Cathy -- you are correct

Dear Cathy,


Re: > Mybe she means the research of O'Leary mentioned her
(stopped before completed) amni

Re: > I hope not. There is no plus lens
therapy in this study. Undercorrection
is still minus. This study shows the risk of undercorrection, which I
assume is consented to by the informed patient. Cathy



You are correct. There has never been a
true-preventive plus lens effort to date.

Individuals have worked there way out of it -- provided
they understand and START the preventive effort
BEFORE they begin wearing the minus lens.

This is completely consistent with the pure SCIENTIFIC
studies concerning the behavior of the natural eye.

I look forward to the day when we are more
open and honest and can conduct at true-preventive
SCIENTIFIC effort with mature adults who have
the understanding to make preventive effective
and successful.

Obviously, that objective is AGAINST the desire
and opinion of the ODs on this site.

It is NOT against the "second opinion" in medicine
that supports a citizen's right to "informed choice".

Best,

Otis
Engineer

 

Not talking about prevention, Otis. Not talking about putting glasses on
those who will never need them. Not talking about those who could have
worked their way out of it if only they'd been given an "informed choice" of
the "second opinion". Talking about different people. Talking about those
who have passed your deadline of having begun wearing the minus lens.
Talking about stopping progression at whatever stage they are today.
Talking about avoiding the maladies that show up more with greater degrees
of myopia and show up less in lesser degrees of myopia. "This is completely
consistent with the pure SCIENTIFIC studies concerning the behavior of the
natural eye", also. I wish you could see the benefit in this pursuit and
not continually divert attention to those at minimal risk. I wish you could
see that stopping progression at -0.75D is beneficial even if one never
bothers to work his way out of it.

Cathy

 

My impression is that these maladies, like retinal detachment and glaucoma,
are associated with high myopes, not your run of the mill myopes. It's
unclear to me if this elusive "staircase" myopia (if it exists) can carry
people into this high-risk area. Is there any evidence that this is the
case?

Scott

 

That's the "if it (i.e., staircase myopia) exists" clause.

I was just trying to point out that high myopia is considered to be a
different animal, possibly with different etiologies, than "normal" myopia.
Whatever studies get done on "normal" myopes would need to be performed all
over again on high myopes, as they are not the same subject pool.

Scott

 

snip

Although high myopia is associated with various diseases, we cannot say that
myopia causes those diseases nor that preventing myopia will prevent those
diseases. Myopia may just as likely be caused by the conditions or most
likely, there is a third factor that causes both myopia and the disease so
that myopia is a "marker".

For example, eyes with a longer than average posterior chamber have an
increased risk of retinal problems. A longer that average eye is also more
likely to be myopic, so the risk of retinal disease is associated with
myopia. However, long eyes without myopia exist and myopic eyes are not
always long. When we look at risk, we find that the non myopic long eyes
have retinal risk and that the non long myopic eyes do not have risk, so the
risk is eye length, not myopia.

"This is completely

 

High myopes pass through the run of the mill area on their way to the high
risk area, beginning, in fact, as hyperopes. This was recently confirmed by
Dr Judy. I see a high myope as at a different place on the one scale, not
as a different animal. The parts all function the same way but in different
ranges. The studies that would speak to the existence of staircase myopia
are those which eliminate suspected inducements such as sustained near work.
None do. They can't! So it's equally unclear that it's not environmental
inducements that carry people into the high-risk area. Applying the clues
from the results of animal studies, that axial length is controllable by
wearing very high plus lenses for short periods to counter all day wearing
of minus lenses, is considered here to be a flight of fancy, so the saga
continues. No offense intended, but, in this context, who cares whether
their high myopia exists as a result of staircasing when a possible
avoidance of greater problems was evident in the research?

Otis sure can keep this forum going, can't he?

Cathy

 

You'll have to forgive me for half following the threads--like I've said
before, I don't consider myopia prevention to be all that much of a
public health problem. I do like to keep an eye on the scientific merit
of the proposals, though. Thinking about what would make a study in this
area scientifically valid is a good excercise.

The etiology of high myopia is quite important if your goal is to prevent
myopia progression because of disease processes associated with high
myopia. If that's your justification for dealing with prevention studies,
then you need to be very careful about your subject pool. For example,
if you were to solicit funding for some project, with the justification
being to prevent the disorders associated with high myopia, a study
section would really hang up on this issue. You'd need to convince them
that the results of your study would apply to high myopes.

High myopia is a very different disorder from myopia, just as gross
obesity is different from being ten pounds overweight, yet the obese go
through a point where they are ten pounds overweight. It's not a matter
of degree-- the two situations need to be managed very differently.

When a person reaches a correction of -8, that might be construed as an
indication that there is something wrong with whatever mechanism is
keeping the eye tuned up right, but plenty of "normal" people could end
up with -2 as an endpoint. One could legitimately argue that the two
populations might respond very differently to any optical "treatment".

Scott

 

Dear Cathy,

Subject: Assigning "responsibility" correctly.

Re:> Otis sure can keep this forum going, can't he? Cathy

The issue of personal responsibility was spelled out
by Dr. Raphaelson. I was very clear to me that, from
his statements, the individual would have to take
a much greater degree of control -- if true prevention
was to be developed. And further this was an
either-or decision at the threshold -- when you
(under your OWN CONTROL) can clear your vision back
to the required legal standard.

It was also clear, that if the individual manages
to "figure this out", and agressively use the
plus lens BEFORE someone puts a minus lens on him,
he can always PASS the required Snellen-DMV test,
and avoid an "over=prescribed" minus lens.
(i.e., a minus lens prescribed for Best Visual Acuity).

So this is why I spent a lot of time "arm twisting"
my sister's children. They used as strong plus
through high school, college and graduate school
(at at time when the downward rate is -1/2 diopter per year),
and kept their distant vision.

Yes, there is not much choice but that you learn to
help youself to prevention, for as Dr. Judy says -- she
has no knowlege of the eye's behavior, and will
give you NO ASSISTANCE with prevention.

My nephew wrote up his experience on my site:

www.myopiafree.com

In Chaper XI

Of couse, it was free -- except for the self-dicipline
it takes to control this difficult situation yourself.

Given the "attitude" of the ODs on this site -- you
don't have any other choice, in my opinion.

Best,

Otis
Engineer

*******


________________

 

I was referring to developmental myopia, not pathological high myopia. Very
high myopes can in fact, be born with myopia and it often starts in early
childhood instead of around puberty.

If you look at the distribution curve of myopia, it looks much like any
normal curve of physical attributes except for a second peak at the high
end. High myopia runs in families with similarities to other single gene
inherited conditions. Tere has been some work towards finding the gene
responsible for high myopia. High myopia is also found in a number of
genetic syndromes.

All this strongly suggests that there are two kinds of myopes: low to
moderate due to normal variation in and mismatch of refractive eye
components and high due to a single gene. The latter type is much more
often associated with other eye disease.

The studies that would speak to the existence of staircase myopia

I think you misunderstand animal studies. While the animals wear minus
lenses, they are hyperopes and the hyperopic blur stimulates eye growth.
While they wear plus lenses, they are myopes and the myopic blur stops eye
growth. The "take away" point is that even very short periods of myopic
blur will override long periods of hyperopic blur in animals with a
functioning emmetropization mechanism.

I see this as evidence that the eyes can distingush between hyperopic blur
due to actual hyperopia (hyperopic blur present at all times and all viewing
distances) and hyperopic blur due to near point work (hyperopic blur present
at only some times and some viewing distances). The eye will respond to
hyperopic blur by growing but will not respond to blur resulting from near
work.

Human myopes, while wearing their correct minus lenses are emmetropes , do
not have hyperopic blur and are not modeled by animals wearing minus to
create hyperopic blur. Even if we accept that human myopes have a
functioning emmetropization system similar to that in non myopic animals
(and I don't accept that), then the corrected myopes do not have myopic blur
and should not staircase. If they do a lot of near work, the animal studies
tell us that they will not increase in myopia as long as they spend a few
hours daily not doing near work (with or without their minus lenses on).

Of course, if human eyes act like animal eyes, myopia will never develop in
the first place as the early myopic blur should be promptly eliminated, as
it is in animals.

So, again, I ask: Why are there myopes, unless those who become myopes have
a non functioning emmetropization mechanism due to genetics?

Dr Judy

No offense intended, but, in this context, who cares whether

 

Let's keep this in mind. Hyperopic blur stimulates eye growth.

What should be expected when the time taken off isn't enough time off? That
space from "all times" to "some times" is all a growth stimulator. Your
last statement is true only when all conditions are met, but all conditions
being met does not give the eye the ability to distinguish between hyperopic
blur due to actual hyperopia and hyperopic blur due to near point work. The
distinguishing factor is time.

You diagnose a weakness, then label it as though it's not, and expect it to
behave as though it's not. This is a problem.


do

To wear a distance correction for less than that distance's work is exactly
what is modeled.


Even if we accept that human myopes have a

Let's keep this in mind. Spend a few hours daily not doing near work.

With? When do they ever have myopic blur?
Without? The low end is a few hours a day.

.... who are given hours away from the minus inducement or minutes with very
high plus lenses.

As always, you supply the answer in your setup, but refuse to hear your own
explanation of environmental activation of emmetropization suppression.

Cathy

 

I was thinking there'd simply be fewer high myopes for the results to apply
to. If holding high myopes at low myopia results in the same maladies
appearing as often, the association with high myopia is gone and so is the
health justification for prevention.

This is THE reason to stop myopia progression at "ten pounds".

The -8s and -2s receive the same treatment now, compensating lenses with
upgrades as needed, so I'd argue that's a bit of a red herring. Also,
the -2s might prefer to be able to see farther than 20" if advised how to do
it. But that's a secondary issue.

Cathy

 

Dear Cathy,


Re: > The -8s and -2s receive the same treatment now, compensating lenses with
upgrades as needed, so I'd argue that's a bit of a red herring. Also,
the -2s might prefer to be able to see farther than 20" if advised how to do
it. But that's a secondary issue. Cathy

While the ODs hate me because I state that the natural eye
is "dynamic" I only wanted to emphasize the work of
Dr. Jacob Raphaelson -- and the reception HE RECEIVED
to his advocacy for prevention.

Since we now know the "downward" rate for the applied minus
lens of -1/2 diopter per year, it makes no sense to
even START with the minus lens -- given the latent
physical risks of "high myopia". Prevention is
the way to go -- even though it transeferrs full
responsibility and control to the person who
wishes to avoid this mess.

So that is why I "arm-twisted" my blood-relatives to
use a strong plus for prevention.

Obviously I can not "prove" that they would have
gone "down" at -1/2 diotper per year. But you
think they would want to find out?

No, they just monitored their Snellen, and when it
started to go below the Snellen-DMV level, they
just "got busy" and cleared to exceed the
legal standard.

My goal for them wast to avoid "stair-case" myopia
produced by an over-prescribed minus lens -- by
having tham take that "first step".

No problem.

Best,

Otis
Engineer