Asian eyecare question

[Fezz]

The Aug issue of Eyecare Business has an article on"Universal Understanding". It deals with eyewear and ethnic groups. There is a statement under the Asian American heading that i have never heard or encountered before.

"In Traditional Asian eyecare they UNDER-CORRECT, so some patients may have less than a full RX.".

Is that true? If so....why? Has anybody dealt or encountered this?

Thanks,


Fezz
:cheers:

[f2chow]

I had a patient from Russia a few months back. She was 1.25 under corrected for her myopia. I asked her if she was surprised since she had only had an examination before being allowed to enter into Canada and she said no, it was common practice to undercorrect. I guess that's why she said she wasn't having any problems, even though her acuities were 6/15 each eye. But I take all patient stories with a grain of salt.

[Fezz]

So what did you do? Did you give her the "right" amount or did you cut back?

That also leads....is there a potential liability if you do cut back and under correct?


Fezz
:cheers:

[Jubilee]

What was explained to me during my interactions with many Asian college students, was that the theory was if you corrected fully, then they were more dependent on them, and more dependence = making your eyes worse...

[HarryChiling]

There is a theory that correcting myopia will lead to a progression in the Rx, I would say a high amount of asian people have myopia so you could therefore conclude that this may be where the statement came from.

[FVCCHRIS]

Perhaps by under correcting, they are guaranteed to get a recheck in a year instead of two?? Hmmmm. planned early obsolecence? Chris.

[sph]

What was explained to me during my interactions with many Asian college students, was that the theory was if you corrected fully, then they were more dependent on them, and more dependence = making your eyes worse...

This is exactly what I hear.

[AEOC]

It is exactly for the purpose of minimizing progression of myopia. Also extends into adulthood where patients will wear an old underminussed Rx in order to avoid multifocals.

[Chris Ryser]

Under correct Miopia is done all over the world for the last 100 years and I never heard anybody finding this something special.

[striker22]

I have not found it strange that under prescribing has been practiced for a long time. I do that all the time. It is my belief that chasing RX is always like a race without a finish line, a process that can be retarded by means of under-correcting. This is by no means an avaricious attempt to sell new lenses earlier than required. It is all for the well-being of the patient.

Of course, it all depends on the needs of the RX wearer. If he/ she is using it primarily for distant vision, I do not under-correct. However, when they say it's for normal day to day use, I almost always under-correct since the majority of the modern man's time is spent on close distant work. This is of course done with the consent of the patient after educating him. I do not find that it is specific to any ethnic group.

[fjpod]

Glasses do not make your eyes "get worse". The bio-physical-genetic process that initiated the myopia in the first place, makes it increase ("get worse").

Every single myope...had a problem with increasing myopia...BEFORE they ever got a pair of glasses. It is foolish of us to think the glasses cause the problem which pre-existed in every case. Genetics, growth factors, and perhaps environment are the culprits in refractive errors.

Just another thought...who ever said that myopia (low amounts, say up to -3) is a "weakness" of the eye? Low myopia is simply the axial length of the eye being out of sync with the thickness of the lens. In fact, the lens of the eye is too "strong" (thick) in myopes. Hyperopes are the ones with the "weak" (thin) lenses. How do you figure that something which is a little long or short...thick or thin... is a weakness? It's just a difference in size or shape.

I know I'll take some heat on this one, but even incorrectly or overprescribed glasses don't cause myopia or eye damage either. There is no evidence to support this. Think about all the people who are 2 and 3 diopter hyperopes at a young age and do not wear glasses. In reality, they are myopes who are over-corrected 2 or 3 diopters. Does this "damage" their eyes. No not really. They may suffer from eyestrain or headaches (many of them don't!) They just appear to become presbyopes at an earlier age. They don't go blind from this. They don't get cataracts or glaucoma from this.

Most infants are born highly hyperopic. They become less hyperopic (move towards myopia) early in life. It's just a matter of where it stops...which is turned on and off by genetic factors and maybe certain environmental stresses This process is the same as what emmetropes go through when they move into myopia.

Human nature makes us believe myopia or presbyopia are made worse by wearing glasses...because we all "see" eyesight getting worse after we do. But this is like making an assumption that our pre-historic ancestors did when they beat on a drum and happened to see rain, then made the connection that if you beat on a drum long enough, it will rain. They made this assumption because they didn't understand the science behind the phenomenon they observed.

I can understand why the general public thinks this, because they don't study optics, visual science, genetics, etc., but I don't understand why people involved in eyecare continue to perpetuate this old wive's tale.

There is some evidence that extended periods of close work, or living in a close environment such as a submarine, can induce myopia, but not glasses. There is some evidence that using plus lenses at near (or removing the minus for near vision tasks) helps slow the progression of myopia in esophores, but not in all cases. So obviously we have more to learn about preventing progressive changes in refractive errors.

Let's base our recommendations to patients on fact, not myth.

[HarryChiling]

that if you beat on a drum long enough, it will rain.

You mean it's not true. :(

[Robert Martellaro]

Glasses do not make your eyes "get worse".

Moreover, this study seems to indicate that under-correcting accelerates myopia.

http://www.newscientist.com/article.ns?id=dn3082

[drk]

Who is this masked man, fjpod?

I like him/her.

Good post.

I have a chinese patient who insists I underminus her. Who knows what eastern medicine thinks? I doubt that they are even operating under the same western, scientific principles that we are. Who knows what the rationale is for undercorrecting? Who wants to take ground-up tiger penis or rhino horn, or have acupuncture to "release energy"?

The whole thing has been studied to death in the west and undercorrecting or adds have not been shown to work.

There also may be behavioralist OD's out here in the US that would say that "the eye seeks to be undercorrected by a half-diopter, due to near point stress, so if you raise the Rx, then it will "correct" itself again, with an "adaptation" towards more myopia, so the mysterious eye will achieve it's underminused goal.

Sure, drive around 20/40 on a bicycle in China, but don't do it on US highways. If you insist on being underminused indoors, at least wear full minus driving, PLEASE!

[Fezz]

Under correct Miopia is done all over the world for the last 100 years and I never heard anybody finding this something special.

Chris,

Sorry, I guess there is a first for everything. I am not as worldly traveled, educated, and optically blessed as some on this board. I find it an interesting statement/procedure. I asked before=what is the legal liabilities with this practice? I understand that if it truly has been "done all over the world for the last 100 years", that doing so TODAY in the USA may be a bit of a problem.

Fezz
:cheers:

[fjpod]

Sure, drive around 20/40 on a bicycle in China, but don't do it on US highways. If you insist on being underminused indoors, at least wear full minus driving, PLEASE!

Forget the small number of undercorrected myopes out there. At least they realize they are blurred. How about the millions of 20/40 or so uncorrected hyperopes in their 40s through 60 who refuse to admit that their vision is blurred at distance ("I can see everything, I can drive, I just can't read the signs."), that they need glasses ("I don't need them all the time. Just for reading, right?"), and are convinced that wearing glasses will only make their eyes get worse. ("I don't want to get used to them.")

At least myopes admit they have bad vision. They may not always wear their glasses as they should, but they admit they can't see.

BTW, thanks for the compliment.

[silky]

I find your posts very interesting and I hope to look for a solution. Have you all had biology studies in your education's curriculum such as Marfan syndrome and endocrine disorders?

I'm a chinese female with -14D on the RT and -11D on my LT. I'm 28 with unstabilized myopia. I wore undercorrected soft contacts for the last 6 years which I noticed worsening of sight. This could be a possible cause out of many causes. The brain accounts for most of what we see, rather than the eyes so could be that it's trying to adapt to uncorrected vision.

In my opinion, asian do have high risk of osteoporosis, a condition common in Marfan / connective tissue disorders which also poses poor eyesight. Like the bones, perhaps the eyeball is too soft to stabilise. By the way, I also have a rib cage deformity.

A lot of studies point to vigorous study habits of the chinese and japanese which may induce myopia. But what about Finland? They are the most educated country in the world, with Japan coming in on second. Do the Finnish have a high population of myopes?

I'd like to ask you optometric specialists, why would none of the three doctors I saw in my lifetime suggest RGP lenses to retard my myopia? They kept me on soft lenses impossible to correct to 20/20 for my vision but not one single specialist introduce me to RGPs. I was walking in a blur for the last few years.

Cynthia

[chip anderson]

Anyone care that the eye is 1/2 diopter more myoptic in darkness. How do these people see at night?

[mike.elmes]

Sure, drive around 20/40 on a bicycle in China, but don't do it on US highways. If you insist on being underminused indoors, at least wear full minus driving, PLEASE!

[/b]



What is the minimum acuity for operation of a motor vehicle in the USA....is it a national standard or a state standard?? Is it not your professional responsibility to meet the minimum?

I'm not saying that you don't but just curious where the line in the sand is.

[LENNY]

20/40 uncorected or corected binoculary!
Checked every 4-6 YEARS!
And if you know what you doing you can renew online with just license # of any MD, OD or nurse.

[npdr]

"...
I'd like to ask you optometric specialists, why would none of the three doctors I saw in my lifetime suggest RGP lenses to retard my myopia? They kept me on soft lenses impossible to correct to 20/20 for my vision but not one single specialist introduce me to RGPs. I was walking in a blur for the last few years.

Cynthia

I think there is no definitive proof that RPGs reduce the progression of myopia. See the following:

1. Walline JJ, Jones LA, Mutti DO, Zadnik K. A randomized trial of the effects of rigid contact lenses on myopia progression. Arch Ophthalmol. 2004 Dec;122(12):1760-6.

2. Walline JJ, Jones LA, Mutti DO, Zadnik K. Use of a run-in period to decrease loss to follow-up in the Contact Lens and Myopia Progression (CLAMP) study. Control Clin Trials. 2003 Dec;24(6):711-8.

3. Katz J, Schein OD, Levy B, Cruiscullo T, Saw SM, Rajan U, Chan TK, Yew Khoo C, Chew SJ. A randomized trial of rigid gas permeable contact lenses to reduce progression of children's myopia. Am J Ophthalmol. 2003 Jul;136(1):82-90.

4. Walline JJ, Mutti DO, Jones LA, Rah MJ, Nichols KK, Watson R, Zadnik K. The contact lens and myopia progression (CLAMP) study: design and baseline data. Optom Vis Sci. 2001 Apr;78(4):223-33.

5. Khoo CY, Chong J, Rajan U. A 3-year study on the effect of RGP contact lenses on myopic children. Singapore Med J. 1999 Apr;40(4):230-

6. Heng LS, Khoo CY. Can contact lenses control the progression of myopia? Singapore Med J. 1994 Aug;35(4):367-70. Review.

7. Grosvenor T, Perrigin D, Perrigin J, Quintero S. Rigid gas-permeable contact lenses for myopia control: effects of discontinuation of lens wear. Optom Vis Sci. 1991 May;68(5):385-9.

[Ory]

I think the really sad part of all this is that the patients rarely know what their potential is. I had a young man in recently who was visiting friends in Canada; one of them works in my office. He had an exam approximately 6 months ago in Japan and was wearing -1.25 DS OU contacts. After refracting I found -2.50 OU! When he put on his new contacts it was easy to see how amazed he was. This was the first time he had seen clearly, and he was quite impressed.

Granted, after trying them for a day he felt it was too much power. I decreased them to -2.25 OU (with a corresponding decrease in acuity) and he was much happier.

It has become such a cultural doctrine that the glasses are to blame. Doctors around the world will do what they think is "good for the patient" but unfortunately many don't follow the scientific evidence.