John Doe still at 20/40 despite use of plus lenses for 3 years

Discussion in 'Optometry Archives' started by RM, Nov 13, 2004.

  1. RM

    RM Guest

    Dear Prevention-minded colleagues,

    I have a case report I would like to inform the group about. I had a
    patient return today for a reexamination for eyeglasses. I will call him
    John Doe to protect his privacy.

    I saw him initially approximately 3 years ago. At that time he was a 55
    year old myope with vision of approximately 20/40 in each eye. Refraction
    was approximately -1.00D in each eye and correctable to 20/20. His ocular
    health was normal and unremarkable. I provided him with an eyeglass
    prescription for bifocals to correct his distance vision as well as his near

    Today Mr. Doe returned to my office. He told me he never bought the
    spectacle lenses because he had grown accustomed to his distance vision and
    didn't feel the correction was necessary for him to function. However, he
    did report that he has been using OTC readers since he did have a little
    problem reading small print. Despite his refusal to use the dreaded minus
    lenses, and despite his use of plus reading glasses, Mr. Doe's vision was
    still 20/40 at distance. His subjective refraction was still about -1.00D
    OU. His keratometry readings were virtually identical to the original
    readings taken three years ago.

    All myopes must be exactly like Mr. Doe. Plus lenses never help anyone with
    myopia. If you don't believe it then that's YOUR PROBLEM. I don't care
    what any of you say, or how cogent and reasonable your arguments are. No
    matter how many of you there are, or what level of training and experience
    you have, I know better than all of you. I will never listen and I will
    argue with you until you give up. Because it's YOUR PROBLEM.

    Yours truly,

    Scientist, Optometrist, Democrat
    RM, Nov 13, 2004
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  2. RM

    Otis Brown Guest

    Dear RM,

    Intersting Post! I will pass it on to the
    interesting parties.

    Obviously this man was casually using the
    plus for reading. I frankly only advocate
    prevention for a young person who is at
    about -1.0 diopters (variously 20/80 to 20/40)
    depending on how the measurement is made.

    It takes INTENSIVE use of the plus to
    clear distant vision from -1.5 diopters
    to 20/20. Shawn can testify to the
    type of effort it takes. Most people
    have no interest in that process.
    But the ones who do can be successful
    if they face scientiric facts,
    and are prepared to make that kind
    of commtiment. I acknowledge that
    no one can ever "prescribe"
    that kind of intelligence and
    motivation. This depends
    on the individual himself and not you
    or me.

    But to maintain our "balance" I will
    pass your statement on to the interested



    Otis Brown, Nov 13, 2004
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  3. RM

    RM Guest

    Really. So your prevention technique only works for younger people? That
    ought to give you a clue Otis. Younger people have functioning, and
    sometimes OVERfunctioning ciliary muscles which cause tonic accommodations
    (read accommodative myopia). This subgroup of myopes, which are still a
    minority even within the larger group of young myopes, are the only ones
    where plus lenses have a chance to improve vision.

    So I assume that you do agree that providing just enough minus lens power to
    the eye of a middle-aged or older myope is OK. Correct? Or should they
    just go around in a blur because you tell them minus lenses will cause
    devastating effects while your group of experts can't offer them any other

    Shaun is a single case study, just as valid to the one I provided you. As
    you have told previously, Shaun is an accommodative myope and is in the
    For sure! No one who complains of distance blur will accept anyone telling
    them they need to wear lenses that make it worse. Impractical Otis. Any
    besides, minus lenses never hurt anybody. Anyone with a small bit of
    accommodative myopia will end up losing it when they approach age 40
    (presbyopia). At that age the effectiveness of ciliary muscle action on the
    crystalline lens is diminished. This is why your "prevention" technique
    works only on a small group of myopes who are young. The ones it will work
    on are all accommodative myopes. The others, who include the majority of
    younger myopes plus nearly all the older ones are anatomical myopes. Plus
    lenses have a snowballs chance in hell of helping them.

    Anyway, I am still waiting for you to explain what physical structures in
    the eye are affected by your plus lens technique. Pulling out the old texts
    by Helmholtz, Donders, etc. won't help. Those folks, while quite innovative
    for their time, had no access to the technologies that exist today and
    constitute the basis for modern refractive technology used by optometrists
    and ophthalmologist. (Or do you think its just a conspiracy?)
    RM, Nov 14, 2004
  4. RM

    Otis Brown Guest

    Dear RM,

    The young man in question was 13 when he started (at -1.5 diopters
    and 20/60), and worked VERY HARD AT IT. This is NOT CASUAL
    and not easy. He read Dr. Stirling Cogates experience using
    a strong plus, and decided to follow his method.

    Since he verifies that he had the POTENTIAL to get to 20/20 by
    looking through a negative lens -- he knew he had
    to change his refractive status by the amount he mesured.
    Since he verified his vision at 20/20 -- after about six months -- he
    is content with his results. Also, and OD verified his vision
    at the completion of his efforts, and told him to
    tear up his previous prescriptions.

    His parents also checked his work -- and he had his
    parents read the eye chart so he could compare his
    vision to their vision.

    But since you raise the question of "age" I have
    posted some remarks by a pilot who is at 20/50.

    By your "theory" he can not clear his vision
    to pass the FAA required line. If you
    are right -- his vision will stay at 20/50.

    I am prepared to pass your recommendations
    on to him.

    What do you suggest -- he give up on planning
    to become a fully qualified military pilot
    with 20/20?



    Otis Brown, Nov 15, 2004
  5. All myopes must be exactly like Mr. Doe. Plus lenses never help anyone with
    Good that you have called yourself a "Democrat".

    Otherwise most of us would have looked at you as a Fascist.
    Rishi Giovanni Gatti, Nov 15, 2004
  6. If it's for prevention, it's obvious is for the young!

    You being a Democrat, and not an Idiot, should have understood this

    But your message is full of bad assumptions.

    Poor Otis, who is becoming tired, I see, has not even told you that
    the plus lenses must be worked out and used for distant vision, if
    they can have any impact on the myopia.

    Unfortunately, your client has used them for reading, which is a bad
    habit, and spoils the sight both for near and far.

    No mystery that the client could not get any benefit.
    Rishi Giovanni Gatti, Nov 15, 2004
  7. RM

    Otis Brown Guest

    Dear Rishi,

    Yes I do get tired of it.

    But there was a ray of hope -- that was Jacob Raphaelson.

    For you it was the ophthalmologist William Bates.

    We all have our heros.

    After I talked with Raphaelson, I realized that
    the person himself (or herself) would have
    to work to "control" the situation himself.
    (always personally pass the Snellen DMV)

    Certainly a great majority will "fight against"
    the use of the plus. If that is their
    choice, and they are in high school, then
    they can expect their refractive-status
    to go down by -1/2 diopter per year.

    If informed of this -- and they do not
    mind it -- then that is the end of
    "prevention" for them.

    Raphaelson reported that the forced
    wearing of a minus lens on humans
    created nearsighedness.

    Since I could not reproduce that result
    in humans, I felt that it indicated
    that the minus lens was not "safe".

    So you take a population of primates,
    measure their refractive status (both plus
    and minus) very clear, does not get
    simpler or clearer.

    You put a minus lens on 1/2 of them
    and measure to see if the refractive
    state of the entire population of natural
    eyes moves in the direction of the
    applied minus lens.

    This is fundamental behavior. A built
    in characteristic of all natural eyes.

    I regret the people who can not face
    these objective facts -- but it is obvious
    that most people wish to "spin" them -- to
    avoid the obvious conclusion.

    So Jacob Raphaelson was right all along.
    But it take considerable force-of-character
    and to implement the preventive method.

    It is not "child's play", and you can
    not "prescribe it", but under the
    proper conditions "prevention" can
    be successful -- under the individual's

    In fact, this is the same thing you
    say about "Bates". The person must
    see the results himself.

    With the minus lens the results are "instant".
    They impress the public. It is very
    hard to talk to a person about the
    "secondary" effect at that point.

    Only later do they begin to understand
    the consequences.

    But that is the point of our pleasant
    discusion of the preventive alternative.


    Otis Brown, Nov 15, 2004
  8. RM

    Scorpion Guest

    Well, I'm a Republican. I could call you a commie collectivist
    socialist. I could, but I don't think I want to lower myself down to
    your level.
    Scorpion, Nov 15, 2004
  9. RM

    RM Guest


    RM, Nov 16, 2004
  10. RM

    Otis Brown Guest

    Dear Rishi,

    While "Bates", may get "beat up", at least you
    and I have the good grace to maintain a sense of humor
    about the issues.

    When a man is defending a "professional position" you
    can expect the type of respons we are getting.

    Please remember -- there are ODs and MDs who are
    willing to take a major step towards effective PREVENTION.

    We can only work towards that "better world", even though
    it is difficult.

    It is hard to see how a "quick-fix" procedure -- put in
    place 400 year ago -- could be based on much that
    is scientific. It can be based on the fact that
    is works immediately -- and the public will reject
    the preventive alternative at this time.

    But let us "calm down" our language, respect each
    other and work as democrats (small "d") to
    achieve a better "preventive" solution to
    this world wide problem.


    Otis Brown, Nov 16, 2004
  11. RM

    Ann Guest

    But in all honesty, you aren't answering their questions are you? For
    the likes of me who is a lay person, it's very difficult to see how
    your view responds to theirs. You just seem to avoid it.

    Ann, Nov 16, 2004
  12. RM

    Otis Brown Guest

    Dear Ann,

    Subject: The "lay" person.

    This issue is of course very serious. Rishi, and
    others have attempted to address it in
    various ways.

    It was clear to me from the statements made
    by a professional optometrist that the "lay" public
    only "wants" the minus lens -- and will reject
    the plus.

    That is because most people only want an
    "instant" solution -- and will not tollerate
    a discussion that would include -- to a large
    extent -- the person "taking over control"
    and using the plus for prevention.

    But I believe that a pilot (or person with
    the technical insight and motivation) can,
    after a tutorial, learn to use the
    preventive plus lens correctly.

    This sort of analysis and presentation
    simply can not be reduced to "medicine",
    and can not be done in 15 minutes in
    an office.

    But I believe it can be done where a
    person has the motivation for it.

    A solution can be difficult -- but possible
    based on accurate scientific assesment
    of the dynamic behavior of the natural eye,
    if the analytical mind of an engineer is involved.


    Otis Brown, Nov 17, 2004
  13. RM

    RM Guest


    This is what Ann said:
    And once again you don't (read can't) reply. More obfuscation.

    RM, Nov 17, 2004
  14. Excuse me.
    Rishi Giovanni Gatti, Nov 17, 2004
  15. RM

    Ann Guest

    I hafe spent the last several years wearing a minus lens that was a
    dioptre less than I really need and I have seen no improvement in my
    Ann, Nov 17, 2004
  16. RM

    Ann Guest


    Ann, Nov 18, 2004
  17. This RM is a polite gentleman indeed.
    Rishi Giovanni Gatti, Nov 18, 2004
  18. Well, I admit I was too polite indeed, if you were a little bit more
    intelligent to put also the words to which I was responding, I could
    now be able to be less polite and restate my own opinions in a
    stronger way.

    Please, don't waste such a time in playing with cut and paste!

    You are read by the whole world, they may think all doctors are just
    like you: go cure your patients!!!
    Rishi Giovanni Gatti, Nov 19, 2004
  19. In other words, being a fascist that cuts and excerpts blocks of
    sentences is much more rude and insulting than any possible insult

    It seems your profession is really a fact of criminality.

    Not only in the practice, but in the very way of thinking of your

    Not only you could not offer any cure whatever to the immense trouble
    of imperfect sight, but you still insist to destroy any other attempt,
    even if greatly successful, to shed more light on the subject.

    I was really too polite.

    You are real criminals, you rob people of their eyesight, using this
    terrible device of the spectacles, which work as a drug, a heavy drug,
    inducing dependance, and causing more trouble than those which are
    intended to resolve.

    Perhaps you still do not see, after many decades of bad practice, what
    is the harm you have done to yourself and to other people.

    I do not know when you will be able to understand, perhaps never.

    What to do.

    Being rude to you is nothing compared to what is the rudeness of your
    Rishi Giovanni Gatti, Nov 21, 2004
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