Dear Padma,

Subject:  Prescription Practices -- Under-Prescription and
   Over-Prescription Policies

I believe that we "the pubic" must learn to take

the "next step" towards true prevention.

This can only be done if "we" learn to accept

an optometrist who will prescribe a "plus" when

we are on the "threshold".  Steve Leung will do it -- because

he his helping his own child in that manner.

Here is some background information.   I believe

that the ODs are driven to "react" to us -- after

we get into it.  They are never permitted to

agressively use the plus when we are on 

the threshold -- and that is OUR FAULT.

Best,

Otis

*******

     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:

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 "grudge" 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 Mr.
    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, were a "quick-fix" is the only solution.

     I am pleased you have chosen the "high road" in working
towards a better solution for yourself and your child.

Best,

Otis

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