Getting Stronger: Discussion Forum

Discussion Topics => Rehabilitation => Topic started by: jimboston on August 02, 2015, 11:54:38 PM

Title: 1 Year @ The Edge of Blur: This Method Failed
Post by: jimboston on August 02, 2015, 11:54:38 PM
Full Disclosure:

I am scientifically minded and will be the first to admit that my experiment would not qualify as truly scientific, simply because it was done on only 1 subject (me), thus rendering generalizations somewhat moot. That said, I have followed strict measurement rules: recording 365+ days of blur point distance under very similar conditions, controlling for bias & data inconsistency. Also, be aware that I honestly wanted this method to work as I am myopic so there was no incentive for me to quickly disprove it. In fact, I continued the experiment despite my better judgment.

Rehab Method:

For the last year, I've spent my working days at the edge of blur (EoB). I have tried every possible distance: from very slight blur (EoB + 2-3cm) to barely readable (EoB + 10-20cm) for many months at each.

Results:

One year in, my data confidently shows there has literally been zero increase in my EoB distance. Not even +- 1-2cm; ZERO. Once I learned to measure properly -- which took months by the way -- the edge at which I can perceive letters with maximum acuity has remained exactly the same for the entire period.

Conclusions:

For the treatment of my myopia, the EoB reading/working protocol has obviously failed. Of course, I cannot reject the technique entirely based on a sample size of 1, but I have to admit I should have known better. If you really take the time to study the literature and set your hopes aside, you will find no evidence of axial length permanently shortening or choroid thickness permanently increasing in adult humans. Furthermore, all the claims strong minus prescriptions worsen myopia or reduced prescriptions prevent myopia have been clearly disproved by studies on children with huge sample sizes, from which the only logical conclusion a reader can draw is that the poor visual acuity that comes from no or undercorrection actually accelerates myopia. For those who want the truth, I can also point out that recent findings suggest myopia genesis has a lot more to do with sunlight than it has to do with the wearing of glasses -- look up recent studies from Australia & East Asia for more information.

What about those who have claimed improvement?

I would have been the last to dismiss claims of recovery from myopia, even the spectacular ones, as they were sources of motivation and hope for myopes. Even though there are ZERO refractometer readings or advanced eye biometrics submitted by those who say they have improved, I didn't dismiss them completely, but now I have strong reasons to be extremely skeptical of such claims. First, in just about all cases, people simply don't measure properly so their data is corrupt from the very beginning. Unlike eye geometry, visual acuity is very hard to measure precisely; e.g. most people would not even notice they have astigmatism. Second, those who want to improve are also highly biased & fail to distinguish barely blurred text from text that is barely recognizable; e.g. they would stare at a chart just about making out some letters on a familiar 20/40 line and would then claim to have passed the test, while their refractive error is in reality 20/100.

Finally, please do keep in mind that there has been no scientific evidence or biometric data to support the claims of Becker, DeAngelis, Frauenfeld and other forum users. If you check some studies on blur adaptation you can explain quite easily the quick improvement in visual acuity that some myopes experience if they stop wearing their prescription for a while: the brain can boost visual perception by quite a margin, while refraction remains completely unchanged. In cases like Becker's, presbyopia could be a strong factor for the "improvement". There is also some spasm than can be released if you are overcorrected and/or do lots of near work, but in all cases the improvement will be limited to the range of 0.25-0.75D.

P.S. I really, honestly hoped for undercorrection and EoB to work, but the science & my personal experience simply say otherwise. Judge for yourself, but do a thorough research before embarking on a yearlong experiment; it might save you quite a bit of time & frustration...
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: gekonus on August 03, 2015, 05:31:35 AM
Im in the same situation as you Jimboston , was nice reading all of this. Im pretty sure there are people who got results and improved their vision by print pushing. In my opinion the amount of myopia doesnt neccesarily mean a person would improve faster or slower. Its like, 2 people see the world blurry, but not exactly by the same reason.

Well sometimes things do work, temporarily tho - being outside in the sun for a while (Got my vision to a stable 20/30 until I got home), or watching tv on dim light looking at the subtitles and suddenly they lost their blur by a bit.
Waking up after a good sleep (Or even a short sleep) gives a boost in acuity - probably a relaxed ciliary effect due to relaxation of the body
Difficult to tell, this subject is extremely tricky, what can we do? I dont know but we should try everything we can.

Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: VisionRecovery on August 03, 2015, 05:59:13 PM
Did you attempt to clear the blur (http://forum.gettingstronger.org/index.php?topic=994.0) as you call it?

If the EoB distance remains constant, at least this might work as a method to prevent distance vision from getting any worse.
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: jimboston on August 03, 2015, 09:21:08 PM
gekonus, VisionRecovery

I've tried everything (active, passive, multiple distances/lenses, physical exercises, cognitive exercises) ever suggested on this & other "vision improvement" boards -- if anything worked as believed, I would have gotten at least some benefit. Sadly, there was none and the logic behind such practices is so shaky, you have to be really stubborn to disregard sound reasoning. You are free to believe and try whatever you find reasonable, of course, but may I suggest you separate hope from reality.

Regarding prevention & worsening, I myself have dismissed undercorrection (i.e. slight blur) as a treatment method. You could read the COMET or Chung studies, where it's shown undercorrection only worsens myopia. There is some benefit to using progressive addition lenses but the benefit is not clinically significant.

What hopefuls refer to "improvement" is in my view: clear flashes (temporary reshaping of the cornea), pupillary constriction from sunlight, relaxing from over accommodation and/or neural adaptation (i.e. brain error correction). In all of these cases, no structural changes in the eye occur. In other words, the refractive error stays exactly the same, but you gain 0.25-0.75D from relaxing, light intensity, blinking/sleeping, or the brain boosting contrast and resolving some blur.

Finally, there is no reason to believe undercorrection stabilizes vision in any way. For example, my vision was stable for many years with full correction. The belief that myopic defocus prevents axial elongation comes from the wrong assumption that results from animal studies should apply to humans (btw, even scientists initially believed undercorrection should slow down myopia, because it was effective in animals). Unfortunately, this was not the case and some of the undercorrection studies had to be stopped in order to prevent the undercorrected children's myopia from worsening even further than the standardly treated.
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: gekonus on August 04, 2015, 10:17:33 PM
But I dont understand this. It is almost 100 percent that a minus lense for close causes vision to deteriorate fast, because of lots of ciliary strain plus hyperopic defocus . How the hell doesnt the opposite do the opposite, myopic defocus should improve vision and shorten the eyeball.
Lets bet that if I use a minus -1 for close , 8 hours a day my vision is gonna get from 20/50 to 20/100 in a few months. Gurantee.
Edge of blur should do the opposite!!! Why doesnt it working??!!!!
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: Myoctim on August 05, 2015, 03:21:36 AM
Hi jimboston,

maybe Otis is right by claiming there being a certain threshold where recovery isn't practicable.
It could be the case because putting myopic blur only at your retina's best acuity spot (which is said having a tiny 100µm diameter) simply isn't enough stimulus (for everybody).

If we look at studies about student pilots it had shown particulary those with central vision emmetropic but peripheral vision hyperopic where at most risk of getting myopic.
So there is a kind of vicious circle. If central vision gets more myopic the peripheral part even gets more hyperopic due to the eye's ball shaped image plane.

I could imagine there being a "locked on myopia effect" by a too much hyperopic peripheral vision.   


Concerning that Chung study about undercorrection you also should have a look at its critics either from Wildsoet as also from Schaeffel.


Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: jimboston on August 05, 2015, 07:51:55 AM
If we look at studies about student pilots it had shown particulary those with central vision emmetropic but peripheral vision hyperopic where at most risk of getting myopic.

You're right on that point. Peripheral hyperopic defocus has been shown to be myopigenic -- that's why ortho-K seems to be an effective prevention. However, keep in mind that while reducing peripheral hyperopic defocus, undercorrection increases central myopic defocus, which leads to blurry vision -- now widely recognized as myopigenic as well.

To summarize, every kind of correction has disadvantages. At best, undercorrection doesn't make matters worse. if you wanted to avoid both peripheral hyperopic defocus and central myopia defocus, you'd have to use specifically designed lenses, which are not available over the counter. As for myopia control, the only success that has been demonstrated is with ortho-K, but the effect on axial elongation is about 50%.

Quote
Concerning that Chung study about undercorrection you also should have a look at its critics either from Wildsoet as also from Schaeffel.

Quote from: OtisBrown
The "Chung Study" designed to justify "traditional treatment", and can never be considered valid science.

Here is the reason.  It was terminated, BEFORE it was EVER completed!!  You can never do that - and draw any scientific conclusion,
let alone any medical conclusion.

If you have trouble with the Chung study, you can look at the COMET (largest double-blind study of such kind) or this:

http://www.ncbi.nlm.nih.gov/pubmed/25000870

or this:

http://onlinelibrary.wiley.com/doi/10.1111/j.1444-0938.2006.00055.x/full

or this on PALS:

http://www.researchgate.net/profile/Carly_Lam2/publication/11185122_The_Hong_Kong_progressive_lens_myopia_control_study_study_design_and_main_findings/links/0046352a8e986e1815000000.pdf

There are dozens more that say the same thing. I mean... is there any doubt here? :)

Also, please consider the fact that the "evil" scientists used to believe what you believe as well. All of those undercorrection studies were done in the hope that the human eye is like the other animal eyes -- that myopic defocus across the retina would stop myopia progression. However, as these studies unfortunately showed, the human eye doesn't respond well to central myopic defocus. If you wanted to use a plus for prevention, it would only be suitable for very near distances, but would be risky beyond your far point.
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: gekonus on August 05, 2015, 08:16:15 PM
Otis, we can continue talking about science and facts , but we already tried to wear the plus for over a year with NO RESULTS AT ALL.
I do believe in the fact that a minus is a killer  , so a plus should do the opposite at the edge of blur but it DOESNT DO ANYTHING for some of us.
I tried this for god damn 14 months with not even being able to read the 20/40 line consistent. Started out as 20/50, I am only 19 and almost never wore the minus .
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: gekonus on August 06, 2015, 03:47:48 AM
I really appreciate everything you write Otis. Im just very sad thats all. I wanted to achieve normal vision but I just cant..

disappointed  :'( :'(
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: rtdfgdfgdfgdfg on August 06, 2015, 10:12:26 AM
what are you saying ? he should have used a plus lens when reading to and find d2 "blur" ?

rather than just going without glasses ?

what should he have done ?

always find the blur and try to clear it ?? this is the basic idea isn't it ?

do you have any youtube videos showing what needs to be done , especially with clearing of the blur, that some people struggle with ?
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: rtdfgdfgdfgdfg on August 08, 2015, 06:55:01 AM
read with a plus lens

simply reading at a blur won't work as well

Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: rtdfgdfgdfgdfg on August 08, 2015, 02:48:25 PM
becker in his video said a study showed the eyeball could change size in just one hour

so anything is possible
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: Myoctim on August 11, 2015, 04:58:50 AM
However, keep in mind that while reducing peripheral hyperopic defocus, undercorrection increases central myopic defocus, which leads to blurry vision -- now widely recognized as myopigenic as well.
not necessarily.

As you probably know there also was a study clearly showing watching TV with undercorrection did result in choroid thickening and axial elongation!
So it raises the question what really did happen to the kids.
If really open minded you can find a possible explanation at the discussion part of that "non NEI founded" studies itself.

You should realize the visual task from animals and "near adicted" kids are pretty different. So kids need to do a lot of reading at school and like playing games on a screen in their free time.

Also the study agrees about myopia being mainly generated by hyperopic blur during near task, so undercorrection should be beneficial if the kids don't get used to that blur resulting in increased underaccommodation. In fact that could be the case because they aren't interested in clearing distance images when being undercorrected.



some more discussion from the non commercial "research camp":

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

Chung study

"It might also be argued based on animal studies, that because the undercorrection strategy imposes myopic defocus at distance, that eye growth should be slowed in all children.
However as school children spend little time outdoors focussed on more distant tasks, they are likely to gain little benefit from this correction strategy in terms of reduced eye growth."


Comet

"The main outcome of the COMET study was a small but significant slowing of myopia progression with PAL lenses that was limited to the first of the 3 years of the clinical trial.

A second weakness of the study is the failure to verify that the children used the near addition during close work although the lenses were fitted in the spectacle frames in a way to encourage reading through the near addition. In general children have little incentive to use the near addition of their PALs; indeed,  the distortions occurring in the lower periphery of theses lenses might act as a disincentive. In contrast, adults who are typically prescribed them to compensate for failing near focusing ability have the incentive of clear near vision to use the lower portion of their lenses. It is of potential significance that the study reporting the most promising outcome using PALs also involved adolescents who may have been better able to follow instructions in the use of their lenses."

"A recent presentation at ARVO (a international vision conference held annually in Florida), tended to confirm this by showing that during reading, children rarely use the optimum part of the lenses for near work (Nakatsuka et al., 2004)."


And of course if the human eye really being so different from the animal's eye you can't exclude the adult's eye behaving different too.

BTW, doesn't sound that optometrist's favorite claim "the human eye being so unique and different" similar to the medieval paradigm "the earth being the center of the universe"?




Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: Hillyman on August 16, 2015, 08:57:20 AM
My goodness. It certainly looks like Otis Brown has hijacked this thread from jimboston.

jimboston's original posting lays out the framework: he is "scientifically minded" and appears to have followed a fairly rigorous test of following the Edge-of-Blur (EoB) protocol for a whole year. He knows the data is spurious because the population of the experiment is on himself (i.e., n=1). That there has been no effect of this approach for him only means that we can say with certainty that it doesn't work for him. Yet, the fact that something that incorporates this approach seems to work with others-- although we should be cautious about taking the word of anyone who says there has been improvement--suggests that we should not immediately disqualify EoB.  And we certainly should not devolve to attacks, and personal ones at that, on jimboston's observations.

I have followed some approach for reducing my myopia over the last two years starting with the Frauenfeldclinic.com approach, and have had some luck, with my full prescription going down from -5.5 to about -4.5. It might be that I was overprescribed to begin with (I have been wearing glasses for 50 years; the -5.5 prescription I got about 5 years ago), and I am one of those whose nearsightedness reduces itself in middle age (I am 62). I follow the edge-of-blur approach, but not religiously, but I do wear a weaker prescription of -1 to -2.5 for reading (I have the adjustable focus SuperFocus glasses--don't bother looking them up; they went out of business).

Some questions I started pondering this past year have been:

--When and how in the course of a 24-hour period does the eye actually change its axial length? When does that small incremental (yet permanent) change happen when the emmetropic eye becomes nearsighted, or indeed, the other way, when the myopic gets less so? Is it during the 10 minutes during which one is doing the edge-of-blur practice? Is it during some hours afterwards as the effects sink in?

--Is it likely that the eyeball axial length changes merely as a result of some physical input or physiological stress (too much near-point accommodation)? Does the reverse positive stress (e.g., EoB) work, and how would it work?

--What is that intricate dance of stimulus and response that causes the eyeball to change shape so that it can function with the least possible amount of stress, and how can we tap into that so that the result is lessened myopia?

--Is there some sort of "communication" between the shape of the eyeball and how vision is perceived in the brain's visual cortex? Is there some stimulus that we can apply to the visual cortex side to promote some positive change in the eyes themselves?

While I do not consistently practice EoB, what I do consistently practice is what I call "seeing space," a concept that I came across in a marvelous piece by the late Dr Antonia Orfield, available here http://www.visionsofjoy.org/pdfs/OrfieldSeeingSpace.pdf.  She put herself through optometry school after finding her eyesight improving after a regimen that combined exercise, nutrition and postural training. She was a successful practicing optometrist specializing in safeguarding childhood vision. (The article first appeared in the Journal of Behavioral Optometry; please don't put any weight on the fact that it has been reposted on the Vision of Joy website, which seems a little too colorful in matters of vision improvement.) I have mentioned this article of hers a few times before in this site, but it does not seem to have piqued anyone's interest.

I was very taken by these statements of hers:

"[Functional myopia] is a reflection of the shrinking of the brain's space world by closure of the periphery, first by stress, and then by errors of spatial judgment induced by minus lenses." [Emphasis mine.]

 and

"[Myopic children's] habits and lenses have programmed their brains to think of vision as looking at something and seeing only that. To cure myopia, one has to re-program the brain to see space." [Emphasis in the original.]

Indeed, I have found that when I am out and about with a weaker prescription (0.50 less or so), I find a sense of better acuity if I try to sense how far objects are from me and where they are relative to each other, rather than how sharp they are. I am following Dr. Orfield's advice of seeing the space, and looking at objects. The effect is that  I feel that I am immersed the environment, and not just looking at things in it.

(An interesting, though I hope not discouraging, point about Orfield's experience. If I recall the details right, she reduced her myopia from -4.5 to -0.50 in the space of 6 or 7 years. This might seem like a preposterous amount of time, but consider how long it takes a child to go from 0.00 to -4 or -5: typically the length of their middle to high school years, which is about 5-7 years. So her reversal is nothing more than following the natural rate of change in the eyeball axial length control mechanism, although happily in the reverse direction.)

Back to jimboston's post: If we are scientific, then if something is not working, try something else--anything else. I suggest that the visual system is far too complex to be reduced to a single theory of EoB or Bates or whatever when we seek improvement in acuity. I also suspect that all organisms must naturally have self-optimizing mechanisms for maximal performance. In the case of vision improvement, it seems that we might want to bring the brain, the visual cortex's "sense of seeing", and whatever other factors we are not even aware of now into the mix of how we can triangulate on, identify, and then tap into such a self-optimizing mechanism.
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: jimboston on August 18, 2015, 12:24:21 AM
Guys, again, let's try to separate hope from fact.

Do I want myopia recovery? Do I believe in a dynamic neurological mechanism controlling ocular shape? Yes and yes. However, the blurry vision that comes with slight undercorrection or no correction does NOT lead to the solution. There have been numerous efforts by scientists to replicate animal studies for the treatment of myopia in children. Sadly, the process is not the same. If it were, we would have fixed myopia in the 80s. I can point to countless studies on the effect of undercorrection on myopia progression -- it doesn't reduce the rate! Think about it, almost the entire new generation of East Asia is becoming myopic. We're talking millions of people. There are government programs forcing children to play outside just to do something against that horrific epidemic. If undercorrection worked, do you think Taiwan, South Korea and China wouldn't use it to help the 85-95% of their children? I discarded glasses for many years -- it didn't prevent me from becoming myopic in the first place nor did it cure me after many years of minus wear. Unfortunately, reading at the edge of blur for a year didn't lead to any improvement as well.

On myopia improvement

Like Hillyman and many others, there are a few reasons some people see a small but significant improvement in their myopia. I will restate:

- neural (a.k.a blur) adaptation (myopes can tolerate extraordinary amounts of blur; the brain adapts by boosting contrast and prioritizing certain parts of the image)
- reducing overcorrection (overcorrecting is easy for the optometrist, easy for the patient; it is a classic result of poor subjective reporting and exam design)
- reducing near-induced accommodative lag (much less or no near work)
- presbyopia (a small improvement in distance vision after the onset of presbyopia in older myopes like Hillyman & quite probably Becker)
- wishful thinking + poor measurement practices (unfortunately, most claims of improvement are the result of this formula)

Myopia Genesis & Progression

The consensus is that myopia is a very complex phenomenon. No one in the scientific community knows exactly how the negative factors contribute to its progression. There is a genetic component, a stress component, and recently it was discovered there is also a sunlight/bright light component. These work together with different weights under different conditions and it's uncertain which one is the Holy Grail -- if such exists at all.

Axial length & Myopia

The sad news is that myopes' eyes begin to diverge from emmetropic eyes way before (3-5 years) myopes realize they have blurry vision, and this has nothing to do with prescriptions or doctors:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657719/bin/nihms24838f1.jpg (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657719/bin/nihms24838f1.jpg)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657719/bin/nihms24838f2.jpg (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657719/bin/nihms24838f2.jpg)

A quote from the largest study (n = 1000+) I know of on axial length and refraction change during myopia progression:

"Myopic eyes were clearly different from emmetropic eyes before the onset of myopia in terms of refractive error, axial length, relative peripheral refractive error, and growth rates for these variables. Compared with emmetropes, became-myopic children were less hyperopic on average when nonmyopic as long as 4 years before the onset of myopia. This finding is in agreement with previous longitudinal analyses in which early refractive error was used as a predictive factor. Axial length followed a similar course—namely, longer than in emmetropes, but only as early as −3 years before onset. Peripheral refractive differences were delayed by 1 year, with became-myopic eyes relatively more peripherally hyperopic than emmetropic eyes by −2 years before onset."

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657719/ (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657719/)

Quote from: Myoctim
As you probably know there also was a study clearly showing watching TV with undercorrection did result in choroid thickening and axial elongation!

Well, choroid thickening -> less myopic defocus. Axial elongation -> more myopic defocus. I am not sure what you meant by this comment, but if you are referring to the Human optical axial length and defocus study by IOVS, it did show a small but significant reduction in AL and an increase in choroid thickening (both a positive for myopes) after 1 hour of +3D lens wear. However, a later study which imposed myopic defocus on humans for a whole day:

http://www.ncbi.nlm.nih.gov/pubmed/22971342 (http://www.ncbi.nlm.nih.gov/pubmed/22971342)

showed the eye-shortening, choroid-thickening effect was practically erased after sleep. Experiments on humans with defocus for more than 1 day have not been officially published so this is the last remaining light using that strategy.

Quote from: Myoctim
Also the study agrees about myopia being mainly generated by hyperopic blur during near task, so undercorrection should be beneficial if the kids don't get used to that blur resulting in increased underaccommodation. In fact that could be the case because they aren't interested in clearing distance images when being under corrected.

A simple thought experiment. Before and at the onset of myopia, myopic children are already having an elongated eyeball and thus myopic defocus across their retinas. Since the peripheral hyperopic defocus is therefore eliminated, why doesn't myopia progression stop there?

On Chung, COMET, etc.

From the same review Myoctim quoted:

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

"The main outcome of the COMET study was a small but significant slowing of myopia progression with PAL lenses that was limited to the first of the 3 years of the clinical trial. The 3-year difference in progression between participants wearing PALs compared to those wearing regular (single vision; SV) lenses was 0.20 +/-0.08 D."

AT BEST, undercorrection doesn't make matters worse and PALS lead to a clinically insignificant improvement compared to standard single vision lenses. We can talk study design to death, but children will never implement a complicated protocol. Even if they did, I know of no evidence undercorrection effectively controls myopia -- quite to the contrary, actually. Kids will be much better off with atropine drops and/or ortho-K, which at least have been proven to reduce myopia progression by up to 50% in large sample sizes.

New Breakthroughs

We need to stop obsessing with over/undercorrection and look into other options. Recent studies from Australia and East Asia suggest bright outdoor light could reduce myopia progression. Innovative lens designs have also been shown to be effective. Atropine and similar cycloplegic drugs have delivered promising results as well. In comparison, over/undercorrection are clinically irrelevant.

I am not sure what this means for adult myopes, but unless the exact AL/choroid regulation mechanism is unraveled or a surprise study shows myopia reversal in a large population study, our options are limited. Thankfully, the picture is getting somewhat clearer: the human eye needs excellent illumination and visual acuity to properly regulate eye shape. Peripheral defocus also seems to be very important. Let's hope we can somehow take advantage of these findings.
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: Myoctim on September 09, 2015, 03:10:38 PM
Guys, again, let's try to separate hope from fact.

 Do I believe in a dynamic neurological mechanism controlling ocular shape? Yes and yes. However, the blurry vision that comes with slight undercorrection or no correction does NOT lead to the solution. There have been numerous efforts by scientists to replicate animal studies for the treatment of myopia in children.

We know emmetropization being a closed feedback loop.
So if myopic blur really would cause some more myopia it would be the same as your heating control system would turn on the heater when putting the setting (setpoint) to a lower temperature.

Unfortunately optometrists don't care anything about the eye's refractive setpoint. They only compensate for blur by shifting the actually (refractive) value back to normal which doesn't correct anything anatomical.

 
Quote from: jimboston
I discarded glasses for many years -- it didn't prevent me from becoming myopic in the first place nor did it cure me after many years of minus wear. Unfortunately, reading at the edge of blur for a year didn't lead to any improvement as well.

but amazingly print pushing worked for me  :-)

Quote
On myopia improvement

Like Hillyman and many others, there are a few reasons some people see a small but significant improvement in their myopia. I will restate:

- neural (a.k.a blur) adaptation (myopes can tolerate extraordinary amounts of blur; the brain adapts by boosting contrast and prioritizing certain parts of the image)
- wishful thinking + poor measurement practices (unfortunately, most claims of improvement are the result of this formula)

but when looking outside at the neighbour building and all the edges are getting clearer and clearer it's neither a matter of blur adaption nor of "wishful thinking".

Quote
- presbyopia (a small improvement in distance vision after the onset of presbyopia in older myopes like Hillyman & quite probably Becker)

In deed that could be a valid point. If we look at

http://www.ncbi.nlm.nih.gov/pubmed/25683786

the refractive index of the lens often decreases when aging (protein aggregation?) causing a relative hyperopic shift.

But it raises the big question why I didn't improve when trying Bates some years before and why I did improve exactly after starting with print pushing.
-Why all the time before my refractive state seemed to be nailed down not changing at all.
-And why other persons at the same age even got more myopic when always wearing their full prescription at the office.
 

Quote
Well, choroid thickening -> less myopic defocus. Axial elongation -> more myopic defocus. I am not sure what you meant by this comment, but if you are referring to the Human optical axial length and defocus study by IOVS, it did show a small but significant reduction in AL and an increase in choroid thickening (both a positive for myopes) after 1 hour of +3D lens wear.

my mistake, of course I meant "a decreased axial elongation".

Quote
However, a later study which imposed myopic defocus on humans for a whole day:

http://www.ncbi.nlm.nih.gov/pubmed/22971342 (http://www.ncbi.nlm.nih.gov/pubmed/22971342)

showed the eye-shortening, choroid-thickening effect was practically erased after sleep. Experiments on humans with defocus for more than 1 day have not been officially published so this is the last remaining light using that strategy.

interesting, didn't know about that 2nd study.

But that overnight cancelling out effect (of some distance blur after prolonged near work) also is reported by some myopes before it had come that night where the blur stayed and they became real myopes.

Quote
A simple thought experiment. Before and at the onset of myopia, myopic children are already having an elongated eyeball and thus myopic defocus across their retinas. Since the peripheral hyperopic defocus is therefore eliminated, why doesn't myopia progression stop there?

IMHO the answer is if the ratio between hyperopic blur (during near tasks) and myopic blur at the distance is shifted too much to the hyperopic side the control technically result by emmetropization is an increased AL.

So let's expand that thought experiment by freeing half of those kids from their near environment by putting them on an island with no school and electronic gadgets.
The result would be no more prolonged hyperopic blur by underaccommodation and strain and consequently a slowly reduction in AL
Quote
I am not sure what this means for adult myopes, but unless the exact AL/choroid regulation mechanism is unraveled or a surprise study shows myopia reversal in a large population study, our options are limited. Thankfully, the picture is getting somewhat clearer: the human eye needs excellent illumination and visual acuity to properly regulate eye shape.

visual acuity -> particulary avoiding hyperopic blur e. g. by underaccommodation!

 
Quote
Peripheral defocus also seems to be very important. Let's hope we can somehow take advantage of these findings.

I agree 
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: OtisBrown on September 09, 2015, 03:17:44 PM
Hi Myoctim,

All the commentary in "blue" was by an "under-cover" optometrist, who wants to keep his job.  (We discovered later.)

If a man is HONEST with me, and his job title makes him biased because of this "money" aspect - I can argue about that issue.

While I do understand his desire to convince you that it is impossible to go from 20/40 (self-measured -1 diopter) to 20/20 (self-measured 0.0 diopters), I truly do not respect an optometrist who does not identify himself accuratly, and the feeds me false scientific information to protect his reputation, and never my long-term vision.

I will never say that prevention (at 20/40) is every going to be easy.  Most people have no motivation to do it.  That is a fact I do respect.

For those who think that light use of a plus can be effective - well they are kidding themselves.  The plus does not "cure", in that sense, but with a broad scientific perspective, it can prevent - if you do it all yourself. 

I just do not "bother" with an OD any more.  I have interest in protecting my distant vision, which is why I am reading this through a +2.5 diopter lens, and personally verifying 20/20 on my "home Snellen".   


Guys, again, let's try to separate hope from fact.

 Do I believe in a dynamic neurological mechanism controlling ocular shape? Yes and yes. However, the blurry vision that comes with slight undercorrection or no correction does NOT lead to the solution. There have been numerous efforts by scientists to replicate animal studies for the treatment of myopia in children.

We know emmetropization being a closed feedback loop.
So if myopic blur really would cause some more myopia it would be the same as your heating control system would turn on the heater when putting the setting (setpoint) to a lower temperature.

Unfortunately optometrists don't care anything about the eye's refractive setpoint. They only compensate for blur by shifting the actually (refractive) value back to normal which doesn't correct anything anatomical.

 
Quote from: jimboston
I discarded glasses for many years -- it didn't prevent me from becoming myopic in the first place nor did it cure me after many years of minus wear. Unfortunately, reading at the edge of blur for a year didn't lead to any improvement as well.

but amazingly print pushing worked for me  :-)

Quote
On myopia improvement

Like Hillyman and many others, there are a few reasons some people see a small but significant improvement in their myopia. I will restate:

- neural (a.k.a blur) adaptation (myopes can tolerate extraordinary amounts of blur; the brain adapts by boosting contrast and prioritizing certain parts of the image)
- wishful thinking + poor measurement practices (unfortunately, most claims of improvement are the result of this formula)

but when looking outside at the neighbour building and all the edges are getting clearer and clearer it's neither a matter of blur adaption nor of "wishful thinking".

Quote
- presbyopia (a small improvement in distance vision after the onset of presbyopia in older myopes like Hillyman & quite probably Becker)

In deed that could be a valid point. If we look at

http://www.ncbi.nlm.nih.gov/pubmed/25683786

the refractive index of the lens often decreases when aging (protein aggregation?) causing a relative hyperopic shift.

But it raises the big question why I didn't improve when trying Bates some years before and why I did improve exactly after starting with print pushing.
-Why all the time before my refractive state seemed to be nailed down not changing at all.
-And why other persons at the same age even got more myopic when always wearing their full prescription at the office.
 

Quote
Well, choroid thickening -> less myopic defocus. Axial elongation -> more myopic defocus. I am not sure what you meant by this comment, but if you are referring to the Human optical axial length and defocus study by IOVS, it did show a small but significant reduction in AL and an increase in choroid thickening (both a positive for myopes) after 1 hour of +3D lens wear.

my mistake, of course I meant "a decreased axial elongation".

Quote
However, a later study which imposed myopic defocus on humans for a whole day:

http://www.ncbi.nlm.nih.gov/pubmed/22971342 (http://www.ncbi.nlm.nih.gov/pubmed/22971342)

showed the eye-shortening, choroid-thickening effect was practically erased after sleep. Experiments on humans with defocus for more than 1 day have not been officially published so this is the last remaining light using that strategy.

interesting, didn't know about that 2nd study.

But that overnight cancelling out effect (of some distance blur after prolonged near work) also is reported by some myopes before it had come that night where the blur stayed and they became real myopes.

Quote
A simple thought experiment. Before and at the onset of myopia, myopic children are already having an elongated eyeball and thus myopic defocus across their retinas. Since the peripheral hyperopic defocus is therefore eliminated, why doesn't myopia progression stop there?

IMHO the answer is if the ratio between hyperopic blur (during near tasks) and myopic blur at the distance is shifted too much to the hyperopic side the control technically result by emmetropization is an increased AL.

So let's expand that thought experiment by freeing half of those kids from their near environment by putting them on an island with no school and electronic gadgets.
The result would be no more prolonged hyperopic blur by underaccommodation and strain and consequently a slowly reduction in AL
Quote
I am not sure what this means for adult myopes, but unless the exact AL/choroid regulation mechanism is unraveled or a surprise study shows myopia reversal in a large population study, our options are limited. Thankfully, the picture is getting somewhat clearer: the human eye needs excellent illumination and visual acuity to properly regulate eye shape.

visual acuity -> particulary avoiding hyperopic blur e. g. by underaccommodation!

 
Quote
Peripheral defocus also seems to be very important. Let's hope we can somehow take advantage of these findings.

I agree
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: User1235 on September 10, 2015, 03:41:06 AM
Quote
Like Hillyman and many others, there are a few reasons some people see a small but significant improvement in their myopia. I will restate:

- neural (a.k.a blur) adaptation (myopes can tolerate extraordinary amounts of blur; the brain adapts by boosting contrast and prioritizing certain parts of the image)
- wishful thinking + poor measurement practices (unfortunately, most claims of improvement are the result of this formula)


This is interesting how can wishing thinking cause someone from 20/200 to see 20/40.This seems to be too big a leap dont you think?I too hope that i can get 20/40 just by thinking wishfully but the fact is that there must be hardwork and effort put in.
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: rtdfgdfgdfgdfg on September 10, 2015, 04:41:46 AM
in the becker myopia youtube presentation , he shows a study showing the eyeball changed shape within one hour

anything is possible
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: User1235 on September 10, 2015, 05:56:42 AM
Yes i agree but what you are saying is that improvement is based on science(supported by studies) whereas what jimboston says is that improvement is due to "wishful thinking" which doesn't make sense to me
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: rtdfgdfgdfgdfg on September 10, 2015, 11:43:48 AM
Yes, I am saying eyesight and eyeball changing shape is based on science

So what ?

Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: Todd Becker on September 23, 2015, 09:30:41 PM
Just perusing the blog forum and somehow missed this very interesting update from jimboston (who I'll call "Jim").  I value feedback and discussion of both personal experiences and the biological science behind the ideas shared here in this Discussion Forum.  I particularly welcome challenges and disagreements, because they often help us refine our thinking and sometimes suggest new ideas or refinements to our approaches.

I'm sorry to hear, Jim, that despite a sincere and prolonged effort for a full year, you've not had success with incremental defocus in any of its forms, whether using print pushing (with or without plus lenses) or other "active focus" techniques based on the concept of effortful focusing at the edge of blur as a stimulus to remodeling of the eye and thereby reducing myopia.

I will be the first to acknowledge that the technique evidently produces variable responses.  As amply documented on this site and several others, many people (myself included) have been able to eliminate or significantly reduce their myopia.  Another group sees minor or modest benefit -- and then it stalls.  And yet another subgroup, like Jim, sees absolutely no improvement. 

Why is the response variable? I can't provide a definitive answer based upon conclusive scientific studies.  I do have some ideas about why incremental defocus techniques work better for some people than others.

But before giving my thoughts, I'd like to respond to one comment from Jim:


...If you really take the time to study the literature and set your hopes aside, you will find no evidence of axial length permanently shortening or choroid thickness permanently increasing in adult humans. Furthermore, all the claims strong minus prescriptions worsen myopia or reduced prescriptions prevent myopia have been clearly disproved by studies on children with huge sample sizes, from which the only logical conclusion a reader can draw is that the poor visual acuity that comes from no or undercorrection actually accelerates myopia. For those who want the truth, I can also point out that recent findings suggest myopia genesis has a lot more to do with sunlight than it has to do with the wearing of glasses -- look up recent studies from Australia & East Asia for more information.

What about those who have claimed improvement?

I would have been the last to dismiss claims of recovery from myopia, even the spectacular ones, as they were sources of motivation and hope for myopes. Even though there are ZERO refractometer readings or advanced eye biometrics submitted by those who say they have improved, I didn't dismiss them completely, but now I have strong reasons to be extremely skeptical of such claims. First, in just about all cases, people simply don't measure properly so their data is corrupt from the very beginning. Unlike eye geometry, visual acuity is very hard to measure precisely; e.g. most people would not even notice they have astigmatism. Second, those who want to improve are also highly biased & fail to distinguish barely blurred text from text that is barely recognizable; e.g. they would stare at a chart just about making out some letters on a familiar 20/40 line and would then claim to have passed the test, while their refractive error is in reality 20/100.

Finally, please do keep in mind that there has been no scientific evidence or biometric data to support the claims of Becker, DeAngelis, Frauenfeld and other forum users. If you check some studies on blur adaptation you can explain quite easily the quick improvement in visual acuity that some myopes experience if they stop wearing their prescription for a while: the brain can boost visual perception by quite a margin, while refraction remains completely unchanged. In cases like Becker's, presbyopia could be a strong factor for the "improvement". There is also some spasm than can be released if you are overcorrected and/or do lots of near work, but in all cases the improvement will be limited to the range of 0.25-0.75D.

I think that this criticism is both fair and unfair.  Fair, to the extent that Jim is right that there are no studies (yet) that specifically and conclusively demonstrate the long-term, irreversible adaptation that Jim is looking for.  The few studies so far show smaller, more transient improvements.

However, the criticism is unfair for several important reasons:

1.  The "failed" studies that Jim cites didn't really study the technique that I advocate.  They studied the passive, mindless wearing of plus lenses.  Subjects were not advised to read at the edge of blur, either with or without glasses.  They just wore plus lenses all day long, regardless of what they were looking at.  If you really understand the IRDT theory and the importance of the "edge of blur" effect, it is not at all surprising that these "passive" protocols did not result in reduction of myopia.

2.  I see no reason to challenge the integrity or honesty of those of us who have succeed by doubting our claims, or suggesting that our measurements are false, imprecise, biased, "corrupt" or based upon wishful thinking.  It would be nice if I could have wished myself into reading movie subtitles from the back of the theater or getting my optical restriction removed by the DMV.  But at some point, reality intrudes.    If those of us with success stories were just deluding ourselves, we sure have one big amazing conspiracy going on here at Getting Stronger!

The successes with this method are reported throughout this forum, but I collected some of them on this thread:
http://forum.gettingstronger.org/index.php/topic,1077.msg8117.html#msg8117

3.  While I believe that success speaks for itself, I would like to see more scientific evidence to explain our success.  Sometimes scientific and medical progress is made by first achieving a result, even if the original explanation is wrong, or incomplete, or there is no explanation.  The lack of an explanation does not mean the phenomenon is not real.  But to convince others and make progress, I would still like to see more convincing evidence.

So, like Jim, I'd truly like to see more evidence that incremental focusing techniques can induce a significant, sustained and irreversible change in axial length of the eye.  It is not the case, however that there is NO evidence for this mechanism.  It is a fact that small reductions in axial length have been demonstrated in animals and humans, in response to retinal defocus. See for example, the 2010 paper by Read et al.:

http://iovs.arvojournals.org/article.aspx?articleid=2126435

Thus it is at least plausible that a large humber of repetitions of this mechanisms could lead to lasting change. It's just that nobody has done this study, perhaps because it would take months or years to carry out, and the economic and academic incentives have so far not been compelling.    Despite that, here is what the lead author of the above paper, Dr. Scott Read, wrote to me when I asked him about this:

Quote
I agree that it is possible that repeated periods of defocus could influence the length of the eye in the longer term.  There is a relatively large amount of evidence from animal studies into myopia (particularly the work of Josh Wallman, which I am sure you are familiar with) that suggests that exposure to defocus can result in longer term eye length changes.  Most current optical myopia treatment strategies designed to reduce myopia progression (e.g. orthokeratology contact lenses, bifocal contact lenses) are based around theories of defocus induced changes in eye growth (where it is proposed that these optical treatments have effects on myopic eye growth due to inducing myopic defocus, often in the peripheral visual field).  However, a definitive link between periods of defocus and longer term eye growth still needs to be established in humans. Longer term studies that comprehensively measure the eye's response to defocus over time are needed to more clearly understand these changes.  The translation of this type of research into widespread clinical practice is something that is likely to take a fairly long time, and really requires substantive evidence from randomised clinical trials illustrating the efficacy of a treatment, in order to gain widespread clinical support.
 
However, there are a number of previous studies that contribute to our understanding of the influence of defocus upon eye growth in humans in the longer term though, which may be of interest to you.  Including the following papers (you may already be familiar with some of these studies):
 
Phillips JR.  Monovision slows juvenile myopia progression unilaterally.  Br J Ophthalmol. 2005; 89:1196-200 
 
Anstice NS, Phillips JR.  Effect of dual-focus soft contact lens wear on axial myopia progression in children.  Ophthalmology. 2011; 118:1152-61
 
Cho P, Cheung SW.  Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial.  Invest Ophthalmol Vis Sci. 2012; 53:7077-85
 
Swarbrick HA, Alharbi A, Watt K, Lum E, Kang P.  Myopia Control during Orthokeratology Lens Wear in Children Using a Novel Study Design. Ophthalmology. 2015; 122:620-30

And here is what Hung and Ciuffreda (http://visp.rutgers.edu/IRDT%20of%20Myopia%20Development.pdf), leading optometry researchers from Rutgers and SUNY, concluded from their studies of incremental retinal defocus:

Quote
In addition, the theory has been able to explain how repeated cycles of near-work-induced transient myopia leads to repeated periods of decrease in retinal-image defocus, whose cumulative effect over an extended period of time also results in an increase in axial growth that produces permanent myopia. Thus, this unifying theory forms the basis for understanding the underlying retinal and scleral mechanisms of myopia development.

So the research continues.  This is not a closed book, but an ever-evolving science.

Now, to the important question I raised earlier: 

Why does the incremental defocus technique apparently work so well for some of us, but so poorly for others?

When you think about it, that's actually the general story of medicine and medical therapies.  Response is variable to many treatments for conditions ranging from allergies to obesity to heart disease and cancer.  Even limiting ourselves to the eye, some respond well to treatments for glaucoma, or to laser surgery.  Humans, like all animals, vary.

While the evidence is incomplete, I believe that several important factors may significantly affect the potential effectiveness of incremental defocus:

1. Genetics. While I don't think genetics dooms anyone to myopia, there is evidence that certain ethnic populations are more susceptible to becoming myopic.  Witness the explosive growth of myopia in Asia.  That said, genes are not destiny, and there are at least two important environment factors to consider.

2.  Age and health. The plasticity of the eye varies significantly as a function of age and health.  Many of the studies that show remodeling of axial length were carried out in young chicks or monkeys, where the eye is still growing and the chorioidal tissue and sclera are malleable, changeable tissues.  So just as it is easier to develop myopia more quickly when you are young, I would expect that incremental defocus can reverse the process more easily when you are young.

3.  Diet.  What you eat may play a major role in both the development and reversal of myopia.  Cordain has argued quite compellingly that high carbohydrate diets are insulinogenic and it has been proven in studies that hyperinsulinemia and insulin resistance are connected with elevated incidence of myopia:

http://www.direct-ms.org/pdf/EvolutionPaleolithic/Myopia.pdf
http://www.pensgard.com/nutrition/12_Sugar_Myopia.htm

Other studies show that the rate of growth of the sclera and choroid are under hormonal control of insulin and other hormones.

It is certainly the case that ethnic groups that previously had lower incidence of myopia have recently seen epidemic explosions in myopia.  Some of this may be due to habits, e.g. schooling, but much of it may also derive from a shift to high carbohydrate, sugary diets.

I personally found my vision became crisper when I went on a low carb, Paleo diet.  I also found that eating brightly colored vegetables like red and green peppers, and increasing fatty fish consumption, increased the intensity of colors that I perceived.  I remember noticing how bright the red in the stoplights seemed after I cut way down on carbs.  I also found that intermittent fasting sharpened my vision -- something echoed by others:

http://forum.gettingstronger.org/index.php/topic,1102.msg8420.html#msg8420

In short, incremental focus techniques can be very helpful, but perhaps it requires an eye that biochemically and hormonally able to adapt responsively to the applied stimulus.

I have no idea what Jim's age, health or diet might be.  Or what his genes and ancestry might contribute to the puzzle.  But it could well be the case that certain genetic and environmental factors make his eyes much less susceptible to the possibility of axial length change in response to applied defocus stimulus.

I wish I had more answers, but I don't.  Much of the science here is still in it's infancy.  But two things cannot be denied:

1. Incremental focus definitely works for some (but not all) of us.
2. The lack of conclusive scientific proof of the IRDT theory, does not mean that there is NO scientific support for it.  There is at least partial evidence supporting key aspects of the theory. 

Again, wish the techniques advocated here were universally effective.  They aren't.  But that's true of most medical interventions.  And as long as incremental defocus techniques like print pushing help SOME people, that's good enough for me, for now.

Todd
Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: warnbd on October 07, 2015, 07:04:20 PM
Otis,

What do you mean by "(We discovered later.) ?



All the commentary in "blue" was by an "under-cover" optometrist, who wants to keep his job.  (We discovered later.)


Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: OtisBrown on October 08, 2015, 02:56:45 AM
Jim Boston stated that he use "edge of blur", and, "it did not work".  He did not state his prescription. He did not state his visual acuity.  He did not keep any records - that we could believe.  He stated as a fact some very obscure studies, (O'Leary) that were discredited some time ago.)  If you wish to believe him - that is fine with me.  In fact, I agree, that prevention (at 20/40, and self-measured -1 diopter) is indeed difficult. 

Let me add that Jim Boston DID NOT USE A PLUS.  For myself, I think a plus in mandatory.  To suggest you used ONLY "edge of blur", is a reason by Boston got NO RESULTS.   

But, in the final analysis, you have to make a choice, to do prevention yourself.  So let us say that I suspect Boston makes his money selling minus lens glasses - and seeks to discredit, one way or another, the concept that prevention is possible at 20/40. 

It becomes a matter of your judgment call on this issue.  I even agree that ODs, will not even help their own children with plus-prevention, when they are at 20/40.  That is the real tragedy - but I agree that they are honest about it.

I just do not agree that science says that the minus lens is 1) Safe and 2) A good idea for the long-term.

Even MDs, state that they try to avoid the minus - if they can.  (Dr. David Guyton, Johns Hopkins)


Otis,

What do you mean by "(We discovered later.) ?



All the commentary in "blue" was by an "under-cover" optometrist, who wants to keep his job.  (We discovered later.)


Title: Re: 1 Year @ The Edge of Blur: This Method Failed
Post by: Alex_Myopic on October 08, 2015, 02:34:51 PM
" If you check some studies on blur adaptation you can explain quite easily the quick improvement in visual acuity that some myopes experience if they stop wearing their prescription for a while: the brain can boost visual perception by quite a margin, while refraction remains completely unchanged. In cases like Becker's, presbyopia could be a strong factor for the "improvement". There is also some spasm than can be released if you are overcorrected and/or do lots of near work, but in all cases the improvement will be limited to the range of 0.25-0.75D."

This describes people who had success as if they are over-optimistic or like the brain just does better deblurring while these same people complain about diplopia or plateaus after correcting more than 1 diopter. Why the brain or self-deception doesn't fix that problems also and why are created then?