Prescribing for myself.

[OtisBrown]

Dear Independent-minded friends.

I have been asked to prove how you can "prescribe" for yourself.  I was very reluctant to take this step.  But I have seen so many "wrong" prescriptions, excessive prescription, incompetent prescriptions - that I realized that I had to "prescribe for myself."

We are all required to have 20/40 or better naked-eye vision.  So I check for that.  If you are going to take personal responsibility to improve your vision - then you may as well do ALL OF IT.

http://www.youtube.com/watch?v=K7cU-0onSvI

Remember -  I always go to an ophthalmologist for true-medical checks - and thank them for it.  But I always VERIFY my refractive state BEFORE I go to 1) A DMV test, and 2) An ophthalmologist. 

[johnlink]

Recently, Philipp, posting here, had a -3.0 diopter prescription.  He was using the "plus-prevention" method advocated by Dr. Colgate.  He made a "general check" that showed that his distant vision was not 20/200 (as the -3.0 diopter would suggest). In fact it was 20/25 - which is very good by most standards.
 

Otis, as I think I've told you already, I believe that your conclusion about Philipp's prescription may be unfounded. If I recall correctly he was not prescribed -3 D when he was 20/25, but rather before he started to improve his vision. Philipp, would you clear this up so that neither Otis nor I confuses anyone with out faulty memories?

[johnlink]

In fact when you rotate your head, your eyes STAY VERTICAL, and your cylinder lenses MOVE WITH YOUR HEAD.

I think these claims deserves further scrutiny. I will check it out for myself, but I believe that when I rotate my head my eyes do NOT stay vertical, which would contradict the first claim. Certainly if I rotate my head 90 degrees my eyes do not stay vertical. They might rotate slightly less than 90 degrees but they certainly do not stay vertical. I believe my toric contact lens moves with my head, agreeing with the second claim.

[peterg]

Hi Otis,

I think this is a better clarification to understand what you mean when you say you have seen people oversubscribed by 1, 2, 3 diopters.  I would suggest the extreme majority in these events are over-subscribed by about 1D, and only in rare cases 2D, and in extremely rare cases 3D.   

Now that I understand what you actually meant when you've stated that, it concurs with what Dr. Judy wrote to me.  She cannot tell her patients to try something that has not been proven to work, and which has potential side effects.  It is the latter which clearly causes the professional medical dilemma.  The OD cannot suggest the patient try  something (vision training, plus therapy, reading at edge of blur) to validate if their recommended perscription is an overperscription or not.  The side effect of wearing minus glasses which you write about extensively, are thus considered an acceptable side effect given the improved distance vision.

It is interesting to note that ODs may concern themselves when a myope progresses rather quickly and then may suggest vision therapy or improved vision habits to prevent further progression.  I guess at that point the risk of further myopia progression (detached retinas, other problems) is a large enough risk to warrant recommending to try some other things that are "proven to not work, but come with risks".

Peter

Hi John,
You miss my point.  I find people with a -4.0 prescription (that suggests 20/300 vision) yet, in a matter of a month the person was reading the 20/60 line, and wearing a +1.0 diopters.  I don't know what Todd's prescription might have been.

[johnlink]

I would be curious how you plan to confirm that the natural eye does not counter-rotate.  I have checked my own eyes - and they do.

By approximately how many degrees do they rotate?

[peterg]

It is obvious (from Raphaelson's statements) that NO OD CAN EVER BE INVOLVED WITH THIS.  So I totally agree with Judy - she will never be involved with prevention - and I MUST UNDERSTAND IT THAT WAY. You also raised the LEGAL ISSUE.  That if she even SUGGESTS it, and you (the patient) think ANYTHING HAPPENED - you can sue her into oblivion.  Again - I realized the final TRUTH OF THAT REALITY.  If you want to AVOID ENTRY - you must realize THAT NO OD WILL HELP YOU.

I have come to the understanding of the malpractice issue.  It was stated fairly clearly by Dr. Judy on the i-see forum when she mentioned the quandry of "not proven to work in studies, and carries risk".  This leads back to the AC:A or AC:C ratios that have been discussed on this forum and elsewhere substantially.

[johnlink]

Otis, who is this Raphaelson?

[johnlink]

Otis, what is Raphaelson's first name? What are the names of his two books?

[Hillyman]

I am curious why Raphaelson prescribed +1.00 glasses, when the distance vision of the printer's son was poor. Wouldn't he have prescribed minus lenses to fix the distance vision as the (still) mechanistic approach would dictate? It did not seem that he already had the insight into the plus-lens therapy with this patient.

[Hillyman]

To John Link:

Raphaelson's name is Jacob Raphaelson. He comes up in a Google search.

For general discussion:

Ever since I got my first glasses 50 years ago, I have always been fascinated and even obsessed about how to understand the causes and therefore find the ways to reduce my myopia. (ODs and opticians, as we all know, don't know anything beyond their test lenses and eye charts and could not care less!) For a long time, I  had no other leads except Bates, vision training and then the Accommotrac biofeedback approach; nothing seemed to get to the root of the matter. And then suddenly: I came across the plus-lens approach this summer, and it made total sense to me. How had I not known this all these years? To think that Jacob Raphaelson had been advocating this in this life but has been shut out from the general public discourse on myopia! It is disheartening and sad. Surely his approach should have ranked in the same importance and significance as a major vaccine (as in to immunize ourselves against myopia)!

Earlier on, even in my teens, I had wondered what the analogy for myopia was: 1) Is the eye like a camera where the camera body itself was growing bigger, pushing the plane of the film back (this is the genetics/you're a growing boy theory), and so putting a minus lens in front of the camera lens compensates for this or 2) Is the eye like a camera but myopia happens because the focusing ring in the lens is stuck at a near point. So putting a minus lens brings "infinity" back, but it also means that focusing at near distance requires forcing the focusing ring further past its normal range.  I--we--now know it is 2).

Each day now is an exciting new exploration of what I can do to improve my eyesight.

[Alex_Myopic]

About Dr. Jacob Raphaelson:

http://www.chinamyopia.org/jacobenglish.htm

[OtisBrown]

Hi Alex,

Most people get this far:

Hillyman>  Earlier on, even in my teens, I had wondered what the analogy for myopia was: 1) Is the eye like a camera where the camera body itself was growing bigger, pushing the plane of the film back (this is the genetics/you're a growing boy theory), and so putting a minus lens in front of the camera lens compensates for this or 2) Is the eye like a camera but myopia happens because the focusing ring in the lens is stuck at a near point.

+++++

Otis> I had "figured out" this out myself.  But for 99.9 percent of the population, (at 20/40 and -1.0 diopter), the plus sounds profoundly strange.  It is "strange enough" so no OD can ever prescribe it.  (Just ask them some time.)  When Raphaelson DID ATTEMPT IT, he was told that the, "... parents WILL NOT STAND FOR THEIR CHILD TO BE WEARING A PLUS LENS FOR NEAR - EVER".

Otis> That simple statement is true.  There is no incentive for any OD to do any more that hold up a minus lens (making your distant vision instantly clear", and selling you that lens because you ASSUME that your eyes are "defective".

Otis>  An even harder statement to make is this.  1) Accept that 20/50 is reasonable, but you do not wish to stay at 20/50, and -1.5 diopters.  2)  You will ask, "but my problem is out-there", and you imply that my problem is "in here"??  I can see perfectly "in here", therefore you are crazy.  I want a "real doctor" to tell me what to do, not some crack-pot that talks about the need to 'reduce the stress of near work'.

Otis> That is the problem in a nut shell.  This is why I measure my refractive status myself, and if necessary, prescribe for myself.  There is simply no OD to help me.  Raphaelson was correct in all the points.

[Alex_Myopic]

In the book "myopia manual":

http://www.myopia-manual.de/

because it is a sum of different researches there is a conflict at every subject. For plus lenses mentions that can be extremely helpful for prevention and reversion of low myopia. But also mentions other researches with no positive results and others with positive results and negative (worsening of myopia) when the power of plus is too much (above +3D). It also mentions some research that plus lenses is of no good when having medium or high myopia or established for long time. But Mr Todd Becker is an example that gives hope even to persons like me with medium myopia (low now after using plus and Bates method) but long established that we can get with time to 20/20 with plus lenses. 

Checked my Snellen yesterday but with no improvement for a month, stuck at 20/32. Maybe I should use +1,5D for an hour at home instead of +1D. I only use +1,5D for close work when reading.

[OtisBrown]

Hi Alex,

Subject: Raphaelson had an intuitive insight into the behavior of all natural, or fundamental eyes.

Issue:  That is, if you measure a refractive STATE, and not an "error" or failure.

The above statements are correct.  It is equally correct to perceive, and test the above statements, for scientific accuracy.  An OD will not make a "pure" statement like that - because he knows that in his office he can NEVER "prescribe" a plus lens for a child.  So he remains silent.  The ODs in their office, prefer to obfuscate any discussion of the natural eye, when I measure it at as refractive state.  That is why you get a large number of studies that totally CONTRADICT EACH OTHER.  If you stick with pure-science, and test the natural eye, you get this answer.

http://www.ocf.berkeley.edu/~wildsoet/images/neg_lens_induce_myopia.swf

This is a scientific check of why Raphaelson called the minus lens, "poison glasses for children".  In an absolute sense - he was right.  In a subtle way, he also identified a child's "nose on page" habit, as another type of "poison".  It is that combination that creates high negative states - in the pure, or natural eye. 

But I still do not blame the OD - because few people will understand the idea that you do not "fix" and eye at 20/40 with a minus lens.  No, you just devote yourself to the "wearing of a strong plus", and thank your lucky stars that you can still read and pass the 20/40 line or better.  The one EXCELLENT plus study (Young-Oakley) shows that if you can wear the plus for the "long-term" you can always pass the required DMV test.  But very few people will face the above facts.

Because of the self-discipline involved, prevention is indeed difficult.  Yes, indeed, Todd Becker did slowly change his refractive status from about -2 diopters to read the 20/40 line, and eventually most of the 20/20 line.  If your question is about scientific proof, then the above is about prevention (before you go much below 20/50).

But the issue of truly whether a  dedicated person can wear a strong plus - for the long-term.  I pretty much agree that very few people will do that. 

(I would have you read, "Hanky", on this site.  He was excited to "start", but after one week, when he heard the "suggestion" to wear the plus - you never heard from him again.  That is indeed the "general publics" mind-set.)

That is why an optometrist will not talk about it - or encourage you to take personal responsibility do make your own measurements - as I do it.  I truly do not blame the OD, he does not know me and my scientific curiosity, and my ability to wear a strong plus, even though I can read and type this with no plus lens on my face.

I was interested in proving Raphaelson RIGHT - on a scientific basis.

[Alex_Myopic]

Otis>  I am curious about how you measure your visual acuity at 20/32?

***

As we are both electrical engineers I' m sure you'll understand me.

The theory about the Snellen chart:
http://en.wikipedia.org/wiki/Snellen_chart

5 minutes of angle = 0,001455 Radians
so the line of 20 feet or 12 * 20 = 240 inches
should have a height of 240 * 0.001455 = 0.35 inches (at 20 feet). Since we know the height then we can produce the 20 feet line in the Snellen chart. With the same method we can have any line we want, for example the line of 32 feet.

I found a very accurate Snellen chart since it is in pdf format and if we print at actual size a pdf document, we have the millimeters the designer wanted when created the digital document, WYSIWYG (What You See Is What You Get). My previous Snellen chart had incorrect font size at 40f and 30f. The chart with the 32 feet line is the below:

http://www.i-see.org/etdrs/etdrs-r.pdf