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Medical Forum / General / Vision / May 2007Preventing myopia entry -- a animation.
Dear Parents, This vidio discusses the role you could play with a second-opinion optometrist in preventing entry into myopia -- in the first place. http://www.preventmyopia.org/flashanimation.html Take your time, understand the scientific issues, and work WITH your optometrist on this subject. And read the "Printer's Son" so you do not make the same mistake that man made for his child. Otis I would also add the wretched habits of some (and perhaps many) children, of initially reading at a reasonable 13 inches (-3 diopters), but then as a "lazy habit", leaning forward on to book, and reading and writing at 6 inches (-6.6 diopters) to 4 inches (-10 diopters) and even 3 inches (-13 diopter!). Yes the majority-opinion NEVER includes this issue in the discussion with a parent, and never checks either. http://www.geocities.com/otisbrown17268/ReadDist.html As with the "Printer's Son", this issue is FAR MORE IMPORTANT THAN THE PLUS -- OR ANY DISCUSSION OF THE PLUS. This is an issue that is, or can be under control of the parents and child -- if they HAVE THE INTEREST. In a way, this is similar to preventing obesity in children. The real issue is the motivation of the child. Not everyting in this world is, or can be under "medical control". Some issues require your understanding, and motivation. Just one man's opinion. Otis On May 3, 10:24 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > Dear Parents, > [quoted text clipped - 12 lines] > > Otis On May 5, 10:13 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > In a way, this is similar to preventing obesity in children. Maybe you can use your "staircase" for this. On May 5, 10:13 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > I would also add the wretched habits of some (and perhaps > many) children, of initially reading at a reasonable 13 inches (-3 > diopters), > but then as a "lazy habit", leaning forward on to book, and > reading and writing at 6 inches (-6.6 diopters) to 4 inches > (-10 diopters) and even 3 inches (-13 diopter!). the "majority opinion" doctors (aka the doctors who follow the medical dictum supported by science) do not oppose children's excessively- short reading distance because that has never been demonstrated to have any effect on anything. just like using plus lenses to neutralize the accommodative influence of excessive near work has no effect on development of myopia. just like having myopes remove their glasses when they read has no effect on progression of myopia. and there is even a study where excessive amounts of minus power were given to children causing them to have to accommodate excessively all day long (how wretched!!) yet IT HAD NO EFFECT on myopia progression. so how can you seriously propose your theory of myopia progression in the face of all this contradicting evidence, which comes from a variety of different researchers scattered about in different laboratories throughout the world (so as to control for your "conspiracy" argument)? Okay, I can understand that initially you were unaware of all this data since you have no training in the field of vision research, but now you have been made fully aware with literature references, etc. Are you really such an irrational man? Its like you are looking at a dog, yet insisting its really a cat-- even though it keeps barking and barking at you. to everyone else out there help me understand Otis. What psychological disorder is characterized by a person who does not accepting the truth, even though the evidence is quite overwhelming and obvious to all others? Otis, have you ever sought out professional counseling? > the "majority opinion" doctors (aka the doctors who follow the medical > dictum supported by science) do not oppose children's excessively- > short reading distance because that has never been demonstrated to > have any effect on anything. I disagree. The relationship between myopia and short reading distance is pretty well established. We evidently can't interrupt the relationship by adding plus or removing minus, but there is experimental support for recommending visual breaks and reasonable working distances. If Otis stopped at recommending such "visual hygeine" I'd have no complaint. -MT > <p.clar...@gmail.com> wrote > [quoted text clipped - 13 lines] > > -MT i am unaware of evidence that changing reading distance affects myopia progression. and i certainly don't know ALL the literature. can you please pass along the reference to this work? thanks in advance > i am unaware of evidence that changing reading distance affects myopia > progression. So am I - I don't think anybody's tested that hypothesis specifically. It'd be hard to do. But I know the strong correlation between working distance and myopia is demonstrated in animals, and it appears to hold true in humans. The only abstract I have handy is pasted below. The recommendation for visual "breaks" comes from animal models of myopia, where even brief respites from close environment appear adequate to interrupt deprivation myopia. I believe myopia is 80-90% genetic. For the other 10-20% contribution of environment, these recommendations are about all that make sense. -MT ============================================ Br J Ophthalmol 1989 Jul;73(7):547-51 Related Articles, Links Effect of spectacle use and accommodation on myopic progression: final results of a three-year randomised clinical trial among schoolchildren. Parssinen O, Hemminki E, Klemetti A. Department of Ophthalmology, Central Hospital of Central Finland, Jyvaskyla. Two hundred and forty mildly myopic schoolchildren aged 9-11 years were randomly allocated to three treatment groups and the progression of myopia was followed-up for three years. The treatment groups were: (1) minus lenses with full correction for continuous use (the reference group), (2) minus lenses with full correction to be used for distant vision only, and (3) bifocal lenses with +1.75 D addition. Three-year refraction values were received from 237 children. The differences in the increases of the spherical equivalents were not statistically significant in the right eye, but in the left eye the change in the distant use group was significantly higher (-1.87 D) than in the continuous use group (-1.46 D) (p = 0.02, Student's t test). There were no differences between the groups in regard to school achievement, accidents, or satisfaction with glasses. In all three groups the more the daily close work done by the children the faster was the rate of myopic progression (right eye: r = 0.253, p = 0.0001, left eye: r = 0.267, p = 0.0001). Myopic progression did not correlate positively with accommodation, but the shorter the average reading distance of the follow-up time the faster was the myopic progression (right eye: r = 0.222, p = 0.0001, left eye: r = 0.255, p = 0.001). It seems that myopic progression is connected with much use of the eyes in reading and close work and with short reading distance but that progression cannot be reduced by diminishing accommodation with bifocals or by reading without spectacles. (trimmed) >Br J Ophthalmol 1989 Jul;73(7):547-51 Related Articles, Links > [quoted text clipped - 26 lines] >reading distance but that progression cannot be reduced by diminishing >accommodation with bifocals or by reading without spectacles. Thanks very much for that. The correlation between reading distance and myopic progression is very interesting, since reading distance could, at least in theory, be modified after taking advice - although I suspect that a correlation of r=0.2 or so is more useful as a signpost than a treatment. Is there any experiment in which an intervention group of patients were advised that changing reading distance might slow the progression of their myopia? If this is true, it would be useful advice to hand out - of course, until such a study is done, it will be uncertain as to whether reading distance affects myopia progression or vice versa.  SignatureA.G.McDowell Dear Friend, Some ODs recognize the reading distance is critical FOR PREVENTION. Other ODs believe that environment has NO EFFECT on the refractive STATE of the natural eye. Here is a statement about how critical it is to prevent a child from leaning forward and reading at -13 diopters (3 inches). Enjoy, Otis +++++++++++++++ Subject: Here is the statement of the "Harmon Distance" STRESS REDUCTION There is an intimate relationship between posture, working distance, desk surface and lenses. Pioneering experiments by Dr. Darrel Boyd Harmon and subsequent research by Drs. John Pierce and Steven Greenspan clearly prove a reduction of stress and improved performance when conditions are arranged properly for near-point visual activities. The following changes were observed: reduced heart rate, more regular and deeper breathing, and reduced neck muscle and overall body tension. To achieve these benefits the following must be arranged: Working Surface: A sloping working surface must be used that is tilted between 20 and 23 degrees from the horizontal. Posture: Seated comfortably, relatively erect, feet flat on floor or box. Working Distance: The "Harmon Distance" is the optimal distance from the eyes to the working surface. It is the distance from the elbow to the first knuckle. This can only be assured with a proper chair height to desk relationship. Nearpoint Lenses: A specific, low power prescription not used to correct a defect in the eyes but to put the eyes into better balance for near tasks. This enhances and integrates the posture, working distance, and surface relationship. Instructions for Visual Hygiene 1. Do all near point activity at HARMON distance or slightly further. This is the distance from the center of the middle knuckle to the center of the elbow measured on the outside of the arm. Working at the Harmon distance reduces near point visual stress. 2. Be AWARE of space between self and the page when reading. Also, be aware of things around and beyond the book. 3. When reading, occasionally look off at a specific distant object and LET its details come into focus. Maintain awareness of other objects and details surrounding it. Do this at least at the end of each page. 4. When studying, place a bookmark 3 or 4 pages ahead. Get up and move around for at least one minute each time you reach the bookmark. 5. Sit UPRIGHT. Practice holding your back arched while you read and write. Avoid reading while lying on your stomach on the floor. Avoid reading in bed while lying on your stomach on the floor. Avoid reading in bed, unless sitting reasonably upright. 6. Provide for adequate general illumination, as well as good central illumination, at the near task. The illumination on the task should be about three times that of the surrounding background. 7. Tilt the book up about 20 degrees (this slopes up about 4 inches in 12). A tilt top for the desk can be made by screwing two door stops to the back of a piece of 1/2 inch plywood or a drawing board, and two rubber knobs to the near end so it doesn't slip off the desk. This can be used for reading, studying, writing. It usually enables working farther away from the task than when the task is flat on the desk. 8. Do not sit any closer to TV than 6 to 8 feet, and be sure to sit upright. Maintain good posture. 9. When riding in a vehicle, avoid reading and other near activity. Encourage looking at sights in the distance for interest and identification. 10. Encourage outdoor play or sports activities that require seeing beyond arm's length. 11. When outdoors, sight a distant object at about eye level. At the same time, be aware of where things are on all sides. 12. Walk with head up, eyes wide open and look TOWARD, not at, objects. 13. Become very conscious of the background of the objects you look TOWARD, be it a person, print on a page, an electric sign, the TV, or any other object. ++++++++ Note: Harmon was a behaviorial optometrist (second-opinion). So now the majority-opinion ODs acknowledge that a very-close near enviroment is a problem for a child. Funny, then never say this until you suggest that the parent pay attntion to his child's reading "habits." Otis ++++++++++ > In article <R6OdnUaeGtEPl6PbnZ2dnUVZ_vCkn...@giganews.com>, Mike Tyner > <mty...@mindspring.com> writes > (trimmed) > [quoted text clipped - 43 lines] > > - Show quoted text - On May 7, 8:59 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > Instructions for Visual Hygiene > 1. Do all near point activity at HARMON distance or slightly further. [quoted text clipped - 35 lines] > 13. Become very conscious of the background of the objects you look > TOWARD otis, please provide any proof that any of these recommendations has any basis in fact. is there any data to support them? we all know that the answer is NO. this is just a bunch of feel-good happy horseshit that a small group of retro-medical optometrists sat down and wrote out that has ZERO substance to it. what does vision have to do with good posture-- really otis. and why should anyone tilt their reading material at 20 degrees, rather than 17 degrees, or 22 degrees. and perhaps they should have added some more important points to their recommendation-- like eating a good diet based upon the food pyramid. perhaps going to church on sundays would also promote good vision, as well as saying "please" and "thank you". I think that properly respecting your elders should definitely be on the list. by the way, you never have let us know what the results were of the study that you performed on myopia development. where is it published? how was it set up and what are the conclusions. i guess you just forgot to reply. > treatment. Is there any experiment in which an intervention group of > patients were advised that changing reading distance might slow the > progression of their myopia? If this is true, it would be useful advice Not that I know of. Of course you understand that reading distance can't be a major factor, since it's mostly genetic. Given parents who are concerned enough to try anything, it's the only advice that can't be laughed off by the medical establishment. -MT > <p.clar...@gmail.com> wrote > [quoted text clipped - 49 lines] > reading distance but that progression cannot be reduced by diminishing > accommodation with bifocals or by reading without spectacles. MT, thanks for the reference. sure, it is quite clear that there is a correlation between near work and myopia. that's been known for decades. but going so far as to say that telling a child whom is reading at a distance that is "too close" to their reading material (according to someones arbitrary opinion), and that they should move back to some other preferable reading distance (again, someones arbitrarily-assigned distance), and that that change will reduce their risk of developing myopia, is going way too far. that's what my objection to Otis and his website link is about. but while I am already familiar with the Parssinen study, I don't remember the specifics that relate to the following part of the abstract you posted: "Myopic progression did not correlate positively with accommodation, but the shorter the average reading distance of the follow-up time the faster was the myopic progression ". that statement is hard to decipher but seems to suggest that the study actually DOES have some data showing that adjusting reading distance has value. i will have to dig up that article and reread it. maybe I am not as familiar with it as I thought. i was trained and employed as a Ph.D. biological researcher before I returned to opto school and became a clinician twelve years later. in general it takes solid scientific proof to make me embrace a treatment regimen. just suggesting something like "have your child move back from their reading material" or "sitting closer than 6 feet from the television is not advised" when there isn't any specific proof for those recommendations doesn't sit well with me. sounds kind of like old-line "behavioral optometry/OEP" type thinking to me and I am not an advocate of that type of practicing. perhaps that's what otis thinks of when he talks about "second-opinion" optometrists-- i.e. older-style optometrists who practice unproven methods just because they feel right but are untested and have never been subjected to scientific scrutiny. please don't come away feeling like I am trying to lump you into that latter group of optometrists. pointing out that there is a correlation between near work and myopia, which i realize is clear, does not mean that one can extrapolate that observation in to specific recommendations about optimal reading distances or TV viewing distances. On May 7, 7:20 pm, p.clar...@gmail.com wrote: > > ...But I know the strong correlation between working distance and myopia is > > demonstrated in animals, and it appears to hold true in humans. The only > > abstract I have handy is pasted below. Isn't it mixing up cause and effect? > On May 7, 7:20 pm, p.clar...@gmail.com wrote: > [quoted text clipped - 3 lines] > > Isn't it mixing up cause and effect? possibly so. but what he said is that there is a correlation, not a cause or an effect. a strong correlation can be used to infer cause, but it cannot prove it. only direct experimental evidence can demonstrate cause. regardless, even if a population of properly-corrected myopes were compared to non-myopes, I suspect you would still find that the corrected myopic group would engage in more near work than the non- myopic group. don't know if its been done. On May 7, 8:39 pm, p.clar...@gmail.com wrote: > > On May 7, 7:20 pm, p.clar...@gmail.com wrote: > [quoted text clipped - 13 lines] > corrected myopic group would engage in more near work than the non- > myopic group. don't know if its been done. I tend to believe that children (and adults), myopes or not, corrected or not, will choose the distance that is most comfortable for them. In other words, their ability to see details clearly dictates their chosen distance, not the other way around. >I tend to believe that children (and adults), myopes or not, corrected >or not, will choose the distance that is most comfortable for them. >In other words, their ability to see details clearly dictates their >chosen distance, not the other way around. Our buddy, Otis, likes to mention that "long-haul truck drivers don't tend to get myopia," to which I have consistently replied that, perhaps, myopes don't often go into long-haul trucking. Otis has a HUGE problem with constantly conflating correlation with causation. Among other things.... > Yes the majority-opinion NEVER includes this issue in > the discussion with a parent, and never checks either. If you Google "Harmon distance" you might feel like an ignorant troll. Or not. -MT Once again you post while playing with yourself Cletis. Take your hand off, pull your pants up and go wash your underwear. Dear Catman, Do you think that all second-opinion ODs (for preveniton are WRONG)? And further to you object to Harmond's recommendation that children be prevented from reading a -10 diopters (4 inches) and for some -13 diopters (3 inches). Or do you consider that this has NO EFFECT on the refractive STATE of the natural eye. Please explain your majority-opinion position. What SPECIFICALLY do you object do in Dr. Harmon's scientific recommendations? Otis ++++++++ Subject: Here is the statement of the "Harmon Distance" STRESS REDUCTION There is an intimate relationship between posture, working distance, desk surface and lenses. Pioneering experiments by Dr. Darrel Boyd Harmon and subsequent research by Drs. John Pierce and Steven Greenspan clearly prove a reduction of stress and improved performance when conditions are arranged properly for near-point visual activities. The following changes were observed: reduced heart rate, more regular and deeper breathing, and reduced neck muscle and overall body tension. To achieve these benefits the following must be arranged: Working Surface: A sloping working surface must be used that is tilted between 20 and 23 degrees from the horizontal. Posture: Seated comfortably, relatively erect, feet flat on floor or box. Working Distance: The "Harmon Distance" is the optimal distance from the eyes to the working surface. It is the distance from the elbow to the first knuckle. This can only be assured with a proper chair height to desk relationship. Nearpoint Lenses: A specific, low power prescription not used to correct a defect in the eyes but to put the eyes into better balance for near tasks. This enhances and integrates the posture, working distance, and surface relationship. Instructions for Visual Hygiene 1. Do all near point activity at HARMON distance or slightly further. This is the distance from the center of the middle knuckle to the center of the elbow measured on the outside of the arm. Working at the Harmon distance reduces near point visual stress. 2. Be AWARE of space between self and the page when reading. Also, be aware of things around and beyond the book. 3. When reading, occasionally look off at a specific distant object and LET its details come into focus. Maintain awareness of other objects and details surrounding it. Do this at least at the end of each page. 4. When studying, place a bookmark 3 or 4 pages ahead. Get up and move around for at least one minute each time you reach the bookmark. 5. Sit UPRIGHT. Practice holding your back arched while you read and write. Avoid reading while lying on your stomach on the floor. Avoid reading in bed while lying on your stomach on the floor. Avoid reading in bed, unless sitting reasonably upright. 6. Provide for adequate general illumination, as well as good central illumination, at the near task. The illumination on the task should be about three times that of the surrounding background. 7. Tilt the book up about 20 degrees (this slopes up about 4 inches in 12). A tilt top for the desk can be made by screwing two door stops to the back of a piece of 1/2 inch plywood or a drawing board, and two rubber knobs to the near end so it doesn't slip off the desk. This can be used for reading, studying, writing. It usually enables working farther away from the task than when the task is flat on the desk. 8. Do not sit any closer to TV than 6 to 8 feet, and be sure to sit upright. Maintain good posture. 9. When riding in a vehicle, avoid reading and other near activity. Encourage looking at sights in the distance for interest and identification. 10. Encourage outdoor play or sports activities that require seeing beyond arm's length. 11. When outdoors, sight a distant object at about eye level. At the same time, be aware of where things are on all sides. 12. Walk with head up, eyes wide open and look TOWARD, not at, objects. 13. Become very conscious of the background of the objects you look TOWARD, be it a person, print on a page, an electric sign, the TV, or any other object. ++++++++ Note: Harmon was a behaviorial optometrist (second-opinion). So now the majority-opinion ODs acknowledge that a very-close near enviroment is a problem for a child. Otis > Once again you post while playing with yourself Cletis. > > Take your hand off, pull your pants up and go wash your underwear. On May 9, 10:27 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > Dear Catman, > [quoted text clipped - 109 lines] > > > Take your hand off, pull your pants up and go wash your underwear. =================================================== otis, please provide any proof that any of these 13 dumb recommendations has any basis in fact. is there any data to support them? we all know that the answer is NO. this is just a bunch of feel-good happy horseshit that a small group of retro-medical optometrists sat down and wrote out that has ZERO substance to it. what does vision have to do with good posture-- really otis. and why should anyone tilt their reading material at 20 degrees, rather than 17 degrees, or 22 degrees. and perhaps they should have added some more important points to their recommendation-- like eating a good diet based upon the food pyramid. perhaps going to church on sundays would also promote good vision, as well as saying "please" and "thank you". I think that properly respecting your elders should definitely be on the list. by the way, you never have let us know what the results were of the study that you performed on myopia development. where is it published? how was it set up and what are the conclusions. i guess you just forgot to reply. On May 9, 7:27 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote: [Otis putting words in people's mouths snipped] > Please explain your majority-opinion position. Please explain why your niece, Joy, is a myope ... despite your intervention with the plus lens? Don't you love her, Uncle Otie?? |
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