismus, etc.

my postings are helpful to many people here-- just not to you!  you
are a foolish old man who gets involved in things he knows nothing
about and apparently isn't embarrassed by being made a fool of.

and how has the investigation by the State of Pennsylvania into the
claims that you are practicing medicine without a license coming
along?  apparently they are slowing you down any?

go play shuffle-board and stick your nose out of everyone's business
otisbrown@pa.net - 02 Apr 2007 13:58 GMT
and how has the investigation by the State of Pennsylvania into the
claims that you are practicing medicine without a license coming
along?

It turns out that the man was posting under a false name,
and making fradulent statements.

I contacted the agency, and forwared his posts.  I stated
that I argued that a person should be supplied with
an HONEST choice by a second-opinion expert
optometrist like Steve Leung at:

www.chinamyopia.org

I stated that this preventive alternative must START before
the minus lens is applied.

I stated that I was an engineer, and suggested that they
read my site:

www.myopiafree.com

I provided references to the primate studies that
proved that the natural eye's refractive STATE follows
an applied -3 diopter lens -- always.

I stated that when experts disagree, then it is
wise for the person himself to be informed in a
manner that allows for intelligent choice.

I stated that once the minus lens is started, the
refractive STATE of the eye will go down
at a rate of -1/2 diopter per year.

I stated that my perspective is to provide
second-opinion information, and to
help the person find a SUPPORTIVE plus-prevention
optometrist.

The address supplied by the person who filed the
"charge" does not exist.

Otis

On Apr 2, 7:04 am, p.clar...@gmail.com wrote:
> On Apr 1, 10:31 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
>
[quoted text clipped - 32 lines]
>
> go play shuffle-board and stick your nose out of everyone's business
p.clarkii@gmail.com - 02 Apr 2007 15:10 GMT
On Apr 2, 8:58 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> and how has the investigation by the State of Pennsylvania into the
> claims that you are practicing medicine without a license coming
[quoted text clipped - 78 lines]
>
> > go play shuffle-board and stick your nose out of everyone's business

you try to dupe people with lies and misinformation.  perhaps
Pennsylvania will take action against you like Iowa did against the
foolish "I See Clearly" people.  probably you are a little safer since
you don't overtly try to sell any products-- except maybe your dumb
book.
otisbrown@pa.net - 02 Apr 2007 15:25 GMT
PClar,

You tell the public scientific lies when you state
that the fundamental eye is not dynamic -- with
respect to an applied -3 diopter lens.  See:

http://www.geocities.com/otisbrown17268/FundEye.html

I would suggest that a person be informed of this fact,
and encouraged to review the preventive
alternative (that is preventing the developement
of a negative refractive STATE) before
that FIRST strong minus lens is applied,
and the individual told to "...wear it all the time ... it
is GOOD for you.".

I think you should respect the intelligence of the person,
and show him the facts, rather than telling him
convient office fibs.

And if the person "loves" the minus, that that would
end your responsibility to him.

But at least he would respect you for being HONEST
with him, and respecting his right of choice.

I know I would certainly respected the medical people
I have talked to -- if they had taken that simple and
honest step.

Is there any (none-medical) person posting on here who would OBJECT
to being supplied with an honest second opinion?

And if so, why?

Otis

On Apr 2, 10:10 am, p.clar...@gmail.com wrote:
> On Apr 2, 8:58 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
>
[quoted text clipped - 88 lines]
>
> - Show quoted text -
otisbrown@pa.net - 02 Apr 2007 15:32 GMT
And PClar, I PERSONALLY wish I had been supported by]
these preventive methods.   And my book is supplied so that
when you state, "there is an alternative to the quick-fix minus.
If you want additional information, read:"

http://www.i-see.org/otis_brown/

And if you wish plus-prevention, then I will help you with it, or,

I, Pclar, can not, and will not support you with plus-prevention,
but others WILL support you.  Please go to an
optometrist like Steve Leung, who has his own
children wearing a plus for all close work so they
AVOID ENTRY into a negative refractive STATE.  See:

www.chinamyopia.org

I realize you must practice what you want to believe.  But
that is not what other optometrists believe -- because
of the science concerning the proven dynamic behavior
of the natural eye.

Otris

On Apr 2, 10:25 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> PClar,
>
[quoted text clipped - 129 lines]
>
> - Show quoted text -
otisbrown@pa.net - 02 Apr 2007 15:37 GMT
And to further enhance your understanding of this
PREVENTIVE second-opinion I suggest you
read this eBook on the subject.:

http://www.preventmyopia.org/ebook/

Otis

On Apr 2, 10:32 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> And PClar, I PERSONALLY wish I had been supported by]
> these preventive methods.   And my book is supplied so that
[quoted text clipped - 157 lines]
>
> - Show quoted text -
p.clarkii@gmail.com - 02 Apr 2007 17:10 GMT
On Apr 2, 10:32 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:

> I realize you must practice what you want to believe.  But
> that is not what other optometrists believe -- because
> of the science concerning the proven dynamic behavior
> of the natural eye.
>
> Otris

hello Otris,
i guess the thorazine is beginning to kick in.
anyway, why don't you give us the names of all the other optometrists
who believe in your "second opinion" hogwash.  we should have their
state licensing boards consider revolking their licenses.  or are
there really any?
Neil Brooks - 02 Apr 2007 16:45 GMT
On Apr 2, 7:25 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:

> Is there any (none-medical) person posting on here who would OBJECT
> to being supplied with an honest second opinion?
>
> And if so, why?

This is simple ... because I believe you're pathologically ill.

You, yourself--on Alex's I-SEE board--stated that this whole -3.00d
thing is an intentional over-correction to see what effect it MIGHT
have WHEN TAKEN TO AN EXTREME.

As I said, 100 aspirin might kill a person.

What you're saying is that nobody should take a single aspirin because
aspirin are inherently dangerous.

:Remember my line, Uncle Otie?  "Safe when used as directed."

This--among several thousand other things--makes you a fool.
p.clarkii@gmail.com - 02 Apr 2007 17:05 GMT
On Apr 2, 10:25 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> PClar,
>
> You tell the public scientific lies when you state
> that the fundamental eye is not dynamic -- with
> respect to an applied -3 diopter lens.  See:

Err-- i don't recall ever saying this.  why are you putting words in
my mouth?

the "-3.00 diopter" data that you are referring to is performed on
monkeys, not humans.
Goss et al. presented data in humans showing that overminusing by
-0.75D had no effect on myopia progression in children.  why do you
ignor human data and grasp onto extrapolation from old experiments
done on lenses sutured onto the eyes of monkeys?  you are not capable
of objective thinking.

> http://www.geocities.com/otisbrown17268/FundEye.html
>
> I would suggest that a person be informed of this fact,

this site has nothing to do with facts.  it is the thought process of
a kook.  unless of course we are worried about inducing myopia in
monkeys where the article you salute clearly supports that we should
not overminus them by -3.00 or they might become myopic (not to
mention develop a crashing headache and have their eyes cross).

> and encouraged to review the preventive
> alternative (that is preventing the developement
[quoted text clipped - 6 lines]
> and show him the facts, rather than telling him
> convient office fibs.

i have scientific references which document my claims.  the facts are
that:
1.  minus lenses do not induce myopia
2.  plus lenses or bifocals do not prevent myopia

please present us YOUR data, performed on human subjects (these issues
HAVE been studies in humans) which supports your claims.  and quit
telling your internet fibs (aka LIES).

> And if the person "loves" the minus, that that would
> end your responsibility to him.
[quoted text clipped - 12 lines]
>
> Otis

Otis, the number of people in the entire world who believe in your
totally unsupported theory ("second opinion") can be counted with the
fingers on 1 hand.  it all has been disproven in the last 25 years.
why won't you get on PubMed and Google Scholar and do a little
searching.

People aren't interested in your so-called "second opinion" because
its rubbish.  such people might as well get their information from the
National Enquirer.

you are a pathetic, and frankly sick, man
William Stacy - 02 Apr 2007 18:01 GMT
You too?  In the days when I was responding to Otris' stuff, he would
say repeatedly that I said that the eye is not "dynamic", which was a
complete fabrication as everyone knows the young healthy human eye is
very dynamic.  It's just that his definition of dynamic is not the
English definition.  Just like his definitions of natural, fundamental,
refractive state, minus and plus to name a few are not from around here...

w.stacy, o.d.

>On Apr 2, 10:25 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
>  
[quoted text clipped - 88 lines]
>
>  
cdavis@directflatscreen.tv - 02 Apr 2007 19:09 GMT
> You too?  In the days when I was responding to Otris' stuff, he would
> say repeatedly that I said that the eye is not "dynamic", which was a
[quoted text clipped - 83 lines]
>
> >you are a pathetic, and frankly sick, man

Is anyone in this group professional? Or does everyone forget they've
been on this merry-go-round before? Life is just a bit of history
repeated until the clearing at the end of the path is attained.
Neil Brooks - 02 Apr 2007 19:24 GMT
On Apr 2, 11:09 am, cda...@directflatscreen.tv wrote:

> Is anyone in this group professional? Or does everyone forget they've
> been on this merry-go-round before? Life is just a bit of history
> repeated until the clearing at the end of the path is attained.

I'd say you're new here, huh?

I'm not.

Absent Otis, everybody here is kind, helpful, and professional.  Otis
is poisonous to an otherwise exceptional group.

Look back at about 7+ years of history before rendering judgment on
those who respond to him.
cdavis@directflatscreen.tv - 03 Apr 2007 17:55 GMT
> On Apr 2, 11:09 am, cda...@directflatscreen.tv wrote:
>
[quoted text clipped - 11 lines]
> Look back at about 7+ years of history before rendering judgment on
> those who respond to him.

I'm not rendering judgement. I'm just curious as to why anyone would
continue to carry on such a "conversation" when there is no resolution
in sight. No pun intended. If it brightens up your day, go for it.
Unless Otis's opinions have caused harm to someone there is no need to
be confrontational. Use your expertise to answer real questions from
real people. Best regards, CDavis
Neil Brooks - 04 Apr 2007 02:00 GMT
On Apr 3, 9:55 am, cda...@directflatscreen.tv wrote:

> Unless Otis's opinions have caused harm to someone there is no need to
> be confrontational.

They have.

I reported just shy of a dozen cases of double vision--induced in
unsuspecting people following Otis's advice, whether for themselves or
their children--to the State of Pennsylvania who has an open
investigation on the matter.

The fact that Otis "prescribes" to pre-teen children, and without
parental consent, is repugnant to most people.
otisbrown@pa.net - 04 Apr 2007 02:28 GMT
> On Apr 3, 9:55 am, cda...@directflatscreen.tv wrote:
>
[quoted text clipped - 10 lines]
> The fact that Otis "prescribes" to pre-teen children, and without
> parental consent, is repugnant to most people.
otisbrown@pa.net - 04 Apr 2007 02:37 GMT
Dear CDA,

Subject: Neil Brooks "qualfications".

Neil Brooks has no medical qualifications to make any
medical statement.

He makes mindless statements with no scientific support.

The minus lens indeed profoudly "easy", and works
instantly -- but that is hardly a scientific justification.

Perhaps you should as Neil to provide his qualifications
to make the statements he is making.

Medicine and science are both developing concepts.

I have identified myself as an engineer, by training, and
have reviewed the subject understand the wisdom
of the preventive second-opinion.

I have stated many times that I would send you
to an optometrist who has his own children
wearing a plus (for prevention) to AVOID entry
into a negative refractive STATE.

It is true that plus-prevention required personal resolve,
and a decision or choice for the parents.

But even in ophthamology, some medical doctors
believe it is wise as Dr. Romano states.

                        Foreword

    Ophthalmologists, optometrists and research workers are
responsible for the second opinion presented in this book, that
nearsightedness (myopia) is as much, if not greatly more, due to
environment (and avoidable) than heredity (unavoidable).

    The essence of avoiding myopia is using a plus lens (a mild
magnifying glass, as in reading glasses required by older people)
before the eye becomes seriously nearsighted.

    If the approach advocated in this book is to work properly,
you must take full responsibility to develop a clear understanding
of the normal eye's behavior.  In addition, you must personally
implement the practical method of prevention.  In this situation
we can only offer the student of science an accurate picture of
existing practices, as well as an education about the fundamental
behavioral characteristic of the normal eye.  This approach will
put you in full control of your visual welfare.

    The author has demonstrated a depth of understanding of the
problems and limits that occur in existing health practice.  With
good judgment, and personal effort, it is highly probable that you
can avoid nearsightedness.

            Paul E. Romano M.D., M.S.O.
            Professor of Ophthalmology,
            University of Florida, Gainesville

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

It is always a good idea to evaluate the scientific fact concerning
the dynamic behavior of the fundamental eye -- and consider
the preventive alternative, before stair-case myopia develops.

Then I do agree that vision-clearing does become impossible.

In other words, a stich in time saves nine.

Otis
Neil Brooks - 04 Apr 2007 03:36 GMT
On Apr 3, 6:37 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:

> Subject: Neil Brooks "qualfications".

Still irrelevant ... after all these years.

> He makes mindless statements with no scientific support.

Actually, I ask pointed, logical, coherent, and relevant questions ...
that you don't answer.

See: http://nbeener.com/NDB_OSB_Qs.txt
p.clarkii@gmail.com - 04 Apr 2007 08:37 GMT
On Apr 3, 9:37 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> Dear CDA,
>
> Subject: Neil Brooks "qualfications".

this is not the subject.  the subject is YOUR qualifications.

> Neil Brooks has no medical qualifications to make any
> medical statement.
>
> He makes mindless statements with no scientific support.

the above two statements relate to YOU.

> I have identified myself as an engineer, by training, and
> have reviewed the subject understand the wisdom
> of the preventive second-opinion.

what about the "wisdom" of paying any regard to the studies that have
tested myopia prevention with plus lenses, removing glasses,
undercorrection, etc.  how come all the HUMAN studies show that the
"wretched minus" really isn't so evil after all.  how come the simple
minded notion that relaxing accommodation by using plus readers simply
doesn't in reality have any effect on preventing myopia-- at least in
the REAL world-- maybe not in the fantasy world that is in the mind of
Otris who decides what is right and wrong and who believes he is
smarter than science!

> But even in ophthamology, some medical doctors
> believe it is wise as Dr. Romano states.

tell me, are you "good friends" with dr romano just as you are with
ted grosvenor (who never heard of you before)?  ;)

are you friends in real life or in your fantasy world where your
beliefs are held in high esteem and where you are regarded as a savior
to the vision of the poor victims of evil optometrists who conspire to
hook people on the wretched minus.
Neil Brooks - 02 Apr 2007 16:41 GMT
On Apr 2, 5:58 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
> and how has the investigation by the State of Pennsylvania into the
> claims that you are practicing medicine without a license coming
> along?
>
> It turns out that the man was posting under a false name,
> and making fradulent statements.

Liar.

The process was initiated using my TRUE name and making perfectly
honest, accurate, and valid statements ... that the State of
Pennsylvania then investigated.  They are awaiting additional
complainants willing to attest.

I'm sure you'll provide a few in due course.

> The address supplied by the person who filed the
> "charge" does not exist.

Liar.  I gave--and YOU POSTED--my real, valid address.

You should stop lying.  It's indicative of poor moral character.
cdavis@directflatscreen.tv - 02 Apr 2007 04:11 GMT
On Apr 1, 7:18 pm, p.clar...@gmail.com wrote:
> On Apr 1, 10:00 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote:
>
[quoted text clipped - 65 lines]
> see his posts appear on the internet.  the value of his posts is less
> than zero.

His post here certainly gives a comprehensive overview of the
situation. I think I might choose  to bring myopia in one eye closer
to the almost "normal" of the other eye. If a person is used to
wearing glasses anyway and expects to need correction after surgery
maybe distance vision in both eyes would be nice. The question in this
case is the proper determination of IOL power in the absence of
cataract. What other factors are used besides corneal curvature, axial
length, and present correction needed for distance?
Say a person had a prescription of:
OD  -13.3
OS  +0.50  -2.25  x170

Has K's of:
OD  44.37  x0  44.37  x0  7.61mm  7.61mm  axial length: 25.48
OS  43.25  x175  45.50  x85  7.80mm  7.42mm  axial length:  23.57

Also, what changes might be made to the calculation if a +1 grade
cataract were found before the natural lens was removed?
Dr Judy - 02 Apr 2007 19:18 GMT
On Apr 1, 11:11 pm, cda...@directflatscreen.tv wrote:
>The question in this
> case is the proper determination of IOL power in the absence of
[quoted text clipped - 7 lines]
> OD  44.37  x0  44.37  x0  7.61mm  7.61mm  axial length: 25.48
> OS  43.25  x175  45.50  x85  7.80mm  7.42mm  axial length:  23.57

The current prescription is not a factor.  There are a number of other
eye measures obtained with ultrasound including anterior chamber
depth, position of the lens capsule that factor into the formula.
More than one formular exists and surgeons chose a formula based on
their experience, the type of ultrasound used and some eye factors.

Whether or not a cataract currently exists doesn't matter as the lens
will be removed.

Here is a link to formula discussion:

http://www.crstodayarchive.com/03_archive/0202/crst0202_1_041.html

Dr Judy
 
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