Who Knew? Bifocals Retard Myopia After All
January 25, 2010
A good study in Archives demonstrates that executive bifocals (+1.50) do retard myopia in fast-progressing myopes among children. After 2 years, axial length was .62 and myopia about -.50 more in the single vision compared to bifocal group- statistically significant, and if true over several years, very important to public health. Time to re-think bifocals and apologize to the optometrists.
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48 Responses to “Who Knew? Bifocals Retard Myopia After All”
In their conclusion, the Archives’ authors stated their concerns that randomization was not performed properly and the study was not adequately masked. Was this study really better / as good as previous studies (which discounted bifocal effects on myopia)?
The Archives article suggested that base-in prism was not useful for retarding myopia in their study. Has this conclusion been accepted by other VT practitioners? If not, what is the mechanism by which base-in prism might work? (The Archives study showed no effect on axial length.)
“so, again- considering that i started this thread apologizing to the optometrists for belittling bifocals all these years, i hope i will be granted the benefit of the doubt that despite the unfortunate breakdown in decorum, that my intentions are honorable and serve only to promote the art and science of eye care.”
See, I don’t see why you feel the need to apologize for “belittling BF all these years” (unless you did it in such an unprofessional manner that you simply demeaned yourself and your profession). As long as you presented a perspective based on uncertainty (i.e. lack of clinical data), you committed no crime.
As far as losing one’s objectivity, I think back to the poo-poohing MDs delivered to those who advocated vitamin/anti-oxidant supplementation (you know, the “expensive pee” line). Was THAT balanced? Was THAT justified? I think we all know the answer.
It’s not about being wrong or right, it’s about EXPLAINING what is known and not known, and providing proper information so the patient can give their informed consent. In the end, it’s not MY decision, or YOUR decision, but the patient’s: as long as we provide a balanced perspective upon which the patient can make a proper decision, then we’ve done our job.
As you point out, the best approach is simply to say that in lieu of clinical data to support any therapy or methodology, the best approach is to remain judgment-free, and admit that there are some answers which we just don’t have. I know, it’s hard for most ‘experts’ to utter the phrase, “I don’t know”, but sometimes it IS the truth.
So aside from sticking to known basic principles (“all things in moderation”, “the dose makes the poison”, “we don’t know how these substances interact with your Rx meds”, etc), perhaps it’s best to acknowledge the fact we don’t know it all (even in the year 2010!), and should avoid rhetoric so we don’t need to supplement our OWN diets with ‘crow’ in the future.
Ari,
I do appreciate the offer to join the blogging team. Seriously. I have passed the offer along to my colleagues. Normally, I would love to blog under the Eye Doc News banner. I have been blogging for about five years and would like the challenge and diverse readership.
However, after witnessing how unprofessionally this blog is edited and moderated, specifically in the LACK of rules or guidelines, I would not consider it. I hope some other OD does.
Good luck, Ari.
-Nate
although i am the medical editor of eyedocnews, this blog is not “mine” but is run by another party. there are no official rules here- just common sense, and so if the postings veer off too much from the debate, especially if they degenerate into ad hominem attacks and goading, then those posts are simply deleted. the last several posts were deleted for this reason.
i take some responsibility for the breakdown of decorum here- some, but certainly not all! i can be very opinionated, and perhaps in a forum like this, i should choose my words a little more carefully. i have never, ever been accused of being politically correct. i detest political correctness, and prefer to be utterly blunt, but on this blog, it looks like i have to practice some.
i don’t back down from the substance of my remarks- sorry nate! certainly, some good valid points were made by defenders of vt, but overall, i disagree strongly. but as a scientist, i never assume i cant be proven wrong, and just as i started this thread apologizing to the optometrists for their good hunch about bifocals, i am happy, as a scientist, to eat my words about vt if it is ever proven (to my satisfaction- which is part of the problem, actually) to be of any use in those with learning disabilities (the definition of which is frustratingly vague in my opinion).
so, again- considering that i started this thread apologizing to the optometrists for belittling bifocals all these years, i hope i will be granted the benefit of the doubt that despite the unfortunate breakdown in decorum, that my intentions are honorable and serve only to promote the art and science of eye care.
i got the last word- i know that’s not fair, but it’s a small privilege when one is the medical editor! thus endeth this thread!
how about this- it might be interesting to have some of you optometrists contribute to this blog and start your own threads. we ophthalmologists are pretty weak in optics, contact lenses etc., and i think it would be great if optometrists contribute to this blog along with the ophthalmologists and ophthalmology consultants we have now. if interested, let me know, and i will speak with my partner who runs this blog.
this thread has veered wildly off topic, and we are just yelling past each other at this point, so the editor has deleted some of the thread, and i will no longer comment on this thread, as i personally find it frustratingly non-responsive ( as i’m sure you do as well!), and i regret losing my temper at my colleagues, or if i wrote anything offensive. im sure we will have opportunity to debate on future topics!
MDs are immune to trends in health care? Say it ain’t so?
Need I remind anyone of RK, where the fervor reached such a height that patients were flying to Russia to be treated on a conveyor belt by Dr. Svyatoslav Fyodorov?
You mean NO ONE suspected that cutting thru 90% of a patient’s corneae MIGHT have been a bad idea, such that today we feel compelled to warn these patients that their eye might rupture due to airbag deployment, etc? We ALL know many of these patients are referred to behind their backs by doctors as “wrecks”?
Dare I mention the ‘revolution’ of treating with frontal lobotomies, which have devastated many a patient? Never mind these were performed as recently as 1980’s? Wow, couching for the brain: hate to sound sarcastic, but you’ve come a long way, baby!
Granted, I suppose a moment’s thought might come up with more contemporary examples (ritalin kids, anyone?), but these two should suffice.
I’m Not suggesting ODs are to be excused for doing the same with VT, but it certainly seems MDs have much dirty laundry hidden in THEIR closet. Glass house anyone?
Ari,
Until you cite some double-blind, placebo controlled studies to back up your wild, tin-foil hat diatribes, I’ll consider it anecdotal and dismiss it.
Fair?
And of course, your offer, “i’l make it easy for you – forget double-blind.” is a total farce and you know it. After all the raving about double-blind, the minute we produce the new, more lenient study, you’ll revert to your old standard and retain your current mindset that we are scammers and snake oil salespeople. Yes, we are doing our research for the inherent value in it, but not because we think it will convince people like you. we are more realistic than that.
And finally, what beef do you have against the English language? The common belief is that a cultural change due to texting and tweeting is ruining the English language amongst the youth. Yet here you are, a doctor, authoring what purports to be a medical blog that is not spell-checked or proofread or even has a single capital letter written by you in the comments that I can find. Man, society really is in trouble if even MDs can’t write.
-Nate
