The Theory and the Facts

MOST writers on ophthalmology appear to believe that the last word about problems of refraction (the deviation of light waves as they enter the eye) has been spoken, and according to their theories the last word is a very depressing one. Almost everyone in these days suffers from some form of refractive error. Yet we are told that for these ills, which not only are inconvenient but often are distressing and dangerous, there is no cure, no palliative except those optic crutches known as eyeglasses, and, under modern conditions of life, practically no preventive measure.

It is a well-known fact that the human body is not a perfect mechanism. Nature, in the evolution of the human tenement, has been guilty of some maladjustments. She has left behind, for instance, some troublesome bits of scaffolding, like the vermiform appendix. But nowhere is she supposed to have blundered so badly as in the construction of the eye. With one accord ophthalmologists tell us that the visual organ of man was never intended for the uses to which it is now put.

Eons before there were any schools or printing presses, electric lights or moving pictures, the evolution of the eye was complete. In those days it served the needs of the human animal perfectly. Man was a hunter, a herdsman, a farmer, a fighter. He needed, we are told, mainly distant vision; and since the eye at rest is adjusted for distant vision, sight is supposed to have been ordinarily as passive as the perception of sound, requiring no muscular action whatever. Near vision, it is assumed, was the exception, necessitating a muscular adjustment of such short duration that it was accomplished without placing any appreciable burden upon the mechanism of accommodation (the adjustment of the eye to different distances). The fact that primitive woman was a seamstress, an embroiderer, a weaver, an artist in all sorts of fine and beautiful work, appears to have been generally forgotten. Yet women living under primitive conditions have just as good eyesight as the men.

When man learned how to communicate his thoughts to others by means of written and printed forms, there came some undeniably new demands upon the eye, affecting at first only a few people but gradually including more and more, until now, in the more advanced countries, the great mass of the population is subjected to their influence. A few hundred years ago even princes were not taught to read and write. Now we compel everyone to go to school, whether he wishes to or not, and even babies are sent to kindergarten. A generation or so ago books were scarce and expensive. Today, by means of libraries of all sorts, stationary and traveling, they have been brought within the reach of almost everyone. The modern newspaper, with its endless columns of badly printed reading matter, was made possible by the discovery of the art of manufacturing paper from wood, which is a thing of yesterday. Only lately has the tallow candle been displaced by the various forms of artificial lighting, which tempt most of us to prolong our vocations and avocations into hours during which primitive man was forced to rest. Even more recently has come the moving picture to complete the supposedly destructive process.

Was it reasonable to expect that Nature should have provided for all these developments and produced an organ that could respond to the new demands? It is the accepted belief of ophthalmology today that she could not and did not, and that, while the processes of civilization depend upon the sense of sight more than upon any other, the visual organ is imperfectly fitted for its tasks.

There are a great number of facts which seem to justify this conclusion. While primitive man appears to have suffered little from defects of vision, it is safe to say that of persons over twenty-one living under civilized conditions, nine out of every ten have imperfect sight, and as the age increases the proportion increases, until at forty it is almost impossible to find a person free from visual defects. Voluminous statistics prove these assertions.

For more than a hundred years the medical profession has been seeking some method of checking the ravages of civilization upon the human eye. The Germans, to whom the matter has been one of vital military importance, have spent millions of dollars in carrying out the suggestions of experts, but without avail; and it is now admitted by most students of the subject that the methods which were once confidently advocated as reliable safeguards for the eyesight of our children have accomplished little or nothing. Some take a more cheerful view of the matter, but their conclusions are hardly borne out by the facts.

For the prevailing method of treatment, by means of artificial lenses which compensate for the refractive error of the eye, very little was ever claimed except that these contrivances neutralized the effects of the various conditions for which they were prescribed, as a crutch enables a lame man to walk. It has also been believed that they sometimes checked the progress of these conditions; but every ophthalmologist now knows that their usefulness for this purpose, if any, is very limited. In the case of myopia (shortsightedness), as long ago as 1916 some ophthalmologists realized that glasses and all ordinary methods at our command "are of but little avail" in preventing either an increase in the error of refraction or the development of the very serious complications with which it is often associated.

I have been studying the refraction of the human eye for more than thirty years, and my observations fully confirm these conclusions as to the uselessness of all the methods heretofore employed for the prevention and treatment of errors of refraction. I was very early led to suspect, however, that the problem was by no means an unsolvable one.

Every ophthalmologist of any experience knows that the theory of the incurability of errors of refraction does not fit the observed facts. Not infrequently such cases recover spontaneously, or change from one form to another. It has long been the custom either to ignore these troublesome facts or to explain them away, and fortunately for those who consider it necessary to bolster up the old theories at all costs, the role attributed to the lens of the eye in accommodation offers, in the majority of cases, a plausible...