Chapter 19
SAVE YOUR CHILD FROM A LIFETIME OF CRUTCHES

With the knowledge you have gained from this book, you know more about myopia prevention than your doctor. So, why do you even need the "advice" of an eye doctor? The information given below will guide you in the steps that will save your child's vision. Although written from a parent's point of view, the same plan applies to any adult whose vision is still getting worse.

Normal and abnormal. Children are born with a considerable amount of farsightedness which is intended to automatically diminish with time and finely adjust the eye's refraction as they learn to focus on the world around them. It diminishes because the constant focusing effort for all distances causes the eye to lengthen. Excessive close work causes the eye to continue lengthening through the point of normal vision and into myopia. When your child's refraction has diminished to +0.5 diopters, it is time to take action, because the ideal refractive status is between +0.5 and 0 diopters. A minus refraction, indicating myopia, is abnormal. To determine this refractive status, you have the option of going to a vision specialist for an eye examination. But this costs money, and you will have to confront the doctor to insist that dilating eye drops are not used. Of course, if you suspect that your child has other vision problems than the possibility of becoming myopic, you should see the proper specialist. If your child's eyes do not work together properly, always consult an optometrist skilled in vision training. If you consult an ophthalmologist, you may be talked into unnecessary surgery as the only option. Numerous children have died while undergoing such surgery.

Vision Testing. Let's assume you wish to avoid the doctors and do as much as you can yourself. To test visual acuity you can purchase the usual eye chart or make your own. To make one, cut letters of different sizes from a newspaper and paste them on a white background. Choose letters 3/8" high for the 20/20 row. This is really all you need, but if you want to add more rows, the letter sizes are: 5/16" for 20/15, 5/8" for 20/30, 3/4" for 20/40 and 15/16" for 20/50. Mount the chart against a vertical surface, put a good light next to it and place your child 20 feet away. If the child can read the 20/20 row with each eye separately, that is normal vision. To tell if the child still has a cushion of +0.5 diopters, just hold a lens of that power in front of each eye while covering the other eye. If the child can still read the 20/20 line, there is at least 0.5 D of farsightedness remaining. If the line is a little blurred, the child's refraction probably lies between +0.5 and 0 and preventive action is called for.

Test Lenses. The obvious question is where to get a +0.5 D lens. You could use cheap off-the-rack reading glasses except for the fact that they usually start at +1 or +1.5 D. You could go to an optical shop and try to buy an uncut lens, but you would spend a lot of time explaining why you needed it and why you didn't have a prescription. The easiest solution is to go to the myopia.org Web site and order a Myopter lens of that power. This can merely be held in front of the eye when testing. However, since the lens is only 20 mm in diameter it will be easier to hold if you make a holder. Cut a 2" by 4" rectangle from a heavy corrugated cardboard box. Round off the corners. Lay the 20 mm lens 1/2 inch from one end and outline it with a pen. Then, using a sharp penknife, razor blade or curved scissors, cut a hole in the cardboard. Push the lens into the hole, add a little cement or tape if needed, and you have a convenient vision tester.

If you wish to monitor more closely how your child's vision is developing, you can go a step further and order several different lens powers, such as +0.5, +1.0, and +1.5. Then record the strongest lens the child can tolerate without seeing a blur at distance. Plot this on a chart periodically and you can extend the line ahead in time and determine when the child's vision is likely to pass the zero point into myopia.

Fig. 1

The chart in figure 1 shows a child whose vision has been tested every three months. Some children need to be examined more frequently than others depending on how their vision is changing. It is quite common for children to become more nearsighted (or less farsighted) at a rate of 0.5 D per year or even faster. Note that the child's natural farsightedness diminishes steadily except during the summer months when the close work is at a minimum. This seasonal difference would obviously be difficult to explain with the hereditary theory.

The dotted line indicates the probable course of the child's vision as predicted after the last examination. In other words, the child can be expected to become myopic in the near future. Preventive measures should be started before this happens, preferably while the child still has at least 0.5 D of hyperopia remaining. Plot your own chart (one for each eye) if your doctor or school does not.

Reading Glasses. There is no ideal preventive treatment that applies to everyone. One child may read a lot in school but not at home. Another child might do just the opposite. So here is a plan that you can use as a starting point and modify according to your own situation. Reading glasses are the first choice in preventing myopia. They should be used as soon as the child has used up the infantile farsightedness and is moving into myopia. For such a child, this usually means +3 lenses. They should be used for all close work. Ideally, the book should be held far enough away so that the print is slightly blurred. Lower power plus powers are suitable for those who are already myopic.

While reading glasses can be purchased off-the-rack in stores for a low price, those are suitable for adult-size heads. The distance between the lens centers conforms to the usual distance between the pupils of adult eyes, around 64mm when looking into the distance and 60mm when reading. If such glasses are used by young children, who have a smaller interpupillary distance, the Prismatic Effect of the lenses causes increased convergence. This can cause problems such as double vision and should be avoided.

Any optician should be willing to measure your child's eyes and sell you a pair of reading glasses in a small frame, but they sometimes refuse to do it. If they say you need a prescription, tell them that reading glasses can be bought in drugstores without a prescription. Or say that you are a scientist conducting an experiment! If they still give you a hard time, go somewhere else. And rather than pay inflated prices for a frame, you can buy a pair of kids' sunglasses in a store and then take them to an optician and only pay to have the plus lenses inserted.

The distance between the child's pupils should be measured when the eyes are converging on a book. Ideally, the centers of the eyeglass lenses should not be any farther apart than that distance. As the child grows, the pupils will become further apart than the optical centers. There is no harm in this because the prismatic effect of the plus lenses will then REDUCE the convergence required.

Some people may have a problem with this technique. If they have weak convergence, they may find that without the assistance of accommodation they feel their eyes "pulling" or even see double. Such people are perfect candidates for the Myopter, which eliminates convergence as well as accommodation.

The Myopter. The Myopter with appropriate plus lenses should be used for all close work at home. The book should be held far enough away that the print is just slightly blurred. This technique of reading at the far point FORCES the eyes to relax and should undo the stress that has built up during the hours spent in school, so that the next day's schoolwork can begin without building on a ciliary spasm from the day before. It should also eliminate any ciliary spasm that may be present and thus could reduce the myopia by a diopter or more. Of course, wearing the Myopter at school when reading would be ideal.

Your role. Some people have stated that children won't accept the minor inconvenience of using this somewhat bulky device even at home. But, when children have been adequately informed of what is at stake, will they really choose instead the inconvenience of a lifelong dependence on glasses to see and the increased probability of eye disease? Point out a few people with thick glasses and ask your child if it isn't worth a little effort to avoid needing such glasses to see.

By means of this book, I hope that a new expression, Myopia Prevention, will be added to our daily vocabulary. It is time to bring to an end the exploitation of the people and enter a new era of vision care.