Myopia: a modern yet reversible disease

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Posted 09 Aug 2014 in Uncategorized

Here is the video and slide set from my presentation at the Ancestral Health Symposium, August 9, 2014, in Berkeley, California. I enjoyed meeting many of you who were at the conference.  I’d recommend watching the video first, and perhaps follow along with the uploaded slide set in a separate window, since it is  more convenient for viewing references and other details.

(Note: You’ll notice some minor differences in the video and slide versions, as the AV team inadvertently projected an earlier draft rather then the final slides I had provided).

Video:

 

Slides:

Screen Shot 2014-08-09 at 8.45.47 PM

 

Overview of the talk.  For ease of reference, here is slide-by-slide “table-of-contents” summary of the presentation. People are always asking to provide a detailed explanation of exactly what steps to take to improve their vision.  You’ll find this bottom line “practical advice” in Slides 23-36

  1. Title: Myopia: a modern yet reversible disease
  2. My story:   I wore glasses from Grade 10 until 15 years ago. I don’t wear glasses any more!
  3. To reverse myopia, we need to first understand the causes.
  4. Myopia defined.   Myopia can lead to serious problems like cataracts and macular degeneration
  5. The prevalence of myopia has increased by 50-100% since 1970, across all age groups in the U.S.
  6. There is evidence for both genetic and environmental causes.
  7. An 1883 study of military recruits found myopia was much higher in students and merchants than farmers
  8. A 1969 study of Eskimos found that myopia had increased dramatically since Western schooling was introduced
  9. A 2012 study of German students found more than 50% of university graduates had myopia vs. 25% for dropouts
  10. In countries like Singapore and Taiwan, myopia is common among even young school children
  11. There is evidence that certain genes predispose to severe myopia. Copper deficiency induces myopia due to increased scleral wall elasticity.
  12. Cordain found that a high carbohydrate diet and deficiency of EFAs and minerals promote myopia
  13. It appears that a myopiagenic environment (near work) is needed to activate  genetic predisposition to myopia
  14. What is the biological mechanism?
  15. The normal lens changes shape to focus
  16. Myopia progresses in two stages: (1) near work induces lens spasm, causing pseudo-myopia; (2) use of minus lenses temporarily improves distance vision, but leads to eye elongation and axial myopia.  The result of elongation is a need to prescribe stronger minus lenses, in a vicious cycle of ever stronger lenses.
  17. Eye elongation is explained by the incremental retinal defocus theory.  Retinal defocus causes release of neuromodulators that lead to decreased scleral tissue integrity, and axial growth
  18. The IRD theory has been proven empirically in chicks, monkeys and humans using optical reflectometry
  19. How can myopia be reversed?
  20. First, it is useful to understand the framework of hormesis — the beneficial response to low dose stress
  21. Weight lifting is a good example of hormesis and the principle of Specific Adaptation to Imposed Demand
  22. What if gyms had the same business model as optometrists?  They would prescribe exoskeletons to help us walk, but these “crutches” would make us weaker, not stronger.  Lenses are crutches
  23. To reverse myopia with hormesis, we need to use active focus.  That means print pushing and plus lenses while reading, and progressively weaker minus lenses and image fusing for distance activities
  24. To embark on this journey, you must first determine how myopic you are, using a Snellen chart
  25. For print pushing, you need plus lenses only if your myopia is less than -2D. Otherwise use your naked eye
  26. Find the distance (D1) where print is at the edge of focus and (D2) where it starts to blur.  Read between D1 and D2
  27. Move back from your computer or book to stay between D1 and D2. Do this for 2-4 hours a day, taking frequent breaks.  Graduate to stronger plus lenses when you drop below 2D, and continue until you achieve 20/20 vision!
  28. For distance (walking, TV, movies, meetings) buy glasses with a 0.5D reduced prescription
  29. Once your vision gets better, you may notice “double vision” or ghosting.  This is a good sign and something you can use to improve your vision!
  30. Find distant objects with sharp contrasting edges: telephone wires, tree branches, edges of buildings or signs
  31. Focus on the darker of the double image and away from the fainter image.  With time, the darker image will become darker, and the fainter image will fade away
  32. Eventually the double image with fuse into a single crisp image — very exciting!
  33. Most people have a weak eye and a stronger eye with less myopia.  The stronger eye will dominate, so strengthen the weaker eye by patching, shielding or winking shut the stronger eye…until the two eyes are roughly even.
  34. Frequently asked questions
  35. How much time should I spend on print pushing?  Spend 2-4 hours a day while doing routine computer work or reading. This is not a separate exercise, but something you build into daily activity
  36. How long before my vision improves?  Be patient — it’s like exercise or diet and won’t work overnight.  Expect some improvement within a few weeks, but it may take a year or more to clear your vision
  37. Is this the same as the Bates method?  Bates had some incorrect ideas about focusing, but his relaxation techniques can help reduce ciliary strain on the lens (pseduomyopia).  However, his method does not help if you have axial myopia and spend a lot of time at the computer or reading.  Print pushing specifically helps with that.
  38. Does active focus really work?  Check out my blog and forum for success stories
  39. And for the skeptical, here is a page of references on the epidemiology and causation of myopia
  40. And more references on methods and websites that provide a similar approach to mine
  41. Your eyes are adaptive organs which allowed them to become myopic, but you can use that same adaptability to reverse the process using active focus for both near and far activities
  42. Rediscover your natural vision — make it fun, make it a habit, make it a game.  You only have your glasses to lose!

Also be sure to check out these related posts and discussions:

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32 Comments

  1. Woody

    Hey Todd!

    I am myopic, and have 20/20 vision in my left eye and 20/200 vision in my right eye (dominant eye).

    I actually bought some reading glasses and a PATCH for my good eye to practice what you preach. Unfortunately I won’t wear a patch in public, and my wife just laughed at me at home when I would wear it while reading.

    If I wear the reading glasses normally will the right eye eventually catch up to the left eye, or am I doomed to wearing a patch if I want better/quicker/best results?

    Thanks.

    Reply
    • Todd

      Woody,

      Yes, I used a patch too and my kids thought it looked nerdy :-). But you have the right idea. As one of my slides above shows, it is important to occasionally block or diffuse the dominant eye to allow the weaker eye to catch up. You can also mudo this by winkingnormshielding When both eyes are almost even, then you ca. Use standard pryint using and plus lenses to make progress with both eyes.

      One downside of patching or winking is the it deprives the patched eye of light for a while. Some alternatives are intermittent blink or putting one hand along you nose at an angle in order to shield the dominant eye from focusing where the weaker eye is looking, but allowing light to get to it. Another option is to patch with a diffuser or order custom lenses from zenniopticsl that handicap the dominant eye.

      Todd

      One problem with a patch is that itmdeprivesmthe patched eye of light.

      Reply
  2. Carol Karwowski

    My vision is about 20/875 and 20/800 I think. I have astigmatism too. I’m not quite clear on what you mean by plus/minus lenses. I have bifocals. Is there a reference that details this more to someone who knows nothing about eyes? Thanks.

    Reply
    • Carol Karwowski

      I gave the incorrect email. It won’t let me through the authentication to contact you to change the email. Ugh. I’m putting in the proper letters/numbers

      Reply
  3. Sarah

    This is fascinating! I have worn glasses or contacts for nearly 30 years. My contacts are, I believe, -7.5. Is my vision far too bad to be able to use some of these strategies to strengthen my eyes and reverse some of my myopia?

    Reply
    • Todd

      Sarah,

      There is no reason you can’t make substantial improvement! Others have done so starting at -5 to -6 diopters. It depends mostly on your motivation and discipline in working at this. Work it into your daily routine for several hours each day.

      At -7.5D, you are only able to focus about 5 or 6 inches in front of your nose. That’s pretty close, but try reading at the edge of focus, extending your range each day. Alternately, you can wear plus lenses OVER you contacts. Pick out some +2 or +3 glasses from the pharmacy that allow you to reach the edge of focus at a comfortable reading distance.

      Graduate to stronger lusnlenses as your vision improves. Ask your OD for some weaker contact lenses that are 0.5 to 1.0 diopter weaker – so -6.5D to -7.0D in your case. You’ll be needing those weaker lenses soon!

      Good luck and please post your progress here or on the Discussion Forum. It inspires others to share tips and experiences.

      Todd

      Reply
  4. Todd,

    It is true – that nothing succeeds like success – your success. You are an example for all of us.

    It is true that at a person starting with self-verified 20/60, (about -1.5 diopters) can slowly get back to 20/40 (pass the DMV)), and then in perhaps nine months could get to 20/20.

    But it does take a person with great insight and long-term fortitude.

    Both of us are engineers, so our perspective in facing the challenge of recovery (from 20/60) is different, from the perspective of an optometrist in his office. I have a difficult time discussing self-prevention with an optometrist in his office.)

    Thanks for your efforts. I hope for the day when a scientific (preventive) study could be offered to pilots who are at 20/50, entering a four year college.

    That WOULD WORK – and you proved it could work.

    Reply
  5. jane

    I feel really stupid (although I am highly educated which is why according to you I am myopic) but I don’t understand how to use the chart and where you are getting the -2 number from. How far from the chart do we try to read? when I look at the chart without my glasses I can read the 20/20 line at about 12 inches. So does this mean I am less than -2? Also does it mean I am in between -250 and -300, is that -2.5 and -3. Sorry very confused. My recent prescription is -3/25 in one eye and -3.75 in the other. None of this makes sense. Can you enlighten me? I think I do understand however that regardless of all these numbers I just need to read, say on the computer without my glasses where I can barely focus. Is that correct? I thought that puts a strain on ones eyes and not good for them? I have been told recently I have mild cataracts and floaters. I am 63 yrs old and have worn glasses since about 5th grade. Any help will be greatly appreciated!

    Reply
    • Todd

      Hi Jane,

      No problem – these numbers can be confusing. Slide 24 “Measuring Myopia with a Snellen Chart” shows several different sets of numbers with different meanings. The Snellen chart on the left side is the eye chart you see at the DMV or your eye doctor. You try to read the lowest line that you can read standing 20 feet back from a full size chart. For example, if you can read Line 5 (PECFD) that corresponds to 20/40, which means you can read from 20 feet what someone with normal vision can read at 20 feet. If you don’t want to print out the full size chart, you can use the online computer charts made for closer distances, such as this one:

      http://www.i-see.org/eyecharts.html

      On the right side of Slide 24 is a table with 3 columns. The left of these 3 columns is the Snellen, which we already discussed. The middle column is an approximate “diopter” or “D” reading, which refers to the strength of the “minus” lens that a conventional optometrist would fit you with to correct that particular Snellen. So if your Snellen is 20/40, that would correspond to a -0.75 D lens. The column at the far right is the distance at which you can focus if you have a given Snellen or diopter reading. So again, the person with 20/40 and -0.75D would be able to read normal size text in focus from a distance of 52 inches.

      Since you can read text from about 12″, using that same chart between 11″ and 13″, you have between 20/250 and 20/300 Snellen and would have lenses around -3 to -3.5 diopters So that’s pretty close to your recent prescription of -3.25/-3.75. It all makes sense!

      Since your myopia is stronger than -2.0 D (equivalent to 20 inch focusing distance), you do not need to use plus lenses. To strengthen your eyes with print pushing, you have two choices:

      1. Read a book or computer that is about 12″ away from your face (your D1 distance) and keep pushing back and forth between D2, which is probably around 14″. That’s a little awkward, but not too bad

      2. If you don’t like sitting so close, then buy some underprescribed lenses. Reduce each eye by 0.5D, which means 2.75/3.25 in your case. A good optometrist or optician will do that for you. If they don’t cooperate, order your own custom glasses from zennioptical.com

      I suggest listening to the video a few times to reinforce the ideas.

      Do NOT attempt to embark on this unless you are willing to put in the time and effort. There is a big reward of clear vision at the end, but at the same time it requires persistence and patience to get there.

      Good luck,

      Todd

      Reply
  6. I attended this talk at AHS and it was great. Thank you so much. I have a question for those of us with astigmatism. We can not correct that with this method, right? However, my contacts do not correct for it either, so I could still get rid of my glasses? I guess my astigmatism is pretty mild so they never get me contacts that correct for it. My script is Right SPH-2.50 CYL-0.75 Axis 5 Left SPH-2.75 CYL-1.00 Axis 165. Is it only the SPH number that we change if we want glasses that are a bit less strong?

    Reply
    • Todd

      Rev. Katie,

      Glad you enjoyed the talk. I didn’t directly address astigmatism in my talk for two reasons: (1) I wanted to keep the talk focused and it is hard enough to address myopia adequately in a short talk; (2) I’m still researching astigmatism and have not yet reached any firm conclusions.

      Anecdotally, I’ve heard that astigmatism tends to diminish in many people as their myopia is reversed. But in quite a few people it persists even after myopia is reduced. I’m working on an extension of my method that may help such people. For now, you may want to get the DeAngelis book (listed in my references in the slides) and investigate Leo Angart’s method for astigmatism reduction:
      http://www.vision-training.com/…/Astigmatism/index.htm
      https://www.youtube.com/watch?v=wAakgY2fdbE

      At this point I cannot vouch for how well the DeAngelis and Angart techniques work, but would love to hear from any who have tried them.

      Todd

      Reply
    • Hi Rev. Katie,

      Subject: How you can covert astigmatism – for better vision.

      Item: If it is less than -1.25 diopters, you can convert to “spherical equivalent” – as I do it.

      In fact, I check my refraction with spherical lenses – and always get 20/20 from that spherical lens.

      The conversion is easy. Just take 1/2 the astigmatic value, and add it to the refraction. (You can ignore the angle of 165 degrees.)

      So, your converted value will be:

      -2.75 D (Sph) -1.00/2 = -3.25

      This is the spherical equivalent. I always have good vision, and check for 20/20 myself.

      You can order the glasses from Zennioptical.com for about $15.

      Otis

      Reply
  7. Nate

    Great talk Todd!! And it’s good to have some posts from you again.

    I first encountered this method of eyesight improvement 3 years ago-and have been doing it ever since. I wore glasses and contacts for over 30 years-constantly worsening. My last prescription was -6.75, which is pretty bad. After two years of applying the method, I had an eye exam, and the results gave me -4.75. And since then I have certainly improved.

    So the method works, but for very bad myopia, it does take a while.

    I agree that the important thing is incorporating the activities into your daily life. And be patient.

    Thanks again. This has really improved my life.

    Nate

    Reply
    • Hi Nate,

      Subject: The power of, “doing prevention yourself”.

      I think it is wonderful to have a medical doctor involved in these discussions. ANY improvement – is a first step in the right direction. I conduct analysis of all natural eyes, using neutral language as far as possible.

      Tragically, as soon as I suggest that it is possible to get the eye to change “in a positive direction”, by intelligent wearing of a plus lens (when at 20/40 to 20/60) I get “attacked” by people in medicine who either claim that

      1) It can be done,
      2) We will prohibit you from doing it. or
      3) You are practicing medicine, when you advocate that at person make an informed choice – to wear a plus and get a change of +1 diopter – to get to 20/40, and eventually 20/20.

      Nate – you are correct. It is a very slow path, to get out of -6 diopters. But I do advocate that a person be informed of the possibility of prevention, before he starts wearing a minus lens.

      For me, that is where true success can develop. Todd had a light prescription of -1.25 diopters (probably about 20/50 to 20/60). He developed a reasonable success.

      I am certain he passes the required DMV test. Beyond that point, with further wearing of a plus, he could get to 20/25 and 20/20.
      Todd’s write-up is EXCELLENT. I posted it on my site. We all learn in different ways.

      The real and powerful effect occurs when Todd gives his lecture, with no glasses.

      Otis

      Reply
  8. Jasmine

    Dear Dr Todd,

    Thank you so much for your website and your video. My daughter is 8 years old and she has intermittant sqint problem from birth as well as myopia. I am sad to find out during our last visit to eye doctor that her right eye myopia has increased from -3.5 to -4.5 while left eye surprisingly decrease from -3.25 to -3.0.

    I thought about it for a long time why should it be so. I started letting her under-corrected glasses a year ago. So both eyes she wears -2.5 since last year. Because of her squint(she can choose to let one eye wander away), she slowly adapts to use her left eye for far distance and right eye for all near work. Thus over the past year, I notice her near sight squint has worsened as well as her right eye myopia. Whereas because she seldom uses her left eye for near work and mostly for far objects, her left eye actually improves.

    I am glad I seem to understand the mechanism behind, but sadly I do not know how to make use of this knowledge until I chance upon your website! Thank God about that. I support fully your theory of using self-adaptive mechanism of the eyes to achieve its own recovery.

    I will start the print pushing method for her nearwork, however, I am confused which eyes to patch for near and far work. Can you give me some advice?

    Thank you very much,
    Jasmine

    Reply
    • Todd

      Hi Jasmine,

      You daughter’s less myopic left eye is dominant for distance while the right eye is dominant for close work. It’s not uncommon to have this condition, sometimes called ambylopia. In fact I have slight ambylopia, with a dominant right eye for distance.

      There are a few steps I can suggest:

      1. She can try reading by patching her right eye and print pushing with her left eye. At -4.5 diopters, she would have to hold a book or screen about 9 or 10 inches away from her face and try to keep it at the edge of focus. An alternative to patching is to have her hold her right hand up to her nose and tilt it slightly to block her view of the book or screen, but still let light into the eye. It’s not that hard to do once you get used to it. Once her left eye catches up to the right, she can do print pushing with both eyes open.

      2. For distance, you can order lens that are slightly undercorrected for the left eye and strongly undercorrected for the right . So -4 for the right and -2 for the left. That will force her right eye to carry more of the load. You can order these for zennioptical.com

      With both #1 and #2 it is important to take frequent breaks. While your daughter may have an excellent attention span for an 8 year old, it’s hard to ask too much. Working at the edge of focus for 1 or 2 hours a day, while doing reading or screen work, will start to move her in the right direction. You may find that you need to buy weaker lenses every several months.

      Good luck,

      Todd

      Reply
      • Jasmine

        Thank You very much Todd,
        I am very thankful to receive your advice. They are very helpful!

        I hope it will really help my daughter. We have already started the print pushing. When she is holding book at edge of focus, I realize it is now her left eye which takes over because her left eye is -2.5 while her right eye is -4.5 for print pushing. Therefore I shall try patching her left eye instead until her right eye catch up. Do you agree?

        I will order the lens for distance viewing from a local optical shop.

        God bless,
        Jasmine

        Reply
        • Jasmine

          Sorry correction: her left is -3.0 and her right is -4.5.

          Reply
          • Todd

            OK…. so we are back to the original advice…patch the dominant (left) eye to allow the weaker right eye to work harder and improve.

            Reply
            • Jasmine

              Thanks!!

              Reply
  9. Nate
    Reply
    • Todd

      Thanks for the link, Nate. I had not seen that site, “Rogue Health and Fitness”. It’s straight up hormesis, with good reviews of basic physiological studies, and a focus on fitness.

      Todd

      Reply
  10. slim934

    OK so let’s look at my situation.

    -7.75 diopter in left eye and -8.00 in the right. Only slight astigmatism in the right eye thus far.

    What would the progression look like for somebody like this? Like, for this level of myopia how would you suggest starting doing concentrated practice with respect to the whole push-pull of doing close work? And what do I do for the rest of the time? My issue is that with my vision being so bad I really have to rely on my current glasses to do just about anything.

    Thanks for your time and work!

    Reply
    • Todd

      Slim,

      With your strong myopia, here is the strategy I recommend:

      1. Get some under corrected lenses, around -7 or -7.5 in each eye for distance work (walking, meetings, movies, riding in cars). Wear these whenever you aren’t reading, but don’t wear them passively. Really look at sharp contrasting edges and consciously try to see things in focus.

      2. For reading books or computers you have two choices: (a) if you wear contact lenses, buy some +2.5 plus lens glasses at the pharmacy and wear these OVER your contacts while doing print pushing; or (b) get some lenses that are under corrected by 2.5 diopters (in other words -8 + 2.5 = -5.5 diopters) in each eye and wear these while reading. You can order these online from zennioptical.com

      3. If you want to get very sophisticated you could combine #1 and #2 into “undercorrected bifocals”. But I’d advise starting out with two different sets of glasses for the two activities until you get the routine down.

      Be prepared to spend some money buying weaker sets of lenses every 3-6 months, or faster if you are more diligent about working at it.

      Todd

      Reply
      • Slim934

        Thanks much Todd. One more query.

        You mention that with respect to using plus lenses for close-up work, you want to make sure that the text is far enough so that it is just out of focus. Can you expand a little bit on how far that is? To use your weightlifting analogy, what is the effective load I can place on my eyes that would still be productive vs. non-productive? Does it have to be JUST out of focus, or can it accommodate a little bit more fuzziness? Or is there not enough information to say.

        I’m more or less trying to make sure I do not overshoot the point of meaningful stress into the “waste of time” zone of stress.

        Reply
        • Todd

          Slim,

          Your question is a good one. My answer is to generate as much blur as you can comfortably tolerate for the activity and situation at hand. There must be at least a slight detectable blur, otherwise the defocus mechanism is absent. Even a slight, barely perceptible amount of blur is effective, but it will take longer to see improvements. At the other extreme, some people on my forum report that a “deep blur” is effective; they sit staring across the room for minutes or hours and see sudden spurts of improvement. I don’t think a high level of blur is necessarily ineffective or a “waste of time”. It can work, but personally I don’t have the time for pure eye exercises and am looking for a way to integrate print pushing and other incremental defocus methods into daily activities like reading or computer work. For that, I find that too high a degree of defocus is distracting and difficult to sustain without frequent breaks.

          So my answer boils down to being pragmatic. Find a degree of blur that is noticeable, yet which you can tolerate during episodes of reading for 15 minutes at a time. You may need to adjust the degree of blur depending on your energy level, lighting level and personal disposition.

          I personally find that keeping the degree of blur very slight and just noticeable is much more tolerable than reading at a high blur level. I think it is a more sustainable practice that you’ll stick with for weeks and months. However, you might experiment occasionally with stronger blur for activities that are relaxing or require less demanding attention, such as TV viewing or going for a walk around the block.

          Hope that answers your question.

          Todd

          Reply
  11. Davina

    Dr Todd, you’ve given me hope! :)

    I have nystagmus and also had surgery to correct severe double vision in both eyes. Do you se these inhibiting my progress as I do the strengthing exercises? I have an incredibly hard time focusing on normal font due to the shaking caused by the nystagmus.

    Reply
    • Todd

      Hi Davina,

      Nystagmus is a condition involving involuntary movement of the eyes. Typically these movements are controlled centrally by the brain. So it is not an refractive disorder, and doesn’t involve strengthening muscles such as the ciliary muscle that control lens focusing so I don’t think the methods I describe can help you.

      Todd

      Reply
      • Davina

        Thank you for responding! I wasn’t very clear with my question. :) I know there’s no cure for nystagmus. I also have severe myopia and was wondering if the nystagmus would inhibit the strengthing exercises for reversing myopia.

        Reply
        • Todd

          Davina,

          Ah, thanks for clarifying. No I don’t think your nystagmus would prevent you from using focusing exercises to reverse your myopia. So long as you have the patience and ability to focus with intention on slightly blurry print or features of distant objects, and ignore the distractions of your nystagmus, you’ll make progress. Try it! To prove that you are making progress, take care to measure your Snellen score with an eye chart at least once a week. Then you’ll know whether it’s working.

          Good luck,

          Todd

          Reply
  12. Shing

    Great talk, just watched it yesterday. Been doing what you suggested there for quite a while now and slow but steady my eyesight has improved. I still have like -1.5 diopters left but the feeling, knowing you are able to get rid of your myopia, is just amazing.

    It all seems so logical to me that I don’t understand why noboby knows about this stuff.

    Reply
    • Shing –
      Todd is correct. With a mild negative prescription, recovery is in fact possible. It just takes strong insights and acceptance that it will take some time to 1) Get to 20/40, that passes the DMV, and then 2) Naked Eye, normal.
      Sadly, very few people have the long-term persistence to do this. I do suggest that you down-load a Snellen chart, put a bright light on it, and check it consistently.
      http://www.i-see.org/block_letter_eye_chart.pdf
      That is what “works” for me. There is a great deal of additional information on Todd’s site (Discussion Forum), that can help you to pass the required DMV line.

      Reply

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