A Compendium on Myopia Rehabililation

[Tom]

Myopia and the Associated Pathological Changes

The long-term repercussions of higher myopia are usually not readily apparent to its sufferers until it is fairly late.  And hence this post, which is based on this meta-analysis. The motivation here is twofold. On one hand, knowing the possible complications of myopia provides one with strong incentives towards myopia rehabilitation. On the other hand, knowing about the pathological changes associated with myopia might shed some light on how myopia could have developed in the first place (at least for me - see if I can get some inspiration from that!).

Cataract

Cataract refers to the condition that as one ages, sometimes protein deposits would start to accumulate in the crystalline lens. Consequently, the lens becomes more opaque, which then over time induces form deprivation myopia. Cataract has at least 3 types: posterior subcapsular, cortical and nuclear. While different types of cataract might not share the same etiology, cataract is generally associated with higher myopia. Although it’s known that cataract can worsen myopia, it’s unclear how myopia progression can induce pathological changes in the crystalline lens. It is speculated that such changes might have occurred due to “damage of rod outer segments,” and an increase in the production of “penoxidation by-products.”  Large cohort studies have demonstrated that cataract in general could result as a complication of high myopia.

Glaucoma

Primary open-angle glaucoma (POAG) is a condition generally associated with pathological changes in optic disc, defects in optic nerve layers and high intraocular pressure. Glaucoma is most likely the result of axial elongation and sustained pressure in the vitreous chamber, and whose incidence is strongly positively-correlated with the severity of myopia. Corroborating evidence includes the fact that emmetropes have substantially lower intraocular (vitreous) pressure than myopes, and that high myopes have larger and longer optic disc, and shallower cup depth. Here are the excerpts of a few findings:

(OR stands for odd ratio, IOP for intraocular pressure)

• ”OR of OAG was 3.1 (95% CI 1.6, 5.8 ) for high myopia (SphE at least –5.0 D), 1.3 (95% CI 1.0, 1.8 ) for low myopia (SphE > –0.25 D to –5.0 D) compared with hyperopia (SphE at least + 0.25 D), adjusted for age, IOP, sex, family history, season, blood pressure, astigmatism, urinalysis and health”
  
  
• ”OR of prevalent glaucoma for myopia (SphE at least –1.5 D) was 5.56 (95% CI 1.85, 16.67), adjusted for diabetes, hypertension, steroid use and iris texture”
  
  
• ”OR of prevalent OAG was 3.3 (95% CI 1.7, 6.4) for moderate to high myopia (SphE at least –3.0 D) and 2.3 (95% CI 1.3, 4.1) for patients with low myopia (SphE < –3.0 D and ≥−1.0 D), adjusted for sex, family history, diabetes, hypertension, migraine, steroid use and pseudoexfoliation”
  
  
• ”Prevalence of newly detected OAG increased with increasing myopia (SphE at least –1 D) (p < 0.01). [0.6% in hypermetropia (≥+1.0 D); 0.9% in emmetropia (SphE > –1 D to < + 1 D) and 1.5% (SphE ≤−1 D) in moderate to high myopia], adjusted for age, gender and IOP”
  
  
• ”Prevalence of OAG higher for moderate to high myopes (SphE at least –3 D) compared with hyperopes in males (p < 0.001) and females (p < 0.001)”
  
  
• ”The age and gender adjusted ORs of prevalent POAG for myopia (SphE at least –1.0 D) was 1.6 (95% CI 1.1, 2.3)”
  

Abnormalities Related to Connective Tissues

Although the strength of connective tissues might vary from one individual to another, an increase in myopia could have lasting repercussion on the posterior part of the globe. Ocular conditions pertaining to this category are numerous, they include vitreous liquefaction, posterior vitreous detachment, Fuch’s spot, lacquer cracks, retinal breaks, macular holes, choroidal atrophy, lattice degeneration, posterior staphyloma and white without pressure.

The association between such abnormalities and myopia progression is generally based on clinical data only. Certain chorioretinal conditions might have been triggered by mechanical stretching or biochemically-modulated atrophy. Here are a few findings:

(AL stands for axial length, and OR for odd ratio)

• ”Percentage of chorioretinal atrophy was 0% if AL < 24.5 mm and 23% if AL ≥24.5 mm Percentage with Fuch's spot was 0% if < 26.5 mm and 5.2% if ≥26.5 mm Percentage with lacquer cracks was 0% if < 26.5 mm and 4.3% if ≥26.5 mm Percentage white without pressure increased from 0% at 20–21 mm to 54% at 33 mm Percentage lattice degeneration increased with AL (p < 0.01)”
  
  
• Percentage of eyes with one of more retinal lesions (white with or without pressure; lattice degeneration; pavingstone degeneration; posterior vitreous detachment) increases with AL
  
  
• The OR of retinal detachment for myopes (SphE at least –1 D) was 7.8 (95% CI 5.0, 12.3), adjusted for age, sex, race and clinic
  
  
• Percentages of posterior staphyloma, but not lattice degeneration increased with AL
  

Optic Disc Abnormalities

Numerous studies suggest that myopic progression is associated with larger, longer, tilted or rotated optic disc:

• ”With increasing myopia, the temporal slope of the disc cup decreased (p < 0.01), the ratio of vertical to horizontal disc diameter (p < 0.01) and ratio of width of peripapillary atrophy to vertical disc diameter increased (p < 0.01)”
  
  
• ”Patients with myopia (SphE at least -5.0 D) had a longer disc–foveola distance (p < 0.001), larger long:short axis ratio (p < 0.001), larger discs (p < 0.01), higher likelihood of tilted (p < 0.001), rotated disc (p < 0.01)”
  
  
• ”The disc area increased by 0.033 mm2 (95% CI 0.027, 0.038), the neural rim area by 0.029 mm2 (95% CI 0.025, 0.034), and the prevalence of parapapillary atrophy [zone alpha by 0.4% (95% CI 0.03%, 0.8%), and zone beta by 1.3% (95% CI 0.57, 1.9%)] for each D increase towards myopia”
  

In another study, tilted disc is associated with the presence of myopia, suggesting that tilted optic disc might have provided predisposition towards myopia development. This could explain in part the variability of diopters in samples where subjects are exposed to similar prolonged near stress environment:

• ”In eyes with tilted discs (77 eyes), 66.2% were myopic (SphE at least –1.0 D), but in eyes without tilted discs (7,089 eyes), 11.3% were myopic (p < 0.001)”

Visual Impairment

In very rare cases, myopic degeneration (due to high myopia) in advanced age could lead to visual impairment (in addition to cataract and glaucoma). Furthermore, myopic age-related macular degeneration is a significant cause of blindness in Asia, suggesting that for people with weak connective tissues, higher myopia increases the risk of macular degeneration in advanced age:

• “In the Rotterdam study of 6775 subjects aged 55 years and older, myopic degeneration was the predominant cause of impaired vision (accounting for 23.0% in adults younger than 75 years) (Klaver et al., 1998).”
  
  
• ”A study of 1000 inhabitants aged 60–80 years in Copenhagen revealed that myopic macular degeneration was one of the most common causes of bilateral blindness (accounting for 10%) (Buch et al., 2001).”
  
  
• ”in a survey of adults 50 years or older in Taiwan, myopic macular degeneration was the second most common cause of visual impairment (contributing 25.0% of cases) (Liu et al., 2001).”
  
  
• ”a survey by Iwano and colleagues in Japan of 2263 adults aged 40–79 years showed that the OR of visual impairment for myopic adults was 2.9 (95% CI 1.4, 6.0) (Iwano et al., 2004)”
  

[OtisBrown]

Hi Tom,

For those interested Richard's true-prevention  - here is the video:

http://www.youtube.com/watch?v=vNNQY2_bTlo

Here is Richard's attractive site on prevention.

http://myopiaprevention.org/

It is funny how "close" Richard gets to the correct solution, with the kids and being in the "open".  The plus, when properly worn (before you become nearsighted, i.e., still read 20/40), creates that "out-door" environment - that he says will keep your child's refractive STATE positive.  But he avoids that type of discussion - completely.

Here is a video on using the plus for threshold prevention.

http://www.youtube.com/watch?v=uWjnNM0VYM4

I love it when an OD actually recommends the plus.

Where are the  "cost comparisons" of these two methods?

I am certain that Richard is a sincere, dedicated optometrist.  He sees that he can "fix" you with an "instant" minus lens - and does not know if you wish TRUE prevention.  So he tells you "up front" that he does not offer you prevention - because that is, in his mind  - impossible.

It is hard to avoid the conclusion that he considers you ignorant (in some manner), and that he has to make his living.  So he sees you as a "$$$$$ bottom line " for his business.  In fact, I do not object.  But I do not ask him for help with prevention AFTER he has told me point-blank, that prevention never going to be possible.

I am not even critical of him.  But if I wish for TRUE prevention (at 20/40) I will have to do it myself.

That is indeed a "bitter pill" to swallow.  I know we want Richard to hold out "hope" to us.  What he holds out is Ortho-K, that does work.

Otis

Just sent an email to Richard Anderson, the author of myopiaprevention.org:


Hello Richard. My name is Tom Lu. I spent the past week reading your website in its entirety. And here are some comments:

------

“Myopia forms because the eye grows too long. There is no anatomical method to shrink an eyeball short of cutting part of it off.”

“True myopia (nearsightedness) means that the eyeball has grown too long. That physical change can not be reversed .”


One would think that it’s impossible, but this is exactly what happened in the animal studies, and consistently so.  The animals who were fitted plus lens generally had a decrease in axial length below baseline level - Not just an inhibition of axial elongation.

On the human front, here is a study to be included in the undercorrection section:
http://www.iovs.org/content/51/12/6262.full?sid=dbdaf664-6184-42eb-a8d7-e94008536dce

And this, under the reading glasses section:
http://www.ever.be/view_abstract.php?abs_id=2042


“The web is full of false information and many doctors have become skeptical of any progress in this area because there have been so many false claims over the years. Patients have become skeptical of doctors because they are offered few options besides "wear the glasses" when their eyes and vision get worse.”

I think the medical community haven’t catched up with science in general. It’s only reasonable if patients look somewhere else if solution is nowhere to be found. At least the web opens up the alternative solutions that are otherwise unavailable. There is always the possibility that you or me or anyone else is not entirely correct anyway.

“The problem is getting worse every year and regular glasses are part of the problem.”
“I'm here to say that your doctor should offer you better options.”

Thanks for speaking out on this. I believe that more eye professionals need to change their usual practice before myopia spirals down into a serious epidemic. See http://bjo.bmj.com/content/82/3/210.full

“There is a good theory based on many studies that high carbohydrate diets could make myopia worse.”

You are not the only one suspecting the connection. I’ve tried incorporating some of your references into this post:

http://forum.gettingstronger.org/index.php/topic,538.msg5474.html#msg5474

“Bifocals and PALs are normally used for the condition of presbyopia, which is what happens to everyone, usually in their forties, when it becomes difficult to focus on both distant objects such as street signs and near objects such as a book. The solution is to make the corrective lens have two powers, one for each distance.”

But have you thought about the risk factors making crystalline lens stiffer over time? People should be aware that Bifocal/PAL does not address the causes of presbyopia.

“The reason would be that while wearing the glasses, the person would create a clear central focus so that they could read. This creates a peripheral hyperopia in many eyes, which would create more myopia, just as if the glasses were not being worn. The peripheral hyperopia would be there with or without the reading glasses. “

I think it should be emphasized that defocus changes as one changes the focusing distance as well. This explains why reading glasses won’t work if you read within your far point. I believe that special contact lenses study could be make to fail as well, if the subject were instructed to read very close. There is a difference between relative peripheral refraction, and the actual peripheral defocus in practice.

“Proponents of reading glasses state they should work because they relax the eye while reading, the assumption being that reading by itself causes myopia.”

If they believe that reading by itself causes myopia, why would they even use reading glasses? I think the main reason of using reading glasses is just so that near stress can be eliminated, but that won’t happen if one continues to read very close.

“Everyone became nearsighted before they got their glasses. If no glasses was a cure, there should be no blurred vision to begin with.”

“There is also the fact already mentioned that people become nearsighted before they start wearing glasses so that suggesting not wearing glasses as a "cure" is logically suspect.”

I believe that the logical suspect is that wearing full minus prescription is better than wearing no glasses. I have all the reasons to believe that near stress is the cause of myopia (which explains how people become myopic in the first place), and that traditional minus spectacles would make it worse. I also think that your recommendation is more dangerous than you think: the animals got myopic by wearing minus lens, and when the lens is removed, they recover from myopia. The same thing happens to me, and countless people on gettingstronger.org forum and frauenfeldclinic.com.

“Animals (including people) become nearsighted if they do not have clear vision as they are growing up. An example would be a child born with a cataract, which does not allow clear vision. If the cataract is not removed early, the eye will quickly become very myopic (and still blind). But it has been shown that brief periods of clear vision, as short as one hour a day in monkeys, are able to greatly negate the myopic effects. A corralary in humans may be that full distance correction needs to be worn at least part of every day to prevent myopic progression. If you don't have any glasses, you never have the clear vision that appears protective.”

I thought about this extensively a year ago and I can tell you that it’s not correct. Form deprivation is not the same as unclear vision. Form deprivation myopia occurs when there is occlusion or obstruction to our visual field. If unclear vision causes myopia, then animals wearing plus lens should have become more myopic, but that is the opposite of what happened. Again, I think your recommendation is more dangerous than you think.

“One study that was done with under-correction was stopped after two years when it became obvious that the under-corrected students were progressing faster than the fully corrected students. “

My experience  suggests that undercorrection alone does not prevent myopia, as we also have to take into account the focusing distance in question. Also, this study did draw some criticisms. See :

a) http://wildsoetlab.berkeley.edu/index.php?title=Controlling_Myopia_Progression_-_A_Confusing_Story

b) http://www.i-see.org/oleary_critique.html

“Due to these factors, many people wear sunscreen on their skin and sunglasses on their eyes. Whether these actions negate or reduce the beneficial effect of being outdoors is not known.”

This is a good point. Using hat outside might mitigate both types of risks.

“Processed carbohydrates are a cheap source of calories and are heavily advertised by the food industry because they are profitable. “

You must have been aware that the same thing applies to the industry of ophthalmic lenses, and the influence they exert on our research studies. It also seems to me that this website is set up to promote orthokeratology and the website orthokdoctors.com. I think myopia is best tackled through myopia rehabilitation (see www.frauenfeldclinic.com).

“there has been no study to show that pseudo-myopia, if not treated, leads to more myopia.“

What if there is no interest in conducting such studies? In fact, we do have countless indirect evidence suggesting that it is the case (e.g., the atropine studies, the studies showing how NITM can increase vitreous chamber depth in susceptible individuals). One just have to seep through the papers.

The idea that pseudomyopia leads to mypia is something that I can witness everyday. After all, research are conducted by humans, who might have all kinds of bias and intentions.

“Scientific thought has a history of both charlatans and subpresssion of alternative viewpoints “

This is why I'm writing to you. Maybe some of the research studies will be regarded as bogus as we look back hundreds of years later. The charlatans are not necessarily the laymen.

“Most do so because they haven't seen the studies, but others will elect to ignore them.”

I think there is a possibility that some researches are only conducted to prove their point, some might not be even well controlled,, yet some others might have a hidden agenda, but I agree that in general, we shouldn’t deny a study unless we have compelling reason to do so.

-------

Also, I really appreciate the three clauses in your mission statement. This shows that you are an optometrist open to alternative viewpoints. I happen to host a topic about myopia, so you can check it out  out in your spare time:

http://forum.gettingstronger.org/index.php/topic,538.0.html



All the best,

Tom

[Alex_Myopic]

and that he has to make his living.  So he sees you as a "$$$$$ bottom line " for his business.

One relative story of mine. My faucet was leaking from the point of the rotation. I asked the plumper if this was fixable and said no so he changed the whole faucet. I didn't had time that moment to try to fix it myself because the tenant was hurried. So the plumber took 20 euros for changing the whole faucet and about 50 for the new faucet which he bought from a store he had business with.
When I had time I managed to fix the old faucet in few minutes with just cannabis fibers for plumbers and teflon tape. I'm not more capable from him in plumping.

Why not doctors take the money in similar ways?

[OtisBrown]

Hi Tom,

I think you are doing excellent academic research on your compendium.  You might submit your ideas to this conference for 2014.  Here are some topics you should include in your book.


http://www.clspectrum.com/articleviewer.aspx?articleID=105665

Previous conference on myopia prevention - FYI:


++++++

From: Berkeley Optometry Alumni Office <optoalumni@...
Subject: REMINDER: 2013 Translational Research Conference, August 17th &
18th

Date: July 26, 2013

Don't forget to register for the 2013 UC Berkeley Clinical Translational
Research Conference Series on Myopia in August - Saturday, 8/17 and Sunday,
8/18! REGISTER NOW

http://www.berkeleyclinicaltranslation.org

 
QUESTIONS:   What do you know about controlling myopia progression & managing high myopia?

1. Did you know that CRT (ortho-k) can slow myopia progression in
children, measured in terms of axial length changes, by about 50%?

2. Did you know that some concentric bifocal soft contact lenses that
are already approved for presbyopia, can also reduce myopia progression by
about 50%?
 
3. Did you know that the human choroid can thicken (just as in
chickens), when eyes are exposed acutely to myopic defocus (e.g., wearing
plus lenses), leading to an apparent shrinkage of axial length and
reduction in myopia?

4. Did you know that topical atropine in a very low concentration more
in keeping with homeopathy practice, with only small, short-lived effects
on pupil size and accommodation, can slow myopia progression by about the
same amount as the above contact lenses?

5. Did you know that a new drug, 7-methylxanthine (in a totally new
class, adenosine analog), has already been approved for use as an ORAL
tablet to control myopia progression in children in Denmark?

6. Did you know spending time outdoors helps to slow myopia progression
and lowers the risk of becoming myopic, although they reason for this
protective effect is not well understood?

7. Did you know that ~96% of ALL young adult males in Seoul, South
Korea, are now myopic, arguing that genes are likely more a determinant of
susceptibility than an absolute determinant of myopia?

8. Do you know that very long, highly myopic eyes become mechanically
unstable and thus will show myopia progression, despite intervention with
improvements in visual hygiene and/or optical interventions, thereby
requiring more invasive and risky intervention with scleral buckles
inserted under general anesthesia?

9. Did you know that all myopes carry an increased risk of retinal
 detachment, maculopathy, cataracts, and glaucoma, and it is only the
 relative risk that changes with the amount of myopia?

10. Do you know that the parents of myopic children are frequently
better informed about the causes of myopia progression and potential new
treatments that the clinicians they consult?

If "I don't know" was your answer to any of these questions, turn over
to learn how to register for the above conference, which should be a "must
attend" for you.

In it's seventh year, this annual campus-based event will host
 world-renowned myopia researchers from overseas, including Professors Ian
 Filtcroft, MD, from Dublin's Children's University Hospital in Ireland;
 Audrey Chia, FRANZCO, from the National University of Singapore; Michael
 Collins, OD, PhD, from Queensland University of Technology in Australia; as
 well as US-based Professors Earl Smith, OD, PhD, from University of Houston
 College of Optometry; Jay Neitz, PhD, from University of Washington,
 Seattle; Jeff Walline, OD, PhD, from Ohio State University and Robert
 Wojciechowski, PhD, from Johns Hopkins University. To get the full scoop on
 the speakers, click here.

http://www.berkeleyclinicaltranslation.org

CE credit will be offered: 9 (3+6) hours, including one hour TPA (all on
Sunday)

REGISTER NOW

http://www.berkeleyclinicaltranslation.org

 Following closely on the heels of this event is the 14th International
 Myopia Conference, this year also being hosted by UC Berkeley myopia
researchers. This conference will take place August 19-22 at Asilomar
Conference Grounds in Pacific Grove, CA.

For more information, please contact Christine Wildsoet at

wildsoet@... or call 510-643-4472.

Diet post expanded - a result of additional infos.

[OtisBrown]

Hi Tom,

I get the impression that all optometrists believe that any "prevention" at 20/40, is impossible.  I wonder if you could provide some commentary on this video.

https://www.youtube.com/watch?v=Dz2UHcmyR4E

I of course believe that, if the person is highly motivated, he can get out of 20/40.  But if you ask an OD to "conduct" a prevention study - you get the "fish eye" from them.

Finally, I just avoid them, and recognize that people like Todd - did prevention himself - and was successful.

Sounds good. I'll see what I can do in my spare time.

If "I don't know" was your answer to any of these questions, turn over
to learn how to register for the above conference, which should be a "must
attend" for you.

The answer is "yes" to all the questions. Maybe I should put those questions in Q&A and people can look over 

[svartberg]

Prescription for close work

The single most myopiagenic activity is to read with a strong minus lens, which has the potential of inducing hyperopic defocus (either due to accommodation lag, or inherently prolate eye shape), or overconvergence (and its associated side effects). One should read either with the weakest minus lenses, or without glasses.

[Edit: The issue of eyeglasses frame got picked up. On the March 11 (2014) blog entry, Dr. Alex recommends frames with minimal border. This is yet another way to free up our peripheral vision. In general, we only want to correct the central vision when using minus lens, so a smaller frame without border is desirable. For those using plus lens, a bigger frame would tend to positivitize peripheral defocus, and hence is preferred for myopia rehabilitators. Personally, I prefer aviator-style frame with peripheral add, because they are stylish and big enough that one can't see the border within one's visual field.]

Since a traditional minus spectacle has an uniform power across all meridians. If you read at your far point, there is still a potential of inducing hyperopic defocus in the periphery. One way to minimize that defocus, is by adding positive cylinder value to your prescription (e.g., -3D with cylinder +1D at 0° axis, as a reading prescription of a -5D non-astigmatic myope). The 0° axis is preferable, since reading is usually done from left to right, in the horizontal meridian. Positivizing cylinder value is applicable regardless of the strength of your reading prescription (e.g, be it -4D or +1D).

(Until lenses with peripheral design are widely available, it's pretty tough to eliminate peripheral hyperopic defocus at all meridians, while maintaining zero central defocus. However, if you use contact lenses and are resourceful enough, you should be able to obtain concentric-design bifocal contact with peripheral add online)

Great thread, still much left to process

Such good info above, luckily I got a rimless pair and could validate alex post right away (funny how I never made the connection)

You lost me at the positive cylinder valus though, what exactly does it do ? how do you calculate it ? is it really that important ?

[OtisBrown]

Hi Tom,

You are correct. But understand where they are "coming from".  They concluded a long time ago that "prevention is impossible".  (Prevention of negative status for the totally natural eye - in my words.)  I agree that prevention (at 20/40, and -1 diopter) is extremely difficult, and requires the person to "wake up" and do prevention by himself.  An optometrist will never attempt to conduct a pure-prevention study - because he always believes that "only an optometrist can do prevention".  Yes, the disconnect, is that they obviously feel that they can only "deal with it" - after the fact.

But,  with all of this, some few ODs have recognized that while "official optometry", declares that prevention (even at 20/40) is impossible, they declare the minus, "poison", and will not use it on their own children.  In fact they insist that THEIR child, always wear a plus for all close work.  Clearly they understand that the ignorance of the public will always "cause the rejection" by the public.

That to me is the only issue.

These people are researchers - Edward Mallen is actually in my people-to-be-contacted list. Both of them are among those who sounded the alarm about NITM. Notice that they are the theories guys - Bridging the missing link between the researchers and the public is kind of like my duty 

[Tom]

I got an update from Scott Read (author behind many important studies, including the TV undercorrection study). These folks are currently focusing on devising biometric to measure scleral changes during near work. This would allow us to better understand in more details how near-stress induces myopia.

Me here:

Hello Scott, Emily and Michael. My name is Tom and I host a topic on gettingstronger.org forum:

http://forum.gettingstronger.org/index.php/topic,538.msg4584.html#msg4584

I have read your 2012 study (http://www.sciencedirect.com/science/article/pii/S0042698912003008).that examines the role of accommodation in axial elongation and choroidal thinning. This is a very important result - Because the public desperately needs to know that NITM in susceptible individuals can lead to permanent myopia.

One way to reduce accommodation gain during close work is to read at 1 meter and beyond. However, this proves to be not very practical at times. For that reason, using reading glasses (plus lens) to read beyond one's far point can eliminate blur-driven accommodation.

However, the matter is not as simple as I once thought. My experiments with convergence and accommodation invariably suggests that even if blur-driven accommodation is completely eliminated, I still experience near stress (symptom of vitreous elongation) when I'm reading at very short distances. The same stress would subside minutes or hours after cessation of close work. This means that there is another crucial driver of near stress in addition to the commonly-known accommodation, and I suspect that the culprit is proximal accommodation.

In light of that, I wonder if you are interested in setting up a study with 2 treatment groups, both being optically corrected so that they read slightly beyond their far point, for 30 minutes, but one group reads at 20cm and the other group can read at, say, 50cm. Assuming that the subjects' left eye are occluded, then convergence shouldn''t be involved in the task. The usual biometrics would then be recorded, several times during and after the reading task (perhaps some scleral biometric as well).

If axial length still increases during the reading task, then this would provide strong evidence that proximal cues, even in the absence of hyperopic defocus, can indeed elongate the eyes temporarily. If not, that will prove me wrong. I know that Emily is writing a thesis on NITM-induced myopia, so maybe we can learn something new from this kind of study.

I sincerely believe that there is a potential that conclusive evidence of myopia via NITM can come from QuT, so I'm interested in anything that you have to say about this.

Thanks for your groundbreaking works on unraveling the causes of myopia.


Regards,

Tom

Scott here:

Dear Tom,
 
Thanks for your interest in our work, and for your suggestion for a potential future study in this area, we agree that this is a relatively complex area, and that there are a number of factors related to the changes in the eye with near work that remain to be fully explored.
 
We are currently running experiments examining the choroidal response to nearwork, as well as developing methods for assessing changes in scleral biometrics with close work.  We hope that our current work will help us to better understand the mechanisms associated with near work induced axial elongation, and help to provide us with methodologies for exploring the changes in the eye associated with near work in more detail in future clinical studies.
 
Best Regards,
Scott
 
Dr Scott Read 
Senior Research Fellow | School of Optometry and Vision Science
Contact Lens and Visual Optics Laboratory | Queensland University of Technology 
O Block, Room D517, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia


t:   (07)  3138 5714

[chris1213]

Hi TomLu: I don't understand this much, where are u getting your facts from or how are you studying it?

Some of you are not going to like this, but my evidence invariably suggests that hyperopization is largely the additive effect of farwork-induced-transient-hyperopia. The so-called "active focus", is really one way to induce transient hyperopia. Not just that, I was able to clear up images at any distance (provided that the objects are far enough). Put it more explicitly, the reason why people think that only staying at the edge of blur works, is because they thought the symptoms resulted from prolonged distance gazing represents a worsening of myopia (which is understandable - It took me one year to figure out that it's false)

Could you elaborate or explain it a little more?

[OtisBrown]

Hi Tom,

A lot of this issue becomes a matter of answer the question, "who do you trust"?

Alex> Who Do You Trust With Your Eyesight Health?

Alex>Dispensing with false modesties, that answer is:  Trust this site.

Alex> Trust me with your eyesight health, and with answers to questions about how you can improve your eyesight.  If you look at these comments from participants in the Vision Improvement Course, previous clients, patients, and just readers of the site, you’ll start to see the trend.


http://frauenfeldclinic.com/how-to-improve-eyesight-without-surgery/

+++++

I would add the question, who do you trust, and why do you trust?  It is clear that successful prevention (from 20/40 to 20/60) will require that you TRUST the concept behind it.  The person I learned to TRUST was a Dr. Raphaelson, who described the minus lens (if ever worn) as POISON.  It a deep scientific sense - I did trust both that idea, and the SCIENCE behind the concept.

I hope Tom includes the proof that the minus is a "terrible idea" and should be avoided, once you confirm you objectively read and pass the 20/40 line.

I do not get into a "dispute" about this, but I know that almost all ODs believe that any form of prevention - is something they will never encourage - or accomplish.

[chris1213]

I see, now when you say the "persistent application of near stress that blurs my vision" are you talking about near stress with or without plus lenses?

[chris1213]

Interesting, interesting...

I want to know one more thing, how close do you read when you feel close-up stress? cause I remember that on some post you said your prescription was about -9 if I'm correct (?). If you're reading too close, I think that even with a plus, or an under correction or with no glasses the near stress would still be present. I can read with a +1 at about 60 cm and see fine, without glasses I can sit at about 1 meter away clearly, but I've noticed that if I sit at about 40 cm with a +1, my eyesight will deteriorate a little bit. So there must be a correlation between the distance and the stress despite the use of plus lenses.

On a side note, I believe that someone with a prescription over -6 would benefit more using an under-correction of no more than +0.25 and working on focusing pulling on far objects. Comparing eyesight 'training' with weight loss, someone with a prescription over -6 is like an overweight/obese person going on a diet. He/she would loose pounds way faster than someone who has an average weight and wants to loose the body fat to be able to show the abs. I mean, if we read Mr. Anders' story here http://forum.gettingstronger.org/index.php/topic,522.msg4503.html#msg4503, he was at -7.25 and his eyesight went down about 2.75 diopters the first year but after that the improvements got slower, at about -1.5 per year.

Just questions and opinions here, nothing else.

[OtisBrown]

Hi Tom,

If it helps - I went through this same "logical process" myself.  It is very good to go though it - because what you come up with just might be the solution.

Far-stress-induced hyperopia is just the term coined to explain the effect of prolonged far stress on the ocular globe. Its mechanism appears to be just the opposite of that from near-stress-induced myopia (which you can find in the theory post). Since there are few reputable infos on this one, I know that I have to somehow exploit the knowledge that's currently available and  extrapolate something useful from those.

However, it turns out that in this case, personal observations came to me first, before I could figure out the anatomical details. Over the months, I have been compiling a list of hyperopization symptoms (which you can find here). I knew that if I persist and carefully observe long enough, then whatever works will become more obvious and lead to predictable symptoms, and those that don't will fail that same criteria. That is pretty much what happened, and this is how I learn to identify the different symptoms - I don't think I could have come up with it in one day.

Once I have more or less mapped the symptoms of myopiazation and hyperopization, the other missing puzzles just fall in the right places. For example, it was the persistent application of far stress that gradually clears up my vision, and the persistent application of near stress that blurs my vision. Many actions and their consequences just become more and more predictable as days go by. Again, these remarks are hard to get in one day, but if you play around with different kinds of lenses, at different distances, for a long time, then at some point you might become acquainted with the symptoms and its associated causes. It was a matter of connecting the dots together.

[Alex_Myopic]

"If near stress persists and remains unmanaged, then things become a bit more serious:

...

    The tension and pressure inside the eye creates more intraocular fluids and heat inside the eye. In particular, the gel in the vitreous humor heats up and some gel would start to liquefy and move around. These little organic debris are usually harmless (and naturally occurs with age anyway), but if they intersect the light rays going towards the macula, then one might see some little transparent "objects" flying around. These "objects" are colloquially referred to as floater, and these vitreous debris would occur more with higher myopia. Some details by Morita et al.:"

If this is true then plus lenses can even prevent eye floaters with an immediate effect (making near far) and not just by preventing myopia.

[OtisBrown]

Hi Tom,

Subject:  Real - versus "fraud" claims.

I have seen endless selling of, "easy, quick, get-out-of -9 diopters" in nine weeks.  Here is an example of that type of thing.

https://www.youtube.com/watch?v=y8-xfgXqqGw

I personally, believe that prevention is possible, if they person still retains 20/40, (at about -1 diopter), but it is never going to be, "easy", quick, and permanent.

Far from it. But that is the type of problem we have about "people selling magic cures".  Perhaps you can address this problem - with your own concept and ideas.

Q&A post expanded.