Sci_Card.txt Dear Fellow Pilot, Subject: Putting all the scientific cards on the table. IMAGINATION: "What we can see is only a small percentage of what is possible. Imagination is having the vision to see what is just below the surface; to picture that which is essential, but invisible to the eye." After discussion with Dr. Jacob Raphaelson, it was clear to me that the confines of an optometrist's office prevented scientific work towards a long-term solution for the prevention of nearsightedness. This was not due Raphaelson's technical failure or lack of desire to prevent a negative refractive state of the eye, but rather to the "attitude" to the patient, who completely lacked both motivation and understanding of the necessity of true-prevention (with the plus) at the critical "threshold" level of -1/2 to -1.0 diopter (20/50 to 20/70 level) of myopia. Missing from this discussion was the knowledge that if nothing is done, the child's vision will move "downward" at a rate of -1/2 diopter per year. My interest then turned to establish EXACTLY what the experimental data tells us about the behavior of the fundamental -- or natural eye. This the REQUIRES a simpler form of testing. That means we stop making assumptions about the eye, and use simple words like the "refractive status" of the natural eye (that can be plus or minus), and we talk about our ability to control (with precision) the "input" visual-environment. The result of this type of intellectual and physical testing can not reveal the "cause" of any defect, but only the built-in behavior of ALL natural eyes. [Since this point is totally ignored I must state it explicitly. When you wish to establish a characteristic of all eye you must test ALL EYES, or a sub-set of ALL NATURAL EYES. If you don't do this you can never reach a conclusion about the eye's behavior.] [Further, you must assume that the proven behavior of all natural eyes, must also be the behavior of each eye in this "population" of natural eyes.] [To subvert or deny, or change-the-subject means no more effective SCIENTIFIC discussion. Once someone REJECTS this analytic evaluation -- the possibility of any further intelligent discussion is ended.] When someone "in authority" can sweep 50 percent of these cards "off the table" -- then she controls the perception of the eye's behavior. This is the effect of "Dr Judy's" statement about what "scientific" data is "on the table", and what scientific facts are to be TOTALLY IGNORED. To wit: 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 From the discussions with Dr. Judy and others it was clear that ALL the ODs on sci.med.vision agreed with the above statement. I would suggest that this "belief" separates a pure engineering-scientific approach to understanding direct-measurements, versus the conjecture that all refractive states are "errors" both plus and minus, which constitutes "OD-Science". If Dr. Judy stated that prevention is almost impossible -- I would agree with her. If she insisted that she can not deal with the great mass of people who want ONLY a instant quick-fix, I would agree with her on that point also. It is not HER job to supply the motivation and support for prevention. But when she insists that the natural eye does not go down from: 1. A forced negative change in the visual environment and 2. The forced wearing of a minus lens. The I must emphatically DISAGREE with her thesis, and her habit of excluding all SCIENTIFIC data she chooses to ignore. The truth is in that type of scientific data. A massive amount of DIRECT experimental data collected over that last 40 years confirms absolutely that the natural eye does the above action -- always when correctly tested. It is the "signature" of a control system that is important in a scientific sense at this point. The "engineering" approach simply asks to test "input" versus "output" questions concerning the natural eye's behavior. There is no mystery here at all. Either all fundamental ANIMAL PRIMATE eyes do this -- or they do not. Either a population of natural eyes is dynamic, or they are not dynamic. If not dynamic, the prevention with a plus would be impossible, and a "fraud", to put is bluntly. But the question can be resolved not in terms of "medical judgment", but in terms of repeatable objective scientific facts, where any intelligent engineer could understand both the nature and purpose of this type of testing. Since we can measure the refractive states of all natural eyes, (the output) and we can control the "input" (a delta in the visual environment) we simply can not fail but to draw the correct conclusion. On a "scientific" level this is a certainty. On "Dr. Judy's" level, this type of perception can not exist, and is prohibited because she can sweep all these scientific cards off the table. If these truths separate "medicine" from "science", then so be it. But that is my understanding of the "bias" of optometry, and why there is necessarily a separation between these two fields of intellectual interest. So when I "argue" the behavior of the fundamental eye and proof, I would take the above perceptions into consideration. This is why I use the term "refractive-state" to describe the eye. If someone reacts with "anger" from that statement, or wishes to "twist" my statement, then I must consider that he has been taught an incorrect perception, and he can not escape it. But using her position as an OD to deny all factual data, is not they way to do scientific research. Best, Otis ___________________________________ P.S. Here is some more of the discussion for your interest: 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 (primate eye testing) 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" or 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 (passive-eye) 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: The O'Leary Bifocal Study -- and discussion by Judy The Wildsoet Lab Controlling Myopia Progression - A Confusing Story The dilemma of managing young progressing myopes. The O'Leary study and The Comet Study Two recently published clinical trials involving under-correction and PALs as alternative myopia control strategies add more rather than less confusion. A paper published in the journal, Vision Research (2002, 42: 2555-9), describing a 2-year Malaysian-based study comparing the effects of undercorrecting myopia with full correction on myopia progression in children. The message from the principal investigator on this study, Dr O'Leary, to doctors, patients and parents, as reported in the New Scientist article is "No glasses is the worst option of all, But don't undercorrect. GO for full correction." The Chung, O'Leary et al study is a small (n=94), 2 year randomized and masked prospective study comparing the effects of full-time undercorrection (UC, by approximately 0.75 D) with full-time fully correction (FC) in young myopes (mean: -2.86 D). The study group comprised approximately 1.4 time the numbers of girls as boys with Chinese and Malay ethnic groups being approximately equally represented. Over the 2 years of the study, the full-correction group showed a progression of 0.77 D compared to the UC group that exhibited a progression of 1.00 D. -- minor snip by Judy -- It is interesting to compare progression rates for the two groups in the Chung et al study with values from the more recently published COMET study, converted in both cases to a D per year rate. The progression rate for the Under-Corrected group (-0.50 D per year) corresponds closely to the mean rate reported for participants allocated single vision lenses in the COMET study (-0.49 D per year). A conclusion based on this comparison alone would be that undercorrection neither exacerbates or slows the progression of myopia, when applied unselectively. This outcome is predicted if we assume that the benefit of undercorrection is limited to those with poor accommodation. [What this analysis does not recognize is that if you are going to do ANYTHING for true-prevention, then the plus-lens method MUST start before that -1/2 diopter per year kicks in. Indeed, anyone working on prevention who manages to clear his distant vision from -1.0 diopter (20/80) to 0.0 diopters (20/20), must recognize that, while he is in a "high-school" environment he must continue with this "preventive" method if he again sees his vision becomes less than 20/40. It would seem very important that this discussion be raised with a person at the threshold of nearsightedness. OSB] Animal model studies predict increased (myopic) eye growth with sustained poor accommodation in fully corrected eyes (see Wildsoet, 1997, for a more extensive discussion of animal-based emmetropization studies and their clinical implications). However undercorrection should improve the state of focus at near as less accommodation is required. A potential parallel with animal studies involves the imposition of binocular low powered positive lenses on young monkeys; their eye growth slows, presumably because their eyes now have almost perfect focus at near distances, the limit of the visual world of these young animals (Smith & Hung, 1999). ____________________ WHAT FORCES THE USE OF A MINUS LENS? We should all thoughtfully evaluate the unfortunate effect of using an immediate and easy fix for the problem of nearsightedness. This situation of a self-perpetuating mistake (produced by public need and attitude) is sometimes recognized by the students of medicine. Dr. Perri Klass said it this way in VITAL SIGNS: "...Sometimes the awesome weight of medical knowledge is totally off the beam. You have to practice medicine with that in mind, with the knowledge that a hundred years or so along the road, they'll be telling stories about the medical theories of today to get a laugh of the medical students of 2085..." And about medicines' confidence in its routines: "...Or something so basic, so taken for granted, that no one has gotten around to questioning it. Whatever it is, probably the medical profession is collectively doing something really dumb and really damaging, and doing it with complete good will and typical medical self-confidence." This applies to vision. The demand for negative lens use comes partly from the public's demand for an instant solution, (and corresponding reluctance to properly use a plus lens) and not from a scientific assessment of the behavior characteristic of the normal eye.