Request for a citation for your single-minus "down" rate.

otisbrown@pa.net · medicine forum Guru Joined: 24 Mar 2005 Posts: 1447

To: Mike Tyner OD
William Stacy

Dear Mike,

Re: What if there are at least two other
experiments with equally
careful design that point exactly opposite? Care to see
citations? No? You've seen them before and you didn't pay
any attention then. Mike Tyner.

Otis> Yes, I want to see the citations. I will publish and
discuss them with interested parties -- concerning
the "down" rate of -1/2 dioper per year.

Otis> Willaim Stacy stated that very few children
show a "progression"
of -1/2 diopter per year. Willaim, of
those people you prescribe a
minus lens to -- what do you estimate to be the AVERAGE
"down" rate for the students wearing a minus lens,
on the basis of your practice?

Otis> 0.0 diopters per year? -1/10 diopter per year? -1/4
diopter per year? -1/2 diopter per year?

Stacy> I see that kind of progression in maybe 1% of my patients.
And I'm talking MANY THOUSANDS OF PATIENTS.

Stacy> Come on, Otis. YOUR NUMBERS ARE WRONG. Sorry. Do some
real research, and stick to facts, preferably verifiable
facts.

Stacy> w. stacy, o.d.

Otis> I posted the following "down" rate of:

Minus vision lenses: - 1.23 D increase (2 years) Progressive
lenses with +1.50 add: - 0.76 D increase (2 years)
Progressive lenses with +2.00 add: - 0.66 D increase (2
years)

Otis> I have also reviewed the "down" rate of a number of these
studies, and the single-minus "down" rate has been
consistently between -4/10 diopters per year and -6/10
dipoter per year.

Otis> Yes, I would like to see citations for rates for
single-minus wear that are significantly different thatn
the above.

Otis> Please ignore the "bifocal" part -- just stick with the
single-minus group, and their published "down" rate.

++++++++++++++++++++++++++++++

Mike> Excellent design. Hard to argue with. I'm convinced... no
wait...

Mike> What if there are at least two other experiments with
equally careful design that point exactly opposite? What
do we do then?

Mike> Care to see citations? No? You've seen them before and you
didn't pay any attention then.

-MT

Otis> Source: Leung JT, Brown B. Progression of myopia in Hong
Kong Chinese schoolchildren is slowed by wearing
progressive lenses. Optom Vis Sci 1999; 76:346, 354.
Published 10/07/00.

Dr. Leukoma · medicine forum Guru Joined: 30 Apr 2005 Posts: 1283

My dear man,

What indeed is the down-rate of myopia without minus lenses?

DrG

otisbrown@pa.net · medicine forum Guru Joined: 24 Mar 2005 Posts: 1447

Dear DrG,

The post was made by William Stacy and Mike Tyner.

I will review their response -- since only they can provide
their answer.

Best,

Otis

Mike Tyner · medicine forum Guru Joined: 24 Mar 2005 Posts: 1299

<otisbrown@pa.net> wrote

otisbrown@pa.net · medicine forum Guru Joined: 24 Mar 2005 Posts: 1447

Dear Mike,

Your statement was to the effect that you do not
see "down" rates (average) of -1/2 diopter per year.

You the demanded that I DOCUMENT this "down" rate
in children who have been put into a minus lens.

THAT IS THE ONLY ISSUE. Not prevention, not
the plus -- just your "challenge" to produce
scientific facts on that specific issue.

otisbrown@pa.net · medicine forum Guru Joined: 24 Mar 2005 Posts: 1447

Correction:

The calculated down rate from -1.87 diopters in 3 years
would be

- 0.635 diopters

which simply verifies even more strongly
the rate of -1/2 dipoter per year for
children wearng the single-minus.

To "O'Leary" study is not to be trusted
for a number of reasons.

Further, no single-minus value was published in
what you provided.

Best,

Otis

Mike Tyner · medicine forum Guru Joined: 24 Mar 2005 Posts: 1299

<otisbrown@pa.net> wrote

otisbrown@pa.net · medicine forum Guru Joined: 24 Mar 2005 Posts: 1447

Dear Mike,

cc: William Stacy

You are right, it was William Stacy who insisted that
the young eye with a minus lens on it does not go
down at an average rate of -1/2 diopter per year.

But William challenged this statement by insisting
that it was not scientifically true,

Stacy> Come on, Otis. YOUR NUMBERS ARE WRONG. Sorry. Do some
real research, and stick to facts, preferably verifiable
facts.

Forcing me to post the "verifiable facts", i.e., the "down" rate
of -1/2 diopter per year for kids when they begin wearing
a single-minus lens. I believe I am "sticking to the facts"
concerning this issue -- far more than Stacy.
He insists that my "numbers are wrong", but then
fails to post any other numbers concerninig this
"down" rate in scientific studies. Office "judgments"
do not "count" under these circumstances.

Best,

Otis

__________

Otis>> It is obvious that the situation is only preventable
(potentially) -- given the -1/2 dioter per year for children
wearing a single-minus, as shown in a number of
published scientific studies.

Stacy> ok so according to this if the kid starts at -1.00 at age
6:

Stacy> he'd be -2 at age 8

Stacy> -3 at age 10

Stacy> -4 at age 12

Stacy> -5 at age 14

Stacy> -6 at age 16

Stacy> I see that kind of progression in maybe 1% of my patients.
And I'm talking MANY THOUSANDS OF PATIENTS.

Stacy> Come on, Otis. YOUR NUMBERS ARE WRONG. Sorry. Do some
real research, and stick to facts, preferably verifiable
facts.

Stacy> w. stacy, o.d.

A Lieberman · medicine forum Guru Wannabe Joined: 30 Apr 2005 Posts: 194

On 1 May 2005 11:35:10 -0700, otisbrown@pa.net wrote:

Mike Tyner · medicine forum Guru Joined: 24 Mar 2005 Posts: 1299

<otisbrown@pa.net> wrote

otisbrown@pa.net · medicine forum Guru Joined: 24 Mar 2005 Posts: 1447

Dear Mike,

You asked for formal studies demonstrating the average
"down" rate of -1/2 diopter per year. This is not just
one study -- that might be suspect -- but a very large
number of studies, with substantial numbers of
young children wearing the single minus.

If you wish to tell the people on sci.med.vision
that your "down" rate is
-1/10 diopter per year -- then go ahead. Is that
your rate?

Best,

Otis

Dr. Leukoma · medicine forum Guru Joined: 30 Apr 2005 Posts: 1283

Otis, my man.

Well, of course the "down rate" of myopia in myopic children is about
0.50 diopters/year, but not every year, and not every child. This
"down rate" is the same whether the child is wearing minus lenses or
not wearing minus lenses.

Prove it otherwise, or please go to bed.

DrG

otisbrown@pa.net · medicine forum Guru Joined: 24 Mar 2005 Posts: 1447

Dear DrG,
The information is that the entire
group in the minus lens when
down by -6/10 diopters over
a period of three years.

This is the AVERAGE of the group.

If a parent thinks his child will
avoid this "down" rate -- then
that is fine. I would be deeply
concerned with this statistic
before I put my child into
an over-prescribed minus.

It is a fact to be presented
to a parent -- that might be
interested in assistance
in working with the plus -- before
a minus lens is used.

I think any parent would be
interested in the plus-alternative,
even if he should reject it.

Then when his child's vision
goes down at that rate -- he
will have no reason to complain
about the expected result.

This issue is indeed the concern
of Steve Leung OD, and "avoiding"
this -1/2 diopter per year is the
reason he has his own children
wearing a strong plus -- when
their refractive status is zero.

This is the reason for a
true "second opinion".

Going into nearsighedness with
the minus is indeed a one-way street,
as these statistics show.

This is the major reason why I
"pushed" my sister's kids into
using the plus -- to avoid this
-1/2 diopter per year effect
of wearing a minus 16 hours
a day.

Best,

Otis

Dr. Leukoma · medicine forum Guru Joined: 30 Apr 2005 Posts: 1283

You still avoid the issue. The issue is proving that myopic children
who wear minus progress at a faster rate than those who do not. I
answered this question myself in clinical practice, and I can say with
utter confidence that children who wear minus lenses do not become more
myopic than those who wear no lens.

I can also state with confidence born out of 20 years of clinical
experience that children who wear bifocals do not become less myopic
than those who wear single vision minus lenses.

DrG

otisbrown@pa.net · medicine forum Guru Joined: 24 Mar 2005 Posts: 1447

Dear DrG,
No, that is not the issue. The issue is whether the child
understands the consequences (to him) of wearing an
over-prescribed minus all the time.

Mike Tyner said quite frankly that he can not be
involved with prevention (for pilots) because he
judged it was "illegal" if he gave that advice,
or the pilot "though" it was medical, rather
than scientific advice.

Mike is totally candid on that point -- as I am.

Since Mike can't do it -- then who can. It leaves
the person (pilot) himself to figure out what HE is
going to do about -- because Mike can not.

I accept Mikes challenge -- with my sister' kids,
and explained the visual requirements that had to
pass -- and the consequences TO THEM, of
neglecting:

1. Reading their own eye-charts to verify their distant
vision met "standard".

2. The fact that if they did not do this -- some one
would put them into a minus -- when there vision
when below 20/40 -- there would be no choice
at that point.

3. The responsibility rested with them to learn more,
understand more, and act effectively for their own
personal protection and interest.

They are now about 40, and have kept their
distant vision -- while many of their friends
are seriously nearsighed.

Obviously no one in "optometry" could "prescribe" this
type of consistent effort, and I explained to them
that the scientific facts showed that the natural
eye is dyanamic, and controls its refractive
state to its average-visual enviroment.

But this issue separates how you deal with the
great mass of people walking in off-the-stree, who
probably have no interest in protecting their distant
vision -- versus and "educated" person who is
truly aware of the science behind the natural
of the natural eye's proven behavior.

This issue was of concern to them -- and so they
took the "high road" of reason, logic and science.

But equally, I know that you could NEVER implement
this type of solution -- except with your own chidren.

And that does become a personal choice indeed.

Best,

Otis

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