Why the plus lens can not be "prescribed" for true-prevention

Discussion in 'Optometry Archives' started by Otis Brown, Jul 27, 2004.

  1. Otis Brown

    Otis Brown Guest

    Dear Friends,


    Subject: Defining "need" as making vision sharp with a minus
    lens. Both the "public" and the ODs (and MDs) define
    "prescription" in this way. This is the result of the
    "classical" definition of the eye.

    Re: Any truly preventive effort means that the plus will be used
    when the refractive status is 0.0 diopters.

    Re: Anyone who does not "see" the need for prevention as we do,
    is going to see a child with "glasses", on her face --
    as "not necessary". The result of this will be the
    title of the article below where, "Children are
    'Prescribed glasses unnecessarily'".


    Any optometrist who attempts to use a plus for prevention is
    going to run into a buzz-saw of opposition. The intellectually
    "abstract" goal of using the plus at 0.0 diopters is to build-up
    the "hyperopic reserve" of the young eye towards +1.0 diopters.

    Why?

    Because, the medical (Naval-Annapolis) department recognized
    that a refractive status of +1.0 diopter was of great value in
    avoiding nearsightedness -- for the entering class.

    Under the box-camera (Donders-Helmholtz) theory, ONLY a
    refractive status of exactly 0.0 is NORMAL. All other refractive
    states are "errors". An excessively idealized an false theory in
    my opinion.

    Normal monkeys in an open-pen environment have refractive
    status of from zero to +2.0 diopters. That should define the
    refractive status of the natural eye -- not the "idealized" normal
    eye of 0.0 diopters. (All eyes that are NOT 0.0 diopters are
    "error" or defective eyes. Under this "idealized" eye there are
    almost no normal eyes AT ALL, since very few primates have a
    situation where BOTH eyes have a refractive status of 0.0
    diopters.)

    This puts the OD in a "straight-jacket". If he is using the
    plus to build up hyperopic-reserve towards +1.0 diopters (in a
    young child), and the child is taken to another OD who believes
    that a natural refractive status of +1.0 diopters is a "defect" or
    "error", then there will be a law-suit, because the child has been
    "prescribed" a plus lens "... that he does not need".

    Tragically, the simplistic "box-camera" theory ALWAYS WINS
    THE ARGUMENT. Assuming the OD is attempting to build up the
    hyperopic reserve of the child -- he will "lose" this argument,
    with BOTH the parents, the child and all the other OD's. There is
    hardly any incentive for the OD to attempt prevention in this
    manner -- except with his own children -- as Dr. Raphaelson did.

    And again "ignorance" will always "win". How anyone can
    break this endless cycle -- is beyond me.

    This is why and how prevention is "prevented". It takes a
    very wise person to "resist" the conventional theory and method!

    The review below explains the "problem" of this deeper
    understanding -- for your thoughtful review.



    Best,


    Otis



    ******************************



    Children "Prescribed glasses unnecessarily"

    Date: July 18, 2004

    By Danielle Teutsch


    Some Australian children are being prescribed glasses
    unnecessarily for long-sightedness, experts say. Professor Paul
    Mitchell, director of the Centre for Vision Research at the
    Westmead Millennium Institute and the Department of Ophthalmology
    at the University of Sydney, said he discovered a number of
    children wearing glasses for no good reason during an examination
    of more than 1500 six-year-olds in Sydney.

    Data on myopia and other aspects of eyesight health is being
    collected in a two-year study, due to be published later this
    year.

    Professor Mitchell said there was "no doubt" that some
    optometrists prescribed glasses for children who would normally
    grow out of mild hyperopia (long-sightedness).

    "Some optometrists go over the top, though in most cases they
    are reasonably responsible," he said.

    Professor Mitchell said he did not expect the amount of
    overprescribing in Australia would be as high as suggested in a
    recent US study, which found as many as 5 per cent of children
    referred on for comprehensive vision exams were prescribed glasses
    they did not need.

    The article, published online in the latest Journal of The
    American Association Of Pediatric Ophthalmology And Strabismus,
    was based on a screening program of more than 100,000
    preschoolers.

    Of more than 3600 children who were referred for follow-ups
    because of suspected disorders, such as amblyopia (lazy eye),
    about one-quarter were found to have no eye problems.

    Yet nearly one in five of these children was prescribed
    glasses.

    When examined by a pediatric ophthalmologist, only a handful
    of those children were given spectacles.

    Royal Australian and New Zealand College of Ophthalmologists
    pediatric committee member Dr Frank Martin said if a child did not
    show symptoms such as constant headaches and blurry vision for
    long-sightedness, they should not be prescribed glasses.

    "Long-sightedness is quite normal as a child. Almost all
    children have low-grade long-sightedness, which they grow out of
    at about age 8-10," he said.

    "My approach is, if they don't have any symptoms, don't give
    them glasses."

    Dr Martin, who is also head of the Ophthalmology Department
    at the Children's Hospital at Westmead, said giving glasses
    unnecessarily to a child would not cause them any harm.

    Optometrists Association Australia spokesman Robert Hilkes
    criticized the US study, saying that the parameters were
    restricted to looking at whether a child had amblyopia. "Under
    their criteria, a child could be legally blind and still not need
    prescription spectacles," he said.

    Optometrists considered a range of factors when prescribing
    glasses, including whether the child could do normal activities
    such as read a book or look at the blackboard comfortably. "It's
    a quality of life issue," he said.

    Dr Martin said the routine screening of preschoolers funded
    by the NSW Government could help reduce any prescription errors.

    Routine screening would also help pick up potentially serious
    cases of amblyopia, a problem that could lead to legal blindness
    if left untreated.
     
    Otis Brown, Jul 27, 2004
    #1
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