Bad vision at end of day -- Part 2

Discussion in 'Eye-Care' started by Otis Brown, Nov 14, 2003.

  1. Otis Brown

    Otis Brown Guest

    Dear Mike,

    Subject: Two scientific paradigms for the natural eye,
    dynamic or box-camera?

    The originsl reason for the post was to
    suggest to Matt a possible alterantive to
    keep his distant vision clear -- by wearing
    a plus two diopter lens while working on a computer.

    The standard approach is to say that working
    at -2 diopters has no effect on the focal status of
    the eye, and to just "quick-fix" the distant vision
    with a minus lens.

    Here is our response to your commentary.

    Thanks you for your time and interest in this

    I will reply to your additional commentary
    (previous thread) shortly.



    Subject: Was: Bad vision at the end of the day, and w/ light

    Otis> > The focal state of the natural eye depends on its average
    visual environment.

    Mike> Most people's experience demonstrates this sweeping
    assumption to be false. Individual eyeballs do not grow to
    fit their environment. Ask any farsighted bookkeeper.

    Otis> This is not a "sweeping assumption". Your "sweeping
    assumption" is that the natural (evolution designed) eye is
    "not dynamic" and does NOT change its focal status as the
    visual environment is changed. I see little proof for your
    box-camera paradigm. I believe that the dynamic-eye
    paradigm is strongly supported by direct experimental data.
    Opinions vary on that subject.

    Otis> I do not ask "a farsighted bookkeeper" to resolve a question
    concerning the behavior of the dynamic eye. I ask
    scientists like Dr. Stirling Colgate, Dr. Francis Young
    Dr. Steve Leung and Dr. John Semmlow questions of that
    nature. But in the final analysis, the actions of the
    natural eye (as a sophisticated physiological system) are
    resolved in the experimental data, if the experiment is done
    correctly and we agree on the definitions of the words we
    use to describe this fundamental behavior characteristic.

    Otis> The pure "natural" or "normal" eye either does or does not
    change as the visual environment is changed.

    Otis> > Since you never bother to make any of these > >
    measurements you simply do not know.

    [N.B. Concerning the dynamic behavior of the natural eye. As a
    scientific issue you and I can measure the focal status of
    the natural eye. We then can apply a negative "step-input"
    to this system and determine if there is a change of focal
    status between the test group and the control group. You
    have no desire to submit your "box camera" to that type of
    testing. And you have no desire to submit your statement to
    that type of scientific testing.]

    Mike> Otis, I have a large practice but that isn't enough to test
    the claims you make for the benefit of plus lenses.

    Otis> I do not expect you to do anything you do not believe it.
    That is why there is a "majority opinion" and "second
    opinion". People who wish to "prevent" nearsightedness
    should seek out the ODs who do support a persons willingness
    to work with the "preventive" concept. This is a very
    "professional" way to deal with the general public.

    Mike> I have to rely on people who can coordinate multi-center
    studies with scientific controls.

    Otis> You mean "medical" controls. I am taking about direct
    SCIENTIFIC testing to determine if the pure-natural eye
    changes its focal status in a negative direction when a
    "forced" change is induced in the external environment. In
    this since I believe in the statement, "Nullus in Verba"
    which means roughly, "Take nobody's word for it; see for
    yourself". I believe this is a reasonable scientific (not
    medical) method of proof -- when the issue has NOTHING to do
    with medicine

    Mike> Most of their work demonstrates that plus lenses do not slow

    Otis> That is not the question. Resolving that issue would come
    later -- after we agree about the dynamic behavior of the
    natural eye. It is not my purpose to "slow" myopia. The
    only reasonable goal would be to prevent it before it
    starts. And that does require a considerable degree of
    knowledge and motivation in the person concerned with the

    Mike> There are some limited positive results ...

    Otis> Yes, thanks for that confirmation. People and pilots who
    look at their own eye chart, are able to clear their distant
    vision when their are on the threshold of nearsightedness.
    I agree with you that it is not easy and no one can
    guarantee results since you rely entirely on the motivation
    and insight of the person who is doing the actual work of

    Mike> ... but MOST studies show "no effect". I don't know why
    this difference exists, but the "minority" evidence isn't
    strong enough to convince a medical audience.

    Otis> It is no my business to "convince" a "medical audience". My
    issue concerns a "scientific-engineering" audience. Indeed
    some medical people agree that prevention would be possible
    if a strong plus lens were used by a highly motivated
    person. Again, that is why and how "second opinions"
    develop in medicine.

    Mike> You continue to single out OD's and blame us for this
    "hostile" response.

    Otis> Not at all. But Matt asked for alternative on, and I suggested the alternative was to use a
    strong plus lens when working for eight hours on a terminal
    at 20 inches. Obviously, Matt must decide the issue for
    himself. It is your belief that Matt should only wear the
    minus lens prescribed (all the time) and his eyes would get
    "better" for that reason. Others, including a number of ODs
    believe that the use of the plus would be wise for use when
    doing close-work. My statements are neither snide, nor is
    their any implication about "blame". This is simply about
    Matt's right of choice of two alternatives.

    Mike> But to convince OD's, you'll have to present evidence that
    convinces MD ophthalmologists and Ph.D. vision researchers
    as well.

    Otis> Actually the person (engineer, scientist or pilot) that must
    convince himself is the person who wishes to work his vision
    back to 20/20 from 20/50. And that is a matter for him to

    Mike> It isn't there.

    Otis> Depends of what you mean by "it". If we are running a test
    to determine if the natural eye is a dynamic control-system
    then "it" is there.

    Mike> You said you don't understand the "hostility" you encounter
    when you preach the benefits of plus lenses. I can explain
    - some of it is disappointment.

    Otis> I can deeply appreciate the "disappointment". This is
    largely due to the fact that any "success" is going to
    depend on the motivation and long-term persistence of the
    person interested in "prevention". You can not prescribe
    the type of insight, judgment and fortitude for the long-run
    that true prevention requires. This does not reflect on
    you, or your desire to "do something". Dr. Raphaelson
    described and explained that the public (with no
    understanding) will always reject the use of the plus at the
    20/50 level. But that is an issue a "patient" must face.
    There has been NO systematic effort among engineers and
    scientists to introduce "prevention" by using the plus on
    professional pilots entering a four year college. But that
    would be were "first" successful results could be obtained.

    Mike> OD's used to prescribe plus all the time.

    Otis> This is simply not true. You can not "prescribe" the plus.
    The individual must have some understanding of HOW to use
    the plus BEFORE it is used. You can not impose a plus lens
    on anyone unless he has some concept of the objective and
    goals of the use of the plus.

    Mike> Then they quit. Why would they do that?

    Otis> You are making this up. Since they never attempted to offer
    pilots the use of the plus (on the threshold) I do not see
    how they could have "quit" as you say.

    Otis> But I look to the future when pilots on the threshold are
    told the FULL STORY about the issues raised here, and are
    encouraged to use the plus as Dr. Stirling Colgate did.




    Previous Commentary:

    To: "Mike Tyner"

    Dear Mike,

    I am certain that you are very professional and believe what
    you are taught. I personally have no desire to get into an
    argument that affects your profession -- except for scientific
    facts that concern the dynamic behavior of an evolution-designed

    Thefore you can have arguments about "organic defect" you
    must first establish if the natural eye is "dynamic".

    I will take this "off-line" and prepare a more extensive
    response. This plus lens is, and will remain the "second
    opinion", for PREVENTION at the 20/40 to 20/70 level.

    I have no problem with a person who wishes to read the
    literature and make his own determination about what course of
    action he might wish to follow.

    Obviously the course of action I advocate is "difficult", but
    then solving problems is ALWAYS DIFFICULT.

    I will pass this on to professionals who are interested in
    introducing PREVENTION as the "second opinion" so that they might
    understand that fully qualified professionals disagree (honestly)
    about the dynamic behavior of the fundamental eye.

    No disrespect is intended by this discussion. Indeed I do
    acknowledge that it does take a person who has the
    force-of-character to use a plus at the threshold -- when it truly
    can be effective.


    Otis Brown, Nov 14, 2003
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  2. Otis Brown

    Dan Abel Guest

    You don't understand, Mike. This method only works on professional pilots
    entering a four year college. And it can only be done by engineers and
    scientists. It doesn't work for us regular folks.

    Dan Abel, Nov 15, 2003
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  3. Otis Brown

    Otis Brown Guest

    No, no one has tested to see if nearsighedness could
    be PREVENTED. That has not been even attempted.

    Please read the statistics for the Naval Academy, particularly
    those dealing with a person with 20/20, (focal state zero) and the probability
    he would have 20/20, after four years.

    If I were presented with that type of analysis, I would consider
    the alternative. That type of PEVENTIVE plus effort has
    never been conducted.


    Otis Brown, Nov 15, 2003
  4. Otis Brown

    Dr Judy Guest

    snip the rest

    You forget that Matt has -0.50 in one eye and -1.75 in the other. His
    discomfort is likely due in some part to the difference in focal plane
    between the two eyes. His -1.75 eye is wearing the equivalent of a +1.75
    lens when he reads without glasses, which he does. If he then wears +2 on
    top of that, the clear far point will be about 20 cm and he will have to
    move his computer monitor that close to be clear -- not a workable distance.

    Dr Judy
    Dr Judy, Nov 15, 2003
  5. Otis Brown

    Otis Brown Guest

    Was: Bad vision at the end of the day, and w/light changes

    Subject: Arguments and counter-arguments about the dynamic
    behavior of the natural eye, Part B


    Discussion with Mike Tyner

    Initial Statement:

    Otis> Before you can have arguments about "organic defect" you
    must first establish if the natural eye is "dynamic".

    Mike's response and reply:

    Mike> MOST people in the US don't get nearsighted, yet all of them
    go to school. Since 3/4 don't grow to match their
    environment, but you extrapolate that to be your "natural
    eye". In other races and other places, 80-90% manage to
    avoid this "dynamic" behavior. Still elsewhere, almost
    _everybody_ gets nearsighted.

    Otis> Mike, you are right. People who live our doors have
    consistently a positive focal status. When you place a
    "natural eye" in a confined visual environment it moves in a
    negative direction. It depends on the amount of the
    confined environment. I hope you understand the meaning of
    "mathematical average" of a visual environment.

    Mike> What is this "natural eye"? Researchers don't talk about
    "the natural eye". There is an "ideal" eye but it is
    fictional. They talk about population statistics, group
    comparisons, and changes in refractive error over time.

    Otis> The eye at birth. But since all eyes are born with
    "refractive errors" their is no "natural eye" at birth -- by
    your accounting of it. That is the nature of our
    disagreement. I believe that at birth, focal states from
    zero to +9 diopters are no the character of a "busted" or
    "broken" eye. By your accounting of it, these eyes are
    under severe stress. Mike, I can not agree with your
    concept of the eye as a box-camera.

    Mike> They tell us that the natural eye is "dynamic".

    Otis> I do not know who "they" are. Certainly engineers who do
    physiological modeling like John Semmlow and George Hung
    will tell you that you can expect that the natural (not
    defective) eye will be proven to be dynamic.

    Otis> I certainly judge that it is important to establish
    experimentally that the natural eye will change its focal
    state if you change the "environment" in a negative
    direction. But this is a pure "engineering" question if not
    a scientific question.

    Mike> While change is constant, they tell us eyes are remarkably
    resistant to change from outside optical manipulations.

    Otis> Perturbations are constant. To overcome perturbations, the
    natural eye is designed, and behaves as a dynamic system.
    You say that the natural eye is "remarkable resistance to
    "changes" in the visual environment. You must run the
    "wrong" experiments or something because I see that exact
    opposite truth in the experimental data.

    Mike> Myopes who wear glasses don't get more nearsighted than
    myopes who do.

    Otis> Your preferred belief system. Since you informed me that
    the natural eye does not "move negative" when you place a -3
    diopter lens on it, the above statement is consistent with
    your belief-system.

    Mike> Kids who wear plus still get nearsighted, except
    here-or-there where it _might_ have made some difference.

    Otis> Well, that judgment will depend on the "kids" like Dr.
    Stirling Colgate, Captain Fred Deakins, David De Angelis and
    other "kids" who got the idea correctly. They have every
    right to make a decision and choice about this matter. In
    then end though, they have to look at their own eye chart
    and see the results of their efforts themselves. There is
    no other way.

    Mike> You contend that wearing plus interferes with nature's
    response to near work.

    Otis> What I said was that eye controls its focal state to its
    average visual environment. This is not "interference" in
    any meaning of the word. What I stated in concept is that
    the natural eye uses its visual environment to CONTROL its
    focal state. Assuming a focal status of -1/4 D (20/30), the
    person can use a very strong plus to CHANGE the "input"
    light. If the person "pushes print", i.e., reads at the
    blur-point, then he has effectively put his work at "optical
    infinity". If he will do this for ALL CLOSE work, then
    effectively his is living "out doors" all the time. While
    this is certainly difficult to conceptualize, the "natural
    process" of the normal eye will result in a VERY SLOW change
    of focal status in a positive direction. That is what I
    mean by "prevention".

    Mike> That isn't evident in most studies comparing treated and
    untreated groups.

    Otis> It is very obvious with primates when you run a "pure"
    scientific (not medical) study. But again you keep assuring
    me that the natural eye is proven to be a box-camera, and
    therefor CAN NOT change it focal state. You are correct.
    Optical benches DO NOT CHANGE when you change the visual

    Mike> Until it is, preaching that plus will prevent myopia is

    Otis> Well, that is a matter of opinion. I certainly clear that
    if a pilot wishes to AVOID nearsightedness he should study,
    analyze and judge the facts himself. This conversation
    would be very helpful as he works to decide the issue for

    Mike> If it helps, my personal feeling is you should start before

    Otis> Mike, we absolutely agree on that point. If anything is to
    be done, the work, and decision must be faced, understood
    and executed by the parents and child. This is a very
    difficult issue for them. With out proper training and
    understanding the instinctive reaction by most people is to
    reject the use of the plus. Welcome to the nature of human
    nature. That is probably much more of the problem than
    anything else we have talked about.

    Mike> By age eight we should start every kid with glasses that
    maintain distance blur ...

    Otis> The plus, used as described, do not maintain "distant blur".
    The kid (20/30) will not be wearing plus-lens glasses for
    distant objects. Close objects will be absolutely clear for
    near objects if used as described.

    Otis> Obviously you can not "start" a kid in the use of the plus.
    THAT would depend on the "kid" and his parents -- and not on
    you. A difficult -- but honest -- choice should be made at
    that point. But rest easy, most parents and child would
    turn down the use of the plus at that point -- only to
    suffer the consequences later of course.

    Mike> ... and make him wear them for a substantial part of his
    day, until he's what - 15, 19 years old?

    Otis> It is indeed a difficult choice, and requires considerable
    wisdom and motivation (in the kid) to do this work. No one
    is ever going to "prescribe" or force the child to do this.
    It must be his own decision. I have been down this road
    many times. The result of this work depends on the quality
    of motivation and understanding of the individual who does
    this work -- and not on you or I.

    Mike> 10 million second-graders each year, figure 5-6 million at
    least for the designer market...

    Otis> I NEVER talk about money -- I just do not care about it. I
    care for people who are close to me, and wish to keep their
    distant vision through the "school years", or wish to help
    their children keep their distant vision clear -- and not
    become -3 or -11 diopter myopic.

    Mike> ... Can you not see the incredible economic pressure that
    had to be overcome when plus fell out of favor?

    Otis> The "plus" is not "in favor" as you well know. The
    difficulties of implementing it are well known to me. I
    recommend it to the intellectual judgment of the person I
    talk to -- with the understanding that is it a now-or-never
    choice. I expect most people to make the "never" choice.

    Mike> It's absurd to contend that doctors and opticians and
    Italian fashion magnates have simply thrown away that

    Otis> This has NOTHING to do with money. It has to do with the
    "care" you might show to your own children. The LAST thing
    I worry about is money. I worry about the long-term visual
    welfare of the people who would like a "right-of-choice",
    even if that means they must do most of the work themselves
    under their own control and by their own judgment. It would
    appear their is no other way based on your clearly stated
    opinion on the matter.

    Otis> Some optometrists have in fact "pointed" in the "preventive"
    direction -- like Dr. Theodore Grosvenor. (This
    professional recommended that a plus be offered to a child
    on the THRSHOLD of nearsightedness -- focal state of zero.
    I accept his recommendation. But the implementation of that
    recommendation is indeed difficult.

    Otis> Please note: I consider a man a professional who will
    discuss alternatives with me when I am on the threshold. I
    would gladly pay for this kind of advice and recommendation
    for prevention -- even though I would have to take a great
    deal of responsibility to do the work correctly myself.

    Otis> In fact "prevention" requires a great deal of support
    for the parent -- and some understanding of the goals
    and objectives of the method. If the parent is not
    clear on that subject, the preventive-plus can not be
    successfully used. This reflects on the motivation
    and insight of the public -- more so than it does
    on the profession of optometry. Some ODs are in fact
    using a plus on their own children. These ODs will
    eventually lead all of us towards successful
    prevention -- if we listen to them and support them.



    cc: Dr. Steve Leung
    Dr. Stirling Colgate
    Donald Rehm
    David De Angelis
    Otis Brown, Nov 15, 2003
  6. Otis Brown

    Otis Brown Guest

    Dear Mike,

    Since you are close to nit-picking, I would say that
    legally, the person is not "nearsighted", since
    he passes the Snellen DMV test. He should not relax,
    and instead take it a serious warning about
    what his visual future is goint to be.

    The person is clearly in trouble, but has some
    time to work "prevention", since there is no
    immediate requirement that he wear the minus lens
    all the time.

    There are a substantial number of Ophthalmologists who
    will NOT prescribe a minus lens at this point -- but
    not tell the parents about their reasons.

    I think they should be more vocal. The have a strong
    scientific case for discussion the need for "prevention"
    at that point. In my opinion.


    Otis Brown, Nov 15, 2003
  7. Otis Brown

    Otis Brown Guest

    Dear Mike,

    You can of couse believe what you wish to believe
    about the dynamic behavior of the natural eye.
    I disagree strongly about your statment about the effect
    of a properly-used plus by pilots for prevention.

    Or, restoration of distant vision from 20/40 to 20/20 by
    INTENSE effort with a proper-strength plus lens.

    The standard downward rate for children using singl-vision
    lenses was -1/2 diopter per year. Even though difficult
    to use properly, a plus lens (given with out instruction)
    stopped further negative movement of the eye, or the
    focal change was approximatly zero diopters per year.
    Francis Young -- Keneth Oakley. But this was done
    with children who did not understand the purpose,
    nor did the have the judgment and resolve to do the
    work under their strong control.

    Prevention or no-prevention. That will depend
    on the persons choice -- not yours -- not mine.

    It does require an intensive commitment -- and
    systemative work. Since that depends on the insight
    of the person involved with it you obviously can not
    use this approach on the general public that
    walks into your office.



    Dr. Steve Leung
    David De Anglis

    Dear Friends,

    Mike is right in the aspect that most people will
    be completely lacking in the motivation to "work" prevention

    Since Mike can not control the child's habitual reading
    distance (as we discussed) he really can do nothing
    for "prevention". That will depend critically on
    the person and his motivation to work the issue
    properly and successfully.

    I do believe that this is very difficult work, and
    should only involve those who have a desire to
    do the work correctly.


    Otis Brown, Nov 18, 2003
  8. Otis Brown

    Dr Judy Guest

    The change in children's vision is the average for the group, some changed
    more, some less, some not at all

    The Young study you are so fond of did not show a stopping of change (at
    least not the one I could find on Medline, is there another unpublishe?) but
    a small slowing of progression. No other studies, using more subjects over
    longer time periods, have replicated those results. The other studies show
    minimal to no effect and one showed a speeding up, not slowing down of
    progression. In science, no study is truly believed until replicated; if
    many studies are done with, one believes the effects found in the majority
    of studies, not minority.

    dr Judy

    Dr Judy, Nov 18, 2003
  9. Otis Brown

    Otis Brown Guest

    Prevention depends on the motivation of the
    pilot or person working this issue.

    But do not trouble yourself with this issue.

    The pilots who clear their vision will never
    bother with you. With their restored 20/20,
    there is no issue for there, is there.

    You say it is not possible. They see by their
    own efforts that they are successful. This
    issue has been taken out of your hands.


    Otis Brown, Nov 18, 2003
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