Dear Prevention minded friends,

Subject: There will never be a "perfect" solution to
myopia PREVENTION.

(Names changed to protect this person.)

Jon contacted me about a year ago.
His vision was -1.5 diopters and about 20/60.

He "cleared" to 20/20 -- spending time out-doors.

He is now at 20/30, which exceeds the DMV level test of 20/40.

What concerns me is that he completely understand the records
at West Point, that the "un-protected" eye will go
down by -1.3 diopters average (-1.6 diopter max).

This implies that retaining 20/40 or better REQUIRES
the continued use of the plus.

Here is the discussion.

Best,

Otis

Dear Jon,

Subject: Keeping your distant vision in the "normal" or
"protective" range through college.

I deeply appreciate your reports on your vision variation. I
believe you are working to the very-reasonable standard of keeping
your vision at 20/40 or better.

As you know, in summer, as "lived" outdoors your vision would
clear to 20/20. I believe that by keeping your vision at 20/40 or
better doing the winter months, will allow you to "improve" to
20/25 or better doing the spring when you can get outside and play
tennis and other out-door sports.

We are both aware that the "un-protected" eye will go "down"
at a rate of 1/2 diopter per year, and the "deeper" purpose of
your effort is to avoid getting "in to it".

I would also be interested in your OD-exam. I believe there
should be a "medical" part (i.e., detached retina, glaucoma -- and
other medically serious issues), and a "refractive" part.

Please remember that these "exams" are done in semi-darkness,
and are only "realistic" -- at dusk. This tends to create an
"over-prescription" of from -1 to -1.5 diopters.

Should this "happen", just go home, and re-certify that your
visual-acuity is better-than 20/40.

Some additional commentary:

+++++++++++++++++++++++++++++

Dear Jon,

Jon > I tested my vision tonight, and found that my vision has
gone down.... a little. I read 1/2 the letters on the
20/30 line.

Otis> I think personal verification is crucial for any "vision
protecting" effort -- as you are now doing it. This means
you see the "ups" and "downs" of your vision. This
information is VERY VALUABLE to me -- so I appreciate these
scientific reports.

Jon > I had no problem with the 20/40 line. I noticed just in the
past week, for some reason things are a bit harder to see.
I believe because its winter and i am inside more... and
the biggest is school.

Otis> I agree with you. 300 years ago, we would spend 3 to 6
years in school, and then go out and "work", sailing,
hunting, fishing, farming. Almost all eyes had a positive
refractive status (from zero to +2 diopters) and there was
virtually no serious negative refractive state. Now we are
spending 16 year in school!!! The "design" of our eyes
indicate that they have "limitations", and that we must keep
them "out-doors", for that 16 years we spend in school and
college. That is the "price" we pay to keep our distant
vision. Though difficult, I think that it is worth it.

Jon > O well... i will do what i can. I'm wearing the plus lens
at home most times when i do close work.

Otis> As always, no one can "tell" you what to do. That is a
unique quality of your intellect. Obviously the millions
who are now seriously myopic -- which they had your
"situation". Just keep wearing the plus as Keith did -- and
keep your chart above 20/40. Not easy, but reasonable. A
fighting chance indeed.

Jon > My main goal is to keep from crossing the 20/40 line. as
long as i stay on the good side of it, i am happy.

Otis> I am pleased that you make that judgment also. By doing
this, I believe that you will keep your vision through the
college years, when your friends enter into this -1.3
diopter "down" movement for the four years they spend in
college.

Jon > I have an appointment with the OD tomorrow....it will be
interesting.

Otis> I agree with you. (I will send you some remarks on the
so-called "Best Visual Acuity" standard -- and its
consequences after your OD exam.) He is never going to
understand what you are doing -- and why you are doing it.
But they are your eyes -- not his. And you are the one who
wishes to keep his distant vision "clear" through the
college years. Keep me "posted" as to your activities and
your "thinking" about these efforts. They are of great
value to both of us.

Sincerely,

Otis

Jon