Author Topic: Why does print pushing not work for everybody?  (Read 8296 times)

Offline HansK

  • Jr. Member
  • **
  • Posts: 52
Why does print pushing not work for everybody?
« on: March 18, 2015, 02:30:17 PM »
Hi,

here are people - like me - who did not improve even after many months of print pushing/edge of blur training. Likewise, a very inspiring story by warned shows print pushing does work and you get very good results.

What do you think is the reason why print pushing does not work for us, but it does for others?

a) Is it a wrong technique we are using?
b) Can myopia only be reversed when there is no axial elongation, but just a spasm of the lens? That would be strange because I cannot imagine that a spasm can last over many many years (see Todd Becker or warnbd, they've been myopic many years!).

It is really surprising that - for instance - warnbd improved so well while others did not improve, not even by 0.25 diopters.

Kind regards,
Hans
« Last Edit: March 18, 2015, 02:32:22 PM by HansK »

Offline OtisBrown

  • Hero Member
  • *****
  • Posts: 1766
Re: Why does print pushing not work for everybody?
« Reply #1 on: March 18, 2015, 04:02:00 PM »
Hi Hans,

That is an excellent question.  It does answer the question about why no "medical person" can do a blessed thing about "just prevention - with a plus - while you still can read the 20/40 line.

If you want a "universal cure" that works on EVERYONE, then you have it in a strong minus lens.  That is indeed the only medical solution.   I happen to believe that that "cure", only "hides the problem", and that, at least at 20/40, some "recovery" is possible.  But never by, or led by a "medical person."  It is just too difficult for anyone in medicine to "deal with", or even consider.

But at least all of us acknowledge that difficult truth.  Some people (at -1 diopter and 20/40) SLOWLY are able to clear their Snellen to 20/20 (refractive state equals zero) while another person, seemingly identical, wears the plus, and sees no "Snellen clearing" at all.

Personally I make no attempt to explain it.  I just recommend that a person who can read 20/40 on his own Snellen, make a dedicated attempt for wearing a plus for all close work.  There is a lot of "pure science" that says that it would be an excellent idea, and can never be conducted by a medical person.

But I wish all medical-people would take this possibility seriously, and specifically for their own children.  But they have "given up" on their own children - and that is what I feel is the most tragic and sad truth of this difficult problem.

I have enjoyed discussing this difficult issue with you.  Warnbd, is truly amazing.  I would not have predicted that he would be successful - at all !!  I also
consider just exceeding the 20/40 line (to read the 20/30) to be a major objective success.

I always prefer that a person report his visual acuity on a bright Snellen.  I always believe them, because he has no interest in a "bad measurement".  I do not "dispute", an OD "refraction" - but I always consider them to be very biased, and always excessive.

Hi,

here are people - like me - who did not improve even after many months of print pushing/edge of blur training. Likewise, a very inspiring story by warned shows print pushing does work and you get very good results.

What do you think is the reason why print pushing does not work for us, but it does for others?

a) Is it a wrong technique we are using?
b) Can myopia only be reversed when there is no axial elongation, but just a spasm of the lens? That would be strange because I cannot imagine that a spasm can last over many many years (see Todd Becker or warnbd, they've been myopic many years!).

It is really surprising that - for instance - warnbd improved so well while others did not improve, not even by 0.25 diopters.

Kind regards,
Hans
« Last Edit: March 19, 2015, 11:52:50 AM by OtisBrown »

Offline Alex_Myopic

  • Sr. Member
  • ****
  • Posts: 429
Re: Why does print pushing not work for everybody?
« Reply #2 on: March 19, 2015, 02:10:35 PM »
The fact that Warnbd had myopia with hyperopic astigmatism also helped with his good rate.

Offline OtisBrown

  • Hero Member
  • *****
  • Posts: 1766
Re: Why does print pushing not work for everybody?
« Reply #3 on: March 21, 2015, 03:35:05 AM »
Hi Jim,

Subject: You make some good and valid points.

There is no doubt that "just prevention" at 20/40, (self-measured -1 diopter) is indeed a challenge.  This is why it can not be offered
to children.  You have made a lot of valid statements - and each person must consider them.  I personally suggest that long-term
plus-wear is totally necessary.  It is dead certain that no OD can help you, or me, with any of these issues.

This video was prepared by Don Rehm, as advocacy.  I can assure you that he makes no money, in his efforts.

https://www.youtube.com/watch?v=YiuC7a1lkrk

We know that if a child does not wear the plus - his vision "goes down" at a rate of -1/2 diopter per year.  But the child and
parents never hear about that issue.  Tragic indeed.

Your commentary is well taken by me.  Each person should understand these issues - before he starts wearing the plus - which
requires a very long-term commitment.

The issue is to avoid "going down" at that rate of -1/2 diopter per year, while you still can read the 20/30 line.

This requires considerable "educated intelligence", because you will be wearing a "plus" (to get rid of that near environment),
and because you know FOR CERTAIN what will happen to your distant vision, if you do not take wearing the plus seriously.

The issues is to personally never allow your visual acuity (objectively) to go below 20/40.  With a child at -1 diopter, it is certain that
the child's vision WILL GO below 20/40, if he does not wear the plus for the long-term.

Yes, some people are successful, who truly "commit" to reading their own Snellen charts and to always always pass the 20/30
line - objectively.

There are MANY people who will claim that they, "were not successful".  But who cares?  Only the person who
wears the plus, and always passes the 20/25 and 20/20 lines -- will "care".  No one else can care - at all.

I have 20/20 (which you will probably deny, one way or another).  I wear a plus for all close work,
because I DO NOT WANT TO GO DOWN, and I KNOW that no OD can or will help me.

But I am very objective in the measurements I make.


It could be that Todd Becker and warnbd are special cases or have overestimated success. My experience with both passive and active focusing at slight blur has been disappointing as well -- i.e. zero improvement after six months.

Therefore, they either:

a) are using a mysterious focusing technique and/or schedule we don't replicate, or
b) rapidly progressed because of previous overprescriptions unraveling, or
c) have presbyopia or astigmatism that compensated positively, or
d) they haven't measured accurately, and have simply learned to tolerate more blur while also overestimating their improvement
e) any combination of the above
« Last Edit: March 22, 2015, 04:00:03 AM by OtisBrown »

Offline Hillyman

  • Jr. Member
  • **
  • Posts: 59
Re: Why does print pushing not work for everybody?
« Reply #4 on: March 21, 2015, 05:36:31 AM »
It could be that Todd Becker and warnbd are special cases or have overestimated success. My experience with both passive and active focusing at slight blur has been disappointing as well -- i.e. zero improvement after six months.


To jimboston: I visit this forum infrequently so may have missed something, but regarding your quote, did you get some improvement by some other approach and what was it that you did to get that?

Offline gekonus

  • Jr. Member
  • **
  • Posts: 84
Re: Why does print pushing not work for everybody?
« Reply #5 on: March 21, 2015, 08:22:42 AM »
Count me in HansK.

Yeah, Im looking for a solution too.. I have no idea why arent we improving after half a year of print pushing (which means eliminating almost all closeup work for half a year).

Vision improvement is POSSIBLE, Im sure about that. But maybe we are missing something..
Maybe we should try somethin else.. Maybe tryin to focus on really small objects or so.

I have no idea, Im in the same situation as you guys.

Offline OtisBrown

  • Hero Member
  • *****
  • Posts: 1766
Re: Why does print pushing not work for everybody?
« Reply #6 on: March 21, 2015, 10:01:35 AM »
Hi Jim Boston,

Jim>  Can rehabilitation predictably improve permanent myopia?

Otis> You will have to make a better "choice of words".  Since you say PERMANENT MYOPIA,
then you are saying, you "can not get out of it".  I happen to believe, that EARLY into
"myopia", you can SLOWLY get out of it - if you have the wisdom to avoid
wearing a strong minus all the time.  But I do mean, the person has self-confirmed 20/40,
and truly understands the standard, -1/2 diopter per year, if he chooses to not
wear the plus for prevention -- when at 20/40.  Obviously, this is to avoid,
"Permanent Myopia", before you go below 20/40 (which I think you mean
is permanent-myopia.)  I rather agree that ONLY PREVENTION is possible.

Otis> You have not understood what *I* have said. (Other people say things,
that I never said.)   Once you start wearing a strong minus lens
all the time - you WILL HAVE, "permanent myopia", and will NOT be able to get out of it.  What I have
suggested is that a person who still can read the 20/40 line, and is in school, should be totally
aware that if he does NOTHING, and continues his "reading habit", he WILL continue down
at a rate of -1/2 diopter per year. That is what I have stated, and almost nothing about "recovery".
Anyone who is in school should understand these facts and statistics.  For me, I wear the
plus for all close work, to avoid this "down" situation - and I have self-confirmed 20/20 vision.

Otis> Remember - I talk about the refractive state of ALL eyes, not just those eyes that have a normal "negative status".

Otis> If you can take this broad perspective, you would see the possibility of "just prevention", when a person can still
read the 20/40 line, and has self-measured -1.0 diopters refractive STATE.

Jim>  ...can you point to research that demonstrates healthy emmetropes go down by -0.5D every year? I doubt this is the case, since a lot of people with normal vision get along without glasses until their 40s-50s.

Otis> A great deal of this will depend on how EXACTLY you determine a person is, "emmetropic".  But let us use the exact definition. An eye that has exactly zero diopters (measured by the person himself.)  (I hope you have a good knowledge of statistics.  Without that wisdom, you will not understand the facts being presented.

Otis> This study concerns children from age 5 to age 17 years, or grades, 1 to 12.  No one can conduct the "perfect" study, but as you can see, almost all the "negative status" develops during those 12 years.  (Extended, in other studies, that "down rate", is true for academic students entering a four year college - see West Point and Anapolis for that additional data.)

Otis> You ask two separate question, in effect.  1) What happens if NOTHING is done for prevention.  (i.e., your "average normal eye's child, with his nose on the book for long hours, for five years.

Otis> and 2) What will happen if that "average child" will wear a plus for all close work.  (This was accomplished by using a bi-focal).

Otis> In a scientific test, you compare the predictive results, on a statistical basis.  IN STATISTICS:  0.05, is considered a SIGNIFICAN result.  p = 0.01 is considered HIGHLY SIGNIFICANT.

Otis>  The results of this difficult-to-run test, were > 0.0001 -- far beyond highly significant, for ONE YEAR.  For each additional year, the
significance doubles.

https://myopiafree.wordpress.com/study/

Otis> This study does not say that "recovery" is possible.  But it certainly suggest that a wise person, understanding these issues,
could teach himself to BEGIN wearing the plus during the school years, to avoid that -1/2 diopter per year.

Otis> This is certainly the reason why *I* wear the plus as I type this - and I indeed have 20/20 vision.

Otis>  It is obvious, that no one in a "shop" will ever help you with this - nor do I blame  them.  There is NOTHING that
is easy about this issue.

Otis> It is also obvious, that you can never "prescribe prevention", because it takes a lot of "smarts" to wear the plus,
when you see your Snellen, "down to 20/30, and self-measured -3/4 diopters".



The issue is to avoid "going down" at that rate of -1/2 diopter per year, while you still can read the 20/30 line.

Otis,

can you point to research that demonstrates healthy emmetropes go down by -0.5D every year? I doubt this is the case, since a lot of people with normal vision get along without glasses until their 40s-50s.

I agree that avoiding vision worsening is definitely desirable, but is insufficient for the already myopic. Anyone with a myopia higher than -0.5D cannot tolerate the image degradation. Therefore, rehabilitation or correction are inevitable. The real question is

Can rehabilitation predictably improve permanent myopia?

Hillyman,

I've had quick but small initial improvement many years ago simply by removing overcorrections. No exercises or techniques have helped since then, however. I have still not rejected slight myopic defocus as a rehabilitation tool, but it definitely isn't as effective as described by some. We need more people trying in order to come to better conclusions, of course.
« Last Edit: March 22, 2015, 04:04:48 AM by OtisBrown »

Offline gekonus

  • Jr. Member
  • **
  • Posts: 84
Re: Why does print pushing not work for everybody?
« Reply #7 on: March 21, 2015, 11:01:35 AM »
Actually after sleep, vision tends to get better temporarily. Improvements however NEVER lock in .
So , gotta relax the eye permanently in some way.. I cant think of a possible solution really.

Offline RynEyes

  • Newbie
  • *
  • Posts: 9
Re: Why does print pushing not work for everybody?
« Reply #8 on: March 21, 2015, 07:46:18 PM »
Does the print pushing method help stimulate the eyes to diverge? 

I've read about certain exercises such as dynamic convergence and divergence.  I could do the convergence exercises with ease, but could not do the divergence ones at all. After I started using the plus lens for near work and trying to increasing d2, I'm starting to notice the divergence exercises are becoming easier to do. It's kind of like I have a better sense of how it feels to relax the eyes.

Offline gekonus

  • Jr. Member
  • **
  • Posts: 84
Re: Why does print pushing not work for everybody?
« Reply #9 on: March 21, 2015, 08:32:00 PM »
Could you please give us the conv/diver exercises so we will know em better and try them out?

Offline Todd Becker

  • Administrator
  • Sr. Member
  • *****
  • Posts: 442
Re: Why does print pushing not work for everybody?
« Reply #10 on: March 22, 2015, 02:35:41 PM »
It could be that Todd Becker and warnbd are special cases or have overestimated success. My experience with both passive and active focusing at slight blur has been disappointing as well -- i.e. zero improvement after six months.

Therefore, they either:

a) are using a mysterious focusing technique and/or schedule we don't replicate, or
b) rapidly progressed because of previous overprescriptions unraveling, or
c) have presbyopia or astigmatism that compensated positively, or
d) they haven't measured accurately, and have simply learned to tolerate more blur while also overestimating their improvement
e) any combination of the above

None of the suggested options (a)- (e) apply in my case.  There is no mysterious focusing technique.  My distance vision is now marvelously crystal clear in all details, so I'm not tolerating any blur.  Whereas before I started my journey, my distance vision was blurry without glasses, and I would not have dared to drive.

It's not just me and warnbd. It's Shadowfoot and dozens of others on this site who have seen improvement.  And you can find similar success stories on the Frauenfeld and DeAngelis (Power Vision System) sites.

Nevertheless, you ask an excellent question: Why doesn't print pushing work for everyone?

I do not doubt that several of you (HansK, JimBoston, gekonus and others) are frustrated that you are seeing essentially zero improvement.  I wish I knew why.  I have nothing to be defensive about, since I'm not "selling" anything. On this site, I'm merely sharing what I know worked for me and others.  Apparently, it works for some of you but not others.

I can suggest a few possible explanations:

1.  Genetics.  While I believe that the modern rapid increase in myopia prevalence has a strong environmental component, there is no question that people vary in genetic susceptibility.  Just as some can more easily gain muscle mass through weight training than others, we vary in our responsiveness to stimuli.  Genetic susceptibility may come in to play in two different respects:  (a) initial progression of myopia from childhood on; and (b) reversibility of myopia.  It may be that print pushing is more widely effective in preventing further progression of myopia, while genetics may pose genetic limits to reversing myopia in a substantial portion of the population.

2.  Diet.  There is significant evidence from Cordain et al. that elevated insulin levels significantly weaken the structural components of the sclera, facilitating more rapid elongation of the eye.  This will tend to counteract the effectiveness of behavioral techniques such as print pushing and distance viewing.  My success in reducing my myopia was concurrent with adopting a very low carb, moderate protein, high fat and high fiber diet and, later on, adopting intermittent fasting.  My basal or fasting insulin levels fell from about 10 iU/ml (insulin resistant) to 4 iU/ml (insulin sensitive).  In addition, including phytonutrients from brightly colored vegetables, and fish oil, definitely increased my perception of bright colors (especially reds and purples) and heightened contrast.  Here's a good summary of relevant references on the diet-myopia connection:
http://thepaleodiet.com/role-insulin-resistance-development-myopia/

3.  Technique. While I think I've described my print pushing technique quite clearly and comprehensively in my blog posts and my AHS talk on YouTube, it is possible that I'm missing or overlooking some aspect of the technique, or failing to convey some important details.  Here are a few points I would emphasize:
- During my early days with the technique, I limited my print pushing to no more than a few hours (at most) per day, with frequent breaks, rest and changes in routine.  These days, I rarely print push. Maybe once or twice a week, to "stay in tune".
- When print pushing, I make almost no effort to strain or intentionally focus. Strain and pain are counterproductive, as they can promote tension, e.g. in the ciliary muscles, leading to pseudo-myopic spasm.   I merely keep the print at the D2 distance and direct my attention to the print, allowing it to spontaneously clear up.  Focusing in intentional, but it must be spontaneous, not effortful.  I don't "squeeze" or squint my eyes.  They are as relaxed as possible.
- Print pushing is NOT the entire technique.  Distance viewing is equally critical.  It is important to alternate between near and far all throughout the day.
- When I'm tired, I rest.  Overtraining is counterproductive, just as it is in weight training or exercise.
- To summarize:  don't strain.  Set the right distance then relax and let your natural accommodation mechanism kick in.  Get plenty of rest and eat an insulin-lowering diet.

Those are my thoughts based upon personal experience, what others have shared, and my reading of the literature.

But I cannot give a definitive answer to this question.  I wish I could, because I empathize with those of you who make the effort but don't make progress. And to the extent there is an answer, I suspect it is a complex answer and the reasons might differ for different individuals.  It's definitely worthy of further investigation.
« Last Edit: March 22, 2015, 03:18:28 PM by Todd Becker »

Offline OtisBrown

  • Hero Member
  • *****
  • Posts: 1766
Re: Why does print pushing not work for everybody?
« Reply #11 on: March 23, 2015, 08:00:27 PM »
Hi Jim,

We now have full, "run away" myopia - where no one knows what to do about it.

http://www.nature.com/news/the-myopia-boom-1.17120

It is always easy to be a "nay-sayer", and suggest that success from 20/40 will always be impossible.  It is
not the job of an optometrist to over-come the nay-sayers.  It is rather up to the person himself
to look at objective facts, and the proven adverse effect of the minus lens on all natural eyes, to
decide to be part of "run away" myopia, or to make the personal commitment, that is so
crucial to avoiding entry, or go from 20/40 to 20/20.  It is not for those who have
little or no interest.

I am just thankful that Todd was successful.

This is because he had the insight and self-discipline to wear the plus with long-term
commitment  -- and finally confirmed his own success.   No optometrist has any
interest in this type of success, so he had to do it himself.

I know that that type of success - is not "acceptable" to you.

I do agree that most people simply do not have the insight or motivation - to avoid entry,
by long-term wearing of a plus, "for near".

You can think that Todd's successful effort is not "worth it" - but only Todd knows he is successful.

Enjoy,
« Last Edit: March 24, 2015, 03:09:48 AM by OtisBrown »

Offline Todd Becker

  • Administrator
  • Sr. Member
  • *****
  • Posts: 442
Re: Why does print pushing not work for everybody?
« Reply #12 on: March 23, 2015, 08:14:57 PM »
Jimboston,

All fair comments and questions that you raise.  Yes, much of the evidence is anecdotal. In an ideal world, we'd have large funded, "double blind" studies (no pun intended  :) ) to support detailed and optimized standardized protocols.   But who will undertake and fund such studies?  Perhaps someone will step up to the plate and offer to do that. 

Until then, however, that doesn't mean we lack at least partial evidence in support of incremental defocus. I disagree with your statement that "there is simply zero" supporting data. 

I believe we have relevant supporting evidence that provides "pieces of the puzzle", and this small pool of evidence continues to grow. Let me provide two recent additions to the story:

1. In addition to the citations I shared in my AHS talk, I've been corresponding with several research ophthalmologists doing cutting edge research. I'd like to share with you recent comments by Dr. Scott Read, of the University of Queensland School of Opthalmology in Australia.  You'll recall, that Dr. Read is the author of "Human Optical Axial Length and Defocus", Investigative Ophthalmology & Visual Science, December 2010, Vol. 51, No. 12.  In recent personal correspondence with me,  he acknowledges a point that you and others have raised -- that that to date, the benefits of incremental defocus appear small and transient in the short term.  Yet from his research and that of others,  he is optimistic that sustained and substantial reduction in myopia is possible if the defocus is practiced repeatedly and for longer times. The problem is that those longer term studies have not yet been done.

Here is what Dr. Read wrote to me earlier this month:

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

2.  In addition to the factors that I've mentioned above (print pushing, low insulin diet, genetics), there may be other important factors.  One of them could be exposure to bright, full spectrum outdoor light.  An interesting study in this month's issue of the journal Nature, indicates that spending time outdoors is associated with reduced incidence of myopia in children. (I posted a link to this earlier today on my Facebook page for this blog). Researchers found that a key factor was time spent in bright, full spectrum light.  This effect was also reproduced in laboratory animals, and a link was shown between exposure to natural light and levels of dopamine in the eye, which functions as a neuromodulator to inhibit elongation of the eye.

http://www.nature.com/news/the-myopia-boom-1.17120

As I've mentioned repeatedly, I've found that distance viewing outdoors played a role in my own reversal of myopia.  I spent a lot of time going for long walks and focusing on tree branches, telephone lines, etc.  Could exposure to natural light have played a role?  Who knows?

This blog and forum have to be seen for what they are: a stimulus to thinking and self-experimentation and a forum for exchange of ideas, experience and tips. The lack of conclusiveness doesn't bother me, because this is not a scientific, peer-reviewed journal where all the results must be statistically validated in repeated trials with appropriate controls. 

While some of what we share here is indeed "anecdotal", that doesn't mean it is useless.  Combined with the "hints" from published research, shared personal experience provides a good starting point for all who come here.

Todd
« Last Edit: March 23, 2015, 08:20:46 PM by Todd Becker »

Offline Todd Becker

  • Administrator
  • Sr. Member
  • *****
  • Posts: 442
Re: Why does print pushing not work for everybody?
« Reply #13 on: March 23, 2015, 08:36:19 PM »

Hi Jim,

We now have full, "run away" myopia - where no one knows what to do about it.

http://www.nature.com/news/the-myopia-boom-1.17120

You can think that Todd's successful effort is not "worth it" - but only Todd knows he is successful.

Enjoy,

Neat that you came across the Nature study at the same time as me, Otis!  And did you notice that it cites the Eskimo study by Francis Young that you brought to my attention several years ago?  It seems that the tide may be starting to change from "genetic determination" to acknowledging the powerful environmental role of vision habits.  The article still has some flaws, I think, in too cursorily dismissing the role of near work in myopia development.  But in many ways, acknowledging the benefits of distance viewing and outdoor light will at least open up minds to the role of other environmental effects like the pervasive and detrimental overprescription of the minus lens.