PrescP.txt Dear Friends, Subject: Prescription Practices -- Under-Prescription and Over-Prescription. Eye-doctors are trained to deal with a great mass of people entering a shop. This is the way it has been for the last 400 years. In some ways, you can argue that the general public will NEVER understand anything other that the instant-sharpness produced by a minus lens. Most ODs and MDs know it and therefore attempt to keep the strength of the minus lens to a minimum. The ODs are never trained to cultivate your intelligence or, more importantly, your motivation on the subject of true-prevention. For me, it necessarily must be your motivation and intelligence that resolves this issue for you. Remarks on ODs. The limits imposed by the public. 1. Very few in medicine talk to a person about prevention -- because they know the person will not take prevention seriously. For that reason, they never engage you in this type of "intellectual" choice. I obviously wish they could. 2. Under-Prescription: All know "something" about the bad effect of the minus lens -- but they do not know how to express their concerns. So what they do is to "not-prescribe" the minus lens if they can possibly do so. However, if the child is at 20/70, they then have no choice and so they use the weakest lens possible to bring the distant vision up to 20/40. These are "under-prescribers." 3. Over-Prescription: The "over-prescribes" are not cautious. They will take a child that PASSES the room wall-chart, at 20/40 put him in a darkened room, and have him reading through the small lenses of a "phoropter". They also prescribe to "Best Visual Acuity". By that I mean the "crank up" on the minus lens, and will produce 20/18, 20/15 and even 20/12 -- because they like the "impression" this has on the child and parent. Thus a child that has 20/40 winds up with a -2 to -3 diopter lens, when strictly speaking -- he does not "need" it. That is the major reason why I say you MUST check your own vision. 4. No one in optometry or ophthalmology has ever been able to get beyond this simplistic method set up a 400 years ago. 5. The "box-camera" theory, and "words" like "emmetropia" and "ametropia" simply reflect this concept and practice -- because they grew out of this simplistic practice. 6. As a practical matter, I realize (as Dr. Raphaelson stated) that the ODs have no choice in the matter -- other than the above. I attempt in every way possible to use NEUTRAL words to describe the behavior of the natural eye -- to avoid the obvious "combat" and "anger" that develops. But obviously I can not avoid the hubris that develops regardless of my wishes. 7. I hold no hostility against any OD. I only hope that a better method of working towards true-prevention can be developed. When I offer my hand in friendship on sci.med.vision, you see what the reaction is. I do not see how I could ever work with the "mind-set" of people like Mike Tyner. The mind-set is truly blind. Equally, I could work with a man like Dr. Steve Leung at an Aeronautical College, were a more rational and respectful method could be developed for true-prevention. As an engineer, I can never deal with a great mass of people entering a shop. I can only deal only with other engineers and scientists who can form deeper judgments and take responsibility for this difficult but honest preventive work. Thus there are two "professions" involved. The profession of facts and science -- and the profession of dealing with a great mass of people, where a "quick-fix" is the only solution. I am pleased you have chosen the "high road" in working towards a better solution for yourself. Best, Otis ********************** Subject: Past Eye Exam Dear Otis, I had only one eye exam before I became myopic. I was seven years old. My mom took me to the eye doctor, I got my eyes checked, I remember that I had "normal" vision for someone my age. I think I had 20/20 vision -- I wasn't given a pair of glasses. My mom never mentioned glasses to me. Today I read 2/5 characters on the 20/20 line! Shawn ***************** Dear Judy, "Those who fall in love with practice without science are like a sailor who enters a ship without a helm or compass, and who never can be certain whither he is going." Leonardo da Vinci Subject: What is the objective, scientific data? What is an "allowed" scientific fact? Who controls what is allowed? In my judgment we should take the broad-based scientific perspective, rather than Judy's very narrow interpretation of scientific research to determine the exact behavior of the natural eye. Re: Any hypothesis for prevention of myopia that is based on the evidence from animal studies is based on evidence that is irrelevant to humans. Dr Judy Thanks for your commentary on your decision to exclude all DIRECT experimental-scientific data proving the dynamic behavior of both the monkey-primate and human-primate adolescent eye. With this enforced total exclusion of ALL SCIENTIFIC data it is hardly surprising that you have no idea or concept of the behavior of the natural eye -- let alone any concept of preventing the development of a negative refractive state for the fundamental eye. Equally I am certain you are sincere in your "office" mind-set. An actual solution can only occur when the person concerned with the issue of true-prevention actually pays attention to this objective-scientific data, and realizes how totally you exclude this critical scientific data from your mind. That indeed does define the separation between a pure-medical approach and a pure-scientific approach to defining and testing the eye's natural behavior. Best, Otis ****************** Subject: Judy's attitude excludes almost all scientific research -- except for her own opinion. More recent animal studies suggest that accommodation in not a factor in eye growth stimulated by minus lenses. There is no confusion here for me; neo-natal animal eyes do not provide a model for non neo-natal human eyes. Animal eyes that are not naturally myopic and do not naturally develop myopia may provide a model for human eyes that naturally do not become myopic, but do not provide a model for human eye that do become myopic. Any hypothesis for prevention of myopia that is based on the evidence from animal studies is based on evidence that is irrelevant to humans. Dr Judy ________________________________ Subject: Pure Scientific proof, vs. OD-Proof Dear Shawn, I have always looked for pure-scientific proof. That was my final goal after talking to Dr. Raphaelson. Nothing else mattered for me but that. The truth that you can't get people "motivated" to use the plus properly can't be part of anything I do. But at least you can be honest about "proof" and science. Here the ODs insist on "proof" with no definition of it. I don't know what they are thinking -- but it is not of science, nor is it part of science in my opinion. Best, Otis ************** Subject: Scientific proof -- Who has the responsibility, and for what? Is the minus lens even safe? Re: "He (Otis) just needs to prove it, first." DrL Re: The burden of proof rests with "DrL" -- to prove that the minus lens is even safe. It has never been proven that the minus lens does not create the very situation that DrL assumes it solves! Discussion: Of course DrL completely avoids defining "it" -- and transfers total responsibility away from himself, where it truly belongs, to others who are sincerely interesting in true-prevention. DrL has an interesting thesis. He has no responsibility to prove ANYTHING. All responsibility is pushed on to me -- never on DrL. Talk about the "artful dodger". I would suggest something else -- after all these years. That DrL has the obligation to PROVE that the minus lens is absolutely "safe" in the first place -- something that has never been done. You would do this with the primate eye. The objective would be to prove that a minus lens can "cause" nearsightedness, i.e., forced wearing of a minus lens on the eye will result in the eye becoming nearsighted. This test has already been performed -- in pure science. The proof is final. But then, DrJudy asserts that all primate testing (monkey) is to be ignored! Any rational scientist is going to take the safety issue seriously. It suggests that the (supposed) need for a quick-fix totally out-weighs the obvious proof that the minus lens was never "safe" in the first place. After this, I can only believe that these ODs live in isolation from the meaning of scientific proof, and set themselves up as "perfect experts", where they can deny the meaning of this essential proof. But of course they get away with it -- because the "public" is never sufficiently informed to even become aware of this type of danger. Best, Otis ******** Dear Friends, Subject: Vaporizing scientific facts concerning the behavior of the natural eye. "I know that most men ... can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the very fabric of their lives." Leo Tolstoy DrL > However, my understanding is that Otis believes that all eyes change their cycloplegic refraction (refractive status OSB) in response to an "average" of the visual environment in a mathematically predictable way. He just needs to prove it, first. Re: "Any hypothesis for prevention of myopia that is based on the evidence from animal studies is based on evidence that is irrelevant to humans." Dr Judy There is no doubt that presenting factual data is "painful" for an OD -- and perhaps others. Further there is little doubt that most people lack the motivation to use the plus at the threshold -- when it can be effective in keeping distant vision clear. Here is some of the reaction on sci.med.vision, by Mike Tyner, Dr. L, and Jan. My own sense is one of tragedy, since their collective attitude is a profound "block" in our efforts to take the first steps towards true-prevention. Best, Otis ______________ Subject: Jan OD, Otis is not correct about the behavior of the natural eye. An exchange on sci.med.vision DrL > However, my understanding is that Otis believes that all eyes change their cycloplegic refraction (refractive status OSB) in response to an "average" of the visual environment in a mathematically predictable way. He just needs to prove it, first. Re: Cycloplegic refraction -- measurement by paralysis of the eye. Re: Most measurements are made using the Snellen chart (room illumination) and a trial-lens kit (or Phoropter). Re: "Any hypothesis for prevention of myopia that is based on the evidence from animal studies is based on evidence that is irrelevant to humans." Dr Judy Otis> This is an exchange on sci.med.vision. The statement is: "He just needs to prove it, first." Given Dr. Judy's requirement that ALL animal data is to be excluded, I would say that the above two statements make any proof ACCEPTABLE TO THEM virtually impossible. I would suggest that any attempt at SCIENTIFIC proof, must consider FIRST a determination if the natural eye is dynamic -- versus passive. That means testing a population of natural eyes (refractive status, zero to +2.0 diopters) in a fundamental way. With adolescent primates you can in fact apply a strong negative "delta" in their environment (or accommodation signal). This is a basic "input" versus "output" approach. You can not go "wrong" with this approach. The eye is either proven to be "dynamic" or proven to be "passive". Quite frankly, for the fundamental eye there is no other possibility. While this approach is "idealized" you can learn a great deal from it. Best, Otis