For William -- offering a pilot a "second opinion" choice

Discussion in 'Optometry Archives' started by otisbrown, May 1, 2005.

  1. otisbrown

    otisbrown Guest

    To: William Stacy OD


    Dear William,


    Subject: Offering a pilot a "second opinion" on the threshold,
    the option of clearing vision with the plus.


    Stacy> I've also kind of wondered about his obsession with
    desperate pilots. As an optometrist in the USAF during
    Viet Nam, stationed at a pilot training base (Lubbock, TX)
    I often would waiver a student who'd gone myopic. I always
    thought the AF used the uncorrected 20/20 just to cut down
    on the applicant pool.

    Otis> You said that you would "waiver" pilots who had "gone
    myopic".

    Otis> Obviously there are "limits" to this waivering process.

    Otis> Let us say you had a pilot the you knew PREVIOUSLY had
    20/20, (refractive state zero) and after 2 years were at
    20/30 (refractive state -1/2 diopter).

    Otis> Did you ever discuss the possibility of using a plus lens
    -- to work on clearing back to 20/20?

    Otis> And if not -- why not?

    Otis> Please discuss and explain -- and in the interests of
    fair-play I will post your reasons on my site.


    Best,

    Otis
     
    otisbrown, May 1, 2005
    #1
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  2. otisbrown

    Dr. Leukoma Guest

    You do a disservice to pilots by offering them a "false opinion."

    Drg
     
    Dr. Leukoma, May 1, 2005
    #2
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  3. otisbrown

    A Lieberman Guest

    Whoa!!!! I thought you were into prevention Otis!!! The above IS NOT
    prevention. What the hell difference does it make??? You give the pilot a
    -0.50 lenses for 20/20 vision.

    Get your story straight Otis. What you suggest above IS NOT prevention.
    What you suggest above sounds like medical advice which you are in no
    position to give!!!

    Allen
     
    A Lieberman, May 1, 2005
    #3
  4. otisbrown

    otisbrown Guest

    Dear DrG,

    The question was addressed to William Stacy -- and not to you.

    And your opinion that a minus lens has NO EFFECT on
    the refractive status of the natural eye is the
    "right opinion", and the judgment that the natural eye
    is dynamic based on objective scientifc results
    is the "false" opinion. You do not have enough
    knowledge to deny a person the right to an
    informed, cometent choice in this matter.

    The second opinion, dispite YOUR opinion is expressed by
    Steve Leung OD.

    www.chinamyopia.org

    Best,

    Otis
     
    otisbrown, May 1, 2005
    #4
  5. otisbrown

    Dr. Leukoma Guest

    Otis, you have not proved that the minus lens has a negative effect on
    vision, nor have you produced a study to that effect. You present a
    patently false argument, "dynamic eye" notwhithstanding.

    DrG
     
    Dr. Leukoma, May 1, 2005
    #5
  6. otisbrown

    otisbrown Guest

    Dear William,

    Thanks for your reply -- but you did not answer the question.

    Just keeping a minus "off" is not enough.

    You COULD have suggestet what professor Grosvenor suggested,
    that the pilot keep the minus lens off the face (assuming
    20/30, and he obviously PASSES the DMV.

    If you suggested this -- you could also state that it is
    the second opinion -- and the pilot would have to
    take complete (legal) responsibility for doing
    this work himself -- and you would not have
    ANY lergal responsibility.

    If fact, for the ODs who offer the plus (for prevention)
    I suggest that a "contract" be signed, so that
    these issues are absolutly chear the the pilot
    who wished to work on true-prevention with the
    plus.

    Further, you are telling me that you are legally
    PROHIBITED from even discussing the
    POSSIBILITY of prevention.

    This means then that the pilot will have
    to work through these issues himself -- with
    the understanding that you will be busted
    to private if you even broach the subject.

    Thanks for your analysis and clear
    statement of your position.

    I will post your statement on my
    site so they understand why an
    OD can not help the with
    true prevention with the plus -- and
    they will have to do it theselves.

    Best,

    Otis
     
    otisbrown, May 1, 2005
    #6
  7. otisbrown

    A Lieberman Guest

    Look who's calling the kettle black Otis. William did answer your
    question.

    Answer my question. Please provide medical websites OUTSIDE your website
    that supports your position. I bet you won't, as usual in the past.

    I will repeat my question Otis for your clarity sake. Please provide
    medical websites OUTSIDE your website that supports your so called
    prevention methods.
    Again, you are not preventing Otis. If a person already has myopia, what
    are you preventing? Sounds like you are giving UNAUTHORIZED medical advice
    to me.
    Your website is useless to a "real pilot"

    Again Otis, take me up on my suggestion. Go to your local airport and ask
    REAL pilots what they need in vision. I would bet everyone would say they
    need the best possible acuity NOW, not 1 month down the road, not 6 months
    or a year down the road. NOW OTIS, not later.

    I bet though you won't go to your local airport as you know my suggestion
    would disprove your so called made up subjects "opinions".

    Allen
     
    A Lieberman, May 1, 2005
    #7
  8. otisbrown

    otisbrown Guest

    Allen,

    Are you an optometrist?

    Yes or no.

    Best,

    Otis
     
    otisbrown, May 1, 2005
    #8
  9. otisbrown

    A Lieberman Guest

    I have answered this before Otis. You obviously have selective memory.
    Look it up.

    Allen
     
    A Lieberman, May 1, 2005
    #9
  10. otisbrown

    A Lieberman Guest

    Looking back Otis, your memory is really poor / selective. I will repost
    my question that you are answering to. PLEASE answer my question.

    Please provide medical websites OUTSIDE your website
    that supports your position. I bet you won't, as usual in the past.

    I will repeat my question Otis for your clarity sake. Please provide
    medical websites OUTSIDE your website that supports your so called
    prevention methods.

    Can I make the question any clearer??

    Allen
     
    A Lieberman, May 1, 2005
    #10
  11. otisbrown

    otisbrown Guest

    Dear Allen,

    The question was for the
    readers of sci.med.vision.

    Since you will not respond,
    I do not see any reason to
    respond to your inane statements.

    Best,

    Otis
     
    otisbrown, May 2, 2005
    #11
  12. otisbrown

    A Lieberman Guest

    You speak for the readers Otis. I don't think so!
    Because you can't provide proof to your stories / opinions. I will
    continue to keep asking these questions so "readers" can see you don't
    answer direct questions or have any credibility.

    Until you answer questions directly, you have NO CREDIBILITY!

    Allen
     
    A Lieberman, May 2, 2005
    #12
  13. A little myopia is a good thing. Up to about -2.50 it really comes in
    handy as you age. For example, you can shave or see that little zit on
    your nose without your glasses that are surely fogging up in the bathroom.

    A little hyperopia is a bad thing. No matter how small the amount, when
    you reach presbyopia, you can't see clearly at ANY distance without
    glasses. You are truly handicapped. Far is blurred, intermediate is
    blurred, near is blurred. These are some unhappy seniors.

    When you're 80 years old, if you happen to be blessed with 1.5 or 2 D.
    of myopia, you can comfortably read without glasses. You might want to
    put on the old specs to see the TV (unless it's a small one close by, in
    which case you can even do THAT without 'em).

    The 80 year old hyperope is a mess. Can't drive without glasses. Can't
    read without them. Can't eat or even wipe his butt properly without
    them. The rest homes are full of them, staring blankly out the blurred
    window, hile their myopic bedfellows are reading or computing, wiping
    their butts, making passes at the ladies, whatever...WITHOUT GLASSES!!!!!

    So the next time you tell me that I should be preventing myopia, I'm
    gonna tell you to go to hell. My myopes are happy. My myopic pilots
    can still land if their glasses go flying in turbulence (unlike their
    hyperopic colleagues, who when that happens have to ask the stewardess
    to look at the maps and tell him where they are, or watch the artificial
    horizon so he'll know if he's right side up or not, or watch the
    altimeter, so he'll know if he's under water or preparing to go
    orbital... (and while you're at it, Miss flight attendant, could you
    wipe... well you get the picture).

    good night otis

    w.stacy, o.d.
    myopia rocks, hyperopia sucks (oh yea, emmetropia is fine until you're
    over 40, when you get most of what the hyperopes get (sic.), and you'll
    hate it. Then, like a lot of my patients, you'll pay the LASIK doc at
    least $2000 to MAKE YOU MYOPIC in one eye!)
     
    William Stacy, May 2, 2005
    #13
  14. otisbrown

    otisbrown Guest

    To: William Stacy OD

    I appreciate your candid remarks about a pilot at 20/30 (refractive
    staus -1 diopter),
    and the fact that you are legally prohibited from discussing the
    possible
    use of a strong plus for prevention.

    You are defining the "bounds" of optometry, and "medical practice"
    here.

    But then, who is supposed to help the pilot at 20/30 who
    is willing to work with a strong plus -- and potentially clear
    to 20/20? Obviously he must figure this out for himself.

    But you had declared yourself "not involved" with this issue.

    Here is my candid response -- for our intellectual
    enjoyment.

    _________________


    Otis response:

    Dear William,

    Just keeping a minus "off" is not enough. Since you
    suggested that they might have "pseudo-myopia" and the plus could
    be used for prevention -- I thought you MIGHT have suggested the
    use of the plus under the above circumstances.

    You COULD have suggestet what Professor Grosvenor suggested,
    that the pilot keep the minus lens off the face (assuming 20/30,
    and PASSING the DMV). He would have no reason to wear the minus,
    and could have agressively used a strong plus -- to clear to
    20/20.\ Further, he could have monitored his own eye chart to
    confirm he achieved this result -- under his own control.

    If you suggested this -- you could have also stated that it
    is the second opinion -- and the pilot would have to take complete
    (legal) responsibility for doing this work himself -- and you
    would not have ANY legal responsibility. I think that approach
    would be completely fair to you and the pilot who wishes to clear
    to sharp vision under his own control.

    In fact, for the ODs who offers the plus (for prevention) I
    would suggest that a "contract" be signed, by both pilot and OD so
    that these issues are absolutly clear to the the pilot who wished
    to work on true-prevention with the plus.

    Further, you are telling me that you are legally PROHIBITED
    from even discussing the POSSIBILITY of prevention with the plus.
    Then that means that the pilot will have to work through these
    issues himself -- with the understanding that you will be busted
    to private if you even broach the subject of prevention, and for
    that reason, can be of NO ASSISTANCE at all.

    I suggest that any pilot who wishes to work on vision
    clearing (20/30 to 20/20) be completely clear in his mind about
    this issue, and the fact that you are prohibited from helping him
    wear the plus for prevention.

    I will post your statement on my site so pilots working on
    "vision clearing" understand why an OD can never help the with
    true prevention with the plus -- and why they will have to do it
    theselves.

    Thanks for your analysis and clear statement of your
    position, that you can not even discuss the possibility of using
    the plus for prevention -- for "legal" reasons and to protect your
    professional career.


    Best,

    Otis
     
    otisbrown, May 2, 2005
    #14
  15. I NEVER SAID I WAS LEGALLY PROHIBITED FROM DISCUSSING OR PRESCRIBING
    ANYTHING. STOP THE LIES.


    YOU CAN. NOBODY ELSE WANTS TO!

    WHERE DID I SAY THAT, OTIS? STOP THE LIES.

    I did suggest being busted for prescribing plus for myopic pilots, not
    to private of course, maybe from Captain to 1st Looie. AND NEVER DID I
    SAY THAT I COULDN'T EVEN "BROACH THE SUBJECT OF PREVENTION". STOP THE
    LIES, OTIS.
    AGAIN, NEVER SAID I WAS PROHIBITED FROM ANYTHING. STOP THE LIES.
    If you post anything I wrote, please so so in its entirety, without your
    lies interspersed.
    WHY MUST I ENDURE THIS REPITITIVE LIE???????

    w.stacy, o.d
    (sorry for shouting, but you're starting to bug me)

    Oh, and Otis, reread the subject line. Myopia is good. As I've said
    before, low myopia is a normal adaptation to 20th and 21st century near
    demand. It's a good thing. Why would I WANT to prevent it anyway?
    That would be harmful. I should probably be ENCOURAGING it. Remember
    the little old hyperopes in the resthomes who lose their glasses.
    Remember they are the invalids. Not the little old myopes. Viva la myopia.

    w.s.
     
    William Stacy, May 2, 2005
    #15
  16. otisbrown

    otisbrown Guest

    Dear William,

    Let us restrict the discussion to the adolescent eye, that
    can have negative or positive refractive states -- depending
    on its average-visual enviroment.

    For purposes of disucssion will you agree to divide
    the refractive state of the natural eye as described below?

    SE = Spherical equivalent -- essentially "averaging-out" the
    astigmatic component of the measurement.

    Commentary?

    Best,

    Otis

    ______________________


    Subject: Definition of Myopia, Emmetropia, Hyperopia


    For analyses, refractive error was categorised into four groups;

    hyperopia ( SE > or = +1.0 D ),

    emmetropia ( -0.5 D < SE < +1.0 D ),

    low myopia ( -3.0 D < SE < or = -0.5 D ) and

    high myopia ( SE < or = -3.0 D ).

    Source of definitions of the refractive states of the young eye:

    METHODS: Of subjects from the Singapore Cohort Study of the Risk
    Factors for Myopia (SCORM), 636 Chinese children aged 9-11
    years from two elementary schools underwent non-contact
    tonometry -- etc.
     
    otisbrown, May 2, 2005
    #16
  17. The above definitions are at variance with generally accepted
    definitions, but close enough I'm sure for your purposes. Generally
    accepted are low, moderate and high categories. They lumped all 3 into
    one in the case of hyperopia, and 3 into 2 in myopia, but whatever.

    Are you going to admit to mis-quoting me in your previous post(s)?

    I have to admit that at least in this one, for a change, you did not
    mis-quote me. Thank you for that.

    w.stacy, o.d.
     
    William Stacy, May 2, 2005
    #17
  18. otisbrown

    otisbrown Guest

    Dear William,

    I have posted your remarks on my site -- and your statement
    about "nearsigheness" being of value to a person.

    Equally, what we are arguing about it the transfer of
    "control" to the person -- or pilot.

    In our example of the pilot at 20/30, you expressed the
    ideat that the pilot only wanted very sharp vision
    with a -1 diopter lens (to bring him to 20/20),
    and simply desired a waiver from you.

    Prevention with the plus is indeed difficult -- and depends
    on the motivation of the specific person -- to achieve
    the desired result.

    But let me suggest that the "pilot", reading about
    Captain Fred Deakins (USAF) when off, obtained
    a plus from WalMart, and worked very hard
    and cleared to 20/20.

    When he came back and read the 20/20 line -- would
    you pass him -- if he did not tell you how he did it?

    Would that be OD with you?

    I think this issue is very difficult -- but I do preceive the
    possibility of prevention along this line.

    You had suggested you were interested in "prevention",
    so that is why I thought that you might suggest "prevention"
    with the plus -- even if you had no interest in "following" the
    person who was making the effort.
    I concluded that -- how ever dedicated the optometrist -- it
    would be impossible to work prevention in the
    sense of "medicine". But had the "Printer's Son" done
    the "plus" work himself, and personally verified his
    vision clearing from 20/40 to 20/20, then I think
    the result would have been completely different.

    If you provide "advice" it is automatically clasified
    as "medical" in a person's mind. If I give
    advice about the dynamic behavior of the
    natural eye -- then there is NO QUESTION about
    who is going to be "in control". It is the person
    himself who will do the work -- and verify the
    results.

    I believe that "prevention" is possible under the
    above circumstances -- and can NEVER be
    broken down into a "magic pill" you prescribe
    in 30 minutes.

    Too many people are "superficial". If you talked
    about prevention with the plus -- they would
    think you were crazy. (I understand this
    "situation" far better that you think I do.)

    But when the person "realizes" this (that a
    quick-fix may not be right for him) and
    takes the "long-view" and does it
    himself -- the he MIGHT be able
    to achieve the results you can not
    supply.

    We should not "fight" each other about this.

    It is just that the person himself has major
    work to do (on his own) if he wishes to keep
    his distant vision clear through four year
    of college -- given the "down" rate
    of -1.3 diopters per year seen at West Point.

    A very difficult decision and choice indeed.

    Best,

    Otis
     
    otisbrown, May 3, 2005
    #18
  19. otisbrown

    otisbrown Guest

    Dear William,

    Accepting that vision clearing is only possible from 20/30,
    here are the notes of a pilot who worked to
    clear his vision by use of a plus.

    ____________________


    Dear Friends,

    Subject: A pilot working with the plus, responds to
    Stacy's belief that "myopia is good for pilots".


    In a number of cases I changed the name of the poster -- to
    protect him.

    Otis

    _____________________



    From: "John"

    To: "Otis Brown" <>

    Subject: An OD, states the reasons why he can not offer
    pilots (at 20/30) prevention with plus.

    Re: William Stacy is legally allowed to discuss prevention with
    you with the plus -- he simply chooses not to because he
    believes that you have no desire to protect your distant
    vision with a plus -- for life. It is also true that
    true-prevention
    with the plus is a very difficult task to accomplish.

    Stacy> Re: I've also kind of wondered about his (Otis) obsession
    with desperate pilots. As an optometrist in the USAF
    during Viet Nam, stationed at a pilot training base
    (Lubbock, TX) I often would waiver a student who'd gone
    myopic. I always thought the AF used the uncorrected 20/20
    just to cut down on the applicant pool. W. Stacy OD

    John> What a crock of poop this is, how can he arrive at the
    conclusion that USAF has a decreased vision acuity limit so
    they can "cut down on the applicant pool". This is why I
    think OD's should be officers of the United States Air
    Force. No civilians picked up off the street, especially
    they need to know the pilots especially military pilots
    vision needs during the harsh combat flying environment. I
    don't even have an interest to read the rest of his mumbo
    jumbo after this stupid statement. Does he know the
    aeromedical concerns of having bad eyesight while flying in
    combat? Have him read on; four main areas of concern
    exist: myopia, hyperopia, astigmatism, and opacities of
    the ocular media. Improper or unbalanced correction with
    spectacles or contact lens can degrade stereopsis and
    contrast sensitivity as well as induce generalized ocular
    fatigue (asthenopia). Myopes tend to progress with respect
    to the degree of myopia, regardless of age, while hyperopia
    tends to remain static.

    John> In addition, myopes may see halos or flares around bright
    lights at night and are also more at risk for worsening
    under dim illumination and with pupil enlargement, a
    phenomena known as "night myopia." Myopes also have an
    increased risk of retinal detachment and retinal
    degenerations, such as lattice. Of note, the risk of
    retinal detachment as related to exposure to G forces in
    flying remains unknown. Hyperopes, especially those with
    greater than +3.00D of correction, will experience greater
    problems with vision after treatment with atropine during
    chemical warfare. They also have a greater association
    with microstrabismus and tropias or phorias that can
    decompensate under the rigors of flight. Moreover,
    hyperopes have more problems with visual aids, such as
    night vision goggles, as they develop presbyopia at earlier
    ages compared to myopes.

    John> Wearing spectacles is a great burden to the flyer since
    todays most NVG systems give pilots problems while flying
    at night conditions. You can not always substitute glasses
    with contacts because we have the chemical attack factor in
    todays modern warfare. You don't want your contacts burn
    on your cornea. You will either have 'em scratched with
    laser or you will prevent and reverse it from early stages,
    this is simple.
    a healthy half diopter myope who couldn't read 20/20
    unaided. Best unaided acuity of 20/30 would translate more
    into the realm of -1.00 or so. But I'll humor you for the
    moment. I mean that's only an error factor of 2...

    John> 20/30 is a -1 diopter? Well maybe that is what they did in
    Vietnam to OVERCORRECT eyesight to make it plummet towards
    double digit of diopters. Since when is -1 D prescribed
    to correct just one line above 20/20???
    without their glasses, always telling them the truth, that
    this may or may not help, but it will do no harm (and you
    say I'm not into prevention!). If they were 20/30, I would
    (obviously) Rx the -1.00 or whatever to get them flying
    (and driving) safely.

    John> He gives them -1.00 (which is way strong in my opinion) for
    a simple 20/30 (20/30 is considered normal vision in most
    fields and even DMV standards are 20/40) and then tell them
    do their heavy studying without their glasses, so they can
    strain them as much as they could. Does he even know how
    the plus lense work?
    plus for myopia, without some convincing evidence that it
    worked, and I would probably have been busted a rank or two
    for practicing voodoo optometry.

    John> Bull, honestly, if he did knew how plus worked and helped,
    he didn't have to RX them, he could simply mention about
    them and how they worked. If the pilot was interested, he
    could have used it only for his close work. Can't beat the
    minus system though, instant fix is needed, there is minus
    for you.
    optical infinity for obvious reasons. Most of them wanted
    to be combat fighter pilots. I don't think I ever saw one
    go over about -2.00 or so. And I maybe ran into one or two
    all together who ever thought their myopia was a show
    stopper or considered it to be a disability as you do.

    John> They demanded it so he overcorrected 'em, just like they do
    to my wife today! Probably those pilots are over -10 by
    now. If you overcorrect 20/30 with - 1.00!!! I'd suggest
    no time wasting with this guy...

    _______________________________


    John> Note to preventive minded friends;

    John> I recently PCS'ed to South Korea and I know that a little
    progress report is over due on my part. I passed a DMV
    test around 2 weeks ago with flying colors while I was
    renewing my DL. Today most service branches test with the
    Armed Forces Vision Tester and it is a pretty easy machine
    to pass. Anyway, I am awaiting to be transfered to my
    gaining unit so it will be a while.

    John> Over the leave time I had before PCS'ing I got to spend some
    time with a friend of mine who wants to fly B-1 Bombers in
    the USAF. He had perfect vision a few years ago but
    recently during an eye chart test I administered below the
    standard lighting conditions (which is today's OD's use so
    they can overcorrect you) he couldn't even read the 20/40
    line, I was able to see 20/20 line with both eyes with same
    lighting. I had explained him last Christmas after he saw
    me first time wearing my plus lenses and how important that
    he should use the plus lense because he does close work all
    the time. This time, 4 months later, after flunking the
    eye chart he got worried and he realized that he should get
    some. We went to Walmart and got him a +1.00 and a +2.00.
    I told him to wear +1.00 at all times outdoors and +2.00
    indoors for close work. That night he decided to drive
    with +1.00 glasses on. We drove about 4 miles towards home
    from Walmart, all of a sudden he removed the glasses to see
    if there was any effect. He paused and said;

    John> "Man, you are a genius"

    John> Take care friends...
     
    otisbrown, May 3, 2005
    #19
  20. otisbrown

    A Lieberman Guest

    Dear friends,

    I have snipped a classic example of Otis's made up stories. As you can see
    from the above, he changes the names of the poster to "protect him", for
    what reason I don't know.

    Please disregard Otis's postings.

    Thank you!

    Allen
     
    A Lieberman, May 3, 2005
    #20
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