Subject: Who defines, "real data" concerning 1) All natural eyes - that can be measured, and 2) Medical studies that start by excluding all real-data (because the medical person never looks at real scientific data)?
Item: I think you have done and excellent write-up of these issues of measurement. Your statement should have a separate thread - since the issue you raise are very important - for anyone seeking to avoid entry into nearsightedness, or get out of 20/60 vision. I would listen to a statement by an OD about plus-prevention to start this discussion.https://www.youtube.com/watch?v=65vrKTJTyDY
Otis> So ... is the plus effective, providing it is taken SERIOUSLY by a person who self-measures at 20/50. It is rather obvious that no one is going to run around and, "nag" a child to put on a plus - when doing close work. That is something that Benny does not consider to be his responsibility. For that reason, I consider it *my* responsibility to always check my own Snellen, and always exceed the 20/40 line - for starters. No OD can truly help me with prevention - I must do it myself.
Jim> It is unfortunate that there is an entire medical profession of people who rehabilitate myopes, yet those professionals are quite reluctant to publish what they know.
Otis> I agree. A few ODs have recognized that is necessary for their own children to begin wearing a plus, before the child goes below 20/60. That works on an personal level, and real-science shows why they are successful. But almost all ODs have been taught (from the first day) that any prevention will always be impossible - so they will never say anything about it. They assume you want to be "quick-fixed" with a minus, and will not say that the minus is a truly a, "bad idea".
Jim> Those who have the most experience and knowledge are, apparently, fearful of having their licenses revoked, so they operate more or less in the shadows.
Otis> All ODs fear a mal-practice suite, or charge. That is why you will not find any OD who will volunteer any information. There profession is not helping you get out of 20/60 vision - that is your job. There job (in their minds) is to make your vision extremely sharp - giving you 20/15 and 20/13 vision - in a few minutes. That is why I recommend that a motivated person get his own minus lens - and make that measurement himself. That way, he is more intellectually, and physically responsible to objectively verify his own results.
Jim> That leaves the public discussion open mostly to amateurs and quacks.
Otis> There you condemn any OD or MD, who discusses the possibility of prevention (at 20/60, and -1.5 diopters), as automatically, being a quack.
Otis> I do not consider self-prevention at 20/60, to be medicine, and I do not consider people with a good grasp of science to be quacks - who restrict themselves to only prevention at 20/60. This does include Todd Becker. Is he a quack, or an amateur? Or is he an excellent engineer who figured out how to conduct true-prevention, for himself based on real scientific data. What ever your opinion, Todd is objectively successful, based on science.
Jim> Real data would be a first step toward getting the discussion on a less speculative footing.
Otis> Again, are you only thinking that ONLY medical people are going to provide you with real-data? I personally do not see threshold prevention (with a plus) as a medical problem. I will agree that no one in "medicine" will be of any help to a person who wishes to avoid entry into "negative status" for the natural eyes.
Otis> But the bigger issue is this. Are you willing to take personal responsibilty to 1) Look at a Snellen objectively, 2) Assuming 20/60, then wear the plus systematically, and WAIT, 3) Keep on wearing the plus until you begin reading the 20/40 line, objectively, and 3) Continue to wear the plus until you substantially exceed the 20/30 line. I do not know what you are reading on your Snellen - so I can not answer these issues for you. Only you can do that.
You answered the question you posed to me. However, I am going to assume that you were not asking the question rhetorically.
In the context of my post, the expression "real data" would mean explaining how axial length is measured, what length qualifies as "elongated", how many myopes at each diopter range had elongation, and how many did not.
Science is a systematic method of acquiring knowledge. The criteria I outline above would be the beginning of a scientific inquiry. It is not outlandish for doctors to publish papers analyzing their patient populations. The way that science works is that the readers of the published papers judge those papers.
In the links I provided Dr. Alex claimed that he stopped measuring the axial length of his patients because the benefits did not justify the costs, because large numbers of myopes had no elongation. This lends support to jimboston's claim that axial elongation is of marginal relevance to myopia. I would find it hard to believe that Dr. Alex, a purported ophthalmologist (an MD, not an OD), stopped measuring the refractive state of those myopes who sought him out to rehabilitate their myopia. How else would he know when to tell those patients it was time to get a weaker prescription?
If Dr. Alex has retained medical records of his practice (and, conceivably, his father's practice), a systematic analysis of those records would be invaluable to those of us seeking to rehabilitate our myopia. For those of us with higher myopia, it might help us to find out what the chances are of halving our prescription, not needing any prescription, etc. It might help us find out if the probability of successful rehabilitation depends on age, other medical conditions (diabetes?), diet, BMI, etc.
For those of us interested in myopia rehabilitation there are at least three sources of information. There are accounts of personal experiences, like Todd's, David De Angelis's, and others. There are peer-reviewed journal articles. And then there are the medical records of those who have undergone myopia rehabilitation supervised by doctors.
The problem with personal accounts is obvious. We don't know how many people attempted rehabilitation and failed. The problem with the peer-reviewed articles is that no one seems to be able to get funding to do a controlled study that tracks a large number of myopes over many years.
The medical records of a behavioral ophthalmologist who has treated many hundreds of patients over a period of decades would be invaluable. No, it would not be perfect. There could be survivorship bias as well as all kinds of biases that can distort the reports of both the doctor and the patients. But if the numbers and the procedures were published, the scientific community could then decide how much of a problem these possible biases are.
It is unfortunate that there is an entire medical profession of people who rehabilitate myopes, yet those professionals are quite reluctant to publish what they know. Those who have the most experience and knowledge are, apparently, fearful of having their licenses revoked, so they operate more or less in the shadows. That leaves the public discussion open mostly to amateurs and quacks. Real data would be a first step toward getting the discussion on a less speculative footing.