What recommendations would you make for 2.5 year-old child?

To: Optometrists on sci.med.vision,

Subject: A mother asks you about her son (at -6 diopters) and
requests recommendations for prevention.

Question for optometrists on sci.med.vision.

Would you recommend that she reduce the amount of
"reading" her son does -- at 4-5 inches?

Would you recommend that she "restrict" the wearing of the
-6 diopter lens, or would you recommend that her son wear the -6
diopters 16 hours a day, 7 days a week. (As per
the "O'Leary Study"?)

I will forward your recommendations (as you state them) to
"Emma" as she is very concerned about her child's long-term visual
welfare.


Best,

Otis

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

Letter 1 from Emma about her 2.5 year old son at -6 diopters


Subject: My myopic son


Hi,


My son is 2.5 years and is myopic (-6D and -4D). I am very
concerned about this. As I read considerably about risks in minus
lenses, I am not using them for my son. Instead, I ordered for a
pair of pinhole glasses, which I intend to use.

He is able to manage on his own and play well. He can see
bright stars too in the sky. I am concerned that as myopia tends
to increase till the age of say 16 years, I am really scared about
how the progression will be. Can you please tell me if I am doing
anything worng by not using the minus lenses prescribed? Will his
myopia increase because of this?

I read about eye exercises and as he is too small to really
get them going, I am making him look at Snellen chart. He is able
to identify alphabets of 4th row from the top from 10 ft or so.

Can you please give me some directions as to how to go about
with my son's myopia?

Thanks and Regards,

Emma


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


Letter 2 from Emma about her 2.5 year old son at -6 diopters

Subject: Re: myopic son


Hi,

Good Morning. Thank you very much for your replies. I will
get back to my Snellen chart get back to you with the details.
These are some of my observations on my son's vision:

1. He holds a books at a distance of ~4-6 inches. Sometimes I
feel he is just used to it. Though he can see the same
pictures from nearly a foot (as he will be able to identify
the pictures when I move the book away), he just refuses when
I tell him to do it. I slowly tried to tell him that his
hands should be straight when he holds a book (as the length
of his hand is just a little longer than a foot). But you
know, he finds the book heavy and cannot manage.

2. He can identify an ant moving (small black ants .. small
means really the tinest ants), from a distance of 1 feet, but
once he identifies it moving, he stoops towards the ant to
nearly 3 inches (I guess this is to get the detailed picture)
to view it.

3. He can identify movements very well. He can identify a
butterfly from more than 30 ft or even more. Once I was
surprised that he could identify butterflies of bright yellow
color which are more than 60 ft. He can identify a crow or a
pigeon sitting on the 5th floor of the building. I heard
that bird watcing is good for the eyes as the eye tends to
move along with the bird. So I encourage that by taking him
to parks etc.

4. The two points which made us go to the doctor are his close
looking at books + not identification of faces that are at
greater distance than 30 ft. Example, if we are say 30 or
even 25 ft.from him, in a market or a park, he looks at
strains to identify the face.

5. I carefully watched him climbing the stairs and getting down.
He does that comfortably and at a good pace too. 6 He does
not watch TV. We don't encourage that.

As you mentioned, I will get back to the snellen chart and
get the right numbers.

I have one very big concern. As I mentioned, his myopia
is -6D (L) and -4D (R). I guess he uses his right eye much more
than left eye. He will not allow me to close his right eye as
much as what he allows me to close his left eye to view something.
But now maybe he got used to me closing his right eye. He allows
it for a few seconds.

I read about amblyopia which says that if the image to the
brain from one eye is not strong, the brain tends to get images
from the better eye and gradually the weaker eye tends to become
weaker. Do you think the difference of -2D between the eyes can
cause this? If yes, could you please provide some tips on how to
handle this without using the minus lenses?

Thanks for your time, again. So I will not try to use
the minus lenses as his playhome for this year only uses blocks
and some big picture books. I guess he can mange. I ordered for
a pair on pinhole glasses and awaiting their arrival. I will try
to use them.

Best Regards,

Emma

 

Dear Prevention minded friends,

Subject: OD who love to "bash" the
second opinion -- but when faced
with honest and fair questions -- fade
completely.

So much for their "warnings".

I will post the same back
to this woman -- that
some OD overprescirbed
her son by probably
-5 diopters, and the
OD who did this
will not be "around"
when her kids retina
floats off into the viterious.

So much for abgniation
of any responsibility.

Best,

Otis

 

Pardon my language, but why the $$$$ is a 2.5 year old kid READING?

 

Because it's fun? When you read, you're deciphering a secret code. Kids,
even tiny ones, like that. The first time a kid sounds out
S...T...OOOOOO...P! on the big red sign, he's hooked!

--
Cheers,
Bev
=========================================================
"If you watch TV news, you know less about the world than
if you just drank gin straight from the bottle."
- Garrison Keillor

 

Dear Mainland (CA) Chinese friend,

That is EXACTLY my question.

The mother should have been warned to NOT DO THIS.

Or if she insisted, the use a "projector" so that the book
would have been at a distance of 6 feet or greater.

When you do this to young primate monkeys,
the refractive state of there natural eyes move
negative.

1. From a prolonged "near" enviroment or from

2. A strong minus lens.

(This is a NATURAL process).

At the minum this woman should have had
this child's eye checked for refractive status
(say zero), and visual acuity.

As it stands now, we have no idea what is
going on.

the recommendation seems to be that:

1. Reading at 4 inches (-10 diopters) has no
effect -- and the child should continue doing so.

2. The -6 diopters should be worn ALL THE TIME.

Frankly this approach and "understanding" scares
the hell out of me -- and I would expect this
child to be at -10 diopters by age seven.

Just my opinion.

Otis

 

Dear Friend,

I like to read also -- but not at age 2.5 years -- and not
if I am going to rapidly lose my distant vision
and wind up at -10 diopters.

The real question is this:

1. Who has the responsibility

The mother? The optomterist?

2. What should be done.
How would YOU wish to be treated?

3. What is the SECOND opinion.

4. Would the monther follow the advice to
"chill out" and stop her child from reading
for 6 months. After all -- what is the rush.

[I have sent these remarks to my sister's
kids -- who have children of their own -- so they
UNDERSTND this "second opinion".]

When YOU have children -- they will have a
"choice" you never had.

Best,

Otis

 

Dear Prevention minded friends,

Here is the recommendation I
made to the mother with
here incipient myopic son.

Best,

Otis

_______________

Dear Emma,


Subject: Your -6 diopter son -- the two opinions


I posted your statement about your 2.5 years-old son who is
(by OD measurement) at -6 diopters. There are two opinions:


THE MAJORITY OPINION

The majority opinion is that your son is at an "honest" -6
diopters, should wear the -6 diopter lens all the time.

The majority opinion also states that teaching him to read at
2.5 years old, and reading at 4 to 5 inches (-10 diopters) has
NOTHING to do with the fact that your son is -6 diopters myopic.

There is no need to determine his "Snellen" reading since the
prescription must be made on the basis of a "paralyized eye"
measurement (cycloplegic).


THE SECOND OPINION

As an engineer -- I can not agree with the above opinion, and
if this were my child I would support the judgment of Steve Leung
OD, on

www.chinamyopia.org


The scientific data shows that the refractive state of the
fundamental eye is senstive to its visual enviroment. While
viewing "close" for 10 or 20 seconds has no effect, long-term
close-viewing (for hours) has the effect that the natural eye's
refractive status "moves negative", and the eye becomes
nearsighed.

If I were you, I would look for a "behaviorial" optometrist
that would help you with this second-opinion, and preventive work.
You should be able to find such an OD in your phone book.

I believe this is a now-or-never type of decision for you and
your child. You need the RIGHT type of professional help at this
point, and should be aware of these contradictory opinions -- and
the long-term effect they can have on your child's vision.

While the -6 diotper might be "right" there also can be
measurement errors if an "auto-refractor" is used. (Computer type
machine.)

A -6 diopter perscription would translate APPROXIMATELY to a
Snellen reading of approximately 20/420.

A -4 diopter person is considered to be legally blind -- with
out his glasses.

From the statement you made about "butterflys" and other
indications I do not believe that your son's Snellen is 20/420.

Before you continue I think it is essential that you do this
check in room-illumination conditions.

With that number, you should contact a behaviorial
optometrist to see if he can help you. It is essential that you
make understand the contradictory nature of these two opinions.


Best,


Otis

 

Dear Prevention minded friends,


Subject: Prevention by Paul's parent. 20/20 and a SLIGHT
positive refractive state will be the result.


Paul Harris, O.D., F.C.O.V.D., F.A.C.B.O.
Director, Baltimore Academy for Behavioral Optometry


Re: I measured well up in +3.00 diopter range when my father (my
optometrist then) was done with me. Paul Harris OD


Since the time of Raphaelson, I was well-aware that a
preventive "plus" could not a "prescribed" plus. Unless the
person understands the real purpose of the plus -- he will "fight
it" rather that use it correctly.

But given the optometrist's understanding of the necessity,
of using it -- his son can be successful in protecting his distant
vision -- for life.

Please be aware that the word "hyperopia" is a mistake. Just
describe the natural eye (in the wild) as having a range of NORMAL
refractive states from zero to plus 2 diopters. (Everyting being
equal, these eyes are 20/20.)

By systematic use of a plus (keeping the eye "in the
distance") it is possible to keep the natural eye's refractive
state in that normal positive range.

Please remember that the goal of the plus is NOT to create a
refractive state of +3 diopters. Anyone who is working to "clear"
their eye chart is changing their refractive state from minus (say
-2.75 diopters) to 20/20, must have a refractive state of very
close to zero. If the use of the plus is maintained beyond the
20/20 level, the person will begin to see 20/15 (occassionally),
and will be able to read 20/40 through a plus-one diopter lens.

His refractive state will be zero or become SLIGHTLY postive
-- but COMPLETELY NORMAL and valuable to him.

I am of the opinion that this is the ONLY method that will
work IN THE FUTURE for true-prevention.

Here is the discussion by Paul:

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

(Erol Basturk) writes:

Unknown> Also, is there such a thing as a progressive hyperope?

Unknown> Yes.

Erol> Well that's news to me. Every moderate to high hyperope (~
+2 D. and up) I ever ran into was about as stable as the
Rock of Gibraltar.

Erol> Progressive hyperopia???

Paul> Yes... This is the development of adverse hyperopia. The
cause most often is as a secondary iatrogenic disease
caused by the overzealous prescribing of plus.

[Comment: This is use of the plus -- when the eye is already
at greater-than +2 diopters. No slightly nearighed
eye is at this level. OSB]

Paul> I know you and others will say if a good cycloplegic were
done.... and things like ....latent hyperopia.....

Paul> I was a subject in a longitudinal study for 5 years as a
child. All this plus, A-Scans, Purkinje images measures
of radius of curvature of front cornea, rear cornea, front
lens, rear lens, anthropomophic measures, IOP, wet and dry
refractions, full 21 point analytical and more were done
every 6 months for 5 years. I have the data on myself.
At no point did I ever show hyperopia more than +1.00 to
+1.25.

Paul> After the study at age 15 I started wearing single vision
plus to play chess and this was upped and upped. NOTE: I
was measured with a 14 to 1 ACA ratio. 16 eso at near
through whatever distance lens of the time and 2 eso with
+1.00 add over that. The standard theory was "push plus".
This was done and I ended up at one point wearing +2.25
OD/ +2.50 OS with a +1.50 add for 10 years. I measured
well up in +3.00 range when my father (my optometrist
then) was done with me.

Paul> There was no latent hyperopia over the +1.00. The
additional amounts were built up slowly over time in
response to my optometric care.

Paul> Once I did Vision Training 13 years ago I now wear just some
plus for near and nothing for distance. My subjective now
is +1.25 OU (both eyes) which I choose not to wear and do
great. In fact I now see better than ever.

Paul> I hope this explains a bit a very big subject which I am
fully aware of there will be little agreement on from the
"conventional eyecare establishment". Please give me some
other alternative to understand the above findings over
time. I also have basic optometric data on me from the
age of 6 months.


Paul Harris, O.D., F.C.O.V.D., F.A.C.B.O.
Director, Baltimore Academy for Behavioral Optometry

 

if you don't understand, then don't post.
if the kid is hyperopic, and esotropic, then thats a very good reason.
slow down, and calm down, boy!

 

OK, in case you don't understand by now, Otis craves attention.
Negative, positive, it doesn't matter. Like a child who stopped
growing about 3 decades ago, he won't shut up. Just ignore him as you
would any 2 year-old who misbehaves.

DrG

 

Dear Chinese Male,

In working with Francis Young, I eventually obtained most of
his publications.

When you teach a very young child to read, the tendancy for
the child is to "pull" the work inward until his nose is
almost on the page, i.e., reading at 5 and 4 inches (-10 diopters).

The eye is made such that it can, for short duration do this.

But what is the effect of "long" duration?

Does the natural eye change its refraction in a negative
direction consistent with this "nearer" environment -- as
a natural process?

It is virtually impossible to put a very young primate in this
type of situation. The only think comparable is to
get very young monkeys and put 1/2 in a visual
box.

Francis Young did this. The result, the young monkeys
in the box had their refraction move in the direction
and approximate magnitude of the "nearer" visual
enviroment.

The "enviroment" was not 4 inches (-10 diopters) however.

The majority-opinion ODs on sci.med.vision deny this
OBJECTIVE scientific data, saying that the monkey-primate
is profoundly different that the human-primate.

You are free to draw your own scientific (not medical) conclusion
about the young eye placed in a more-convined visual enviroment.

Best,

Otis

 

Dear Chinese (16)

My last contact with this woman was to the effect that
the -6 diopters (if cycloplegic) was most likely correct.

The only choice remaining for her is to:

1. Get a -6 diopter lens and have the 2.5 year-old child wear
it all the time. (Seems to be recommended by the
"majority opinion" ODs on sci.med.vision. Or,

2. Take the child to a behaviorial optopmetrists and
see if anything can be done.

I will not communication with thie woman further.

I do think we are naieve to think that there is NO RELATIONSHIP
between our visual enviroment and our refractive status.

I just have seen a massive amount of direct experimental
data that says it that way.

I think parents should be wanred to NOT teach their
children at age 2.5, in the belief that there no such relationship.

That relationship is proven (except for the "majority-opinion")

But most people (even with full knowledge of the scientific facts)
will ignore the implicit warning and wonder "why" my kid
is 6 diopters myopic.

Best,

Otis

 

Good if it were so. We could all be declared legally blind and get
all sorts of benefits to which we aren't at present entitled.

You do talk rubbish Otis. At least if it's really true in one country
you should state that country. It certainly isn't true in the UK.

Tom

 

Dear Tom,

Obviously each country has its own definition
of "legally blind" without glasses.

Obviously you can "correct" a myopia with a -4, and
make the eye 20/20 with a strong minus lens.

The issue is really about how "bad" vision is
naked eye at -4 diopters.

But equally, you can continue to "correct" stair-case
myopia until it hits -10 diopters or so -- and just
keep continuing.

The real point of this piece is that when you place
the natural primate eye in a "box", (control-group, test group)
the group in the "box" shows a negative change in
refrefractive status relative to the control group -- thus
indicating the the natural eye is CONTROLLING its
refractive status to its average visual enviroment -- and
a natural process.

This suggests that teaching a 2.5 year old is a
"risky business", and should not be attempted
UNLESS the mother if fully award of the
risks of having her child reading at -10 diopters
for long periods of time.

If clearly informed, and she still decides to teach
her kid to read at age 2, then she should not
regret the this proven effect that a
more-minus enviroment has on the
primate eye (human or monkey).


Best,

Otis

 

There is no definition of "legally blind without glasses". The definition
of "legally blind" always includes the phrase "with best correction" ie,
legal blindness is ONLY defined with glasses. Talking about "legally blind
without glasses" is nonsense.

Dr Judy

 

You blurted this nonsense out: "But equally, you can continue to
"correct" stair-case
myopia until it hits -10 diopters or so -- and just
keep continuing."

this is totally baseless. please provide proof that this is true in
humans. also prove plus lenses are beneficial.

why does a recent well controlled scientific study show that slight
overcorrection with minus lenses seems to slow myopia progression.

you are a zealot and a sicko.

To all listeners-- please disregard any comments from otisbrown. He
ignors scientific facts and preaches his own biased agenda.

 

Emma, your son is a [beeping] loser. More loser than me, unless he is
uglier than me. Does myopia this bad run in your family? If it does
then why do you have kids?

 

Frankly this approach and understanding scares
the hell out of me -- and I would expect this
child to be at -10 diopters by age seven.

That's horrible. I became -10 diopters when i was 15, when a boy has
his "golden years". I don't even remember anything in my life before
4, I don't think I read. Either this boy has pathological myopia, or
he has a case of his extreme intelligence leading to myopia.

Sickening...

 

It is virtually impossible to put a very young >primate in this

Otis, I am disgusted by a world. I do not want to live in a world,
where children's worst enemy are their parents. I do not want to live
in a world where kids are encouraged to read, in a world where staring
out windows is a "bad thing to do". I do not want to live in a world
where children are PRAISED for reading a book, where glasses are seen
as symbols of intellectual of status.

I do not want to live in a society, where, you are ridiculed, if you
CARE about your image.
I do not want to live in a society where you are taught not to care
about how you look, where you are taught that everyone is equal. This
is a massive brainwashing, as, when we become teenagers, or, when we
try to get jobs, we realize that looks matter very, very much,
especially when we start to be called UGLY.

 

My parents claimed that they thought I "knew" that too much close work
caused myopia. I do not know where they got that idea. All they say
is, "we thought you knew". I'm sure. Oh yeah, sure I knew. Just like
how all the other kids in the world "know" that reading may cause
myopia. I'm being sarcastic if you can't tell, because if everyone
knew, no one would get myopia. Common now, common.