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:

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.

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.

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?

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

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)

Pot, meet kettle.

-MT

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.

I think everybody knows what your limitations are.

DrG

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