The United States Congress, on August 16, 1968, passed Public Law 90-489, authorizing the establishment of a National Eye Institute as part of the Federal Government's National Institutes of Health. The mission of the institute, as specified in the law, is to "conduct and support.... research for new treatment and cures and training relating to blinding eye diseases and visual disorders, including research and training in the special health problems and requirements of the blind and in the basic and clinical sciences relating to the mechanisms of the visual function and preservation of sight." The NEI has failed in its mission.
It is becoming widely accepted in the vision research community that the cause of acquired myopia is environmental rather than genetic. That is, the cause is prolonged accommodation on close objects such as books and computer screens. It follows that the way to prevent myopia from developing is to eliminate this accommodation to the greatest extent possible.
In recent years, numerous studies have been carried out in which children were provided with bifocals that contained an undercorrection for close work. But, almost without exception, these studies fail to show that this method works. The reason for this is that the studies are flawed from inception. In fact, they are designed to fail so that the proponents of the inherited myopia theory can point to them and claim that myopia cannot be prevented.
Although myopia and its complications are a major concern around the world, it is not listed as a separate research funding category in the Clinical Studies Database. This database is divided into six "Disease Program Areas." Since myopia is NOT a disease but a refractive "error", myopia doesn't belong in ANY of these Program Areas. It is not even mentioned in the title of the category where it IS buried, "Strabismus, Amblyopia, and Visual Processing." And there are only four projects mentioned in that category that pertain in any way to myopia. These are completely invented non-issues that are only being used to fool the public into believing that myopia research has not been totally ignored. This is called "lip service", "window dressing", "junk science" or "token research" by those who know what is going on.
The first of these, the Correction of Myopia Evaluation Trial (COMET), clearly illustrates these flaws. Children were given progressive addition lenses (PAV) with a full correction for distance and a two diopter undercorrection (+2 add) for near work. The control group got only a full correction to be used at any distance. The results were disappointing. Over a three-year period, the PAV group moved into myopia only 0.20 diopters less than the control group. This is almost an insignificant difference.
Note that "correction" is the first word in COMET. Nowhere in the published analysis of this study is the word "prevention" mentioned. It is all about "treatment" to slow myopia progression. This gives a clue to the intention of the study designers. When people wear glasses, they are "correcting" their visual problem. But in the case of nearsightedness, astigmatism, and juvenile farsightedness, this action tends to lock the defect on the eye. Or, in the case of nearsightedness, make it worse.
Two different reports on this study were published in an ophthalmological journal, one in 2003 and one in 2004. When the 2003 report was issued, the NEI issued a Statement giving its interpretation of the results. Unbelievably, although the study produced some positive results, the NEI stated that no changes were called for in the way myopic children are treated. Then the researcher analyzed the data from another viewpoint and found a substantial benefit to some of the children, in spite of the flaws in the study. This analysis was published in 2004 but has not been mentioned by the NEI. In a sense, the study backfired on the NEI, since it was intended to show no benefit from plus lenses.
The 2003 published report for this study can be read at 2003 COMET Paper and the 2004 report at 2004 COMET Paper. This study is a perfect example of deliberate complication of a simple matter. The result of such studies is usually, "These results suggest the need for further study" (and more reserch grants for the researchers). Note also at the bottom of page one that the study is funded partly by several optical companies. If you think they are doing this for humanitarian reasons, and not to sell more of their products, think again.
This study was touted as the final answer to whether myopia progression could be slowed or prevented, but it failed completely to do what it purported to do for several reasons:
1. It is quite unlikely that the test subjects always looked through the lower portion of the glasses for near work. Unlike presbyopes, who would see a blur if they did not look through the lower portion, the children would see fairly well through any area of the glasses. Computer usage provides an excellent example of this. While they might use the lower portion when looking at the keyboard, looking up at the screen without moving the head would cause the upper portion to be used. The designers of the study MUST be aware that doing this prolonged close work through the upper part of the lens will negate any benefit that might be obtained from the undercorrection at the bottom of the lens.
2. Since there is more distortion through the lower portion of such glasses, particularly toward the sides, the children would have that as an incentive to look through the upper portion.
3. When one realizes that many children literally put their noses in a book, using eight or ten diopters of accommodation, reducing this by two diopters cannot be expected to have much effect. In this and similar studies, no explanation is given of why such a small undercorrection was used. This is a CRITICAL omission.
4. As in other studies, the children were, in effect, given the glasses and pushed out the door. They were given no instruction or guidance about the cause of myopia, why they should always hold the book as far away as possible, why they should not read in poor light, etc. They were guinea pigs, not participants who were actively involved in the experiment.
The reason usually given for this lack of instruction is that, since this is a "blind study", the children are not supposed to know which study group they are in. Giving them any instructions would supposedly reveal this "secret." This is used as a convenient excuse by those who want the experiment to fail. But it should be obvious that the study would still be useful if these instructions were given to both groups. And no real-life prevention program is going to succeed unless the children are properly instructed in the true cause of myopia and how the eyes must be used to prevent it.
5. Page one of the study states that, "At present, mechanisms involved in the etiology of myopia are unclear." What does it matter if the exact mechanism inside the eye is not understood in every detail? What matters is that prolonged accommodation causes the eye to lengthen abnormally. The obvious answer is to prevent that accommodation.
6. The COMET study was essentially a repeat of a flawed 1985 study that was given much publicity: the Houston Myopia Control Study, undertaken at the Houston, Texas School of Optometry. Control groups of children were given bifocals with either a one or two diopter undercorrection for reading. Again, they were given no instruction on good close work habits, etc. After three years, there was little difference between the test groups and the control group. The fact that NEI repeated a failed study shows that they WANTED the new study to fail also. The only essential difference was that progressive lenses were used in the COMET study rather than bifocals.
The second study, Contact Lens and Myopia Progression (CLAMP), was designed to "examine the effects of rigid gas permeable contact lenses on the progression of myopia in children" and to "determine what changes in the eyes cause certain eyes to progress in nearsightedness more slowly." This is nothing but a variation on previous studies that have proven nothing. A major drawback is that rigid contact lenses tend to flatten the cornea, giving the APPEARANCE of reducing or stopping the myopia progression. But if the cause is not eliminated, the eye will still continue to elongate abnormally.
The third study, Trial of Bifocals in Myopic Children With Esophoria, proposes to use bifocals on two groups of children, those who have a latent tendency to converge more than they need to (esophoria) and those who tend to converge less than they need to (exophoria). When these variations in the function of the external muscles of the eyes exist, they are usually of no significance. The plan is to see if there is any difference in the myopia progression of these two groups when they are fitted with bifocals. This kind of frivolous research cannot lead to any significant increase in our knowledge about the cause and prevention of myopia.
The fourth study is the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE). The "Background" information describes what this is about:
The Orinda Longitudinal Study of Myopia (OLSM) was started in 1989 to investigate normal eye growth and the development of myopia in over 1,200 school-aged children to date. Beginning in 1997, three parallel study phases are being conducted. Phase 1 investigates additional factors that may predict the onset of juvenile myopia (accommodative function, peripheral refractive error, intraocular pressure, and school achievement). Phase 2 compares and contrasts the optical ocular components and refractive error profiles of other ethnic groups with the predominantly Caucasian Orinda database. Phase 3 conducts DNA-based studies on the prevalent OLSM myopes and their families to use these phenotypically well-characterized children and a panel of candidate genes to look for evidence of genetic factors. In parallel with the candidate gene association, family material is used in an allele sharing approach to identify loci using highly variable, PCR-based markers.
It is almost unbelievable that tax money is being spent on such NONSENSE. This is a classic example of examining trees and failing to see the forest. It is an ongoing study that is really going nowhere.
The NEI rejects novel and logical approaches to the myopia problem while it funds flawed studies such as the above. To illustrate the NEI's lack of interest in a meaningful study, in 1975 it turned down a grant application for a proposed study called The Pittsburgh Myopia Prevention Study. This study was submitted by researcher Donald Rehm and optometrist Sidney Heller and was based on their successful reversal of myopia in several of Heller's patients through the use of a viewing device called a Myopter. This device eliminated convergence as well as accommodation. This was the first time anyone had shown that myopia could be reversed. Yet, the NEI had no interest in investigating further. Read the actual brush-off letter from the NEI at NEI Rejection Letter Comments.
A logically designed study aimed at myopia prevention would contain the following:
1. Bifocals would not be used because of the above-mentioned limitations. They are also more expensive than single vision glasses.
2. The children would be provided with reading glasses with a minimum add of +3 and instructed to use them for all close work.
3. They would be instructed to hold the work far enough away so that it is slightly blurred (reading at the far point). This insures that no accommodation is being exerted. Furthermore, as the eye tries to clear this blurred image, a relaxing force is exerted on the lens by the ciliary muscle.
4. A full correction for distance would never be given. If distance glasses are needed, they should have an undercorrection of 0.50 to 1.0 diopters to aid in relaxing the eyes. When children are outside playing, they should go without any distance correction at all, if possible.
5. If close work must be done without the protection of reading glasses, the children must be instructed to hold the work as far away as possible and to use plenty of light.
We claim that the NEI is under the control of eye doctors and optical companies which stand to lose billions if myopia is prevented. We claim further that it is misusing public funds in a way that harms the public. For a website that has been created by the optical industry and which details just how they put pressure on the NEI, see Eyeresearch.org. Click on "About the Alliance" and then "Member Organizations" to see all the companies that are directing the work of the NEI for their own profit. They call themselves the National Alliance for Eye and Vision Research. They have even established their office at 12300 Twinbrook Parkway, Suite 250, Rockville, MD 20852, very close to the NEI office in Bethesda, MD. Their interest is maximum profits, not public health.