A Compendium on Myopia Rehabililation

[Tom]

A Subjective Account of the Repercussions of Extreme Myopia

For an example of how extreme myopia could affect you as you age, let's listen to Lisa Emrich as she talks about her myopia experience:

Since the ago of four, I have relied upon eye doctors to keep me seeing well.  Both my parents are nearsighted and when their genes mixed, the result was double bad eyesight for me.  For those who know how prescription strengths work, I just picked up a new pair of eyeglasses today which are powered at -13.75 in one eye and -13.25 in the other.

While it's true that refraction is positively correlated to parental refraction, every doctor and patient need to become aware that:

• Correlation studies alone cannot establishing causation. In this particular context, there is simply no indication whether the correlation results from shared genes, or shared environment.
  
  
• The genetic contribution to myopia refers primarily to the inheritability of physiology, and its responses given the presence of relevant stimuli. To claim that gene causes myopia is to either not understand the concept of causation, or to have a set of outdated beliefs about myopia.

While it's important to emphasize that diseases occur only via the interaction between gene and environment, it's even more important to emphasize, in the case of myopia, that it is the near environment that pulls the trigger, for the "susceptible" individuals.

I remember in high school being warned, kindly but repeatedly, about reporting any sudden change in vision, especially the appearance of “flashes” of light.  The doctors who had cared for me since the age of four put the fear of a torn or detached retina in the front of my mind.

This is the doctor responsible for most of her myopia, telling her to be careful of any sign of retinal detachment. A hundred years later, people will probably look at this with dismay and incomprehension.

When I moved to Washington, DC, I needed a new doctor so I called home for a recommendation.  The morning in 2000 when I woke up and couldn’t see well out of my right eye - it appeared as though I was looking through vaseline-covered lenses - my new eye doctor’s quick response ensured that I receive prompt medical attention, resulting in the diagnosis of optic neuritis.  This is the first concrete point in time that I can connect directly to the multiple sclerosis diagnosis I later received.

In addition to myopia, she probably has some systemic inflammation in the body, which over time reduces the structural integrity of her ocular connective tissues.

During the past ten years or so, my vision finally stabilized.  No longer do I require updated prescription lenses each year.  However, I did develop a new problem - presbyopia - which is a sign of being “of that age.”  With presbyopia, the lens of the eye loses its ability to focus up close.  Ever watch “older” folks read the paper way out at arms’ length?  Well, I was approaching that situation so now I wear multifocal contact lenses to compensate.

At least it's better with the multifocal. One would bet that she doesn't "exercise" her eyes regularly (i.e., engage in activities requiring focusing on different focal planes)

Somewhere along the way, I also developed two “floaters” in my right eye.  They are harmless but were a distraction at first.  Floaters may have different causes.  Mine were explained as the result of little bits of the gel inside the eye (the vitreous) sticking together and creating a shadow on the retina.  Uveitis, an inflammation in the eye which can be caused by rheumatoid arthritis, might cause floaters in addition to light sensitivity and blurred vision.

The first cause that she was trying to describe is called the posterior vitreous detachment (PVD). For the record, the vitreous gel doesn't glue together. Rather, it got detached from the retina.

Again, one example of how the body really functions as a system, and failure of one part can affect another. In her case, the systematic inflammation happens due to multiple sclerosis and rheumatoid arthritis (or so she claimed).

Last month when we were preparing for a yard sale, I noticed new floaters in my left eye.  Not something which was alarming, but definitely not welcome.  During the next day, the amount of floaters increased.  I thought to myself that this wasn’t good and I became concerned that this might be a new manifestation of optic neuritis.

Then, I noticed the flashes of light.  Uhoh!!  I had been warned since childhood that flashes of light = retinal tear or detachment.  The flashes increased during Sunday night and I called my eye doctor first thing Monday morning.  After a thorough eye exam, I was diagnosed with PVD.  I did not in fact have any retinal tears.  Phew.

This must have been a pretty scary experience, and it illustrates the necessity of being proactive about one's own health, before the emergencies occur.

I’m told that gravity will help to settle the floating, detached vitreous toward the bottom of the eye.  The flashes ,which continued for almost three weeks, have subsided.  I still see floaters in my central vision, but my brain is learning to adapt to the distraction.  Hopefully those floaters will indeed float out of my line of sight.  Only time will tell.

Here is her advice to others:

If you ever experience any of the following symptoms, please call your doctor immediately:
1. Black curtain coming across your vision


2. Sudden onset of numerous flashes


3. Sudden onset of a floaters that look like sand


4. Sudden blind spot in your side vision

1), 3) are symptoms of PVD, 2) is a symptom of retinal detachment, and 4) of macular holes.

There is a topic that is missing, and that is what causes these symptoms to occur. You can find out more in the post "Myopia and the Associated Pathological Changes".

As a sidenote, it seems that she is under the impression that RA and MS just happen out of thin air. In fact, new information is coming out about how an inflammatory diet, coupled with compromised immune system, can a portal to these diseases.

P.S. - In addition to near stress, connective tissues can be degraded by the shear force of saccadic movements over time. If such a mechanical model is true, then highly myopic people reading with full prescription and fast saccades, is a very bad idea.

[OtisBrown]

Hi Tom,

Optometrists are all "over the map" when you talk about prevention. It would be nice if they discussed this issue with you before that FIRST minus lens is applied.

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

I obviously think the person should do some verification at home, and not rely exclusively on an OD to tell him which line he reads on his Snellen.

But at least Bennie says that prevention is possible.

Close work post expanded.

[Tom]

Testimonies of Inadequate Medical Practices in the Eye Care Industry

Well, our societies have reached a critical time in history that we can no longer take our doctors' expertise for granted. For that reason, we will just let the patients have their say.

People

• Anne
• David
• Jeanie Brave

Anne

Originally posted here.

Hi everyone,
I took my youngest son to see the ophthalmologist today and I am feeling so disappointed, frustrated and angry ….
Let me first give you some background history:

I joined the Frauenfeld Clinic program on March, 24th 2014 after my 2 youngest children (Robin,7 and Eline, 10) had been diagnosed with myopia. This made me really worry (it kept me awake at night) about their future eyesight. From my own childhood, I can clearly remember that, once I started wearing glasses (around the age of 10-11), my eyesight only got worse. It made me really sad and at one point (age 31-32), my right eye was at -8 and my left eye at -9 and I could not live without my glasses. I have been wearing contact lenses for most of the time and they were always less strong then my glasses.As I grew older, I made a little progress in both eyes (R: 7.5 and L:6.5).

When, I took Robin and Eline to an ophthalmologist she pointed out that our children “inherited” our myopia (my husband is also myopic) and she prescribed minus lenses (-2 for Robin and -1 for Eline).
As I have always been convinced that there must be other ways to help them, I started looking around for other solutions to prevent their eyes from getting any worse. One of the things I came across was the use of reading glasses.

It all made a lot of sense to me so I decided to talk to my optician about it. He had never heard about it and looked at me as if I was some crazy woman who wanted to try something out that could be harmful and advised us to use -1.75 lenses for Robin (they measured his eyes again) and -1 lenses for Eline. I felt so disappointed when we left because he didn’t even bother listening to me.

A couple of days after our visit to the optician, I came across the Frauenfeld clinic site and decided to subscribe.I decided to try the program myself (hoping this would enable me to demonstrate some improvements to the ophthalmologist so this would then convince her to help my kids) and for the last couple of weeks I have been focusing on improving my own vision.

I ordered my first close-up prescription R: -6 and L: -5 (based on the results of the Myopia calculator. This is -1.5 diopters lower than my distance prescription.I received my glasses on April 14th. Before this time, I’d been doing the morning focus differential awareness and stress reduction exercise; the 2×30′ outdoor activity and peripheral awareness exercise.

Since it felt so comfortable, I have been wearing my reduced prescription for most of the time. They offer me excellent vision for close-up work. I can work on my pc and read without any problems (taking into account the blur zone). The distance between my pc and my eyes is about 55cm (best vision is at 50cm).As I was in between jobs for about a month and the weather was nice, I spent a lot of time outside.Already, after a couple of days, I could notice some difference in my vision: in the morning I could read my alarm clock without glasses, could watch tv (most of the times only with some blurriness) and go for walks with my reduced prescription, could read sign posts, license plates…

When I went back to work, I didn’t experience any real problems with close-up work or walking around the office. I only experienced some blurred vision when I had to look at a presentation on a screen at a distance from me. After wearing my glasses for about 3 weeks I could also use them to drive to school and work.

Just for professional purposes, I decided to order reduced contact lenses (L: -5 and R: -6) and combine these with an additional pair of minus glasses (-0.75) to use for distance vision when needed. It would not be very practical to switch between glasses when I’m working at a client’s side.

I received my contact lenses today and decided to try them out. I was surprised how much more they improved my vision and decided to do a Snellen test. I was surprised that I could read the 20/13 line at a distance of about 5.20 m (didn’t try if I could read it from >5m). With my reduced glasses, I can read the 20/25 line (with active focusing) at a distance of about 5m.

My neighbours recommended me to take my kids to their ophthalmologist. I had to wait for more than 2 months before I could take my son to his appointment, which was today. In the meantime, I encouraged my children to play as much outside as possible, I watched the time they spend working up close, watching tv, playing games, reading, etc …

So this afternoon, we went to see the ophthalmologist. I was glad I’d already made some progress with my own vision. I very carefully (knowing how upset some professionals get when you ask them too many questions) asked her if my son’s vision could be improved (or if we could at least try to just stop the progression at this point) by using reading glasses for close-up work. I also told her about my own experience. Her first question was: “are there any other relatives in your family with myopia?” She then said that the main cause of myopia is that it’s hereditary (so not caused by cramped eye muscles) and that she had never heard of the stuff I was talking about.

She said that due to his young age (7), Robin’s myopia was (probably) due to the elongation of his eyeballs and that this was something genetic (so we couldn’t do anything about it). If he would have -2 than she would recommend him to wear his glasses all the time (this really shocked me).
To find out his true myopia (the genetic one) she could put some drops in his eyes to paralyse the eye muscles so they wouldn’t be cramped anymore. She also mentioned she didn’t expect this measurement to be any different from the one she did today and that this would then prove that his myopia was not caused by cramped eye muscles but by genetic elongation of the eyeballs.

With respect to my own progress, she explained this was due to my age as your vision can get better as you grow older (I’m 44 years and I don’t think that such improvement in vision over a period of 5 weeks can be linked to me getting 5 weeks older). She said my true myopia (the genetic one) might be less f.i. -4. Then why did I end up with -8 and -9 at age 32 ?

When she measured Robin’s vision, she came up with the following results: right eye: -1.75 and left eye: -1.25. At the time of the measurements, Robin was feeling tired as he’d been on a school camp for 3 days and had only been back home for about an hour. He also had a light infection in one of his eyes (at least that’s what the ophthalmologist said). She recommended us to come back to see her on an annual basis as his eyes would get worse every year.

So this is why I feel frustrated, disappointed, sad and even angry! How can I encourage my children to use reading glasses for up-close work if I can’t find an ophthalmologist who wants to give us a prescription? As an adult, I can order my own glasses over the Internet without needing any prescription.
Over a period of about 4 months, my son has been given 3 different prescriptions:
- Feb-March: -2 in both eyes
- End of March: -1.75 both eyes
- May, 14th: -1.75 right eye and -1.25 left eye → how come there is a difference in both eyes? There wasn’t one in the previous 2 measurements.

To be honest, right now I don’t really now what to do next.
Which prescription is the right one?
I live in Belgium and I just think that I will never be able to find a professional who will be willing to help me as this is still a very conservative country when it concerns eye care, medicine, etc
Has anyone of you been in the same situation as me or has anyone some advice for me?

Best regards to all of you,

Anne

David

Originally posted here.

Hey all,
I started the program back in October and had been not using glasses for a bit before that, but wasn’t doing active focus or blur horizon work, till October. Anyway, had my first Optometrist visit in 2 years, just to break the ice and get things checked up from a general health standpoint. Some interesting takeaways:

1. I wanted to believe better, but was surprised how much glasses were pushed and mostly by the assistants and desk folks (they just assume that you are there to get your prescriptive fix). It truly was very sales oriented. I knew this was the case, but thought surely there might be a little more to the checkup than that. (They did take a picture of my retina which was cool to see and probably the most beneficial part of the visit)

2. I cleared 20/20 with both my right and left eye (measure by themselves) with my cheap -2.50 glasses from Zenni optical. Not that this was a surprise as I’ve been able to do this for the last month or so, but something about doing it in the Optometrist office that made it feel better. I did get an appointment for 8:30 am and went for a 10 min walk before the visit so it was good conditions for measurement. I started with -4.00 2 years ago and have only been doing targeted stimulus since October 2013.

3. Even with the reading, my optometrist wanted to pass this off as a case of blur interpretation and some overprescription that he said I was able to deal with the overprescription because of a higher accommodative range, so essentially I was able to deal with a -4.00 because I could accommodate better than the average person…however, this doesn’t explain the fact that -3.75 felt blurry if I put on my old glasses back when I first started…even my -4.00 glasses were not 20/20 compared to my -4.00 contact lenses I used all the time. He claimed that my true prescription was -3.00 or -3.25 which he said he got from when he shined a light into my eye while flipping through the lens settings and that when it flashes back bright that is the true myopia value (axial myopia?) of my eye at the time. Alex, does this seem right to you that maybe I’m -3.00 in my “true” value, but I’m able to use active focus to pull 20/20 with -2.5? When He put it on -3.25 I was able to read 20/15 no problem and half of 20/10. Since when was 20/20 not good enough ? To his credit he was fine with me staying with my -2.50s (that I sheepishly had to admit I bought online without their prescription), but said he would only write a prescription for -3.25 (in case I wanted it) because that was his determination of my “true” value was. Interesting to say the least. I wonder what he will say next year when I’m hopefully -2.00 or possibly lower? More blur interpretation? Maybe I’ll just interpret the blur better all the way down to 20/20 . I just wonder what the threshold for improvement is for them that they no longer could consider it blur interpretation. I know better, my vision is qualitatively (as well as quantitatively) better than it used to be. I also understand that, if they truly believe myopia is not reversible, then logically they have to have another explanation if they want to keep that paradigm.

My centimeter measurements are running in the 36-38 range after I push focus for 5 min or so, right in the -2.75 range which makes sense with my experience with the -2.50. On good sunny days, I’m nearly ready to push to -2.25, but on cloudy days or night the -2.50 offers enough stimulus still. Anyway, a small little update. I’m still keeping at it even though I haven’t been in the program since December.

Take care everyone and all they best with your efforts!

David

Jeanie Brave

Below is a letter (original link here) from Jeanie Brave to Otis Brown, about her daughter's excessive overprescription.

JEANIE BRAVE'S LETTER:

Here are copies of my daughter's eye records and
prescriptions. You will never know how grateful I am for you and
Mr.  Severson. When I stop and think of what could have happened
to Shanna had I not found you -- my blood starts to boil.  I have
come to realize that people never question eye doctors as they do
medical doctors.  We are all at their mercy and do not even know
it.  You have my permission to give my telephone number to anyone
who you feel needs it.

A CHECK-UP BEFORE SCHOOL

Shanna received the new contacts on August 5.  She puts in
-10.0 Diopter and is able to see -- she says one mile down the
road.  I immediately told her to take them out.  After begging my
optometrist to please give me information to stabilize her vision,
he becomes EXTREMELY UPSET.  I then went to the libraries and book
stores looking for information but I found only William Bates'
name.  I then ordered his book.  Next I found Mr.  Severson and
finally you in the back of his book.  After reading your books I
immediately knew I had the wrong optometrist -- so I nicely asked
his assistance in obtaining a -6 Diopter lens for studying.  The
doctor reluctantly gave them to Shanna, telling us to use them for
STUDYING ONLY. I then confirmed the focal status of Shanna's
eye's, by assisting her in checking her vision against the eye
chart -- both inside and outside.

8/26/95   20/20   -8.0 RE -7.5 LE
8/26/95   20/100  -6.0 RE -6.0 LE (Provided for reading)
8/31/95   20/40   -6.0 RE -6.0 LE
9/26/95   20/20   -6.0 RE -6.0 LE (See the -10.0 D prescription below)

     Since she was seeing so well on 9/26/95, I told her to remove
her contacts and then come back outside.  Without ANYTHING on she
stood 20 feet away and could focus on the 20/70 and 20/50 line for
about 2 or 3 seconds -- then she said it would flash or float
away.

AN EXCESSIVE -10 D PRESCRIPTION?

   Prescription by Dr. Bob Smyeth, Optometrist, Dated 8/5/95:
   Patient:  Shanna Brave, Birth Date, 3/2/82:
8/5/85   20/20    -10.0 RE -9.5 LE (Prescription)

[OtisBrown]

Hi Tom,

Subject:  Testimonies of Inadequate Medical Practices in the Eye Care Industry

I know that medicine (and optometry) is locked into the default minus lens - in a tragic believe that over-prescription constitutes, "perfect science".

Since you are writing a compendium on "nearsightedness", (and reactions to it) you might include a history of the problem is your book.

I obviously "forgive" the OD in his office, with is default minus lens - who basically "killing" a child's distant vision with that FIRST minus lens.  It is tragic that so few ODs will admit that all they do is use a "default", and will not allow anything else to exist.

With kindness, and consideration - we both need to address that issue - by understanding the history of this problem.

[Tom]

Glossary and Q&A - Part II

The old Q&A has now exceeded 20000 characters - Hence a second Q&A post.

        Miscellanous

• What are the potential sources of error in the refraction/visual acuity obtained by eye professionals?
  
  
• Often people who are myopic are noticed to have somewhat "lifeless", bulgy, immobile, and "aloof" looks. Do you know why this happens?
  
  
• Are there any eye professional advocating ideas similar to those found in the Compendium?

What are the potential sources of error in the refraction/visual acuity obtained by eye professionals? 

In a clinical setting, refractive status is measured with autorefractor, and visual acuity iwth Snellen Chart.

Autorefractors are reputable for its sensitivity to blinking and eye movements. In countless instances, researchers have had to trim the measurements so as to exclude the outliers that invariably occur in the data.

When measuring visual chart using Snellen Chart (or other similar charts), one needs to take into consideration that visual acuity can be made substantially lower just by reducing the background lighting. Eye professionals tend to gather visual acuity measurements in a dark room. Consequently, the visual acuity obtained tend to be our worst data - We may even be prescribed the strongest minus lenses as a result.

Many people are not aware of the impact of near stress on refractive status/visual acuity. An early morning visit (before doing any close work) to eye doctors will result in less unbiased measurements. Visiting eye doctors in the evening, after many hours of close work, can easily lead to overprescription.

You can also find similar information on Dr. Alex blog here.

Often people who are myopic are noticed to have somewhat "lifeless", bulgy, immobile, and "aloof" looks. Do you know why this happens?

I'm not sure to what extent we can generalize that claim. Some eye professionals (especially the behavioral optometrists, or other folks from the Skeffingtonian school of thought) do notice that myopes tend to be more introverted, with a more inward personality.

There is a theory out there claiming that introverted people, who tend to feel uncomfortable in a social setting, are driven towards activities requiring near vision, and hence become myopic as a result.

Or it could be the adrenal burnout outlined in the diet post.

Or it could be innervation insufficiency in the sympathetic nervous system (e.g., natural tendency to tense up easily, difficulty in relaxing). This insufficiency might result in greater near stress and longer dissipation of near stress to baseline level.

(I know for one that I don't feel very comfortable in front of a large crowd - it's a mix of self-awareness, higher demand on oneself, and just simply reflexive body response.)

Also, check out sections 3.18.1 and 3.18.2 in the Myopia Manual.

Are there any eye professional advocating ideas similar to those found in the Compendium of Myopia Rehabilitation?

Yes. There are indeed a few eye professionals advocating similar ideas. The readers can find more tangible advice and elaborated details in the Compendium though.

Eyecare Practitioners

Arcadiy Davydov - An behavioral ophthalmologist/optometrist from Russia. Dr. Davydov believes in the careful use of prescription that takes into account the focusing distance. This table from his website elaborates on that.

Benny Shao - A developmental behavioral optometrist from California. Dr. Shao believes in the idea that close environment causes ocular "pressure spikes", which drive axial elongation over time, in susceptible individuals. He illustrated this idea pretty well in one of his blog post.

Merrill Bowan - A neurodevelopmental optometrist from Pittsburgh, Philadelphia. Here is his most updated paper on myopia (note that the paper dated back to 1998, and a lot has been learnt since then).

Steven Gallop - A behavioural optometrist from Broomall, Philadelphia. Gallop is himself a patient of high myopia and published several articles on myopia reduction via using appropriate lenses (undercorrection/base-in prism) for close work. His website contains many articles on different ocular issues.

(The late) Antonia Orfield - Dr. Orfield, formerly a teacher, went to optometry school after recovering from around -3.5D of myopia in 7 years. She advocated minimum minus prescription for far, and undercorrection for near. In this article, she documented her recovery from myopia in an almost spiritual manner.

Glen Steele - An optometrist from Memphis, Tennessee. He advocates the use of minimum minus prescription to reduce near stress, and encourages parents to become informed of the effects of "improper lighting, close working distance, and prolonged reading without taking a break" on myopia.

Academics

Neville McBrien - A professor of Optometry and Vision Sciences (University of Melbourne). Dr. McBrien published several instrumental studies on lens-induced myopia, scleral changes during myopisation and form-deprivation myopia. He advocates against the traditional treatment of fully correcting myopia via minus lenses. Here is a quote from "The Mechanisms Regulating Scleral Change in Myopia":

Recent studies have confirmed the importance of visual information in the control of scleral remodelling in myopia. Studies have established that accurate correction of induced myopia, simulating correction of myopia in humans by the wearing of eyeglasses or contact lenses for myopia, prevents the recovery response.49,63 In contrast to the animals allowed to recover from induced myopia, animals wearing lenses that fully corrected the induced myopia did not recover and their sclerae retained a ‘myopic’ phenotype of reduced glycosaminoglycan synthesis (Fig. 13) and reduced thickness.49 This phenotype persisted over an extended period of lens wear and beyond the period during which eye growth was found to stabilize. Despite the fact the visual image is immediately placed in focus on the retina, and that the eye has returned to a stable growth rate, the sclera retains a myopic biochemical phenotype for a substantial period of time. Such a finding has important implications for the correction of human myopia.

[OtisBrown]

Hi Tom,

Let me correct a mis-conception about the plus (when used in a bifocal). (Steel's paper:)

++++++

Three-diopter add at home, pinhole glasses at school

Donald Rehm: Reading glasses or bifocals have been shown by numerous studies to slow the movement into myopia, not stop or reverse it.

This is not exactly what Don stated.  I have exhaustively reviewed Dr. Young's papers, and they indeed show a very slow "reverse" of the myopia - on the threshold.  These were 16 year-old young men - but the "reverse" was about +1/4 diopters per year.  I wish this mindless "trashing" of the plus would stop.

Don> This failure is due to the fact that a full 3 D add is not given, because it would overly disrupt the accommodative/convergence relationship.

Otis>  Perhaps.  But the choice is to use the the +3 has been recommended many times.  But Don feels the child should wear a "Myopter", and I have no objection to doing that.  But to get full effect of the +3, the child must understand to "push away" until the "just blur" point is reached.  Only in that manner, can the plus be fully effective - for the long term.  This is why I expect that for a disciplined person (at 20/40) can get that +1/2 diopter per year reasult, when otherwise, his refractive state will go down by -1/2 diopter per year.

Don>  I recommend the Myopter (see www.myopia.org/myopterpaper.htm) with a 3-D add for all close work at home, reading slightly beyond the far point with a little blur and forcing the eyes to relax. This should undo the stress that has been set up during the day’s schoolwork so the next day’s work can be done without building on the ciliary spasm of the previous day.

Otis>  As always, these suggestions depend on the person himself to fully understand the reason why - it would be wise to wear a strong plus, while you can still read the 20/40 line.  This means no bi-focal, and, in time, a return to reasonable 20/20, and positive refractive status.

Otis> This is truly a matter of a person's self-intelligence, and self-motivation.

Otis> This is why I try to set a "limit" on personal recovery, and the need to wear the plus through the college years - assuming you have the motivation to do so.  It is truly a difficult challenge - that can never be prescribed.

+++++

http://www.healio.com/optometry/contact-lenses-eye-wear/news/print/primary-care-optometry-news/%7Bdc52f0cb-d794-4a11-9e71-ef794857db5c%7D/several-treatment-options-recommended-for-myopic-children

There is always a lot of talk about "prescribing something", after the child is actually myopic.  Tragically no "thought" is given to helping the child begin the use of the plus, while the child still reads the 20/40 line.  The OD also talks about the child sitting there "passively", and having no interest in prevention in any sense of the word.  This is the reality of "office prevention" and why no OD will even discuss the subject.

The deeper reality is this - that the OD admits to -  is that our eyes "go down" at a rate of -1/2 diopter per year, from the moment of SLIGHT myopia of 20/40 and -1 diopter.  That is the real issue - and the response is very seldom "therapy" -- that the child and parent will understand.

Just my opinion.  Even Raphaelson stated that the "parenst" (in their ignorance) would never understand plus-prevention. He was totally correct.

[OtisBrown]

Hi Tom,

I do not ordinarily post "testimonials", unless the person is fully aware of that -1/2 diopter per year, if he chooses to NOT wear the plus when he still can read the 20/40 line.  Further, by this manner of optometry thinking, there is, and can be no "cure", since that -1/2 diopter per year is reality, and can not be "wished away". 

This is even tougher that I thought it would be.  I think even Raphaelson thought it would be easier than that.

But after the truly dedicated Raphaelson told me that the "general public", in ignorance, would always REFUSE to wear the plus (at 20/40), I knew that no OD could help with this issue.  Only the person who understood and ACCEPTED that repeated re-starts with the plus - could make himself successful.  So, no OD can help anyone with prevention.

I  explained Raphaelson's plight to my nephew, and that no one was interested in protecting his distant vision, except for himself.  Here is his remarks about his own commitment to wearing the plus when it went down to 20/40.  (His expression, it was "... it was getting blurry out there".)

++++++

YOU MUST TAKE CONTROL

From Jacob Raphaelson's experience with, "The Printer's Son", (Chapter 3), it has become clear that you must understand the bad results that occur when you use the negative lens. More than this, Jacob's analysis demonstrated that even a completely dedicated eye doctor can not overcome the popular misconceptions that exists in the public's mind about eye doctors and the use of the preventive lens.

I made a major effort to help my niece and nephew. They developed a clear understanding of the problem of nearsightedness and the type or solution that could be expected. I believe that providing them with a "fighting chance" to defeat the problem is better than providing no chance at all. Both used the plus lens and retained clear distant vision without prescription lenses. They understood that it would take long-term commitment to achieve the desired result. I asked my nephew to write a short note to describe his own effort and outcome as he worked to maintain clear distant vision through college.

FOUR YEARS OF COLLEGE WEARING A PLUS LENS

Dear Uncle,          February 19, 1990

     Thank you very much for the book, "How to Avoid Nearsightedness".  I got it yesterday after I came back from the weekend.  I am looking forward to reading it soon, but for now I have a great deal of school work to read.

     I would imagine you'll be pleased to have me tell you that one of the first things I did after opening your book was to check my eyes with the eye chart.  I am able to read the 20/20 line on the eye-chart. I have been using my drug store plus lenses most of the time now.  I have always passed the driver's license eye test.

     I use these glasses nearly 100 percent of the time when I read text books and use them for about 70 percent of the total reading I do.  I started using them as much as possible again because, at the end of last semester my sight was pretty bad (I didn't check them on a chart).  I am lucky to have an uncle who showed me back in eighth grade that I could prevent my nearsightedness.

     One thing college has taught me is to listen to others and then use or adapt methods to work for me.  In the last few years I have had a great deal more reading work to do. If I don't use the magnifying lenses I notice fairly quickly that my sight starts to deteriorate.  Then I realize it's time to do something to stop that process.

     At the moment, I am wearing the magnifying lens because I know what it does for my vision.  Thanks for taking the time to tell me how to avoid a situation, wearing glasses at all times for the rest of my life, that I would find unpleasant, and for sending me a copy of your book so I can learn more in-depth about the methods I am using.

Keith B.

+++++

As expected, when Keith had long-term close work to do - for 8 hours a day, he noticed again that it got "blurry out there".  It was my understanding of Raphaelson that convinced him to re-start the wearing of a plus, and to never let his visual acuity go below 20/40, or refractive state below -1 diopters.

No OD could be involved, because they are all convinced that recovery from 20/40, is just "out of the question", and completely impossible.

Keith understood that any true-prevention, had to be a personal responsibility.  He understood that he must verify that he exceeds the legal requirement - by self-checking.  But more than that, you do not "stop" at 20/40.  You keep on wearing the plus until you get to 20/20.

Is this not a verification of a "cure".  It is verification that a person, understanding Raphaelson's remarks, could personally use a plus, and avoid going down by -1/2 diopter per year - in college and in graduate school.  That does indeed require "educated competence", but a great deal of self-motivation to wear a plus, not to "cure" but to prevent.

Here are the FACTS that are part of that education.  Check Vis 6 - 17 on this page.

http://myopiafree.wordpress.com/facts/


This is verification that a wise, motivated person, knowing full well that if you do not do "prevention" yourself, then you will lose your distant vision at rate of -1/2 diopter per year - for each year in school.

Further, that if you let this "go" for to long, (refuse to wear the plus for close work) you just can not "reverse it".  Therefore, the time for prevention, is before you even START wearing an  over-prescribed minus lens - all the time.

For those who do not wish to understand this issue, or think "plus prevention" is a joke, I am certain you will say, '... well he would not have become nearsighted at age 14... from 2 more years in high school, and four more years in college, with some graduate school.'  The truth is that he would have become about a -2.5 to -3 diopters more nearsighted, if he had declined to wear the plus - during the college years.

Keith is a lot smarter than that.  I admire him for his insights - to protect his distant vision - by this plus-preventive process.

EXAMPLE:

Some people do not need the "encouragement" of analysis and science.  They just "figure it out" themselves - and do it.  Here is an example.

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

But please note - the medical department considered this man with 20/20 - to be "myopic" - by THEIR measurements.  This is why I suggest a person be expert enough to measure both his visual acuity and refractive state  himself.

Do not rely on the "medical department" to make measurements.

Don will reappear in the "journey" post - which I have been thinking how to write for a long time (technically, I have spelled out the details in the theory post, but I still need an informal post to convey the message to the public as to what it means in practice and what not to do).

For those who wish to review the FACTS, you will find them here:

http://myopiafree.wordpress.com/facts/

Just click on Vis 6 - 17.

Yes, that -2/3 to -1/2 diopter per year is depressing.  But it is better to understand these facts, and act on them, before you start wearing a strong minus all the time.  This is an issue of "educated responsibility".  No OD, in his office, will tell you anything that makes you responsible for protecting your distant vision - for life.


In the meantime, here is a testimony post.

[OtisBrown]

With due respect for both Jim and Tom, let me add my commentary.

Except that the eye doesn't always work predictably
...
As for the preconditions and the feedback-driven changes required, Well, still working on it.

I suspect the results might be completely unexpected.

Otis>  If you restrict yourself to the natural eye, "in nature", the effect of placing this natural eye in a "long-term near" situation, are indeed predictable.  But what is also predictable - is this type of science and fact - is totally ignored.

the most reliable way for me to induce hyperopization so far, is to simply go outside for a walk for an hour or so, and just let the eyes take care of the rest.

I'd add outdoor sports could be the overall best combo of preconditions, but then the natural follow-up question is:

How do we lock in the improvement?

Otis>  I know this is intensely personal, but I do agree that 'getting outside' is a big part of the right answer.  For me, I, "lock in" my distant vision by wearing a "open environment" plus lens for all the close work I am now doing.

Otis>  I wish you all good luck and success - but indeed the plus (and open environment) does produce, "hyperopiazation" (change in refractive state - of the natural eye - in nature.

Enjoy,

[warnbd]

Tom

If I might, I would like to challenge in your most recent post shown in quote below, the premise that any close work within 1 meter causes myopia, even with minus/plus lenses beyond one's far point but less than 1 meter.  I have been following the under-correction method of doing close work at the point of blur/active focus for the last 6 months (see my thread "My Myopia/Astigmatism Journey") which has resulted in improving my vision by 2 diopters.  Most of this work has been at distances of 20" to 28", at or just past my far point.  Does my experience contradict your statements about spending time with a focal plane of < 1 meter away inducing myopia? Please pardon me if I am misinterpreting any verbage incorrectly. 

warnbd

In Dec. 2013, I set up a series of self-experiments, and discovered that I was able to induce myopia by simply reading very close (with minus/plus/pinhole prescriptions), yet beyond my far point. This convinced me that near-stress-induced myopia is primarily caused by close reading distance (for more, I substantiated a theory in the Theory post).

This means that prolong close activities, within 1m or so (depending on your optical profile) can slowly induce myopia.

• ~1 meter and beyond
• Under high ambient lighting

[Alex_Myopic]

In May 2014, I observed that prolonged use of sunglasses can also induce another kind of myopia, called form-deprivation myopia (more on the form-deprivation post). The symptoms here are detectable, but pretty hard to describe. In any case, the point is that ambient lighting regulates emmetropization via its anti-myopia effects.

That's in agreement with Bate's method books about the good of sunning and not wearing sunglasses to much (which ca prevent from photophobia as well)  but hat instead!

[Alex_Myopic]

Ηι Τοm,

I don't know if you have read about the amygdalin or "vitamin B17" and acting as a smart bomb against cancer.

I'm sorry for about grandmother.

[ZC]

Wash your eyes? At the risk of appearing barbaric, I'll ask the question. How do you wash your eyes?

Most days I shower soon after waking. But sometimes on weekends I might, e.g., play tennis first and shower later. It would never occur to me to wash my eyes. I am not even sure I know what that means. My best guess would be washing your face, eyelids included. How'd I do?

[svartberg]

Thanks for the reply Tom.

So the issue you mentioned is only for Minus lenses ?
I'm actually getting the distortion as I go higher on the plus lenses.

[CapitalPrince]

any type of lens will create a distortion. also plus lenses tend to make things bigger, and and minus lenses make things smaller. But distortion/magnification should not be a problem unless wear + or - 2.0D or more . Another good reason to keep myopia in control

[svartberg]

Thanks CapitalPrince

Ah I was referring to distortion at edges of lenses, noticeable if I move eyes from one corner to the other
(better example if I fix my gaze at an object at front, then rotate my head left and right the distortion becomes really obvious.)

You are right, I only start really notice this distortion at about +1.5 ...
Still using +0.75 here, but curious about this and if it will have any negative effect