What We Think We Know About Myopia 1

7/30/2019 What We Think We Know About Myopia 1

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This paper was published in The Journal of Optometric VisionDevelopment. Voloume 34 Number 1, Spring 2003, pages 24 to 30.

Nearsightedness:Seeing Beyond The Obvious - Part 1 by Roberto M. Kaplan

Key Words: nearsightedness, myopia, lenses, vision therapy.

INTRODUCTION

Visual science attempts to explain the development of nearsightedness

by examining the components of the physical eye. (1 - 5) Using rationalthinking, theories about the causes and treatments of nearsightednesshave evolved. Many clinicians have accepted these research conclusionsas obvious facts. For example, when the various optical componentsinteract resulting in an out-of-focus image on the retina, the eye isdescribed as myopic or nearsighted. The person has an out of focus eyewhen looking into their distant world.

The facts state that an obvious rational treatment for an out-of-focus

eye is to diverge the light rays with a minus lens. Like a medication thatsoothes away a headache, a minus lens gives instant gratification - the

blurred view of the distant world comes into illusionary focus for theperson. It is therefore no surprise that minus lenses many years agobecame the treatment of choice for nearsighted patients.

For a person with a busy doing life spectacles or contact minus lensesare the prefect quick solution for becoming focused outside of oneself.

Gallop says, and many vision therapy oriented clinicians would agree,that Optometry seems addicted to 20/20 distance acuity. Thisobsession with 20/20 acuity has created acuity addicts. (6)

The difficulty many clinicians have been faced with is that the wearingof minus lenses doesnt permanently alter the optics of the eye. If the


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minus lens were a corrective therapy then wearing the minus lens wouldresult in a lowering of the measurable nearsightedness. This is not thecase. The minus lens compensates for out of focus optics, however,when the minus lens is removed the eye optics are still out of focus, and

the person again sees unclear.

Clinical evidence shows that education and the wearing of minus lensesincreases the nearsighted optical measurements of the eye resulting infurther drops in visual acuity of the patient. In 383 school children fromages 6 to 17 years, the prevalence of myopia increased from 30% at ages6-7 years, to 70% at ages 16-17 years. (7)

It is the purpose of this paper to look beyond the obvious logicalexplanations of nearsightedness. Seeing beyond the physical eye into thenot-so-obvious provides a deeper look into the the actual causes ofnearsightedness in a physical eye. To accomplish this means going intothe brain and mind of the person who has a nearsighted eye.

Behind the eye lies the not-so-obvious with answers to how cliniciansand patients alike can more effectively manage nearsightedness andmyopic behaviour. By integrating the obvious with the not-so-obvious

one can propose a way to solve this clinical dilemma of alarmingincreases in world nearsightedness. Vision therapy can greatly contributeto what appears to be a visual condition reaching epidemic proportions.Over 25% of the U.S. population are nearsighted, while in far easterncountries such as Taiwan, Singapore and Hong Kong, 90 per cent ofyoung people are near-sighted. (8)

THE OBVIOUS - WHAT WE THINK WE KNOW

Clinicians measuring refractive errors keeps themselves focused on thephysical reality of the eye. The measurement of nearsightedness is aneye finding based on an out-of-focus image on the retina. A primary careapproach is to treat the eye problem alone and solve the patientssymptom of blurred distance vision by using minus lenses. These daysclinicians can be seduced to believe that corrective laser surgery is ananswer for the problem of a nearsighted eye as well.


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There are many theories regarding the etiology of nearsightedness whichin turn have led to many contradictory methods of treatment and therapy.Research from Asia emphasises environmental factors, like close work.

In Europe genetics is considered more. Studies using bifocals to reduceaccommodative demands have had varying results. (9 and 10) The roleof academic demands seems to be a major factor in the progression ofnearsightedness. (11)

If the person looks through their full nearsighted lenses for close work itis proposed that this will lead to the eye ball elongating resulting in thedistant eyesight decreasing. A recent study, reported in New Scientist,

November 20th, 2002, used under prescribing as a way to control theincrease in nearsightedness. 47 children with under correctednearsightedness deteriorated more rapidly than those given full

prescriptions. Yet, when Asian children wore progressive lenses withbetween +1.5 and 2.00 diopter adds the progression of nearsightednesslessened as the adds increased. (12)

Gallop reminds us that from a deeper point of view, it is the eye that isnearsighted whereas it is the behaviour of the person that is myopic. (6)

He proposes that what we measure in the eye should be callednearsightedness. Behavioural optometry has built a strong case fornearsightedness in the eye being orchestrated by the conditioning of thehuman being behind the eye. Gallop suggests that this controlmechanism for the nearsighted eye be called myopia. It is the myopic

behaviour of the person that leads to the development of a nearsightedeye. This discernment between what happens in the eye(nearsightedness-theobvious) and behind the eye (myopia-not-so-

obvious) is a good starting place for this paper.

CLINICAL OBSERVATIONS - GLIMPSES OF THE NOT-SO-

OBVIOUS

In my practise of vision care, my time has been divided into two phases.Firstly, as a clinician, I spent many hours of the day conducting visionexaminations to determine and refine lens prescriptions for nearsighted


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patients. I noticed in the early years of my career, my thinking was muchmore oriented to the obvious approach in treating nearsightedness. Iwould instruct my patients to wear their full minus and stated there wasnothing that could be done to correct the problem of an out-of-focus eye.

As my interest in vision therapy deepened I began to change the way Ispoke to my nearsighted patients. Through vision therapy it becameapparent that myopic behaviour could be modified by modelling whatfarsighted individuals have mastered well, that is, how to see into thefuture, project their seeing ahead. In the not-so-obvious behind the eye,in the brain and the mind was information that could help me guide the

patient to change their myopic behaviour. (13)

Interacting with a nearsighted person usually reveals linear and rationalbehaviour. A forward directed stooped posture is possible. A myopictendency is to ask many logical questions. Persons with nearsightednesstend to pursue learning, reading and close activities . Farsightedness

persons tend to be more spatial than temporal, and reach out into theirworld by participating in outdoor activities in preference to reading. Inmy observations, these varying ways near and farsighted individualsdirect their eyes from the mind seemed like different personality states.

Psychiatrist Putman evaluated brain wave patterns of visually evokedresponses in 10 patients with multiple personality disorders. (MPD) Hisexamination took each patient through three personalities. He identifiedstartling differences, where the subjects seemed to vary as much fromone personality to another as from one normal person to another. (14)

Optometric findings were taken on MPD patients in their various

personalities. One patient needed a correction for nearsightedness nearlyfour times stronger for one personality than another. When the subjectchanged into a 6 year old, her nearsightedness improved to the point thather original childhood prescription adequately compensated her visualacuity back to 20/20. In her teenage personality this patient required anincrease in prescription strength, but her unaided visual acuity was betterthan her adult selves.


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It would appear that the brain and the mind go through profoundmeasurable changes as these MPDs change their personalities. Thissuggests that their is a vast capacity for human beings to reorganise their

inner worlds. Surely, this reorganising phenomenon could be applied tomyopic behaviour and nearsighted seeing.

INTEGRATED VISION THERAPY

Integrating the obvious with the not-so-obvious led me to write about

an integrated form of vision therapy.(15)

I learned that modifying lenses before the patients eyes, with theintention of encouraging greater degrees of binocularity demanded of

them to restructure their perceptions. Rather than just trying to bringtheir acuity into focus I used lenses to train a deeper integratedawareness in the brain and mind. This helped patients to have new

perceptions, thus providing them with a way to modify their myopicbehaviour. I observed that the success of changing myopic behaviourwould result in immediate visual acuity changes. (16) With practisethese new perceptions eventually programmed the nearsighted eye andless diopters would be recorded. (17)

These changes in patients demanded of me to examine my usual fullstrength minus lenses I was prescribing. During vision therapy Iencouraged deeper and deeper spatial viewing for these nearsighted

patients. At home they had specific practices to follow using sometimestwo or three spectacle lenses of different dioptric strengths. I made surethat patients were informed that for driving they were to use full-strengthlens prescriptions. Reduced lens prescriptions were a form of homeintegrated vision therapy. (15) (The lens prescribing strategies will be

the topic in part two of this paper)

Using my retinoscope I shifted from just measuring the obviousnearsighted optics in the eye. I followed the principles of behaviouraloptometry and investigated the retinal reflex while engaging the patientin the not-so-obvious. For example, I saved some of my case history


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questions to be asked during retinoscopy. I wanted see what wouldhappen to the retinal reflex when I engaged the human being behind theeye. The favourite question was: When did you first receiveeyeglasses? In this not-so-obvious approach to retinoscopy I am less

interested in the retinal reflex informing me about the refractive status.As the patient goes through their thinking and remembering process, oneis observing the changes in the colour of the reflex and movement.

When the patient accesses unclear states of their personality in theirmind, they will usually not feel comfortable. The patient can remembersituations which are linked to their inner decision to alter the perceptionof their outer world. These not-so-obvious inner processes are reflectedin the eye via the retinal reflex. Like a new language, one can learn tointerpret the colour and reflex changes to see when the patient retreatsfurther into their myopic self or reaches out in a farsighted way. In otherwords, retinoscopy can be used to observe how and when the patientlearns from vision therapy to make the inner mind changes of being lessmyopic and moving in the direction of hyperopic behaviour.A second and profound way to interpret the inner workings of the visual

behaviour of the patient is to interpret the genetic and imprintingconditioning of perceptions from the iris of the eye. (This strategy will

be the topic in part three of this paper)

COMPUTER ANALOGY TO EXPLAIN THE NOT-SO-

OBVIOUS

The changes in the inner world of the patient demanded a new way ofexplaining what was happening in the nearsighted eye. I would explainto my patients that the eye can be considered like a scanner or faxmachine. In the scanner part of the analogy, the eye receives light and

like a scanner transforms this raw information into electrical impulsesthat are transmitted to the brain. In the fax analogy, the eye is able toprint out messages from the brain of the patient.

In the obviousapproach to treating nearsightedness a minus lens canfocus the light more accurately. However, the over focusing minus lenscan program the not-so-obvious in a way that leads to further myopic


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development. The more the patient becomes addicted to the minus lensin their mind the greater the likelihood the fax in the eye will say giveme more. Clinical experience and research shows that over time the faxkeeps printing out the need for stronger minus lenses. In other words, the

application of full as well as under corrected minus, without a programof integrated vision therapy, is insufficient in altering myopic behaviour.

The analogy can be extended to the brain and the mind as well. Thescanner brings in a replica of an image into a computer. The brain, likethe scanner stores the raw data of what is transmitted through the eye.With the appropriate software of the mind, which in vision therapy wecall developmental experience, the person is able to interpret the imagescanned in. The perceptual state of the patient will determine how thisscanned image is viewed and understood. If the patients inner

personality is one of myopic behaviour then the message that is sent as afax to the eye is seen via the retinal retinoscopic reflex as a nearsightedeye. The subjective visual acuity response is that the patient sees less.The retinoscopy reveals a dimmer reflex because the patient is lessengaged in reaching out to their visual world. It is safer for them toremain in their inner myopic world.

Integrated vision therapy offers the patient a way to be guided inchanging this myopic personality behaviour. Through experience theymaster how to modify their perceptions and find safe ways to reach outonce again in a more farsighted way. These developmental changes can

be measured via retinoscopy, subjective findings, binocularity and visualacuity. (17)

In order to be able to read the fax messages in the eye it is useful to

further understand the scanning process of the analogy. Scanners can beadjusted to scan in material in varying degrees of clearness andprecision. By changing the dots per inch setting modifies the final imagethat is stored in the computer.

In a similar way, the physical eye is designed to receive light in twoways. Incoming light can be focused onto the fovea or peripherally


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scattered onto the retina. Foveal directed light results in an image thathas higher resolution than retinal processed light.

Harris suggests that vision can be considered like adjusting bandwidths.

(18) The bandwidth determines how much information is simultaneouslytransferred through the visual system. A wider bandwidth is when a largeamount of information is being transported. In the case of the visualsystem this would be the retinal component where decisions can bemade based on lots of information being received at the same time. Anarrow bandwidth occurs when only a portion of the capability of thesystem is in use at one time. There is less data available for the personto make a decision about what is seen. The narrow bandwidth would beakin to a foveal way of perceiving, like reading a sign while driving. Theview of the world is narrowed down to have only the relevantinformation necessary to understand what is looked at.

CONSTRUCTING OUR VIEW OF REALITYThis bandwidth design principle of the eye must be considered if we aregoing to have an impact on helping the patient modify their myopic

behaviour software. In the obvious approach to vision care thetendency is to limit our treatment options to full compensating minus

lenses for the treatment of nearsightedness. What is important for thepatient in this approach is to get the light rays focused on the fovea.

In this case the light scanning process through the fovea programs themind to enter into more thinking and understanding. Be clear, think, and

be precise. This is helpful in small dosages because foveal directed lighthelps the person construct their mental identity, the understanding part oftheir personality. This helps the who do I think I am part of their inner

visual construct.

On the other hand, a full compensating minus lens prescription forcesthe person to construct a perceptual reality that who they are is whothey think or understand they are. This thought driven myopic behaviourof the patient is further cemented in its development by over focusedminus lens light through the fovea. The myopic behaviour is


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characterised by the patient having the tendency to explain andrationalise their feelings and perceptions. Nearsightedness compensatedwith a full minus lens creates a frozen state of existing, where the personis driven to look to understand.

What in turn is suppressed is the ability for the person to see and feel - toknow who they really are and how to have a deeper interpretation oftheir life. When the person trains themselves to suppress or not see partsof their visual reality, this leads to a distancing from significant aspectsof their environment, emotionally, and physically. There are distortionsin how the outside world is seen as well as how the self is perceived, states Orfield. (19)

By reducing the minus lens and defocusing foveal light leads the patientto appreciate the less focused retinal light - in Harriss terms, a wider

bandwidth. This programming of the scanner sets the stage for thepatient in their mind to look and do less and see and feel more.This means they learn to rely more on feeling what they are looking atthus perceiving less from their analytical looking. In the long run thisactivates less myopic and more movement toward hyperopic behaviour.

The patient can then discern what their true nature is versus theirconditioned personality. Is it possible that myopic behaviour is part of aconditioning process that takes the person away from being their trueself? By reducing the compensating lens prescription we are assistingthe patient in realising what their conditioned behaviour is. In addition,the integrated vision therapy practices of expanding perception, toinclude retinal feeling, guides the patient out of their survival foveallooking.

TYPES OF NEARSIGHTED PATIENTSFrom my clinical experience three kinds of myopic patients have beenidentified:

i) Logical thinkerThis person is more entrenched in their myopic behaviour.They are very


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fast in their thinking and talking. They tend to have their own answerswell constructed from mental reasoning and are fixed in the way theywant to handle their vision care. These persons will more than likelyfollow conventional vision care desiring maximum visual acuity and will

not have time to talk about options like not-so-obvious, except perhapscorrective surgery, because they have read about it. From my experience,it is best to treat these patients in the normal way with full minus

prescriptions.However, I examine the subtle levels of binocular vision. I demonstratethese breakdowns of binocularity with the full minus lenses in place tothe patient to illustrate that there is more to vision than just visual acuity,diopters and sharp eye sight. This is a preparation for when the logicalthinker one day in the future shifts their perceptual attitude to level ofthe fitness thinker.

ii) Fitness thinkerThe fitness thinker has had an internal experience where they recognisethat they have control over how their body functions and behaves. These

patients have modified their lifestyle and are better taking care ofthemselves. They read books on topics of health and fitness. Theyexercise more regularly and eat healthier food. The patient may ask

whether there is anything they can do for their eyes. Are there exercises Ican do to help my eyes? The fitness thinker is an excellent candidate fordeeper visual examination of their binocular system. In most cases areduced lens prescription can be prescribed in addition to their fullcompensating lenses. (Reference 17) Once this patient has worn thefitness lens prescription then more than likely they will over time

become a transformer, and move into level iii).

iii) Transformer thinkerThese myopic patients have been through the spectrum of wearingeyeglasses and contact lenses and reach the point where they say theycan no longer tolerate their contacts and/or their strong glasses botherthem. At first glance it may appear that a simple lens modification would

be the answer for this level of patient. Generally this is not the case. Thetransformer has involved themselves in personal development


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experiences that has led to a fundamental change of what is happening inthe not-so-obvious, the software of their mind. This creates a veryinteresting and usually frustrating clinical dilemma.

The transformers visual acuity is unstable and their dioptric findings aremore difficult to pin down. In a busy practise it can be easy to dismissthe transformer as a malingerer who is unable to pay attention to yourinstructions. I have learned to love these challenging patients. They offerme the excitement and opportunity to expand my vision of what is

possible when I consider the not-so-obvious.

The transformer is in a state of change. The research of visual changes inmultiple personality disorders (MPD) implicate that the transformersfax of the changeable eye findings means they are in the process ofmodifying their software and programming in their minds. As cliniciansit becomes prudent to consider lens prescriptions for the transformer thatassist them in seeing in their new way.

Generally, this means to reduce the minus to maximum binocularity aswell as to an acuity level, usually 20/40, where the light is less focusedon the fovea. This approach lets the transformer think less and see and

feel more. This helps them guide their lives and transform it to matchtheir true nature not their conditioned thinking. If the prescription isrelatively equal between the eyes vision therapy for binocularity andfusion can be started. In addition, emphasis on peripheral awareness andmovement can be included. Also, be prepared to set aside time to talk tothe transformer. They will have lots of questions and I arrange anintegrated vision therapy appointment time for these moments,especially when they begin to feel more deeply.

This classification of myopic patients can help identify the best methodof approaching the management and treatment options. Vision therapyoriented optometrists recognise that much of their practise involveseducating patients about the

positive outcomes of vision therapy. The logical thinker with gentleguidance can become a fitness thinker, and with experience and time,


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become a transformer. This is a way to increase the number ofnearsighted patients who are willing to undertake a corrective approachto their myopic behaviour.

SUMMARYThis article looks at the alarming increase in nearsightedness in personsliving in countries where education is emphasised. It is clear that theobvious treatment of minus lenses does not appear to be correcting thenearsightedness in the eye. A not-so-obvious approach of integratedvision therapy is proposed to correct the myopic behaviour. The inputand output system of vision is revisited in the form of a computer,scanner, facsimile and software analogy to explain the inter-relationship

between the eye, brain and mind.

A different analysis of the retinoscopic findings is presented as a way tohave a glimpse into the deeper world of the patients myopic way ofsurvival thinking. In addition, modified minus lens prescriptions can beconsidered that help the patient construct new perceptions that disembedtheir myopic behaviour.

Three types of nearsighted patients have been identified. Varying

treatment options have been outlined to alter the myopic behaviour inthe patients brain and mind. Clinicians are encouraged to adopt a

broader and integrated approach to vision therapy. In this way modifiedlens prescriptions can become a true corrective therapy. This will changethe current primary care method where full prescriptions further embedmyopic behaviour.

It is the integration of retinal and foveal driven light that leads to a

balance in the brain. Integration is necessary in order to construct a fullpicture of reality. Seeing beyond the obvious, is a life process thatdeeply transforms myopic perceptions. The patient is helped when wemodify the lens prescription and guide them in changing their myopic

patterns of behaviour via integrated vision therapy.

Perhaps including the not-so-obvious approach with the obvious will


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help alleviate the epidemic of nearsightedness so prevalent in our worldtoday. Is it possible that to look and see in a broader and more integratedway will help in creating a peaceful way of seeing more deeply thechallenges of the world. Can this depth of perceiving into self and others

lead to less need for terrorism and war?

REFERENCES

1. Schaeffel F. Howland HC. Properties of the feedback loopscontrolling eye growth and refractive state in the chicken. Vision Res.1991 31: 717-34.

2. Troilo D. Wallman J. The regulation of eye growth and refractivestate: an experimental study of emmetropization. Vision Res. 199131:1237-50.

3. Grosvenor T. Perrigin DM. Perrigin J. Maslovitz B. Houston MyopiaControl Study: a randomized clinical trial. Part II. Final report by the

patient care team. Am J Opto. Physiol Opt. (3PJ), 1987; 64 (7): 482-498

4. Zylbermann R. Landau D. Berson D. The influence of study habits on

myopia in jewish teenagers . J of Ped Ophth. & Strab. 1993:30(5):319-322

5. Gwiazda J. Bauer J. Thorn F. Held R. A dynamic relationship betweenmyopia and blur-driven accommodation in school-aged children. VisionRes, 1995 35(9):1299-304

6. Gallop S. Whats so great about 20/20? or The plight of

nearsightedely-challenged individuals. J Behav Opto. 2001 12 (2)

7. Lam C.S. Goh W.S. The incidence of refractive errors amongschoolchildren in Hong Kong in relationship with the opticalcomponents. Clin Exp Optom. 1991 74:97-103

8. Lin L.K. Chen C.J. Hung P.T. and Ko L.S. National- wide survey of


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myopia among schoolchildren in Taiwan. Acta Ophthalmol. 1988185:29-33

9. Shotwell A.J. Plus lenses, prisms and bifocal effects on myopia

progression in military students. Am J Optom Physiol Opt. 1981;58,349-354.

10. Shotwell A.J. Plus lenses, prism and bifocal effects on myopiaprogression in military students. Part II. Am J Optom Physiol Opt.1984;61, 112-117.

11. Tay M.T. Au Eong K.G. Ng C.Y. and Lim M.K. Myopia andEducational Attainment in 421,116 Young Singaporean Males. Ann AcadMed Singapore, 1992 ;21(6):785-91

12. Leung J.T. Brown B. Progression of myopia in Hong Kong Chineseschoolchildren is slowed by wearing progressive lenses. Optom Vis Sci2000; 76:346, 354

13. Kaplan, R. M. Seeing Without Glasses. Hillsboro Oreg.: BeyondWords, Third Edition 2002

14. Puttman F. s research reported in Brain Mind Bulletin, October 3,1983 ;8, (16), 1 - 2

15. Kaplan R M. The Power Behind Your Eyes, Healing Arts Press,Rochester, Vermont. 1995.

16. Kaplan RM. Light, Lenses and The Mind -The Potent Medicine ofOptometryJ Optom Vis Dev. Autumn, 2002; 22 ( 4); 153-160.

17. Kaplan R M. Conscious Seeing, Beyond Words, Hillsboro Oregon,2002

18. Harris P. The Binocular Continuum. J Behav Optom. 2002; 13 (4).


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19. Orfield A. Seeing space: Undergoing brain re-programming toreduce myopia. J Behav Opto. 1994; 5 (5)

__________________________________Correspondence regarding this article should beaddressed to Roberto Kaplan, OD, FCOVD,

Post Office 68,

Roberts Creek B.C. V0N2W0

Canada.e-mail: [email protected]

__________________________________________________________

Common Law Copyright 2003 - 2010 Roberto M. Kaplan. - AllRights Reserved

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What We Think We Know About Myopia 1