Dear Keith,

Subject: This OD simply does not "get it".

If you have had 20/20 previously, and the develop
a negative refractive status of -3/4 diopters, after
two year in school, the 20/50 MIGHT be a "medical"
issue or problem.

THAT should always be identified to you (and this
IS the value of an OD exam. However, to assume that
ALL NEGATIVE REFRACTIVE STATES ARE MEDICAL, and MUST
BE CONTROLLED BY EXCLUSIVELY MEDICAL PEOPLE -- IS
A MISTAKE.

I was well aware, that to the person must understand
this issue clearly. That in this case, responsibility
and CONTROL MUST be turned over to the person.
(I know that most people are scared to take this control
for various reasons. But that is indeed the issue.)

That is why it is better that you check you kids eye
chart BEFORE they go to an OD or MD. If you see
that it is 20/40, you can be prepared to hear
that you child needs a -2.0 diopter lens. (Yes,
they over-prescribe by that much!) In fact,
with no medical problem, the child could fly
an airplane -- with that vision. That is why
I "warn" you about this "attitude" they have.

Equally, something must be done, and the
"preventive issue" is difficult as
both of us know.

You are prepared. But you will cross this
bridge when you come to it. If you
keep the kid's heads off the page, they
will probably start getting into 20/40
in junior high school. At that point
you can reason with them (I hope).

At least they can know that they had
an "alternative" that most people NEVER
have.

Here is Retinula's statement and
some of my commentary.


Otis> I think that Judy and Retinula should
> point out to us that we expect
> INSTANT results -- and that we
> would not take "prevention" with the
> plus seriously -- even if they offered
> it. But that would be our problem
> then.

[Comment: What I am suggesting that the person's intelligence and
motivation be respected. Certainly the fact that Steve Leung has
his own child in a plus -- at a refractive state of zero -- should be
part of the second-opinion pitch. OSB]


Ret> ...you keep trying to make it sound so simple-- we just give
people what
they want, we take the easy way.

Otis> Have I EVER stated that prevention was "simple"? I think it
is one of the
most difficult things you could do! I think this is why you had
to do it yourself.


Ret> you are wrong.

Otis> Ret's majority opinion -- again.


Ret> do you know how hard
it is to tell a parent that they need to put their child through
visual training (patching, exercises) and possible strabismus surgery
when they have amblyopia in one eye.

Otis> Ret again missed the point. I stated that a person PREVIOUSLY
had 20/20,
and none of these MEDICAL problems. Is it that hard to state this --
and
tell them about the Steve Leung's second opinion?


Ret> do you know how hard it is to
tell an indifferent patient...

Otis> If the "patient" is indifferent, then you can forget about
prevention. In any
event I DO NOT talk to a person who considers himself a "patient".
See
my statement about separating pure-science issues from "medical"
issues.
Ret does not understand the issue, nor the difference.


Ret> that they need to see an retinal
specialist because they are developing a subretinal neovasuclar
membrane that is threatening their vision.

Otis> Again, this is NOT THE ISSUES. The person previously had
20/20 an not
one of these MEDICAL problems! Boy is this man DENSE.


Ret> do you know how hard it is
to refuse contacts to someone who has worn them but has developed a
degenerative corneal disorder that would be worsened if they wore
contacts again?

Otis> Keith, if you had ignored the intelligent use of the plus --
you would have
needed contacts in college. Then the above could have happened to
you.
This begs the question. The "patient" could have avoided this mess
in the first place by "protecting" his distant vision himself -- under
his own, wise control.


Ret> why don't we just give them what they want-- they
would be happier and we would make more money, right?

Otis> I an not certain what Ret is saying here. I only stated that
he
should inform the parents of the POTENTIAL use of the plus, while
the child was still at 20/40, and could function without the minus.
Money is not the issue. Professional information is the issue.
The PLUS is NOT A MEDICAL TREATMENT! I am sorry
if ANYONE thinks that it is!


Ret> i'll tell you
why-- its our job to tell people what is best for their eye health.


Otis> This is Ret's "GOD" complex. This is why I hate even dealing
with this man.
He assumes that the "minus" is perfectly safe -- a fact that is
profoundly
disproven in direct scientific fact. He then ASSUMES he can over-ride
this scientific proof and DECIDE to put a child in a strong minus --
an
step that will have PERMANENT consequences for that child.
He then says it is HIS job to TELL PEOPLE what is BEST for
their eyes! Total arrogance -- of the most damaging kind.
My eyes are valuable to me. I think these people OWE us
an informed choice -- whether we can "work" that preventive
choice or not. This "attitude" forces you to learn
the science fact that this man totally ignores.



Ret> in fact, we are legally accountable for screwing up if we don't
tell
them the right thing to do.

Otis> i.e., putting a strong minus 2 diopter on 20/40 eye, and
creating
stair-case myopia is the "right" thing to do? I think that it would
be the RIGHT thing to do to discuss this specific issue, and
provide an informed choice. The kids eyes will be permanently
screwed up if he begins wearing that -2.0 diopter lens all
the time. But you will get a dead silence from Ret on that
issue. The is the real meaning of understanding the
"second opinion".


Ret> the problem is, plus lenses have been
proven to be ineffective.

Otis> In a blind study where you do not tell the child to look
THROUGH THE PLUS,
and the do not -- then yes, for that reason alone. "Prescribed" when
the
person does not understand the reason "why", then again yes.
But that is due to the lack of high-quality scientific data -- that
this man trashes. When you understand these issues, the
YOU can prove to yourself that the plus is effective -- FOR YOU --
and that is ALL that matters. But I am pleased
that you are hearing this "majority opinion" attitude.


Ret> thats why we don't recommend them.

Otis> On a pure "medical" level, as per Raphaelson's, "The Printer's
Son"
I would agree. The public is BOTH ignorant and none motivated.
But that is the issue you must resolve. The recommendation
for prevention is made on a scientific level -- not on
Ret's "medical" level. That issue MUST be understood
by anyone who wishes to clear his vision back to
20/20.


Ret> in fact
if we did, we could be liable

Otis> Ret is correct on this point. He just needs to state it
clearly. That he can not support prevention as a PRESCRIPTION
lens. Because if ANYTHING happens (having NOTHING to do with the
plus -- he will get sued, but BOTH the person, his fellow ODs,
AND the OD board. This again spells out why you must make
the "preventive" decision, and why I so totally checked the
safety of it. But to IGNORE to real risks of the minus lens
(i.e., -1/2 diopter per year), and not state them, is
tragic. That is why it takes an intelligent person
to work through the "logic" of this situation.


Ret> for suggesting an unproven treatment
just like the problems your friend Steve Leung is facing.

Otis> Steve is VERY BRAVE. Yes, he had "board action". Nothing
came of it. I suggested to Steve that he always have his patients
SIGN and agreement or "contract" so that they could understand these
issues. This would be very wise for any OD who is offering
the preventive plus to the public.


Ret> sorry to bust your "Raphaelson" bubble.

Otis> Ret has only more strongly explained why, if you wish
to protect your distant vision for life -- with eye-chart and plus --
you
had to be smart enough to do it yourself on a scientific level.

Best,

Otie