Chapter 11
MYOPTER CASE HISTORIES AND MYOPIA REVERSAL
To illustrate the kind of results that can be obtained by using these myopia prevention methods, let us look at actual records from the office of a prevention-minded optometrist.1 These examples show what can and should be done by every vision specialist.
The previous section on bifocals detailed how myopia progression could be slowed by the use of bifocals alone. The following case histories are from a practice where both bifocals and the Myopter are used in order to get the maximum effect and stop the progression of the myopia completely.
The following treatment was used both for those patients who were approaching myopia and those who had already developed myopia. If those children who have already developed myopia have not progressed beyond about one diopter, the method often results in regaining 20/20 vision. Those children who have passed one diopter of myopia may not attain 20/20 vision because of the stretching that has taken place in their eyes. Nevertheless, their myopia can still be halted and reduced.
A bifocal is prescribed for school use. The upper half is plano and the lower half is an undercorrection (or "add") of at least 1.25 diopters. For homework or other reading at home, a Myopter viewer is prescribed with lenses that totally eliminate accommodation for close work. The child is told to wear the instrument at least one-half hour each evening, and longer if possible. The child is instructed to hold the book beyond the far point so that it is slightly blurred. By eliminating accommodation, convergence, and stereopsis, the instrument provides a period of time each day for what could be called "active relaxation."
It was felt that if the child has already moved into myopia when treatment is started, halfway measures are not sufficient to reverse the condition by relaxing the ciliary spasm. What the child needed at this point was a strenuous program such as: 1) the Myopter for all close work, or 2) a bifocal in school and the Myopter at home. Then when the ciliary spasm has been removed (this might take weeks), the strenuous measures could be relaxed somewhat. The child could then be given a choice of: 1) a bifocal in school and at home, or 2) nothing in school and the Myopter viewer at home. One of these measures was felt to be sufficient to retain the improvement and prevent regression.
The logic of the second alternative is that the Myopter viewer provides such a strong relaxing force that it can sometimes counteract any tendency toward the development of a ciliary spasm that may have developed during the day's schoolwork. Naturally, the validity of this statement is dependent upon how much close work is done at school and how much use is made of the Myopter viewer in the evening. Different methods will be needed for different individuals. The idea is to have the eyes fully relaxed by the end of the day so that the next day's schoolwork can be done without adding on to the close-work stress of the previous day.
The exact procedure must be tailored to the individual. A child who reads extensively and has been progressing rapidly into myopia will need every weapon available. A child who does not read as much and has not progressed very rapidly can get by with less elaborate measures. Of course, good reading habits are stressed in every case.
If children were given the kind of eye care they should have, those who were found to be approaching myopia would be given treatment before the myopia actually develops. In many of these cases, nothing more than a bifocal would be needed.
The object of this program is to reduce accommodation to the greatest possible extent. Improvements of up to 1.25 D have been obtained by this method. In other words, a ciliary spasm can amount to as much as 1.25 D, and it is possible to eliminate this much myopia by relaxing the spasm. It is also important to remember that even if these methods do not completely prevent myopia in every individual, no harm has been done. The real harm to the eyes is in the use of concave lenses.
Of the many children who have benefited from this myopia control program, a few representative case histories will he given. These cases fall into two groups.
GROUP A: Myopia Prevention by Ciliary Muscle Relaxation.
These are patients who were treated before they became myopic. Since
these patients were not yet appreciably myopic, it was more a
question of increasing the hyperopia than of decreasing the myopia.
In other words, as the ciliary muscle relaxes, the patient becomes
slightly more farsighted and is less likely to move over the zero
point into myopia. This is the type of preventive treatment that all
children should receive.
Case 1: Erin C., female, student. The patient was first seen on January 19, 1974 at age five. Since both parents were highly myopic, they wanted to take steps to prevent the same thing from happening to their children. At the time of the first examination, the patient was still 0.5 D farsighted. No prescription was given. When next seen, on March 29, 1975 at age six, the patient's refraction was:
In other words, the patient was just at the point of passing into beginning myopia. She was given a Myopter with +2.50 D lenses for her close work. Six months later, the patient had regained a small cushion of hyperopia. A bifocal was prescribed that contained a plano upper segment and a +1.25 D add for reading. On April 24, 1976 at age seven, the patient's vision showed no change. Both the bifocal and the Myopter viewer were being used at various times.
Case 2: Vince C., male, student, brother of E.C. (Case 1). He was first seen on January 3, 1972 at age four. There was no myopia at that time. On December 29, 1972 at age five, the patient's refraction was:
On January 19, 1974 at age six, the patient was approximately pIano in both eyes. On March 29, 1975 at age seven, the patient showed slight myopia. A Myopter viewer and a plano/1.25 D bifocal were prescribed for close work. On April 24, 1976 at age eight, the patient had regained a small cushion of hyperopia. Continued use of the viewer and bifocal was prescribed.
GROUP B: Myopia Reduction by Ciliary Muscle Relaxation.
These are patients who had low myopia and who could be treated
successfully merely by relaxing the ciliary spasm.
Case 1: Maureen B., female, student. The patient was first seen on September 11, 1974 at age nine. Her spectacle Rx (the eyeglass prescription required to attain 20/20 vision) was:
The patient wore a Myopter viewer with +2.00 D lenses for all close work. She was checked every four weeks and at the end of six months was 20/20. She continued using a bifocal for all close work and held steady at 20/20. The bifocal was plano for distance with a +1.25 D add.
Case 2: Penny H., female, student. The patient was first seen on July 6, 1974 at age ten. Her spectacle Rx was:
The patient was given a Myopter viewer with +2.00 D lenses for all close work. Four weeks later, the Myopter lenses were changed to +2.25 D. On September 8, 1974, the Myopter lenses were changed to +2.50 D. After using the instrument for another four months, the patient reached 20/20. She was then checked once a month and stayed at 20/20.
Case 3: Luanne A., female, student. The patient was first seen on August 27, 1974 at age fourteen. Her spectacle Rx was:
The patient was given a Myopter viewer with +2.50 D lenses for close work. On September 21, 1974, an office visit showed no improvement so the Myopter lenses were changed to +3.00 D. Four weeks later, the patient's vision had changed to:
On February 15, 1975, the patient's vision had reached 20/20. She continued using the plano bifocal with a +1.25 D add for all close work. This held her vision at 20/20.
Case 4: James H., male, student. The patient was first seen on May 20, 1974 at age eight. His spectacle Rx was:
The patient was given a Myopter viewer with +2.00 D lenses. Two months later, his vision had improved to:
At this time, the Myopter lenses were changed to +2.50 D. The patient's vision was checked again on September 28, 1974 and had improved to:
The patient was checked every six weeks and on March 15, 1975 he reached 20/20. He continued wearing a plano bifocal with a +1.25 D add for all close work.
Many similar cases could be given here. The method is simple and effective, and works on virtually every child who follows instructions. In the above cases, the myopia was of a low degree and the children were able to regain normal vision. Patients with higher amounts of myopia can expect vision improvement but not total elimination of the myopia.
Since this study was done, pinhole glasses have become available on the market, after being suppressed by the eye doctors for decades. They are now recommended instead of reading glasses or bifocals because of their simplicity and low cost. There is no need to calculate in diopters and go to an eye specialist or opticial to buy reading glsses. Pinhole glasses will be described in a later chapter.