Socially Compulsive, Biologically Unacceptable, Sustained Nearpoint Tasks.  It was a phrase coined by Skeffington to account for a variety of visual conditions held to be secondary derivatives of nearpoint stress.  One of these adaptive conditions may be functional myopia, and no doubt SCBUSNT will be revived now that screen time is becoming a socially compulsive ubiquity.  Zuckerberg’s embrace of virtually reality and other immersive environments heralds the latest coming of SCBUNST.


But wait awhile, as my old mentor Nat Flax used to say.  Can myopia actually be a very useful adaptation?  And given the way societal demands are going, is there a purpose to trying to eradicate all myopia?  Nat was of the strong opinion that developing a couple of diopters of myopia might actually be worth a thumb’s up.  Is there virtue in myopia putting the fun in functional?  This is worthwhile to consider more deeply in an age where myopia is drawing significant attention as a public health epidemic of sorts.

It was the late, great Elliott Forrest who brought to Optometry the work of Hans Selye regarding the concept of optimal levels of stress.  As Selye pointed out, if we eliminate all stress, we die.  One needs some level of arousal in order for bodily systems, including vision, to function – and that results in stress.  The key is to effective performance and tranquil states is to operate within an optimal level of stress that Selye termed eustress.  Exceeding that limit results in distress.


The classical notion of operating within a zone of clear, single, simultaneous binocular vision (ZCSBV) at all distances may be overrated, and what some patients may value is operating within that ZCSBV at near.  It’s really no big deal to them to put on a distance Rx as needed.

Is -1.50 is the new plano?



6 thoughts on “SCBUSNT

  1. I believe the bigger concern is that progressive myopia is akin to trying to slow a freight train at full speed. Sure -1.50 would be okay refractively but kids are developing myopia earlier and more are converting to the arbitrary high myopia and with it, all of its pathologic consequences. Let’s keep ’em between -1.00 and -2.50

  2. I fully agree. Uncorrected myopia beyond a useful focal point verges on the pathological and would be consistent with distress. So for those doing myopia containment, perhaps we should be setting a “target value” much like there are target IOPs. I like the -1.00 to -2.50 suggestion as an endpoint, as did Flax.

  3. Pingback: Vision Blindness Part 3 – What we won’t see. –

  4. As we know, the key to limiting myopia is NOT “correcting it with glasses”.The factors that I use are; binocular VA in a lit environment using a REAL Snellen Eye Chart not projected,and the ability to use the “Out the Window Effect” to relax
    focus and use fusional divergence. The last 20 in the20/20/20 rule is not sufficient, it should be much farther than 20 feet.
    My favorite is to trace clouds in the sky,great when they are Cumulus as they are right now .If VA is in the 20/50, 20/40 range and plus is worn at near point with active home VT, my patients function very well, but I don’t remember any 2.50 myopes or high level baseball players.


    • You’re the main reason I selected my upper level office space, with large windows in the therapy rooms looking across a highway to elevated trees and distant mountains to facilitate divergence and accommodative relaxation. You’ve been a huge influence, Arnie, and for that I’m forever grateful.

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