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

Discussion in 'Optometry Archives' started by otisbrown, Jun 14, 2005.

  1. otisbrown

    otisbrown Guest

    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




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

    Subject: My myopic son


    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,



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

    Subject: Re: myopic son


    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,

    otisbrown, Jun 14, 2005
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  2. otisbrown

    otisbrown Guest

    Dear Prevention minded friends,

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

    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.


    otisbrown, Jun 14, 2005
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  3. Pardon my language, but why the $$$$ is a 2.5 year old kid READING?
    CHINESEMALE(age16), Jun 15, 2005
  4. otisbrown

    The Real Bev Guest

    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!

    "If you watch TV news, you know less about the world than
    if you just drank gin straight from the bottle."
    - Garrison Keillor
    The Real Bev, Jun 15, 2005
  5. otisbrown

    otisbrown Guest

    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

    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.

    otisbrown, Jun 15, 2005
  6. otisbrown

    otisbrown Guest

    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.


    otisbrown, Jun 15, 2005
  7. otisbrown

    otisbrown Guest

    Dear Prevention minded friends,

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




    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 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).


    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


    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

    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

    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.


    otisbrown, Jun 16, 2005
  8. otisbrown

    otisbrown Guest

    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

    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
    otisbrown, Jun 17, 2005
  9. otisbrown

    retinula Guest

    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!
    retinula, Jun 19, 2005
  10. otisbrown

    Dr. Leukoma Guest

    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.

    Dr. Leukoma, Jun 19, 2005
  11. otisbrown

    otisbrown Guest

    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

    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

    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.


    otisbrown, Jun 20, 2005
  12. otisbrown

    otisbrown Guest

    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.


    otisbrown, Jun 20, 2005
  13. otisbrown

    Tom Guest

    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, Jun 21, 2005
  14. otisbrown

    otisbrown Guest

    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).


    otisbrown, Jun 22, 2005
  15. otisbrown

    Dr Judy Guest

    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
    Dr Judy, Jun 24, 2005
  16. otisbrown

    retinula Guest

    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.
    retinula, Jun 24, 2005
  17. 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?
    CHINESEMALE(age16), Jul 2, 2005
  18. 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.

    CHINESEMALE(age16), Jul 2, 2005
  19. 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.
    CHINESEMALE(age16), Jul 2, 2005
  20. 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.
    CHINESEMALE(age16), Jul 2, 2005
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