Author Topic: What do Optometrists think about the plus?  (Read 5794 times)

Offline OtisBrown

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What do Optometrists think about the plus?
« on: February 27, 2012, 06:33:14 AM »
Subject: Why don't ODs help their own children with prevention?

I know we are given the impression that all ODs are hostile to the concept of having a child begin wearing the (preventive) plus before the child even begins to lose 20/20 on his Snellen.  This is not the entire story, so I must show that, for his own child, an OD will insist his child "be wise" and wear the plus.  For those of you who are now wearing the plus, I post this to show the wisdom and safety of doing so.

Some ODs, seeing the massive amount of myopia that has developed if no plus is used, "wake up" and insist that their own child wear the "best plus" possible. This is a story of Father/Son optometry and the wise useof the plus -- even AFTER getting to 20/20.

This is a story by Paul Harris, behavioral optometrist. In 1996 he wrote to the newsgroup sci.med.vision, saying:

http://groups.google.com/group/sci.med.vision/msg/3d07f6f5f866c5c0

Remarks by Paul Harris OD:

I started wearing single vision plus to play chess and this was upped and upped.

NOTE: I was measured with a 14 to 1 ACA ratio. 16 eso at near through
whatever distance lens of the time and 2 eso with +1.00 add over that.

The standard theory was "push plus". This was done and I ended up at one point
wearing +2.25 OD/ +2.50 OS (1) with a +1.50 add for 10 years. (2)

I measured well up in +3.00 range when my father (my optometrist then) was done
with me. There was no latent hyperopia over the +1.00. The additional amounts
were built up slowly over time in response to my optometric care.

Once I did VT 13 years ago I now wear just some plus for near and nothing for
distance. My subjective now is +1.25 OU (3) which I choose not to wear and do
great. In fact I now see better than ever. (4)

+++++++

1. Left eye and Right eye.

2. Plus for distance and more plus for near!

3. OU = Both eyes. So-called "subjective" is objective when you have your own
Snellen and test lenses. I means you can read 20/20 at 20 feet, and, can
continue to read 20/20 as you put stronger and stronger plus lenses on yourself,
until you find a lens that "just blurs" the 20/20 line. The point here is the
necessity and safety of continued wearing of the plus lens, to not only get to
20/20 (refractive state zero) but to develop some "protective" positive status
for your eyes.

4. In order to keep your Snellen clear, it is necessary to measure a refractive
state of zero to some positive value -- yourself. This shows the total safety
of the plus, and the wisdom of long-term wear. The fact that a parent will
insist that his own child wear the plus should be very instructive to all of us.

I will post some remarks about so truly poorly defined words, "myopia, emmetropia, hyperopia".



Offline peterg

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Re: What do Optometrists think about the plus?
« Reply #1 on: February 27, 2012, 07:39:28 PM »
I tried to reach out to Paul Harris about a month ago, no reply unfortunately. I suspect he gets lots of people like myself attempting to reach out to him.

He is now a researcher or professor at Southern College of Optometry.

http://www.sco.edu/faculty/Pages/default.aspx

Has glasses in his profile picture.

Offline OtisBrown

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Re: What do Optometrists think about the plus?
« Reply #2 on: February 29, 2012, 11:27:25 AM »
Dear Peter and Todd,

I hope you can reach out to Dr. Harris, and that he can help you with the concept of preventing entry into myopia.  I would always appreciate a conversation in science and about prevention -- if the person has the understanding, motivation and commitment to wear the plus as he his getting into it.  I posted Dr. Harris's remarks to show that his heavy wearing of a plus DID NOT HARM HIS EYEs.  In fact his refractive state is positive at +1 diopters.  I believe in science and facts.  Here are the facts (and Sigma) for Eskimos that 1) Did no reading and have a positive refractive state.  2) Young children at young age have a refractive state of +1.4 diopters.  3) After seven years with nose-on-page, the see a change of -2.4 diopters approximately.  This is a direct result of "long-term near".  But does anyone attempt to tell them about this problems of the "adaptability " of our totally natural eyes?  Do you think that if they were INFORMED IN A SCIENTIFIC MANNER, they would take wearing the plus (at -1/2 diopter) seriously?  Who has the engineering responsibility to sit down with the parents an explain that the choice (at 20/40 and -1/2 diopter) is to consistently wear a plus lens for prevention?  I would think that, while true prevention is not medicine, we should make an effort to explain this problem of the refractive behavior of all natural and  normal eyes -- on a scientific level.  I don't think Paul Harris has the time for this type of review -- but I hope he does.

++++++

Here is the data itself:

Title: Ocular Biometry of Eskimo Families.

Francis A. Young,  George A. Leary

Primate Research Center, Washington State University,  Pullman, Washington 99163

Summary of the data:

Age (Average), Eyes (Each Group), Mean, Sigma (S.D.)

Age 58 Eyes 96 Mean +2.21 Sigma 1.31

Age 39 Eyes 180 Mean +1.19 Sigma 1.55

Age 16 Eyes 194 Mean -0.93 Sigma 1.97

Age 9 Eyes 218 Mean +1.40 Sigma 1.70


+++++++++++++++++++++++++++++

The use of the plus, creates a DISTANCE environment -- if  used correctly.

This is why Todd and others have become successful.  But is does take great insight to do it correctly.

Offline peterg

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Re: What do Optometrists think about the plus?
« Reply #3 on: February 29, 2012, 06:44:39 PM »
It would be interesting to note what Dr. Harris recommends now for his patients.  And what he feels is the best method of prevention.  From his website, he lists this myopia control success story and considers it the best potential way to stop myopia in its tracks for a child that is already progressing in it (I think rapidly).  He also notes it does not always work.  Truthfully, I would love to have been able to take my children to see him if he was somewhere close (unfortunately not).

http://www.paulharrisod.com/category/success-story/myopia-control-using-gas-permeable-contact-lenses

Myopia Control using Gas Permeable Contact Lenses

Grant

Grant has been wearing Rigid Gas Permeable (RGP) contact lenses of the past 4-5 years. His vision has been stable since he started wearing them. He does daily exercises to relax the eyes and also has been going to eye therapy sessions recommended by Dr. Harris. I don't know what would have happened had we not found Dr. Harris. I am grateful everyday for finding Dr. Harris. At my recommendation, my nephew is also seeing Dr. Harris for myopia control.

Grant's father, 8/26/2009
 
Note from Dr. Harris: Grant was progressing rather rapidly in myopia/nearsightedness that began early in his school years. RGP's are the most powerful tool I know to stop the progression of myopia dead in its tracks. It does not always work but in most cases the progression stops and the amount of myopia can be held while the child goes through their growth years. Once he is an adult he will be in an excellent position to look into alternatives of care to reduce the myopia. The main thing during the growth years is to stop the rampant progression of myopia that we see far too often. Many children progress from -0.75 to -1.25 per school year. The higher degree of myopia is associated with eye health problems later in life. It is very rewarding to be able to offer a treatment that stops this progression and allows me to give my patients full clarity at distance.
.

Offline OtisBrown

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Re: What do Optometrists think about the plus?
« Reply #4 on: February 29, 2012, 09:29:10 PM »
Hi Peter,

Thanks for your reference about the goal to "slow down" the nose-dive into -8 diopters.  With respect to Paul Harris, he has no "practice" that could truly be called PREVENTION.  I truly understand why.  No one can prescribe prevention, but, in my judgement, the idea is that the person himself realizing from the Eskimo data, that NO ONE WOULD HELP THE ESKIMO -- TO EXPLAIN WHAT WAS CERTAIN TO HAPPEN -- UNLESS THEY STARTED WEARING STRONG PLUS WHEN THE ESKIMO FIRSTS WENT FROM +1.4 DIOPTES TO -0.5 DIOPTERS (AND 20/40).  Since no OD will talk to me about doing this (for rather obvious reasons), it follows that if I truly want to change my refractive state in a positive direction (with intense use of the plus), I will simply have to have the knowledge, the courage and fortitude to DO IT MYSELF.  I am not a critic here, but I recognize that few people have the motivation to learn how to do it.  That is why wise understanding of the Eskimo data is so important -- in my opinion.  I may dislike the challenge of personally clearing my Snellen with a plus (and avoiding wearing the minus -- consistent with passing the 20/40 line), but I truly know that no OD is ever in a position to help me.  Otis

Offline peterg

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Re: What do Optometrists think about the plus?
« Reply #5 on: March 01, 2012, 09:52:34 AM »
The question is what is considered a reasonable treatment prevention plan that factors in known risks.  Considering an agressive use of  a heavy plus, one must also consider the possible consequences on developing eyes, i.e. the price you mention for accomodating for far but converging at near.  This is a very difficult thing for people to get a handle on, in fact, I am still trying to understand the potential consequences of such a decision.  I think that is why behavioral ODs will only perscribe a light light plus and then hope to use vision training to relax the eye further especially with young children.  I can see when dealing with young children how this approach will often show limited success because of the patient group and the effort they must make to be disciplined and avoid some of the vision pitfalls (bad posture, too much video gaming, etc.).   

Harris makes the case that hard contact lenses is perhaps the only way to  potentially stop it with the young until they are mature enough to handle the vision training alternatives.  I know you disagree, but I believe that Harris knows and recognizes risks of the heavy plus and because of that reason avoids considering it.  It is possible that it can only be a feasible treatment option under very tight control/supervision of an eye care professional who can closely monitor and be on top of all the things that can go wrong.  That is why his father may have done it with him, and why it may be impossible as a public health practice.

With these thoughts of mine, I can see why your idea on engineering college entrants is  a wiser test point as the eyes are already more mature and potentially a less downside risk.  And the person can be on the lookout/monitor for problems. But again, I'm still having difficulty understanding the accomodation/convergence issue and weight of the potential risks, so even I as a mature adult am unsure what to monitor for.




Offline OtisBrown

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Re: What do Optometrists think about the plus?
« Reply #6 on: March 02, 2012, 06:55:02 AM »
Hi Peter,
Subject: Living under the "thumb" of a person who is "medical".

Re: What type of person does it take to make himself successful?

Yes, I truly understand your fears.

But I am an engineer.  I know that if I want something done RIGHT -- I must do it myself.  If our lives are controlled by our fears -- then that is sad.

Some people, however, managed to over-come their fears, and with wisdom teach themselves the correct use of a strong plus -- and slowly get out of it.  But it is not possible to predict who have these intellectual skills.  Here is one of them:

http://schwerdfeger.name/articles/pluslens.shtml

Yes, personal "boldness" is a required ingredient in science and engineering.  I wish you luck with other methods you might discover to clear your Snellen back to naked-eye 20/20.

Otis

Offline peterg

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Re: What do Optometrists think about the plus?
« Reply #7 on: March 03, 2012, 08:47:53 PM »
Ray Gottleib, an OD, self-cured himself of myopia and presbyopia.  I am not sure what that means for his patients, but I would think he tries to discuss prevention of myopia with them.

BTW, I am not fearful Otis. 

I've had two friends in my life that traveled far away to be healed.  One friend ended up in Taiwan as a 13 year old, after more then a year of a broken wrist /wrist surgery that did not heal properly and was continuing to be painful. He visited a very old traditional chinese medicine man, and to keep the story short, within 5 minutes, and a few very sharp snaps of his arm/wrist (my friend was screaming in agony), he was set on being healed.  The next day he could not tell, but 1 week later the pain had subsided, and gone away.  3 weeks later, back visiting with his doctor, who he told what had happened and had his doctor completely scold him.  After he was done, my friend asked him if he could give him an assessment on his wrist.  That doctor said "everything is fine, you are healed".  The other friend had a different arm injury, had a father who was very wealthy, and flew him to various doctors around the world trying to help him.  He was fixed in Cuba. 

So, while in the United States, defensive medicine is often the rule because of fear of malpractice, there are other places in this world where an eye doctor would not fear strong plus therapy if they felt it was appropriate.  It does not seem logical that one can not find a country where plus therapy is practiced more forcefully.  American legal action and decertification in the profession can only go so far.  And even within America, there are plenty of midwives and naturopaths practicing medicine in a way that jeopardizes health if one asked the medical establishment.

So, I would think that my trying to understand what is the downside of accomodating for far while converging for near is very rational.  I know that at least 1 out of 100 doctors would actually care about the outcome of his patients enough to advise them to be treated a certain way and would dare their professional associations to kick them out of their field for doing so.   I do believe, especially in America, there would be a lot of independent minded ODs that would never aquiesce to the status quo if they felt it was the right thing to do.

You may consider that fear, but that is just me trying to understand what is the problem that stops that 1 in 100 from acting.
« Last Edit: March 03, 2012, 09:19:53 PM by peterg »

Offline OtisBrown

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Re: What do Optometrists think about the plus?
« Reply #8 on: March 03, 2012, 09:21:54 PM »
Hi Peter,

I NEVER think badly of an OD or MD.  I just realize that they are never going to be in a position to help me with prevention.  I think that a lot of people get upset when I suggest that preventing negative status for the natural eye -- will always be possible.  But, in my judgment, only up to about 20/40 to 20/50, and ONLY by very heavy motivation in the person himself.

This is as Todd suggests, a matter of scientific education and self-interest motivation - and I agree.

I know children can not be taught to "prevent" at this time, but, as you know, I suggest that the person, at age 14, be taught basic physics of the natural eye's proven behavior (if at 20/40 and -1/2 diopter),  and make that type of decision.  What most people don't know (or refuse to understand) is that, when you are at 20/30 to 20/40, and in high school, you eye is CERTAIN TO GO DOWN by -1/2 diopter per year for each year in school.

If you are intellectual enough to understand that basic fact of all a natural eyes you MIGHT be able to over-come your personal resistance to wearing a 2 to 2.5 diopters for all close work.

That is the real 'sticking point' for all of us.  No OD or MD, in an office, has the time to supply this type of education for us, let alone the understanding of the need to "stop it before it starts" -- but I think some will understand.

You have been a big help, in getting the "test lenses" from Zennioptical, setting up a Snellen, checking your visual acuity (at 20/60 to 20/20), and considering  your choice.  I think we ALL LEARNED TOGETHER FROM YOUR EXPERIENCE.

I take that as true science among friends.

Otis

Offline peterg

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Re: What do Optometrists think about the plus?
« Reply #9 on: March 04, 2012, 12:07:16 PM »
Otis you write: >> That basically no OD or MD can practice "prevention". <<

To be clear, what you mean is that no OD or MD can practice prevention of myopia when it is defined only as using a strong plus for all near work.  There is no monopoly on what constitutes prevention for myopia.

Of course, it is quite clear, that an OD and MD can practice other methods of prevention.  There are many examples of ODs out there that will perscribe a weak plus and call it prevention.  In particular, ODs that are of the behavioral optometrist ranks.  Even some ODs who are not behavioral optometrists.  Similarly, ODs and MDs will all discuss prevention in terms of good visual habits.  

Which again, leads back to the original prevention method discussed - the use of strong plus for prevention which as you say you will you not find an OD or MD that will recommend it for prevention, ever.  Including Paul Harris, who for at least some time, was coached by his OD father on wearing a strong plus for near work.  

One is in danger of being sued if you make false claims in the way you practice public health.   That threat of being sued happens whether you advise your patient to wear a weak plus or a strong plus if the patient doesn't realise the expected benefits they feel they were sold on.  What however is likely to affect if one is sued is when something goes wrong.

So clearly there must be some inherant risk or common outcome that happens to a portion of the population when they use a strong plus for prevention if an OD would be sued by recommending it.  Again, I am not aware of what the risk entails, just that it is the issue of accomodating for far when converging for near.  And the common body of health professionals believe that young developing eyes are more at risk for the unwanted outcome when training their eyes to do that.

So, I am assuming there is a real, tangible risk to a person's vision system by utilizing a strong plus, else I fully expect that behavioral optometrists would be lining up to coach their young patients on how to do it.   A lot of the behavioral optometrist's business is not based on eye exams, but on vision training (therapy), and offering the strong plus therapy does not diminish that business in any way.  One doesn't need to visit an OD to conduct their standard vision training - you could learn it on your own and do it yourself to avoid the costs.  

Finally, take a look at this link from Yale's department of opthamology:

http://www.eyes.yale.edu/patient-care/pediatrics.aspx

I like the first line where reads:

In Pediatric Ophthalmology and Strabismus, we promote the science AND ART of pediatric eye care to improve the visual health of children.

It is interesting to read one of the most prestigious research institutions in the world refer to the ART of eye care.  That is a very interesting choice of words, as it indicates to me that even in a prestigious institution there is more to seeing than pure optical physics.
« Last Edit: March 04, 2012, 12:09:37 PM by peterg »

Offline OtisBrown

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Re: What do Optometrists think about the plus?
« Reply #10 on: March 22, 2012, 08:54:31 AM »
Subject: Fair play -- equal time for the majority-opinion OD.

BlueOD>  ...kind of depends on his age doesn't it Otis?  Or maybe you don't
understand.
and why does his eye have to be "negative".  I know you have
difficulty following this, but not everyone is a myope.  There are
emmetropes, amblyopes, anisometropes, hyperopes, astigmates, and
patients with mixed prescriptions.  You are only capable of thinking
about things through the narrow slit of your own personal experiences
and that's what makes you so unable to understand the overwhelming
facts that some trained and experienced professionals have taken the
time to present to you here over the years. Yet instead you just
default to your standard "dullard denial" stance.
Why don't you go off somewhere else (there's probably a "dementia"
forum out there somewhere) and give someone engineering advise on
building airplane engines, bridges, or something.  Perhaps you have
something of value to say to someone on those topics.  But here you
just keep shoving your foot farther and farther into your mouth every
time you open it.  You're kind of pathetic.  You are doing a
disservice to the old spectacle-peddlers whose outdated theories that
you still adhere to.  Ever notice how there seems to be fewer and
fewer of your like-minded buddies around.  Science moves on.  Old
notions get displaced by medical facts.
I know what Raphaelson and Merrill Allen have done!  Fade away.  Go
the way of the buggy-whip.  There's a new sheriff in town, and it's
called medical science.
Indeed there is a lot of ongoing modern research on the topic of
myopia development all over the world.  Why aren't you all over that?
Why do you keep clinging onto a few old studies that have since been
proven wrong, and instead try to use some convoluted logic to proclaim
that all primate eyes are "fundamental eyes" blah blah blah.  Get real
man.  Or fade away.
Big Blue OS

++++++
I believe in "standing up" for your right if choice -- for prevention.  The personal attacks -- don't concern me. 

Your long-term visual welfare is more important than my personal feelings.

This is the reason I get my own Snellen and trial-lens kit, and check myself. 

The other people Big Blue OD attacks, are people who advocate that you be informed of EDUCATED CHOICE TO PREVENT.  Obviously Blue must attack them also.

Otis

Offline OtisBrown

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Re: What do Optometrists think about the plus?
« Reply #11 on: March 23, 2012, 04:50:00 PM »
Subject: The second-opinion as expressed by Dr. Raphaelson and so many others.

There is a rabid arrogance in these ODs -- which must be understood.  It was Raphaelson who call the minus, "... poision glasses for children" -- even when he knew, as all ODs knew, that the ONLY THING PARENT AND CHILD WOULD "ACCEPT" WAS A MINUS LENS.  These insightful ODs, went on to say, that, in addition to never "solving" any but the superfical problem of 20/30 to 20/40 vision "instantly", that in his judgment, the minus was RESPONSIBLE FOR PROGRESSIVE MYOPIA ITSELF.

A person who is rabid in defense of a crude simplistic quick-fix, will not be paying attention to any science and facts that supports Raphaelson's deep insights about the eye.  But to truly understand this issue, is to provide the necessary education to the person when he is in the "pesudo-myopa" stage, which we must define as, refractive state of -1/2 to -1.5 diopters, and VISUAL ACUITY OF FROM 20/30 TO 20/70.  There has been no adequate definition up to the present time.  I would add also, that the person be taught to measure this refractive status himself.

To show support for prevention in this "pseudo-myopia" stage, I will post the remarks by a highly qualified ophthalmologist, who I am certain this "Blue-OD" will also trash.

Who loses, because of this vicious name-calling?  In my judgment -- we all do.  Otis

Offline OtisBrown

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Re: What do Optometrists think about the plus?
« Reply #12 on: March 29, 2012, 09:05:10 AM »
Subject:  Remarks by an Ophthalmologist about the need for plus-prevention:

Dear Kaisu,

As I was working on plus-prevention -- I kept on being asked, "...do  ophthalmologists support the concept of plus-prevention".

You do a great service to all of us by saying so.

A lot of responsibility (and education) must be given to the parents.

The only real issue is this -- WILL THEY TAKE (PROTECTING) THEIR CHILDREN'S  EYES SERIOUSLY.

Tragically -- I never know the answer to that question.


++++

Dr. Kaisu's further remarks:

All "fine-tuning" is unnecessary:

- no exercises - which rather are harmful.

- no films are needed - they are only attention binding and     confusing.

  - And they need much energy and do lead nowhere!!!

Everybody has to progress at that speed it succeeds, which is individual, but progresses by everybody if only done purposefully, and unyieldingly.

That the vision becomes blurry, is relevant.  If it makes one scvared, the reaction is wrong!

In close work it is to compensate with the distance and then, little by  little, to "stretch" it.

Good luck!

Kaisu

Offline jimnicol

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Re: What do Optometrists think about the plus?
« Reply #13 on: April 13, 2012, 04:37:45 AM »
Update...with my -3.75R, -4.25L specs, -3.50R, -3.75L contacts (2nd step down from -5.00R, -5.50L specs, -4.75R,-5.00L contacts) I find that during the daylight hours I'm doing pretty well...well enough that I don't notice any real issues of underpowered sight. I'm probably 20/25, 20/30. At the end of the day, however, when the light gets weaker, my vision seems to lose its acuity and I fall back quite noticeable. 20/60 maybe. Wondering if that's the eyes getting tired, not being able to hold the line, or just the weaker light. Still using +1.00 for close work and for stretches while driving...