Whatsadoctortodo3

HANDOUT 1

This handout is what I use to advise parents of children at risk. The questionnaire that is published in your book is probably quite valid, but truthfully, I have found no way to use it clinically. It lends itself more to being a research screening device. The Mandelbaum test performs irregularly for me. I have not given up on it, but I have not discovered a mesh that works for everyone. It would be neat to find a way to make it work.

So, optometry doesn’t know what two times 13 is. That does not men there isn’t an answer.

We can control the majority of ametropia. Not all of it.

We owe it to our patients to use techniques to analyse their potential for changes toward these diseases and to care for them in the most proper way. We need to be diagnostic doctors - REAL doctors - not merchandising doctors. Diseases beg for healers - will we be the healers we are called to be? Thank you.

[OVERHEAD #12 - Questions for research]

Animal studies:

1) Would myopia develop in de-adrenalized animals?

2) What are the Cortisol levels in the animal studies?

3) Will lens-induced hyperopia be induced in animals whose EOM’s are detached?

4) Scleral strip tests: subject them to drugs and normal stress products to determine their properties, plus effects on uveo-scleral outflow.

Human studies:

1) Dark focus to far point focus: what is the nature of the mechanism? Is it axial change? Corneal? Crystalline lens?

2) Prospective study of IQ/reading/myopia.

3) Vocabulary and myopia.

4) Exophoria and myopia.

5) Determinations of the crystalline lens thickness under sustained accommodation.

REFERENCES

1. Price SA, Wilson LM; Pathophysiolology: Clinical Concepts of Disease Processes, 5th Ed.; Mosby, St. Louis, 1997.

2) Rosner J, Rosner J.; Comparison of Visual Characteristics in Children WIth and Without Learning Difficulties, Am. J. Optom. Physio. Optics, 64:531-533, 1987.

3. Mutti D, Zadnik K; The Utility of Three Predictors of Childhood Myopia: a Bayesian Analysis, Vision Res. 35(9):1345-1352, 1995.

4. Angi M., Clementi M, Sarki C, Piattelli E, Bisantis C; Heretibility of Refractive Errors in Identical and Fraternal Twins, Arch. Clin. Exper. Ophth., 231:580-585, 1993.

5. Hauge M, Basic Rules and Principles of Genetic-epidemiological Studies, Acta Ophthal, Supplement 185: 58-60, 1988.

6. Lin LL-K, Chen C-J; A Twin Study on Myopia in Chinese School Children, Acta Ophthal, Supplement 185: 51-53, 1988.

7. Zadnik K., Mutti DO, Fusaro R, Adams A.; Longitudinal evidence of Crystalline Lens Thinning in Children; Invest. Ophth. and Vis. Sci., 36(8):1581-1587, July 1995.

8. Mutti DO, Zadnik K; The Utility of Three Predictors of Childhood Myopia: a Bayesian Analysis, Vis Res, 35(9):1345-1352, 1995.

8. Eulenberg A; The Case for Preventability of Myopia, http//php.indiana.edu/~aeulenbe/i_see/prevent_myopia.html

9.Young FA, Leary GA. Baldwin WR, West DC, Box RA, Harris E, Johnson C; The Transmisison of Refractive Errors Within Eskimo Families, Am J Optom and Arch Am Acad Optom, 46(9):676-685, 1969.

10. Young F; The Nature and Control of Myopia, J. Am. Optom. Assn. 48(4):451-457, 1977.

11. Watten RG, Lie I; Time Factors in VDT-induced Myopia and Visual Fatigue: an Experimental Study, J Hum Ergol (Tokyo) Jun;21(1):13-20, 1992.

12. Lane BC; Myopia Prevention and Reversal: New Data Confirming the Interaction of Accommodative Stress and Deficit-Inducing Nutrition, J. Int'l Acad. Prev. Med. 7(3):17-30, 1982.

13. Lane BC; Calcium, Chromium, Protein, Sugar and Accommodation in Myopia, Doc Ophthalmol Proc Ser Vol 28 Third Int’l Conf on Myopia (The Hague, Netherlands) Dr. W Junk Publishers 141-148, 1981.

14. Lane BC; Chromium Protects Against Sucrose Effects in Myopia Progression, Suppl Invest Ophthalmol & Sci, 22(3):218, 1982

15. Gardiner PA; Dietary Treatment of Myopia in Children, Lancet, 31 May, 1958, 1152-1155.

16. Lane, B; Food Folate vs. Supplemental in Myopia Development and Tear Film Integrity, Optom Vis Res, 71(12)=Dec Suppl, 1994.

17. Senate Document #264, 74th Congress, 2nd Session, 1936.

18. Young FA.; The Effect of Restricted Visual Space on the Refractive Error of the Young Monkey Eye, Invest. Ophthal. 2(6):571-577, 1963.

19. Tay M, Au Eong K, Ng C, Lim M; Myopia and Educational Attainment in 421,116 Young Singaporean Males, Am. Acad. Med, Singapore. 21(6):751-791, Nov. 1992.

20. Luria S, Newmark H, Beatty H; Effect of a Submarine Patrol on Visual Processes, Report #641, Bureau of Medicine and Surgery, Navy Dept. Research Work Unit, M4305.08-300ID.06, 14 Sept. 1970.

21. Greene M; Submarine Myopia in the Minuteman Launch Control Facility, J. Am. Optom. Assn. 41(12):1012-1014, 1970.

22. Simensen B, Thorud L.; Adult-onset Myopia and Occupation, Acta Ophthalmologica, 72(4):469-471, Aug. 1994.

23. Bowan MD; Stress and Eye: New Speculations on Refractive Error, J Behav Optom, 1996:7(5)17-22.

24. Sapolsky RL; Why Zebras Don’t Get Ulcers, WH Freeman & Co., NY, 1998.

25. Zadnik K, Mutti D; How Applicable are Animal Myopia Models to Human Juvenile Onset Myopia?, Vision Res. 35(9):1283-1288, 1995.

26. Devadas M, Morgan I; Retinal Control of Scleral Precursor Synthesis, Aust N Z J Ophthalmol 25 Suppl 1:S-73-75, May 1997.

27. Leech EM, Cottrial CL, McBrien NA; Pirenzipine Prevents Form Deprivation Myopia in a Dose-dependent Manner; Ophthalmic Physiol Opt, 15(5):351-356, Sept 1995.

28. McBrien N, Moghaddam H, Reeder A; Atropine Reduces Experimental Myopia and Eye Enlargement Via a Non-accommodative Mechanism, Invest. Ophth. & Vis. Sci., 34(1):205-215, Jan 1993.

29. Bowan MD; The Control of Myopia, J Opt. Vis Devel, 12(2):17-24,1981.

30. Owen DA; The Resting State of the Eyes, Am Scientist Vol 72, Jul-Aug1984: 378-387.

31. Jaschinski-Kruga W, Toenies U; Effect of a Mental Arithmetic Task on Dark Focus of Accommodation, Ophthal Physio Opt, 8(4): 432-437, 1988.

32. Gray LS, Winn B, Gilmartin B, Eadie AS; Objective Concurrent Measures of Open-loop Accommodation and Vergence Under Photopic Conditions, Invest Ophthalmol Vis Sci, 34(10): 2996-3003, Sept 1993.

33. Leary G; The Reconciliation of Genetically Determined Myopia with Environmentally Induced Myopia, Am J Optom & Arch Am Acad Optom, Sept 1970 702-709.

34. Van Alphen G; On Emmetropia and Ametropia, Suppl of Ophthalmol 142:1-92, 1961.

35. Young F; Personality and Refractive Characteristics, The Optician Sept 8, 1978.

36. Gawron V; Differences among Myopes, Emmetropes, and Hyperopes, Am J Optom & Physiol Optics, 58(9):753-760, Sept. 1981.

37 Angi M, Rupolo G, DeBertolini G, Bisantis C; Personality, Psychophysical Stress, and Myopia Progression, Graefe's Arch. Clin. Exper. Ophthalmol., 231(136-140), 1993.

38. Schapero M, Hirsch M; The Relationship of Refractive Error and Guilford-Martin Temperament Test Scores, Am J Optom & Am Acad Optom 29(32-36), 1952.

39. Lanyon R, Giddings J; Psychological Approaches to Myopia: A Review, Am. J. Optom. & Physio. Optics 51(4):271-281, 1974.

40. Tzevtkov VL; The Origin of Myopia; The Conference on Prevention, Pathogenesis, and Treatment of Eye Disease; J Ped Ophthal, 9, 120, 1972.

41. Eva FR, Pascoe DT, Vaughan DG; Refractive Change in Hyperglycaemia: Hyperopia, not Myopia, Br J Ophthalmol, 66(8): 500-505, Aug 1982.

42. Rosner J, Rosner J; The Relationship Between Moderate Hyperopia and Academic Achievement: How Much Plus is Enough?, J Am Optom Assoc, 68(10): 648-650, Oct 1997.

43. Bowan MD; Accommovergence: A New (?) Concept for Preventing Visual Problems; Transcript of the 40th Annual Kraskin-Skeffington Invitational Symposium, Optometric Extension Prog Found, Jan 1996.

44. Shum PJ, Ko LS, Ng CL, Lin SL; A Biometric Study of Ocular Changes During Accommodation, Am J Ophthalmol 115(1): 76-81, Jan 1993.

45. Lopping B, Weale RA; Changes in Corneal Curvature Following Ocular Convergence, Vis Research, 5(3):207-215, April 1965.

46. Skeffington AM; The Functional Approach to the Study of Visual Problems, Presentation at the Middle Atlantic Optom Cong, October, 1944. Mimeographed Copy. Caryl Croisant Transcripts.

47. Guyton A.; Basic Human Physiology: Normal Function and Mechanism of Disease, Saunders, Philadelphia, 1977.

48. Wallman J, Gottleib M, Rajaran V, Fugate-Wentzek L.; Local Retinal Regions Control Local Eye Growth and Myopia, Science, 237(4810):73-77, 3 Jul 1987.

49. Pendrak K, Nguyen T, Lin T, Capehart C, Zhu X, Stone RA; Retinal Dopamine in the Recovery from Experimental Myopia, Curr Eye Res, 16(2):152-157; Feb 1997.

50. Angrist A; Research in Myopia (A Problem in the Stability of Collagen), First Int’l Cong on Myopia, NY, NY Sept 10-13, 1964, Professional Press.

51. Hogan MJ, Alvaredo JA, Waddell JE; Histology of the Human Eye, WB Saunders, Philadelphia 1971.

52. Selye, H. The Stress of Life, (Revised Ed.), McGraw-Hill, New York, 1976.

53 Raviola E, Weisel TN; The Neural Basis of Myopia, Harvard Mahoney Neuroscience Institute Letter, 4(3) Summer 1995.

54. Bullimore MA, Gilmartin BC; Cognitive Demand and Accommodation, Am J Optom & Physiol Optics, 64(1), 1987

55 Hosack D; Observations on Vision, Philosoph Trans Royal Soc Lond, 84(196ff.) 1794.

56 Prentice C; The Eye in its Relation to Health, AC McClurg & Co, Chicago, 1895.

57. Bates WH; The Cure of Imperfect Sight by Treatment Without Glasses, Central Fixation Publishing Co, NY, 1920.

58. Getman G; The Retinoscopic Observations, Optometric Extension Program Courses, Ser. 1, No. 8, May, 1977.

59. Gawron, V.; Ocular Accommodation, Personality and Autonomic Balance, Am. J. Optom. & Physiol. Optics 60(7):(630-639), 1983.

60. Fry G, cited by: Skeffington AM; The Functional Approach to the Study of Visual Problems, Presentation at the Middle Atlantic Optom Cong, October, 1944. Mimeographed Copy. Caryl Croisant Transcripts.

61. Roy R; Headaches and Binocular Stress, Opt Weekly, 47(41): 35-38, Oct 11, 1956.

APPENDICES :

HANDOUT No. 1:

The Myopia about Nearsightedness

Merrill D. Bowan, O.D.

I. The Cure for Myopia. III. What Can be Done?

II. What is Myopia? IV. The Future.

I. THE CURE FOR MYOPIA (Nearsightedness).

Q. Can myopia be reversed?

A. Unfortunately, no.

Q. Can myopia be prevented?

A. Fortunately, yes, most of the time. That's the cure for myopia: PREVENTION.

Q. But what about surgery? I see many ads.

A. Radial corneal surgery and lasers only address symptoms of the problem. Studies have never shown close associations of myopia with the corneal shape. Just as you learned in school, in myopia the eye is optically too long. The great majority of refractive surgery patients will need glasses or contact lenses over the weeks, months or years following the surgery.

Q. But what are the best things that can be done for myopia?

A. Work to prevent progression of nearsightedness, once it's started. The only real cure for myopia is to prevent it. You have to understand what myopia is.

II. WHAT IS MYOPIA?

Myopia is one of three adaptive optical errors that occur as responses of the visual system to sustained, repeated stress -- they are stress diseases. The others are astigmatism and progressive hyperopia -- farsightedness. In nearsightedness, the eye is optically too long. Astigmatism distorts the image on the back of the eye and farsightedness causes the individual to pay too much attention to focusing on near work, causing eyestrain and reduced performance.

The idea that myopia is genetic is not borne out by the available data. Family histories, at best, have only a modest predictive value for eye problems. Genetics may predispose certain families toward specific eye problems, but the trigger to the distortion of the optics of the eye is stress and reading, in the great majority of cases. Since the human eye is almost full size by age four and certainly adult size by age eight, the concept of an eye that "grows" too long is not a valid concept. Most myopia begins after age eight. Most beginning myopes get their first glasses at ages 9 to 10, but there is a new group of beginning myopes who have begun to emerge over the past 20 years: adults who use computers.

A British ophthalmologist has described myopia as "juvenile expansile glaucoma", caused by reading. Technically, he's probably correct, although it's a benign condition, and not the adult, damaging form of glaucoma. Myopia has affected mankind since the beginning of time whenever the visual system is stressed and the individual can't or won't escape the stressing environment. The combination of events that causes the nearsightedness include extended nearwork, depletion of Vitamin C, stress-induced calcium losses, muscular weakening of the rear chamber of the eye, and increased pressure in the eye relative to the softened sclera, the white superstructure of the eye. The combination results in a gradual ballooning of the eye -- incredibly, adding only 1/2 mm. of extra length to the eye reduces vision to 20/200 or poorer! The increased length of eye is all in the posterior chamber.

III. WHAT CAN BE DONE?

The main factors in preventing nearsightedness are proper nutrition, preventive lenses to protect normal farsightedness, proper visual hygiene, and stress reduction techniques. To elaborate:

1) Nutrition - supplementing the diet with several hundred milligrams of vitamin C each day is reasonable. (Experts have estimated that cavemen received 1100mg. or more per day in their diets.) Adequate dietary levels of calcium, magnesium, and zinc are in order, as well. Children given calcium in one British study showed stabilization and reversal of their myopia. A diet adequate in fresh fruits and vegetables should be preventative, but not many children have the taste or opportunity to do so. B-complex vitamins help to reduce the effects of stress of any sort.

2) Proper visual hygiene :

A) Posture: sitting upright for reading or writing is very important. The visual system works best in a slightly downcast position.

B) Lighting: lighting engineers recommend a 200 W. glare-free study lamp. The benefit is to increase figure-ground contrast and also to constrict the pupil, which increases the depth of field and thus reduces the need for critical focusing, which is the primary distress on the visual system.

C) Time: the eyes appear to be designed for up to 20 or 30 minutes of sustained work without sustaining ill adaptive effects. Therefore, eye breaks every half hour - looking away and stretching hard or walking away for a moment, plus a walk-away for 10 minutes every 90 minutes when reading, writing, or computing, will minimize the stress effects on most people's eyes.

3) Preventive lenses - "Plus 50" or "Plus 75" reading lenses are powerful tools against myopia for most students, beginning as early as second grade for most, though some students are showing signs of this developmental nearsightedness by the middle of first grade. Personality style analysis can help to detect earlier need for these "brain glasses", as they're sometimes called: children prone to myopia seem to be the sort who are intelligent, analytical, withdrawn, stress-absorptive, underactive children, who are driven to please their superiors. Bifocals with clear top portions are sometimes a more practical way to provide the reading lenses without the bother of taking them off to see distance objects.

Rigid, gas permeable contact lenses have been shown to slow or stop progression, but just why isn’t exactly clear. Soft contact lenses are well-known to permit progression: it’s called "myopia creep".

Base-in prisms ground into the lenses have had preventive value since the mid-1800's when ophthalmologists in Germany used them on students becoming progressively more myopic. They are still sometimes used for this purpose. [There are no guarantees that preventive lenses will work for any particular individual, but research shows that they do work 60-70% of the time. Our only other option is to do nothing and watch the 60-70% of at-risk people get worse and worse vision.]

4) Stress reduction techniques - action is a useful antidote to stress. The body under stress gives all the appearance of being readied for fight or flight, even when either of those responses would not be appropriate. So a walking program, or low-impact aerobics, a sports hobby or other energy-burning activity will tend to help.

Relaxation, meditation, and/or prayer are scientifically proven ways of reducing stress. Progressive relaxation techniques were used for fighter pilots in WWII and Korea to not only reduce stress, but also improved flying combat skills. They reduce stress effects and can improve thinking skills in students, as well - it would be interesting to study formally. Teaching children how to take a "5-minute vacation" as Dr. Herbert Benson talks about in his book "Beyond the Relaxation Response", would be beneficial at many levels.

"Children need more baseball, less T.V.", said Dr. Francis Young, a primate researcher from Oregon. He was responding to questions about his conclusions of what made animals nearsighted in his experiments. Children need more outdoor activity and preferably interacting with other children.

Performance anxiety needs to be dealt with constructively, as well as control issues, so that a pattern of prolonged distress response(s) doesn't become a habit.

IV. THE FUTURE

Will there ever be a remedy for nearsightedness? It's hard to see how that can be, especially since our society is moving toward MORE nearwork with the advent of the microcomputer and the Internet Age. Hopefully, more and more vision care providers will finally acknowledge that functional nearsightedness (the nearwork theory) is responsible for most garden-variety nearsightedness - up to 75% it would appear. Then we can get on with the real cure for myopia, PREVENTION.

For Additional Reading:

Bowan, MD: The Control of Myopia; Journal of Optometric Vision Development; Volume 12, Number 2, June, 1981.

Bowan, MD: Stress and Eye: New Speculations on Refractive Error; Journal of Behavioral Optometry; Volume 7, Number 5, 1996.

Forrest, E: Stress and Vision; Optometric Extension Program , Santa Ana, CA, 1988.

[2005 Note: SEE ALSO: www.myopia-manual.de]



		HANDOUT 1 This handout is what I use to advise parents of children at risk. The questionnaire that is published in your book is probably quite valid, but truthfully, I have found no way to use it clinically. It lends itself more to being a research screening device. The Mandelbaum test performs irregularly for me. I have not given up on it, but I have not discovered a mesh that works for everyone. It would be neat to find a way to make it work. So, optometry doesn’t know what two times 13 is. That does not men there isn’t an answer. We can control the majority of ametropia. Not all of it. We owe it to our patients to use techniques to analyse their potential for changes toward these diseases and to care for them in the most proper way. We need to be diagnostic doctors - REAL doctors - not merchandising doctors. Diseases beg for healers - will we be the healers we are called to be? Thank you. [OVERHEAD #12 - Questions for research] Animal studies: 1) Would myopia develop in de-adrenalized animals? 2) What are the Cortisol levels in the animal studies? 3) Will lens-induced hyperopia be induced in animals whose EOM’s are detached? 4) Scleral strip tests: subject them to drugs and normal stress products to determine their properties, plus effects on uveo-scleral outflow. Human studies: 1) Dark focus to far point focus: what is the nature of the mechanism? Is it axial change? Corneal? Crystalline lens? 2) Prospective study of IQ/reading/myopia. 3) Vocabulary and myopia. 4) Exophoria and myopia. 5) Determinations of the crystalline lens thickness under sustained accommodation. REFERENCES 1. Price SA, Wilson LM; Pathophysiolology: Clinical Concepts of Disease Processes, 5th Ed.; Mosby, St. Louis, 1997. 2) Rosner J, Rosner J.; Comparison of Visual Characteristics in Children WIth and Without Learning Difficulties, Am. J. Optom. Physio. Optics, 64:531-533, 1987. 3. Mutti D, Zadnik K; The Utility of Three Predictors of Childhood Myopia: a Bayesian Analysis, Vision Res. 35(9):1345-1352, 1995. 4. Angi M., Clementi M, Sarki C, Piattelli E, Bisantis C; Heretibility of Refractive Errors in Identical and Fraternal Twins, Arch. Clin. Exper. Ophth., 231:580-585, 1993. 5. Hauge M, Basic Rules and Principles of Genetic-epidemiological Studies, Acta Ophthal, Supplement 185: 58-60, 1988. 6. Lin LL-K, Chen C-J; A Twin Study on Myopia in Chinese School Children, Acta Ophthal, Supplement 185: 51-53, 1988. 7. Zadnik K., Mutti DO, Fusaro R, Adams A.; Longitudinal evidence of Crystalline Lens Thinning in Children; Invest. Ophth. and Vis. Sci., 36(8):1581-1587, July 1995. 8. Mutti DO, Zadnik K; The Utility of Three Predictors of Childhood Myopia: a Bayesian Analysis, Vis Res, 35(9):1345-1352, 1995. 8. Eulenberg A; The Case for Preventability of Myopia, http//php.indiana.edu/~aeulenbe/i_see/prevent_myopia.html 9.Young FA, Leary GA. Baldwin WR, West DC, Box RA, Harris E, Johnson C; The Transmisison of Refractive Errors Within Eskimo Families, Am J Optom and Arch Am Acad Optom, 46(9):676-685, 1969. 10. Young F; The Nature and Control of Myopia, J. Am. Optom. Assn. 48(4):451-457, 1977. 11. Watten RG, Lie I; Time Factors in VDT-induced Myopia and Visual Fatigue: an Experimental Study, J Hum Ergol (Tokyo) Jun;21(1):13-20, 1992. 12. Lane BC; Myopia Prevention and Reversal: New Data Confirming the Interaction of Accommodative Stress and Deficit-Inducing Nutrition, J. Int'l Acad. Prev. Med. 7(3):17-30, 1982. 13. Lane BC; Calcium, Chromium, Protein, Sugar and Accommodation in Myopia, Doc Ophthalmol Proc Ser Vol 28 Third Int’l Conf on Myopia (The Hague, Netherlands) Dr. W Junk Publishers 141-148, 1981. 14. Lane BC; Chromium Protects Against Sucrose Effects in Myopia Progression, Suppl Invest Ophthalmol & Sci, 22(3):218, 1982 15. Gardiner PA; Dietary Treatment of Myopia in Children, Lancet, 31 May, 1958, 1152-1155. 16. Lane, B; Food Folate vs. Supplemental in Myopia Development and Tear Film Integrity, Optom Vis Res, 71(12)=Dec Suppl, 1994. 17. Senate Document #264, 74th Congress, 2nd Session, 1936. 18. Young FA.; The Effect of Restricted Visual Space on the Refractive Error of the Young Monkey Eye, Invest. Ophthal. 2(6):571-577, 1963. 19. Tay M, Au Eong K, Ng C, Lim M; Myopia and Educational Attainment in 421,116 Young Singaporean Males, Am. Acad. Med, Singapore. 21(6):751-791, Nov. 1992. 20. Luria S, Newmark H, Beatty H; Effect of a Submarine Patrol on Visual Processes, Report #641, Bureau of Medicine and Surgery, Navy Dept. Research Work Unit, M4305.08-300ID.06, 14 Sept. 1970. 21. Greene M; Submarine Myopia in the Minuteman Launch Control Facility, J. Am. Optom. Assn. 41(12):1012-1014, 1970. 22. Simensen B, Thorud L.; Adult-onset Myopia and Occupation, Acta Ophthalmologica, 72(4):469-471, Aug. 1994. 23. Bowan MD; Stress and Eye: New Speculations on Refractive Error, J Behav Optom, 1996:7(5)17-22. 24. Sapolsky RL; Why Zebras Don’t Get Ulcers, WH Freeman & Co., NY, 1998. 25. Zadnik K, Mutti D; How Applicable are Animal Myopia Models to Human Juvenile Onset Myopia?, Vision Res. 35(9):1283-1288, 1995. 26. Devadas M, Morgan I; Retinal Control of Scleral Precursor Synthesis, Aust N Z J Ophthalmol 25 Suppl 1:S-73-75, May 1997. 27. Leech EM, Cottrial CL, McBrien NA; Pirenzipine Prevents Form Deprivation Myopia in a Dose-dependent Manner; Ophthalmic Physiol Opt, 15(5):351-356, Sept 1995. 28. McBrien N, Moghaddam H, Reeder A; Atropine Reduces Experimental Myopia and Eye Enlargement Via a Non-accommodative Mechanism, Invest. Ophth. & Vis. Sci., 34(1):205-215, Jan 1993. 29. Bowan MD; The Control of Myopia, J Opt. Vis Devel, 12(2):17-24,1981. 30. Owen DA; The Resting State of the Eyes, Am Scientist Vol 72, Jul-Aug1984: 378-387. 31. Jaschinski-Kruga W, Toenies U; Effect of a Mental Arithmetic Task on Dark Focus of Accommodation, Ophthal Physio Opt, 8(4): 432-437, 1988. 32. Gray LS, Winn B, Gilmartin B, Eadie AS; Objective Concurrent Measures of Open-loop Accommodation and Vergence Under Photopic Conditions, Invest Ophthalmol Vis Sci, 34(10): 2996-3003, Sept 1993. 33. Leary G; The Reconciliation of Genetically Determined Myopia with Environmentally Induced Myopia, Am J Optom & Arch Am Acad Optom, Sept 1970 702-709. 34. Van Alphen G; On Emmetropia and Ametropia, Suppl of Ophthalmol 142:1-92, 1961. 35. Young F; Personality and Refractive Characteristics, The Optician Sept 8, 1978. 36. Gawron V; Differences among Myopes, Emmetropes, and Hyperopes, Am J Optom & Physiol Optics, 58(9):753-760, Sept. 1981. 37 Angi M, Rupolo G, DeBertolini G, Bisantis C; Personality, Psychophysical Stress, and Myopia Progression, Graefe's Arch. Clin. Exper. Ophthalmol., 231(136-140), 1993. 38. Schapero M, Hirsch M; The Relationship of Refractive Error and Guilford-Martin Temperament Test Scores, Am J Optom & Am Acad Optom 29(32-36), 1952. 39. Lanyon R, Giddings J; Psychological Approaches to Myopia: A Review, Am. J. Optom. & Physio. Optics 51(4):271-281, 1974. 40. Tzevtkov VL; The Origin of Myopia; The Conference on Prevention, Pathogenesis, and Treatment of Eye Disease; J Ped Ophthal, 9, 120, 1972. 41. Eva FR, Pascoe DT, Vaughan DG; Refractive Change in Hyperglycaemia: Hyperopia, not Myopia, Br J Ophthalmol, 66(8): 500-505, Aug 1982. 42. Rosner J, Rosner J; The Relationship Between Moderate Hyperopia and Academic Achievement: How Much Plus is Enough?, J Am Optom Assoc, 68(10): 648-650, Oct 1997. 43. Bowan MD; Accommovergence: A New (?) Concept for Preventing Visual Problems; Transcript of the 40th Annual Kraskin-Skeffington Invitational Symposium, Optometric Extension Prog Found, Jan 1996. 44. Shum PJ, Ko LS, Ng CL, Lin SL; A Biometric Study of Ocular Changes During Accommodation, Am J Ophthalmol 115(1): 76-81, Jan 1993. 45. Lopping B, Weale RA; Changes in Corneal Curvature Following Ocular Convergence, Vis Research, 5(3):207-215, April 1965. 46. Skeffington AM; The Functional Approach to the Study of Visual Problems, Presentation at the Middle Atlantic Optom Cong, October, 1944. Mimeographed Copy. Caryl Croisant Transcripts. 47. Guyton A.; Basic Human Physiology: Normal Function and Mechanism of Disease, Saunders, Philadelphia, 1977. 48. Wallman J, Gottleib M, Rajaran V, Fugate-Wentzek L.; Local Retinal Regions Control Local Eye Growth and Myopia, Science, 237(4810):73-77, 3 Jul 1987. 49. Pendrak K, Nguyen T, Lin T, Capehart C, Zhu X, Stone RA; Retinal Dopamine in the Recovery from Experimental Myopia, Curr Eye Res, 16(2):152-157; Feb 1997. 50. Angrist A; Research in Myopia (A Problem in the Stability of Collagen), First Int’l Cong on Myopia, NY, NY Sept 10-13, 1964, Professional Press. 51. Hogan MJ, Alvaredo JA, Waddell JE; Histology of the Human Eye, WB Saunders, Philadelphia 1971. 52. Selye, H. The Stress of Life, (Revised Ed.), McGraw-Hill, New York, 1976. 53 Raviola E, Weisel TN; The Neural Basis of Myopia, Harvard Mahoney Neuroscience Institute Letter, 4(3) Summer 1995. 54. Bullimore MA, Gilmartin BC; Cognitive Demand and Accommodation, Am J Optom & Physiol Optics, 64(1), 1987 55 Hosack D; Observations on Vision, Philosoph Trans Royal Soc Lond, 84(196ff.) 1794. 56 Prentice C; The Eye in its Relation to Health, AC McClurg & Co, Chicago, 1895. 57. Bates WH; The Cure of Imperfect Sight by Treatment Without Glasses, Central Fixation Publishing Co, NY, 1920. 58. Getman G; The Retinoscopic Observations, Optometric Extension Program Courses, Ser. 1, No. 8, May, 1977. 59. Gawron, V.; Ocular Accommodation, Personality and Autonomic Balance, Am. J. Optom. & Physiol. Optics 60(7):(630-639), 1983. 60. Fry G, cited by: Skeffington AM; The Functional Approach to the Study of Visual Problems, Presentation at the Middle Atlantic Optom Cong, October, 1944. Mimeographed Copy. Caryl Croisant Transcripts. 61. Roy R; Headaches and Binocular Stress, Opt Weekly, 47(41): 35-38, Oct 11, 1956. APPENDICES : HANDOUT No. 1: The Myopia about Nearsightedness Merrill D. Bowan, O.D. I. The Cure for Myopia. III. What Can be Done? II. What is Myopia? IV. The Future. I. THE CURE FOR MYOPIA (Nearsightedness). Q. Can myopia be reversed? A. Unfortunately, no. Q. Can myopia be prevented? A. Fortunately, yes, most of the time. That's the cure for myopia: PREVENTION. Q. But what about surgery? I see many ads. A. Radial corneal surgery and lasers only address symptoms of the problem. Studies have never shown close associations of myopia with the corneal shape. Just as you learned in school, in myopia the eye is optically too long. The great majority of refractive surgery patients will need glasses or contact lenses over the weeks, months or years following the surgery. Q. But what are the best things that can be done for myopia? A. Work to prevent progression of nearsightedness, once it's started. The only real cure for myopia is to prevent it. You have to understand what myopia is. II. WHAT IS MYOPIA? Myopia is one of three adaptive optical errors that occur as responses of the visual system to sustained, repeated stress -- they are stress diseases. The others are astigmatism and progressive hyperopia -- farsightedness. In nearsightedness, the eye is optically too long. Astigmatism distorts the image on the back of the eye and farsightedness causes the individual to pay too much attention to focusing on near work, causing eyestrain and reduced performance. The idea that myopia is genetic is not borne out by the available data. Family histories, at best, have only a modest predictive value for eye problems. Genetics may predispose certain families toward specific eye problems, but the trigger to the distortion of the optics of the eye is stress and reading, in the great majority of cases. Since the human eye is almost full size by age four and certainly adult size by age eight, the concept of an eye that "grows" too long is not a valid concept. Most myopia begins after age eight. Most beginning myopes get their first glasses at ages 9 to 10, but there is a new group of beginning myopes who have begun to emerge over the past 20 years: adults who use computers. A British ophthalmologist has described myopia as "juvenile expansile glaucoma", caused by reading. Technically, he's probably correct, although it's a benign condition, and not the adult, damaging form of glaucoma. Myopia has affected mankind since the beginning of time whenever the visual system is stressed and the individual can't or won't escape the stressing environment. The combination of events that causes the nearsightedness include extended nearwork, depletion of Vitamin C, stress-induced calcium losses, muscular weakening of the rear chamber of the eye, and increased pressure in the eye relative to the softened sclera, the white superstructure of the eye. The combination results in a gradual ballooning of the eye -- incredibly, adding only 1/2 mm. of extra length to the eye reduces vision to 20/200 or poorer! The increased length of eye is all in the posterior chamber. III. WHAT CAN BE DONE? The main factors in preventing nearsightedness are proper nutrition, preventive lenses to protect normal farsightedness, proper visual hygiene, and stress reduction techniques. To elaborate: 1) Nutrition - supplementing the diet with several hundred milligrams of vitamin C each day is reasonable. (Experts have estimated that cavemen received 1100mg. or more per day in their diets.) Adequate dietary levels of calcium, magnesium, and zinc are in order, as well. Children given calcium in one British study showed stabilization and reversal of their myopia. A diet adequate in fresh fruits and vegetables should be preventative, but not many children have the taste or opportunity to do so. B-complex vitamins help to reduce the effects of stress of any sort. 2) Proper visual hygiene : A) Posture: sitting upright for reading or writing is very important. The visual system works best in a slightly downcast position. B) Lighting: lighting engineers recommend a 200 W. glare-free study lamp. The benefit is to increase figure-ground contrast and also to constrict the pupil, which increases the depth of field and thus reduces the need for critical focusing, which is the primary distress on the visual system. C) Time: the eyes appear to be designed for up to 20 or 30 minutes of sustained work without sustaining ill adaptive effects. Therefore, eye breaks every half hour - looking away and stretching hard or walking away for a moment, plus a walk-away for 10 minutes every 90 minutes when reading, writing, or computing, will minimize the stress effects on most people's eyes. 3) Preventive lenses - "Plus 50" or "Plus 75" reading lenses are powerful tools against myopia for most students, beginning as early as second grade for most, though some students are showing signs of this developmental nearsightedness by the middle of first grade. Personality style analysis can help to detect earlier need for these "brain glasses", as they're sometimes called: children prone to myopia seem to be the sort who are intelligent, analytical, withdrawn, stress-absorptive, underactive children, who are driven to please their superiors. Bifocals with clear top portions are sometimes a more practical way to provide the reading lenses without the bother of taking them off to see distance objects. Rigid, gas permeable contact lenses have been shown to slow or stop progression, but just why isn’t exactly clear. Soft contact lenses are well-known to permit progression: it’s called "myopia creep". Base-in prisms ground into the lenses have had preventive value since the mid-1800's when ophthalmologists in Germany used them on students becoming progressively more myopic. They are still sometimes used for this purpose. [There are no guarantees that preventive lenses will work for any particular individual, but research shows that they do work 60-70% of the time. Our only other option is to do nothing and watch the 60-70% of at-risk people get worse and worse vision.] 4) Stress reduction techniques - action is a useful antidote to stress. The body under stress gives all the appearance of being readied for fight or flight, even when either of those responses would not be appropriate. So a walking program, or low-impact aerobics, a sports hobby or other energy-burning activity will tend to help. Relaxation, meditation, and/or prayer are scientifically proven ways of reducing stress. Progressive relaxation techniques were used for fighter pilots in WWII and Korea to not only reduce stress, but also improved flying combat skills. They reduce stress effects and can improve thinking skills in students, as well - it would be interesting to study formally. Teaching children how to take a "5-minute vacation" as Dr. Herbert Benson talks about in his book "Beyond the Relaxation Response", would be beneficial at many levels. "Children need more baseball, less T.V.", said Dr. Francis Young, a primate researcher from Oregon. He was responding to questions about his conclusions of what made animals nearsighted in his experiments. Children need more outdoor activity and preferably interacting with other children. Performance anxiety needs to be dealt with constructively, as well as control issues, so that a pattern of prolonged distress response(s) doesn't become a habit. IV. THE FUTURE Will there ever be a remedy for nearsightedness? It's hard to see how that can be, especially since our society is moving toward MORE nearwork with the advent of the microcomputer and the Internet Age. Hopefully, more and more vision care providers will finally acknowledge that functional nearsightedness (the nearwork theory) is responsible for most garden-variety nearsightedness - up to 75% it would appear. Then we can get on with the real cure for myopia, PREVENTION. For Additional Reading: Bowan, MD: The Control of Myopia; Journal of Optometric Vision Development; Volume 12, Number 2, June, 1981. Bowan, MD: Stress and Eye: New Speculations on Refractive Error; Journal of Behavioral Optometry; Volume 7, Number 5, 1996. Forrest, E: Stress and Vision; Optometric Extension Program , Santa Ana, CA, 1988. [2005 Note: SEE ALSO: www.myopia-manual.de]