(Prev73.txt) What is the judgment of Optometrists about the systematic use of a plus lens for prevention of myopia? Is it effective when used properly? *********************************** NEARSIGHTED CHILDREN CAN BE CURED [FROM PREVENTION MAGAZINE, The December 1973 Issue] Michael Clark -- (Pseudonym Cyril Maxton) with some clarifying editing by Otis Brown Researchers have discovered that myopia can be successfully treated if special lenses are fitted before it gets too bad. When Otis S. Brown was a young boy, he dreamed of someday becoming an airline pilot. In fact, everything he did throughout those early days in grade school was aimed at achieving that goal. Then, disaster struck, and Otis Brown's dreams of becoming a pilot faded as he was fitted with increasingly stronger minus glasses to correct a worsening case of myopia, or nearsightedness, a condition which causes distant objects to appear blurred. Brown was born too soon. Today, there is good reason to believe, if his parents could take that same 10 year old boy to an optometrist, there is at least a 50-50 chance that Brown would never have to wear a pair of glasses or contact lenses to see distant objects. And, instead of being limited to flying his home-built, Volkswagen powered cub plane, Otis Brown might have the regular Pan Am route between Philadelphia and Paris. It is only in the past few years that substantial numbers of optometrists have begun using a radically new treatment, involving "plus" lenses, that is said to keep myopic eyes of children from deteriorating further, and even to cure or prevent myopia. It is a direct contradiction to the more traditional forms of treating nearsightedness which use "negative" lenses that bring distant objects into sharp focus. When rays of light enter the eye, they are bent by the eye's lens so that they converge on a single point on the retina of the eye. The retina, it should be noted, is the inside coating of the eyeball. Although it is only the thickness of a newspaper page, it contains 10 distinct layers and between 125 and 150 million sensing rods which we use to see directly ahead and to all sides, according to Dr. Harris Gruman (New Ways to Better Sight, Hermitage House, 1950). In the individual with myopia, the eye has adapted itself to the reading environment. Therefore the light rays converge on a single point in front of the retina, making distant objects appear blurred. The traditional treatment for this problem has been to fit the patient with negative (or minus) lenses which make an adjustment to the light rays, resulting in their finally being focused on the retina. If some of the optometrists now doing research on myopia are correct, then the child should be using a plus lens for prevention, rather than the traditional minus lens. Although a direct opposite treatment, the plus lens may be the right one to actually prevent the eye from developing a negative focal state (nearsightedness). Here's how it works. The eye functions by "accommodation," which is the term used to describe how the focusing apparatus of the eye adjusts to objects at different distances. "Accommodation" takes place by increasing the convex shape of the eye's lens through adjustment of the ciliary muscles in response to blur sensed at the surface of the retina. In man, according to some of the researchers, the eye's normal function is programmed to distant objects. But, by starting children in school at an early age -- and keeping them there -- as well as letting television baby sit them -- the eye's "long-term focusing" adjusts to close-up work. To perform the adjustment the eye alters its corneal curvature and length, thereby blurring its distance vision. TREATMENT STARTS WHEN SQUINTING BEGINS The positive lens advocates believe that when a child starts squinting in school -- one sign that may mean myopia is right around the corner -- the child should be fitted with weak positive lenses. The positive lens, which is a magnifying glass, minimizes the need for large amounts of accommodation. For example, when a child dons a pair of plus glasses, (strong enough to neutralize the near enviroment) the reading material will become clearer, since the plus lens is a magnifying lens. This means that the eye's accommodation process does not have to work at all for close work. When the child stops his reading to look at something in the distance -- the distant objects will be clearer. And in order to minimize the number of times a child might have to put on and take off his glasses, those who advocate the use of positive lenses recommend either a full-face plus, or a half-lens or "granny" glasses, so that the child can look over the positive lenses when gazing at distant objects. What happens, on the other hand, if the child who develops a ease of myopia is fitted with a pair of negative lenses? The negative lens corrects the blurred image and distant objects literally leap into focus the minute the glasses are put over the nose. But, the negative lenses do not correct the overall problem of accommodation, and in fact moves all objects (optically) closer to the eyes. The basic problem of adjustment to close-up work still exists. And what's worse is that the eye will continue on the same path, developing a worsening case of myopia. This means that until the individual is about 25 or so, he will continue to need stronger and stronger negative lenses until the myopia gradually grinds to a halt. Even then, there is no guarantee it will stop. And besides having to wear glasses every waking minute, the individual winds up spending anywhere from $600 on up to thousands of dollars for new glasses during the course of his life. On the other hand, there is a good chance that if a child is fitted with positive lenses, he can slowly work his way out of a myopic state to the point where he will never have to wear negative glasses. By this theory, the use of plus lenses enables the child to use his distance vision all the time, keeping the myopia from developing further, and in many cases eliminating it. Does the "positive lens" theory work? "Yes, definitely," says Dr. William M. Ludlam, an optometrist who formerly directed the Laboratory for Myopia Research in New York and is now working on a year-long National Institutes of Health grant at the University of the Pacific. "I've used that method for the past 20 years and have had good success with it." Dr. Ludlam believes that myopia can be cured and, what's more important, can actually be prevented through development of good reading and other eyesight habits such as holding books farther away from the eyes during reading and frequently looking at distant objects during and after long periods of reading. "But once they (optometrists or ophthalmologists) fit negative lenses, that's it. The child has myopia," he said. One time an accountant brought his young son to Dr. Ludlam for treatment of headaches associated with long periods of reading. After fitting the son with positive reading glasses and prescribing a series of visual exercises, Dr. Ludlam was asked if he could cure or at least help the accountant's myopia. "The accountant had normal vision up until he was about 23 or 24. In fact he had served in the Air Force. But by the time he came to me, he had 20/400," Dr. Ludlam said. 20/400 means that the accountant who was in his early 30's could see at 20 feet what people with perfect vision could see at 400 feet. In practical terms, he could read only the largest letter on an eye chart. Dr. Ludlam treated the accountant with a series of exercises and positive lenses which increased the eye's flexibility. "I brought him down from 20/400 to 20/80 and 20/40 where he is now and I've held him there," Dr. Ludlam said. "He-still wears glasses to drive, for the theater and to watch television, but other than that, he doesn't need them especially for his close-up work." Dr. Ludlam has done the same for children, bringing them from extremely poor distant vision right down to 20/40 through exercises and positive lenses and "held them there for 10 years. I reported on 30 cases that I treated for over a 10 year period of time, so I know it can be done. They're still there today." NOT ALL MYOPIA RESPONDS There are two different kinds of myopia that Dr. Ludlam has studied. One is caused by pressure of the eye growing too fast, causing the eye to become elongated. "It literally grows right out of focus." Treatment calls for fitting the eye with contact lenses which press the eye into focus, acting like a "pressure bandage." If a 10, 11 or 12 year-old child is fitted with contact lenses, there is a good chance that the myopia will be caught and not progress further, he noted. But the other type of myopia can be reversed. It's caused by a spasm of the ciliary muscles. For example, a person is reading and then looks up. If the eye fails to focus on a distant object, the ciliary muscles are believed to be undergoing spasms. If a child comes in and tells me that he has trouble trying to focus on a black-board or a clock until he blinks a couple of times, he's accurately describing a ciliary spasm," Dr. Ludlam said. This second type of myopia is controlled by use of positive lenses which tend to take the close-up environment and push it outwards, increasing the reading distance. "The nearer you hold something like a book, the greater the problem, because the more the ciliary muscles must contract," Dr. Ludlam said. "Reading at 8 inches or less is murder on eyes and someone who does this continually will become nearsighted very quickly." Sometimes, a person will have both problems, said Dr. Ludlam, citing the instance of a college student he treated. In cases like that, Dr. Ludlam said he first fits the eye with contact lenses to "pressure" the eyeball into place. Then, the patient is fitted with positive lenses. "I had one case of a college girl. During the summer time, her eyes weren't too bad. So I attributed her problems to reading. After fitting her with contact lenses and positive lenses, her vision improved. Now, the only time she wears reading glasses is during periods of heavy reading. But she wears her contact lenses." Dr. Ludlam pointed out, however, that other factors might play a role in myopia as well. "There are indications that nearsightedness is caused by a number of things such as the environment, nutrition and function (i.e. reading)," Dr. Ludlam told PREVENTION. "There are cases where one aspect of the problem is more important than the other. For example, if a child eats a well-balanced diet and lives in a good home, but all of a sudden becomes a book worm and develops myopia, it's pretty obvious what the cause is." Dr. Ludlam cited a study done on Eskimos in which it was discovered that myopia had reached near-epidemic proportions among the current school-age generation. The study of 204 children in grades 3, 4, 5 and 6 in Alaska showed that the proportion of myopes in grade 5 approximated that found in grade 12 among Caucasians, or 26 per cent. However, the proportion of myopes in grade 6 (59 per cent) usually is never reached in any school population among Caucasians (American Journal of Optometry and Archives of the American Academy of Optometry, Young, et al., May, 1970). Dr. Ludlam pointed out that the grandparents of these children had no myopia while the parents of these school children had less than a 5 per cent incidence. "This near-epidemic of myopia may be a combination of many different factors," he said. "This is the first generation to read. It's the first to use electrical lights and it's the first generation to eat a non-protein diet. They're eating everything from popcorn to Coke. Who can say what is causing their nearsightedness." The optometrist is now in the process of analyzing data on 525 children with an NIH grant. While in New York he and his associates followed these children for several years, taking down all the information they could, ranging from the size of the eyeball to total weight. Now, the information is being analyzed by computer. "In a year, we should have most of the answers about what affects what. We'll know exactly how one thing relates to another. And then, we'll be able to make some kind of judgment," he said. "We'll know what factors relate to myopia and why there is such an increase, even in the United States." Dr. Ludlam also believes that heredity can pretty well be discounted as a cause of myopia simply because of the fact that it is growing much faster than if it were a genetic defect. Although the "positive lens" theory works and can possibly lead to a life free from the anchor of negative glasses, it is extremely difficult to convince many patients that it will work for them. A lower Bucks County (Pa.) optometrist, Dr. Carl Cordova told us that many patients are reluctant to try the preventive approach because it doesn't work right away. "They believe in making a distant picture clear and they'll go from doctor to doctor in order to hear the answers they want." But, the onset of myopia is a gradual one. It can happen over a year or two and a person might first be conscious of it after being examined. And, as Dr. Cordova pointed out, patients want the blurred vision eliminated almost immediately. They will not take the time to effect a cure but will settle for having their distant vision cleared with a minus lens. A cure, however, can take almost as long as the eye took to reach the point at which correction started. A variations of the positive lens cure, Dr. Cordova said, is to fit the patient with bifocals containing a reading (positive) lens on the bottom, and a negative lens of a lower power than needed on top. He has had success with patients using that method and was eventually able to almost completely corrected myopia in patients who were willing to use the treatment. Almost a universal problem of parents today revolves around the question: "How can I prevent my child from becoming nearsighted?" There are several ways, the first of which begins in the crib. Mothers, according to Dr. Amiel Franke, of Washington, D.C., should keep a child out of the playpen as much as possible. By stimulating the baby's eyes they are given more of a chance to develop. "When a child's activities, even in infancy are limited, his vision growth and development is limited too," he told a recent meeting of the Southeastern Congress of Optometry. Other things: Keep a dim light in the nursery so that a child sees something if he awakens at night; his crib should be placed in different spots in the room for variety; the baby's position in his crib should be changed; and bright, moving objects should be within his sight at all times. This, believe some optometrists, will help the infant's eyes develop strongly for later use. Besides exercises in infancy, diet has been blamed for the near epidemic incidence of myopia. Dr. Jin Otsuka, a leading Japanese authority on nearsightedness and professor of the Department of Ophthalmology, Tokyo Medical and Dental University, believes that diet as well as the environment plays a major role in myopia. "If you give sugar to a rabbit, the rabbit becomes myopic," is the way the Japanese researcher describes it in a soon-to-be published book, The Cause and Treatment of Myopia. He pointed out that shortly before World War II, the Japanese population was developing extensive myopia, a condition which seemed to disappear during the war and, strangely enough, reappeared more recently. Dr. Otsuka attributes the rise in myopia to the extensive use of sugar and refined foods in place of a more traditional Japanese diet which was heavy on natural foods. During the war, of course, most refined foods and sugars were unavailable. In experiments conducted at the Columbia College of Physicians and Surgeons by Dr. Arthur A. Knapp, animals were fed diets deficient in vitamin D and calcium. The animals developed an amazing variety of eye problems including myopia (Medical World News, Sept. 17, 1965 ). Dr. Knapp then tried feeding vitamin D and calcium to human patients suffering from the same eye diseases as those produced in the animals. The results were significant. In one group, 18 out of 52 vitamin supplemented patients showed a reduction in myopia while only 8 remained unchanged. Myopia, therefore, seems to be a disease which can often be corrected, if the proper steps are taken. For many, who have gone through several increases in minus lens strength, it's too late. The die is cast. But it would be wise for parents to: o Make sure their infants get plenty of eye exercise; o Insure that their children eat a balanced menu including plenty of vitamin D and calcium; o Guard against excessive close eye work and long hours of reading, especially at distances of less than 8 inches; o Have the child use a plus lens for all reading, the strength of the plus lens to be based on the child's habitual reading distance. o Watch for signs of squinting, headaches and tiredness; o Train their children to take breaks in reading and look at far-off objects over the tops of the plus lens. Unfortunately, all of this "new" information comes much too late for Otis Brown. His eyes are bad and they will remain that way. But, despite his run of bad luck and being born 20 or 25 years too early, he hasn't lost his zest for evangelism and constantly warns others against accepting negative lenses too readily without examining the alternative. "Parents should know that there is an alternative for their children," Brown said. "But this alternative stops later on in life. If they can stop myopia early, they should be able to take advantage of it and use the preventive process. "The biggest advantage to trying the positive lens approach is that it is completely harmless. It can't hurt." But, Brown continued, "it could help tremendously. If the child is 8, 9, 10 or 11, how important is it that he have 20/20 vision immediately? If the condition has developed over a year or a year-and-a-half, what's the matter with waiting a year or a year-and-a-half to clear your distant vision with a plus lens -- if it means your whole life?".