Author Topic: Why "medical studies", fail - to address the issue of "just prevention".  (Read 1731 times)

Offline OtisBrown

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Dear Friends,

These studies, run by exclusively medical people, (no engineers are permitted to make commentary), always fail.

They fail, because they do not trust *you* to understand that, while difficult, "plus prevention" is possible - if you are
fully prepared to 1) Start before you go below 20/40, and 2) Measure your own refaction, and 3) continue to wear
the plus, and wait for results.  Here is Jake's review of "child myopia" inducement.


Otis> I have reviewed many of these studies. Not one study, was designed to help a motivated person, objectively, change his refractive status from -1 diopter to 0.0 diopters, or go from 20/50 to 20/20. Their judgment is that the “patient” will never understand “plus prevention”. They all “wait” until the person is seriously myopic. They never help a person to understand what must be done – before you go below 20/40 to 20/60.

Statement> Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children.

Otis> These studies, only suggest that, 1) You can never get out of it, if at 20/40. 2) They only suggest that it MIGHT be possible to “slow down” the rate at which you are certain to “go down”. 3) The result is that optometry convinces itself, that even the slightest recovery, is probably impossible. That is the “mind set” of an “office optometrist.” Both of us do believe that it is possible to avoid entry, and with fortitude, possible to get to naked eye 20/40, and then to 20/20. Your book on “Child Myopia”, will discuss these issues – that MUST be discussed before you start wearing that first minus lens.

Otis> The rate at which children go down is -2/3 to -1/2 diopter per each year in school. This suggests that the real, “risk factor”, is long-term close work, and the child’s habit of reading with “nose on book” is creating “negative status”. I consider this a “natural process”, and that the child must be disciplined to never read at 6 to 4 inches. (Reading at -6 to -10 diopters !!) But no OD will WARN the parents to check their child for this myopia inducing habit.

Otis> To discuss this issue of "child discipline", is never considered an "optometrist responsibility".  This is what Don Rehm calls, "The Myopia Silence".
I can appreciate the "silence", but it does not help me if I need to go from 20/40 to 20/20 - on my own.
« Last Edit: May 20, 2015, 07:42:47 AM by OtisBrown »

Offline OtisBrown

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The reason that ONLY a bifocal could be used, and not a “pure plus”, is that the children had no idea 1) What they were doing, or 2) WHY it was wise and necessary to do it !!!
In fact Dr. Young OBJECTED to this issue (the COMET STUDY) very strongly.   With a “progressive” the child simply AVOIDS LOOKING THROUGH THE “LOW” OR “CHIP” PLUS ON THE BOTTOM.  This is why these “studies” that do not consider this issue – will produce no meaningful results.  But the OD’s do not care. 
Jake>  There are also other issues that we discuss here from time to time.  For example the fact that it's quite easy to cheat with progressive lenses, and simply not look through the bottom part of the lens.  If you combine the fact that the top half of the lens is much easier to see through and the lack of active focus efforts, positive results diminish greatly.
Otis> A pilot, who truly NEEDS to go from 20/40 to 20/20, (and self-verify is refractive STATE -  himself) is not going to “cheat” by not wearing the plus for near.
Otis> That is why these “children” studies fail.
Dr. Young did this:
Subject: You simply can not “prescribe prevention”, because the child can not be instructed to wear the preventive plus “correctly”.

Issue: But you can use “existing practice” to get as close to that “ideal” as possible.

Issue: For me, no OD has ANY interest in prevention, and I accept that ONLY prevention is possible.

Intense use of the plus – is out-of-scope for any medical person sitting in an office – prescribing a strong minus – for all who enter.

TITLE: “Bifocal Control of Myopia”

Author: Dr. Francis Young, Dr. Kenneth H. Oakley

1975 Issue of the, “American Journal of Optometry and Physiological Optics”

Let me clarify. What we need to know, in a plus-group versus minus-group, what the effect was over a five year period – on the totally natural eye. (A natural eye can and does have negative and positive refractive states. With a positive state, you have 20/20 or better – if you measure it yourself.)

Since a child can not be trusted to wear “just the plus” alone, a “bifocal” was prescribed. This is not a plus-prevention study as such, but with some intelligence and wisdom on the part of the person himself – it would be perceived that prevention would be possible at 20/40 and -1.0 diopters.

Here was the protocol for children:

Young> … the parents were offered a discussion about the fitting of a “reading lens” or bifocal which would provide 3/4 to 1 diopter (D), of plus lens magnification over the minus distance prescription which was usually under-corrected by 0.5 diopter.

Young> For example if the chidren’s refraction indicated -1.0 diopter, the prescription would be written for a -.5 diopter with a plus 1.5 diopter add.

What this study FAILED to do – was to EXPLAIN the need and wisdom of wearing the plus “correctly”. If you give a young man a plus – but do not tell him WHAT he is doing or WHY he is doing it, you will find that, when he puts the plus on (say a +2 for reading), and then he will LEAN FORWARD to about 13 inches. When he does this – he totally CANCELS OUT THE INTENDED, AND DESIRED EFFECT OF THE PLUS.

This would ruin the study – as a practical manner. But still, even NOT TELLING the child to “push print” (the study DID have a highly significant effect.)

This does not mean “cure”. It does not mean you can ever “prescribe it”. Further, I limit myself to those who understand these difficulties.

But this study did proven that a plus (used before you go below 20/40, and -1.0 diopters) could have a MILD “recovery effect”.

That is the reason why, for a study with intelligent, motivated pilots, you could get recovery from 20/40. But you would have to TRUST both the intelligence and motivation of each person in the study.

NOT ONE STUDY ever extended that type of trust to the person himself.

Until THAT is done, all plus-prevention studies will fail.

No OD wants to give you authority and competence to work on prevention (with you in control) because if you succeed, the entire “science” that he thinks SUPPORTS a prescription – will be proven wrong.


As always, I take it that no OD can train a person to “wear the plus correctly” at 20/40.

That is “out of scope” for all medical people.  But do not beg them to help with “just plus prevention”. They are not going to do it.


Offline OtisBrown

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Subject:  There SHOULD be a dispute about these issues.  We should decide WHO is responsible.

[A Note From the Web Master:   I'd like to add that in my own experience, the optical profession is made up of highly qualified, competent, caring individuals, some of whom I happen to disagree with.  Regardless, I do not envy their positions, for they face quite a dilemma.  The existing standard for treating nearsightedness is to let it run wild; traditional treatments do not help nearsightedness, and quite probably make it worse.  On the other hand, in adopting newer treatments for nearsightedness the brave ones risk raising the eyebrows of parents, patients, and colleagues alike with unfamiliar treatments that most of us are not accustomed to.  (A major goal of this site is to educate the public so that we can be better patients!)  That there is a spirited debate between the two camps should not be taken as any sign of disrespect for the optical professionals we so depend on -- none is intended.   ja]


I use "neutral words", like refractive state (self-measured) rather than "error".  I never us the word, "cure".  But I do think that a person needs a better education about the issue of "preventing entry", or getting "out of", 20/40 vision.  I fully expect that few people will take prevention seriously, and will never take it seriously from an OD or MD.

Here is a summary of this issue:

Do not blame the OD or MD.  He is "defending" an age-old process, that works - in his office.  You can not blame him for that issue.