Clarifying the statment "over 70 percent myopic"

Subject: A High Percentage Myopia in School and College


I previously stated that with certain groups of Eskimos, the
percentage who were myopic increased to 85 percent.

I do not have that report at this time -- however these
statistics prove the same thing.

One OD stated that this was not the case, but failed to
present is "new" study.

Here are some more recent statements of the percentage of
school students whose refractive state moved from a positive value
to a negative value (as a natural process). At least 70 percent
and up to 85 percent at the higher levels.

Here is the statement of those statistics.

Are these statistics a "myth"? I guess that is
the belief of the ODs on sci.med.vision. What do
you think? Who is responsible? You or the OD?

You asked that I "stick to the facts" concerning
the dynamic behavior of then natural eye - so here
are the facts. Do you deny them?



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

1) Lam and Yap (Lam, C.S. and Yap, M. "Ocular dimensions and
refraction in Chinese Orientals", Proc. Int. Soc. Eye
Res., 6:121, 1990) found that in a group of optometry
students at The Hong Kong Polytechnic University, the
prevalence of myopia was 75% in females and 69% in males.

2) Goh and Lam (Goh, W.S. and Lam, C.S., "Changes in refractive
trends and optical components of Hong Kong Chinese aged 19-39
years," Ophthal. Physiol. Opt., 14:378-382, 1994) found
that in 2000 first-year students at the University of Hong
Kong, the prevalence of myopia was 87.5%.

3) Lin et al (Lin, L.-K, Chen, C.J., Hung, P.T., and Ko, L.S.,
"National- wide survey of myopia among schoolchildren in
Taiwan, Acta Ophthalmol.", 185:29-33, 1988) found that in a
national survey of children in Taiwan, the prevalence of
myopia was over 70%.

4) Lin et al (Lin, L.K., Shih, Y.F., Lee, Y.C., Hung, P.T., and
Hou, P.K., " Changes in ocular refraction and its components
among medical students - a 5-year longitudinal study", Optom.
Vis. Sci., 73:495-498, 1996) found that in a study of 345
National Taiwan University medical students, the myopia
prevalence increased from 92.8% to 95.8%! over the five year
period.


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

December 6, 2000

By Liu Shao-hua
Staff reporter
Taipei Times

Subject: Myopia Increases Among Children

One of every five children in the first grade in Taiwan's
elementary schools is myopic (nearsighted). The proportion of
myopics in this group has increased from 12.1 percent in 1995 to
20.4 percent this year, according to the results of a survey
released by the Department of Health yesterday.

The results also show that 60.7 percent of sixth graders in
elementary schools, 80.7 percent of third graders in junior high
schools, and 84.2 percent of third graders in senior high schools
suffer from myopia. In addition, the number of seriously myopic
children is also on the rise. The proportion of seriously myopic
children among sixth graders in elementary schools has increased
from 2 percent five years ago to 2.4 percent this year.

Serious myopia is defined as exceeding 600 degrees (6
diopters). Anything over 25 degrees (0.25 diopters) is myopia.
Normal eyesight is zero degrees.

"We appeal for reductions to children's work load in schools
and the amelioration of visual environments in daily life," said
Chen Tzay-jinn, director-general of the health promotion bureau,
under the health department.

The survey was conducted by the department, in cooperation
with National Taiwan University and its hospital, and involved a
sample of 12,000 students from four million students between the
ages of 7 and 18 nationwide. Myopia has been on the increase in
Taiwan ever since the first myopia survey in 1983. The department
manages the survey every four or five years.

The growth of nearsightedness among young children is thought
to result from learning to read very young and using computers
very young, Chen pointed out.

Last year, the department and the Ministry of Education
delivered official documents to kindergartens nationwide demanding
that children not be taught to read or use computers too early.
"But many teachers and parents protested against this appeal,"
said the department officials. "They questioned exactly what they
were permitted to teach if reading was not allowed."

"We do hope that parents and teachers can heighten their
awareness of myopia and understand that early learning does not
guarantee students' performance in the future, but it does bear a
strong correlation to defects in vision," Chen said. The
department also appealed for children under the age of 10 not to
be taught how to use computers.

Senior high school students suffer the highest rates of
nearsightedness, at over 84 percent. "It reached a plateau five
years ago and has not changed this year. But their myopia has
become more serious," Chen said. According to the survey, 20
percent of third graders in senior high schools are seriously
nearsighted.

Many people thought operations could cure myopia. "But the
superficial improvement of vision does not better the health of
the eye. More importantly, it might reduce people's awareness of
other problems associated with nearsightedness, apart from visual
ones," said Lin Lung-kuang, ophthalmology professor at National
Taiwan University. "Myopia cannot be cured. We have to prevent
children from becoming nearsighted. Don't let them use their
vision too early," Lin urged.

Because of the public's lack of awareness of myopia, the
department estimated its prevalence would continue to grow.
"Singapore resembles Taiwan in many respects and the extent of its
myopia problem might serve as a warning for us," Chen said.


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

Subject: Rejection of the plus for prevention.


Clearly this is a "Mexican stand-off" on the use of the
plus-for-prevention. (It is about time that the preventive method
be "suggested" -- even with the "understood" resistance to using
it "correctly".

It is up to the person concerned with true-prevention to
learn to use it "effectively." How much does the person understand
of this issues, and how much does he value his distant vision?

I would suggest that prevention is a "now or never" choice,
where the minus lens is much easier and obvious -- but is creating
"stair-case" myopia as a "secondary consequence" of the desire to
make distant vision very sharp with an excessively strong minus
lens.

But what is "obvious" is not necessarily the "right" or
better solution.

Best,

Otis

 

The following (see below) is a brand new study just published
in Australia which I'm sure Otis will use his "Otis-speak"
(garbage in, garbage out)to hem and haw this very valid study.

frank


Little evidence for an epidemic of myopia in Australian primary school
children over the last 30 years

Barbara M Junghans1 and Sheila G Crewther2
1School of Optometry and Vision Science, University of New South Wales,
Sydney, UNSW Sydney 2052. Australia
2School of Psychological Science, La Trobe University, Bundoora 3083,
Australia

BMC Ophthalmology 2005, 5:1 doi:10.1186/1471-2415-5-1

This is an Open Access article distributed under the terms of the
Creative Commons Attribution License
(http://creativecommons.org/licenses/by/2.0), which permits
unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

Recently reported prevalences of myopia in primary school children vary
greatly in different regions of the world. This study aimed to estimate
the prevalence of refractive errors in an unselected urban population
of young primary school children in eastern Sydney, Australia, between
1998 and 2004, for comparison with our previously published data
gathered using the same protocols and other Australian studies over the
last 30 years.

Methods

Right eye refractive data from non-cycloplegic retinoscopy was analysed
for 1,936 children aged 4 to 12 years who underwent a full eye
examination whilst on a vision science excursion to the Vision
Education Centre Clinic at the University of New South Wales. Myopia
was defined as spherical equivalents equal to or less than -0.50 D, and
hyperopia as spherical equivalents greater than +0.50 D.

Results

The mean spherical equivalent decreased significantly (p < 0.0001) with
age from +0.73 ± 0.1D (SE) at age 4 to +0.21 ± 0.11D at age 12 years.
The proportion of children across all ages with myopia of -0.50D or
more was 8.4%, ranging from 2.3% of 4 year olds to 14.7% of 12 year
olds. Hyperopia greater than +0.50D was present in 38.4%. A 3-way ANOVA
for cohort, age and gender of both the current and our previous data
showed a significant main effect for age (p < 0.0001) but not for
cohort (p = 0.134) or gender (p = 0.61).

Conclusions

Comparison of our new data with our early 1990s data and that from
studies of over 8,000 Australian non-clinical rural and urban children
in the 1970's and 1980's provided no evidence for the rapidly
increasing prevalence of myopia described elsewhere in the world. In
fact, the prevalence of myopia in Australian children continues to be
significantly lower than that reported in Asia and North America
despite changing demographics. This raises the issue of whether these
results are a reflection of Australia's stable educational system and
lifestyle over the last 30 years.


The prevalence of myopia is currently receiving worldwide attention as
many recent studies report dramatic increases over the last 20 years
[1,2]. Myopia and its aetiology is an interesting example of the
intertwining of 'nature and nurture' with both genetics and life-style
environment as important issues [3]. There is strong evidence
indicating that genetic inheritance is a major contributor, both from
the examination of prevalences across different racial backgrounds [4],
from family pedigrees [5] and from twin studies [6]. However, there is
increasing evidence suggesting that high heritability does not preclude
rapid environmentally-induced increases in prevalence [7], rather,
inherited factors are likely to both drive the susceptibility and
resistance to environmentally-induced myopia [6,8].

Despite much research interest over the last half century, there have
been surprisingly few well-designed epidemiological studies of
refractive error with large numbers of randomly selected younger school
children to form the basis of valid world wide comparisons of the
earliest stages of development of myopia [3,9,10]. However, a group
sponsored by the World Health Organisation in 2001 has devised a
protocol to be used during studies of refractive error across different
cultural and ethnic settings: the 'Refractive Error Study in Children'
(RESC) [11].

In general, estimates of the prevalence of myopia have shown less
increase in the Western world than in Asia, and less increase in rural
than in urban populations [1,10,12-16]. Five very large studies across
two decades and involving over 10,000 children in Taiwan are very
important for understanding the changing prevalence of myopia in young
Asian children (1.8% in 1986 rising to 12% in 1995 for 6 year olds, 40%
rising to 56% for 12 year olds) [2]. A similar change is also reflected
in Singaporean studies of myopia in military conscripts aged 17 years
(26% to 83% from the late 1970s to the late 1990s as reviewed by [1]),
of whom notably 82% were Chinese [17].

It has often been suggested that myopia is more prevalent in ethnic
Chinese (reviewed [18]), but only relatively recent studies compare the
prevalence of myopia in young ethnic Chinese children living either in
China and in other countries [1,12,15,18-22]. For younger Chinese
children aged around 5-7 years, the prevalence of myopia was found to
range from under 5% in rural China [14,23] to 24% in Chinese Malays
[20] and 30% in urban Hong Kong [19,22]. For older Chinese children
aged 11-12 years, the prevalence ranged from 23% of rural
Chinese[14,23] to 40% in urban China[12], 47% of Chinese Malays [20]
and 57% in urban Hong Kong [22]. Japan has a similarly high prevalence
of myopia in young school children estimated in recent times to be
43.5% of 12 year olds [24].

By comparison, the epidemiology of refractive error for young
Australian school children is relatively well documented and presents a
very different profile. A number of studies were carried out in the
early 1970s and the 1980s on relatively large groups of unselected
primary school children from the socio-economic extremes (generally
aged 5 to 12 years), and indicated a prevalence of myopia ranging from
approximately 3% to 13% (see Table 1) [25-29]. Two of those early
studies investigated children largely from underprivileged, rural,
families [26,27], and the other was of children from several, middle to
upper socio-economic class private schools [25]. One smaller study was
carried out in the mid 1980s on children from a representative
selection of government schools in Brisbane [29], and would therefore
have investigated children from a broader range of backgrounds.
Interestingly, this latter study was the only Australian study to have
determined refractive error under cycloplegia, yet yielded the highest
prevalence of myopia. Thus, it has been difficult to determine whether
the prevalence of myopia has increased in young school children in
Australia as reported elsewhere. The majority of Australian residents
are of Caucasian extraction living a very western lifestyle, leading
one to expect the prevalence of myopia to be similar to that found in
US or Europe. Yet, studies suggest that the prevalence of myopia in
Australian primary school children is low by world standards [10].

In 2003 we reported the relative proportions of refractive errors in a
large unselected primary school population of 2,535 children drawn from
a very broad range of socio-economic backgrounds in Sydney, the largest
city in Australia, in the early 1990s [30]. The children attended
fourteen primary schools and two preschools. As in the earlier studies,
the proportion of children with myopia greater than -0.50 DS spherical
equivalence, as determined by non-cycloplegic retinoscopy, was found to
be low by world standards (1.0% of 4 year olds rising to 8.3% of 12
year olds). We have now analysed the prevalence of refractive error in
a new similar group of 1,936 children unselected primary school
children drawn generally from the same area as our first study.

The study design is a retrospective examination of records of the
Vision Education Centre (VEC) [31] school vision screenings (so named
because parents were not present to ratify history) conducted in the
Clinic of the School of Optometry and Vision Science, UNSW. Approvals
for the study and permission to approach schools were obtained from the
Committee for Use of Humans in Research at the University of New South
Wales (UNSW), Sydney, Australia. The protocols adhered to the tenets of
the Declaration of Helsinki. Parents or guardians were provided with an
information sheet and requested an outline of known symptoms. Signed
consent was required prior to a child's participation.

Sampling and recruitment

Permission was obtained from the NSW Department of Education and the
NSW Catholic Education Office to approach all schools in the eastern
region of Sydney (some thirty coeducational primary schools) to send
entire classes to the VEC. A flyer was sent describing the VEC science
excursion and age-appropriate eye examination, inviting Years 1, 3 and
5 particularly to participate.

The group of 1,936 children examined came from the eastern suburbs
along the southern beaches of Sydney, and may be thought of as randomly
selected with little likelihood of bias to the data as individual
classes were free to respond. Children were drawn from twelve
government and non-government primary schools and one pre-school and
attended the clinic only once. During the 1996 Australian Bureau of
Statistics census 14,785 children aged 4 to 12 years were recorded in
this region (Randwick and Waverley precincts of Eastern Sydney) who
came from a very broad range of ethnic and socio-economic backgrounds
present, where 37 different languages might be spoken in the home [32].
This was reflected in the children attending VEC. Census data indicate
approximately 9% of the children in the current study were likely to be
of Asian origin [32], a figure supported by our interpretation of
family name for each child [30]. Participation in the eye examinations
was typically well over 90% for each class, with teachers reporting
non-participation to be predominantly due to illness on the day. Less
than 3% of parents intentionally prevented participation, even if eye
care had previously been sought. This particularly high participation
rate was largely due to the attraction of a an age-appropriate
student-centred hands-on science lesson about eyes and vision [31]
delivered alongside the eye examination.

Clinical examination

The comprehensive optometric examination by experienced paediatric
practitioners included all age-appropriate tests meeting Australian
Optometric Competency Standards, except that parents/guardians were not
present to ratify history. Refractive error was determined by
non-cycloplegic retinoscopy with optical fogging while the child
maintained fixation on a distant non-accommodative (6 metre) target. In
most cases refractive status was confirmed by subjective refraction.
Other tests included letter visual acuity at 6 m and 33 cm, cover test
for strabismus, motilities, saccades, pupil reactions, near point of
convergence, heterophoria, stereopsis, accommodative facility, colour
vision and ophthalmoscopy.

Justification of choice of testing procedures

Cycloplegic retinoscopy was not undertaken for many reasons including
the fact that VEC studies started prior to the 2000 convention
suggesting use of cycloplegic retinoscopy for studies of refractive
error prevalence [11]. Secondly, the VEC visit was meant as an
excursion and the children had to return to normal classes with near
work demands after the morning outing. Thirdly, it was important for
comparison purposes to use refractive data procured under the same
conditions as that used for the earlier groups of children. Fourthly,
an initial evaluation without cycloplegia is necessary in order to
understand daily function. Fifthly, non-cycloplegic retinoscopy was
only one component of the exam. Outcomes regarding a decision to refer
would not alter for most children had a cycloplegic refraction been
carried out, as several other near function tests that would also
indicate the possible existence of latent hyperopia or pseudo-myopia
were included. Lastly, the degree of refractive error may in fact be
influenced by cycloplegia (see Discussion for elaboration [33-38]).

Autorefractors were not employed as hand-held versions were unavailable
when the first cohort was seen. Equally as important, there is no
convincing evidence that the proportion of myopes identified in the
sample would have changed [39].

Comparison with earlier data

To compare the estimated prevalence of myopia in this urban population
of 'Australian children' over the last decade, this more recent 2000s
data set was analysed against data from an earlier cohort of 2,322
children with similar demographics seen in the early 1990's, using the
same testing protocols and seen at the same venue [30]. The optometric
results of that earlier cohort have previously been reported [40], and
it was noted that 7.1% of those children were already wearing
spectacles [30], indicating that our recruitment procedure did not
preclude children already under the care elsewhere. The data for any
child examined in both cohorts was deleted from the earlier data set to
avoid bias in the analysis. The mean date of assessment for this last
2000s cohort was September 2000, and for the early 1990s cohort was
June 1992. Thus, the average gap between assessments of children from
the two cohorts was 8 years and 3 months.

Statistical analyses

Data was analysed by Analysis of Variance ANOVA (StatView software).
Only refractive data from right eyes was used for the current
refractive class analysis, as the correlation between right and left
eye refractions was extremely high (p < 0.0005). The preferred
criterion to define myopia in this study is that used clinically in
Australia: a spherical equivalent equal to or more minus than -0.50 D.
However, as myopia more minus than -0.50 D has occasionally been used
to define myopia in epidemiological studies [13,19,41], analyses using
the criterion 'myopia more minus than -0.50 D' were also performed for
comparison. Hyperopia was defined as spherical equivalents greater than
+0.50 D. Thus, emmetropia for this study was defined as refractions in
the range -0.25 to +0.50 dioptres spherical equivalence inclusive.
Means are quoted with the associated standard error.


Outline Results
The records of 1,936 children aged 4 to 12 years from a non-clinical
unselected population examined during the six years from March 1998 to
May 2004 were analysed retrospectively to estimate the prevalence of
different types of refractive error. Primary schools of their own
choice sent more children from years 1, 3, and 5, which resulted in
unequal numbers of children in each of the age groups. There were 925
boys and 951 girls, and the relative numbers for both males and females
in each age group are shown in Table 2. For 59 children, the gender was
not indicated on the record card and could not be inferred with
certainty from the given name. The data not associated with gender has
only been included in analyses entitled 'All' as shown in Tables 2 and
3. Mean age was 8.36 years. The relative proportions of the different
classifications of refractive error for all children combined
(including those of unknown gender) for each age group are shown in
Table 2.

The mean spherical equivalent refraction of all 1,936 children was
+0.45 ± 0.02 DS, however it should be noted that there is a
preponderance of children aged 5-6, 9 and 11 years old corresponding
with Years 1, 3, and 5 of primary school. Overall, there was no
significant difference in spherical equivalent refractive error between
girls and boys (p = 0.697). In general, mean refraction demonstrates a
highly significant shift towards less hyperopia with increasing age (p
< 0.0001) from 0.73 ± 0.1DS for 4 year olds to 0.21 ± 0.11 for 12
year olds, however this is more noticeable after the age of 9 years as
seen in Fig. 1. With increasing age, more children are found in the
emmetropic category and fewer in the low hypermetropic category.

A summary of the relative proportions of myopia and hyperopia for this
cohort of children of all ages seen during the six years ('2000s' data)
is given in Table 3. The majority of children screened are emmetropic
by our criteria: 53.0% averaged across all ages. The proportion of
children manifesting moderate to high degrees of hypermetropia
(=+1.50 DS) is 6.2% across all ages. Only 6.9% of children of all
ages had refractive errors more minus than -0.50 DS, ranging from 2.3%
of 4 year olds to 13.3% of 12 year olds (Fig. 2). If the more liberal
definition of myopia is applied (myopia equal to or more minus than
-0.50), then 8.4% of all children were myopic (ranging from 2.3% of 2
year olds to 14.7% of 12 year olds). Only 0.8% of the 1,936 children
were more than -4.00 DS myopic.


An analysis of the prevalence of refractive errors in young school
children in eastern Sydney during the last thirteen years has been
presented. The latest data gathered from 1,936 unselected primary
school-aged children in the last 6 years, indicates that the prevalence
of myopia remains quite low compared to that reported for the western
world and Asia, especially as refractive error was established by
non-cycloplegic retinoscopy (as will be discussed later). These
findings are not significantly different (p = 0.13) to our previous
report [30] indicating that 6.5% of 2,535 unselected children aged 4 to
12 years seen in the early 1990s were myopic by at least 0.50 D.
Notably, those children were of similar socio-economic and ethnic
status drawn from the same region of Sydney and seen at the same Centre
using the same testing protocol.

Therefore, if we take the total 4,258 children seen since 1990, the
relative frequency of refractive error across all is: 54.2% emmetropic
by our criteria, 32.3% low to moderate hyperopes, 5.3% myopic greater
than -0.50D spherical equivalence and 7.4% myopic by at least -0.50 DS.
The number with myopia of at least -4.00 DS was an extremely small
0.6%.

The prevalence of myopia in Sydney primary school children compared to
the rest of the world

As alluded to in the introduction, the proportion of Sydney children
with myopia is dramatically less than in Asia. Indeed, the proportion
appears significantly lower than in the USA [41] and Canada [42] (4%
and 6% of 6 year olds respectively, or 20% of 12 year olds in USA), but
higher than urban India with only 4.4% of all school children under 16
years myopic [13] and higher particularly than in other less developed
countries [10].

In the past, a lack of internationally accepted definitions for
'myopia' has hampered valid comparisons across the various studies
[10]. Commonly the criteria 'greater than -0.50 DS' or 'at least -0.50
DS' are employed. However, our separate analyses using both of these
criteria only resulted in a difference of 1.5% of all children included
as myopic, in keeping with other dual analyses [13,41], and is low
either way when compared with Asia or North America.

Comparison across studies is also difficult when only an 'overall' mean
refraction is presented covering all children in a study, due to the
well known increasing prevalence of myopia with age. Indeed, the
comparison of data from our own two data sets is confounded to some
extent by the slightly different age profiles for each cohort. However,
in neither cohort was the age range nor mean significantly different,
so the similar proportion of myopes is not unexpected.

Comparison of refractive error with and without a cycloplegic agent

The question of optimal ocular conditions for comparison of the
prevalence of refractive errors remains controversial. A cycloplegic
agent is typically proposed as the gold standard [3,43,44] in the
belief that it will eliminate ciliary muscle action or spasm, and thus
unmask latent hyperopia or pseudomyopia. Thus, the use of a cycloplegic
would be firstly predicted to lead to a decrease in the prevalence of
myopia, and an increase in the prevalence of hyperopia. However, as a
cycloplegic also leads to associated mydriasis and the introduction of
unpredictable spherical aberrations, it is arguable that cycloplegia
will induce unpredictable errors. In fact, Gao et al [38] in 2002
reported significant changes in the refractive components of children's
eyes under conditions of deep cycloplegia and mydriasis that were
greatest in hyperopic eyes and smallest in myopic eyes, adding no
definitive evidence as to the relative efficacy of cycloplegia.

Thus there appears to be no scientific concurrence regarding the
efficacy of cycloplegia for studies on the prevalence of myopia
[35-37], with several major studies electing to use cycloplegia (see
review in [10,9,11]) and others not [18-21,23,42,45]. Presumably this
design variability exists because there is no decisive evidence
indicating a difference between refractions determined with and without
a cycloplegic agent in eyes that have a myopic refraction. In general,
a more positive retinoscopic finding is reported under cycloplegia,
though considerable individual variation is seen including a myopic
shift in some [33,35-37,46]. Not surprisingly, the differences noted
decreased both with age and with less positive refraction.

As our refractive data was derived from non-cycloplegic retinoscopy we
readily concede that mean refractive error may be less hyperopic than
if a cycloplegic had been used. However, we suggest that as the
influence of a cycloplegic is uncertain and is of least concern for
myopes, the estimated prevalence of myopia will not be significantly
altered by our decision to not use a cycloplegic. In support of this
notion are new conference data from Rose et al [47,48] reporting
refractive status ascertained by cycloplegic autorefraction in over
1,000 children aged 6-7 years from across the same city of Sydney.
They reported values of 'around 3%' for the prevalence of myopia of at
least 0.50D [47], and then the value of 1.5% for myopia of
'approximately 0.50D' [48] with a participation rate between 73 and
80%. From Table 2 it can be seen that 2.4% of our 6 year olds in the
current study were at least 0.50D myopic - a value that is strikingly
similar.

Demographics versus lifestyle

Worldwide patterns of the prevalence of myopia suggest significant
differences are likely to be due to the different demographics and
lifestyles [1,10,49]. Zadnik [41] concedes that the increase in numbers
of myopic children in the US Orinda study may be due to changing ethnic
demographics. The apparent slight increase in myopia in Australia
reported in the current study may also be in part accounted for by our
changing ethnic demographics in urban areas. However demographics and
ethnic compositions are unlikely to be responsible for the large
changes reported in Asian and some other western countries [1,50].

Whatever way it is argued, our results indicate little evidence for an
epidemic of myopia although there is a developmental trend towards an
earlier decrease in hyperopia to the point of myopia. Thus, the
question of whether it is a matter of lifestyle, or perhaps familial
environmental stress, or more, remains. Certainly, the education system
and housing has changed little in Australia the last 30 years. By
comparison, most Asian children participating in myopia epidemiological
studies reportedly are more likely to live in high-rise residential
blocks [17] and have strong demands at school to memorize along with
parental and peer pressure to do well, and for some, a competitive
entrance examination to enter school [19,51].
Conclusions
It is concluded that despite some differences in methodology across
earlier studies, the prevalence of myopia in young Australian school
children does not appear to have increased significantly over the last
30 years if one allows for the change in ethnic demographics. It is
also proposed that an explanation for the large increase in prevalence
of myopia reported in other countries must include questions relating
to lifestyle in addition to genetic propensity.

 

Oits - this was a great post. Well done! It sure raises some
interesting and very important questions. Maybe children
are not meant to do a lot of close work so early in life. At
least not for extended periods. The parents were lamenting
the lack of learning in the children if they weren't reading.
Maybe the parents are the ones that should be teaching them.
Then that wouldn't entail extended close work.

Just a thought.

Subject: A High Percentage Myopia in School and College

 

Chinese parents have the highest respect for education and will start the
learning process as early as possible. If Australians aren't so myopic
that means that Australian kids aren't doing so much close work. And
their scholastic scores would solidify that point. In a music school
I used to attend the Chinese parents (the population of the city was about
1/4 Chinese yet 90% of the students were Chinese - and it was NOT a Chinese
music school!) would register their children BEFORE they were born.
Because there was a 2 year waiting list and they wanted to have them
started at age 2. Myopia is always the highest where the children
start close work the earliest and do it the most. That's why urban
kids are more myopic (higher scholastic standards and competition)
then rural kids.

 

Dear Joe (GG),

These ODs like to pull out ONE study that they love -- while
totallly ignoring the 70 percent to 80 percent that has
developed for the Chinese. Says a lot about their
selective and blind bias. But you make your own
judgment.

I was well award that SOME children have a "bad habit".
Particularly when taught to read at a very young age.
They "pull" the book in close about 4 inches (i.e., -10 diopters,
where "distance" is zero diopters).

The parents think this is "cute" -- so they ENCOURAGE the
child to CONTINUE doing this. Naturally, the ODs keep
their mouth shut -- because they can not admit
the proven effect this has on that NATURAL primate eye.
(That would be "bad for business" -- even though
it is now scientific truth.) But ever so -- if the
OD even SUGGESTED that doing that was a "problem"
the parents will totally ignore this "warning". They
want there child to "compete" in academics -- even
if the poor kid gets stair-case myopia a part
of the "price" to be "smart".

So each group "passes the buck" and thinks
some one else is responsible. The ODs are
"protecting" their "position". (Why should they
put themselves "at risk" for your long-term visual
welfare -- when YOU will not take it seriously?

The net result is "galloping" myopia -- and every one
says "gee wiz -- some one should do something".

I think that we all should do more "thinking" about
these issues -- but then when I suggest that your
own intellect is involved I get these "warniings" from
you-know-who.

Best,

Otis

 

Can you say
Oakley-Young-Oakley-Young-Oakley-YoungOakleyYoungoakleyoungoakelyoung...


DrG

 

Dear DrG,

Can you say -- continue the traditional minus lens with
out ANY CHAGE for the last 400 years.

Can you say IGNORE ALL SCIENTIFIC PROOF YOU DON'T LIKE.

Can you say "stair-case myopia is not my responsibility".

That is always the "fault" of the person's "bad heredity", thus
avoiding ANY responsibility for anything?

But, thank to the compassionate and reasonable Jacob
Raphaelson I have learned about this "office-myopia" -- and
how to avoid it.

I regret that kind of "blindness" but you are making
it a "scientific fact". This is very similar to
"bleeding" people to "solve" medical problems.

But it is true that the minus does give an "instant" solution.
That is about the only difference.

But do not take this a "critical". You simply state the
"majority opinion". For the readers, there is a
"second opinion", that does not reflect this
kind of arrogance. It is nice that DrG has
made this issue clear to you.

Enjoy,

Otis

 

Plus lenses have been around longer. If they cured myopia, then there
wouldn't be any. Get it? Even a society of chimpanzees would have
figured it out by now.

You can't even search PubMed for a study on Eskimo myopia, so don't
lecture me.

Hmmm. Can you say hocus pocus maybe these plus lenses will help you
focus?

I don't see you promoting anything remotely resembling responsible
advice. You just keep carping about how your high myopia ruined your
career as a pilot.

Then, show us the scientific studies that show how your recipe
successfully prevented myopia in a group of subject. In fact, at this
point I would be happy just to see a list of people who were going to
get myopia but didn't thanks to you.

I'm open to being convinced. You just haven't presented any
justification.

Minus does give vision to a nearsighted person. What is the right
amount of time to make a 3 diopter myope wait to be able to obtain a
driver's license? What is so humane about preventing a child from
excelling in sports because of a visual handicap? The world is not
going to wait for you to present your Magnum Opus, Otis.

There are many opinions. Not all of them work as claimed.

DrG

 

What's with all the quoting? A stuck key on your keyboard or something?

You are defining yourself. Good! You're finally getting "it".

Yeah, because it exists only in your mind.

Who said that?

Cool! Another "Otis term" .

Blindness means "no vision", not blurry vision you idiot. And for your
information, bloodletting has some scientific merit, especially when
using leaches. Your theory, on the other hand, does not exist in the
world of scientific reality, yet you continue to preach it like some
sort of crazed zealot.

"Your" second opinion reflects either your ignorance or lunacy. I don't
think you have enough intelligence to be arrogant.

Otis, old man, you are, every day, digging yourself deeper and deeper
into a pit from which you will sooner or later disappear. Why not just
get it over with. Inquiring minds are getting tired of waiting for to
"self-destruct."

 

Dear Mike,

Subject: You obviously have no clue what we recommend. -MT

Then why not make the recommendations here and now.

Let us say you have a child whose parents checked
his vision at 20/40 (at home).

In a darkened room you have him read a Snellen, and
find that it takes about a -1.5 diopter lens to "clear" the
20/20 line. William Stacy knows that the retina's of
some children have the capablity of resolving 20/10
letters. So you continue to increase the strength
of that minus lens until the 20/10 line is cleared.
That takes a -2.0 diopter lens.

Now, the child is going to be impressed with how
sharp you have made his vision.

What do you tell the parents:

1. Do not wear that minus lens -- unless absolutly
necessary. Take it off at all other times.

2. Wear that -2 diopter lens ALL THE TIME.

What do you recommend?

Best,

Otis

 

The state-of-affairs you have depicted is not within the realm of
reality, so there is no point in commenting.

DrG

 

You're missing the boat. This Australian study, along with others,
shows that there is not an universal increase in myopia (especially
the 70% stat) and that one needs to consider the genetic propensity
as well.

It would be interesting for someone like you or Otis to actually
spend a few days observing in an optometric clinic/practice to
realize that it's not all cut and dried like Otis believes. Then
you could see the countless number of individuals who do NOT
progress or change their myopic posture while wearing their full
correction or others that do increase even after they broke or
lost their most recent pair of glasses and were wearing an older
pair. Or the student that was wearing her sister's glasses (who
was more minus than herself)and did not increase her refractive error.

But Otis would simply pretend that there was a conspiracy or that
the O.D.'s were somehow incompetent.

frank

 

What indeed would motivate Otis to do this?

He is seemingly conducting a one-man army against optometrists for some
reason. I wonder if he is looking for a scapegoat for his own genetic
myopic background?

DrG

 

Dear DrG,

Otis> The reason -- the person's right to choose between
the "traditional minus lens" and the preventive plus -- when it
makes sense to do so.

Otis> The science of the natural eye's behavior.

Otis> I goal of helping my sister's children make a choice
in the matter -- even though prevention-with-plus is honestly
difficult.

Otis> To recognize that some people have the motivation
to do this work correctly, even facing these difficulties.

Otis> An finally, to assist my niece and nephews recognize
some "bad habits" in there own children that are condusive
to producing a situation where the natural eye will change its
refractive state from a positive value to a negative value -- when
placed
in a confined environment. This makes the first "line of defense"
the parents -- and the monitoring of those "bad habits" a personal
or parental responsibility.

DrG> What indeed would motivate Otis to do this?

Otis> My desire to help them understand the imperative
nature of prevention -- as an either-or choice on the
threshold. To undrestand the over-prescription policy
of the "majority opinion" and the direct consequence of
that policy. To transfer "control" of this issue to the
parent. To recognize that this isssue is one of accurate
preception of the natural eye's behavior, and that
the implementation is "low cost" if under control of
the parents. But it is indeed a motivational issue
for the parent and child. That means that they will
be making this judgment -- and not you.


DrG> He is seemingly conducting a one-man army against optometrists
for some
reason.

Otis> Absolutly false. I support Steve Leung OD and
all other optometrists who will offer the plublic an
honest discussion of these issues. You do not
judge that you have this "professional responsibility",
and that you can "commit" a person to the full-time
wearing of a minus lens without that discussion.
Steve Leung judgest (and respects) the person concerned
with this issue. I SUPPORT ALL OD WHO RESPECT
A PERSON IN THIS MANNER. That is NOT
an attack on "all ODs". Only the arrogance
of the "majority opinion".



DrG> I wonder if he is looking for a scapegoat for his own genetic
myopic background?

Otis> What I do respect it the design and behavior of the
fundamental eye -- as a system that controls its
refractive state to its average-visual environment. This
has been proven many times with primates and other
animals. Such testing is prohibited on humans -- but
you can draw the correct conclusion by studing
(by analysis) the actual behavior of the eye in this manner.

Otis> I did have some "poor" reading habits as a young
child. I remember them well -- and I regret them. Given
my knowledge of the eye's proven behavior -- I would not
do them a second time. But life is a one-way street -- and
we do not get a "second chance" at this. For this
reason I have made this "situation" clear to my
sister's chidren, so that they understand that they
can insist that there children not engage in these
visual bad-habits. Thus true-prevention must start
at home -- with the family. It is certain that you have
no control over this -- only the parents and child.

Otis> If their children are 20/20 (refractive state zero to
+1.5 diopters) at age 5, it is almost certain that they
can keep their refractive status positive -- by correct
use of the plus -- when necessary.

Otis> Thus the real issue will be the extent that they
are willing to help there own children understand these
issues -- and take responsible actions to prevent
the develpment of a negative refractive state (at a
natural process) for them. If they do this successfully
(always pass all visual acuity requirments) then you
will not be "prescribing" a minus lens for them.

Otis> I obviously have no control over what actually
will develope -- so the actions they take will be up to
them.

Otis> In other words, a "fighting chance" is better
than no chance at all. The Oakley-Young study
is VERY CLEAR on that point. It is time to
learn from the mistakes of the past -- and
not keep repeating them.

Best,

Otis

DrG

 

I agree that your sister should not be placing her children in a closet
and keep them there. Is that what she does?

First of all, the parents are always "in control" of the issue. To
think otherwise is completely delusional.

What part of the eye's natural behavior do you use to frighten people?
Do you mean the part about putting young primates into very high minus
lenses? The real world correlate to that would be if a mother brought
her child into my office, and despite the fact that the child was 20/20
and had zero refractive error, I place the child into 10 diopter minus
lenses.

Yes, I see that you support Steven Leung. How many referrals to you
send him, or cause to be sent to him based upon that website of yours?

I rest my case. In this pile of blather, there is no mention of the
genetic basis for myopia.

OK, you are busted on that statement. You went way over the top on
that one. You should stick to pilots.

The real issue will be the extent that they believe your previous
statement about the certainty of prevention with a plus lens on a five
year/old.

Sure you have control, because you cleverly wrap your advice in the
cloak of authority.

The Oakley-Young study was very clear that myopes with nearpoint
esophoria will show less mypopic progression if they wear bifocals. It
says nothing about preventing myopia in a five year/old by wearing plus
lenses. You go way beyong the conclusions of that study.

DrG

 

I don't think that it is exactly a newsflash to say that a lot of
posters on newsgroups are into conspiracy theories.

 

Dear Dan,

I am certainly NOT in to "conspiracy" theories.

It is very easy to "quick fix" a person with a strong
minus lens in an office -- in 15 minutes.

Perhaps most people ONLY what that.

But there are strong scientific concepts and data
that suggests that that simple procedure has
serious "secondary" consequences.

This truly becomes an "issue" for the person who
is mature enough to "choose" between the
secondary-opinion (with exhaustive review of the facts)
and the majority-opinion, which is easy as pie.

My "motivation" was to provide a "fighting chance"
for prevention for my immediate relatives.

Fair enough?

Best,

Otis

 

Liar. You continually accuse doctors of conspiring to suppress *your*
unfounded theories in support of their evil methods of doing good for
the visually impaired.

Liar. There is not one. Prove your statements. You can't. You lie.

I don't care what your motivation was, but posting the same drivel here
for three years and having the scientists here continually demonstrate
that you are wrong, lie, deceive and otherwise do nothing other than to
embarrass yourself is very, very strange. In fact, sick.

Someone copy this and put it back under "OTISBROWN WARNING"

LB

 

Is that so? What are the suggested and proven consequences. I suggest
that you word your reply very carefully.

If a mature person were reading your drivel, they would say that you
were very immature.

Your motivation is to drag up whatever old, discarded, disproven
theories that can be easily recycled to shift the blame from your
myopic genes onto someone else.

DrG

 

Dear Mike,


Please point us to a comparison between people wearing glasses and
people
who don't. If you find one, it'll disagree with you.

Otis> Yes, the Oakley-Young study, were the children wearing
a +1.5 diopter lens had a "down" rate of approximately
zero diopters per year, were the single-minus had
a "down" rate of about -0.52 diopters per year. This
suggests that a "better educated" person at
20/50, could gradually "clear" to 20/30 or better
with intensive use of a stronger plus -- say
+2.5 diopters -- consistent with the person's
habitual reading distance. But of course this
has already been done by the scientist
Dr. Stirling Colgate.

You haven't reviewed the facts "exhaustively." You're presented two or
three
old papers and LOTS of opinions.

Otis> There is no doubt that the entire population of natural-eyes
primates will show a change in refractive state if you
place a -3 diopter lens on one eye. But it is
a scientific fact that you will think up some
reason to ignore all objective facts -- when
the consequences become obvious.

Do your relatives read s.m.v.?

Otis> I have posted our discussions to them -- to
be very careful about your "prescription" of 20/10
vision (about a -2 diopter lens) for a child
with 20/40 vision. Yes -- they have good reason
to be very careful about what you are doing -- and
the effect of what you might do to their children.

Otis> There have been many MDs who have been
VERY CAUTIOUS with over-prescribing that minus lens,
but have not been articulate about the reasons for
there caution. Given the results of the
Oakley-Young study -- there are very strong
reasons for that caution. The parents should
be better-informed of this issue.

Best,

Otis