Children's Eyes (I)[...THE PREVENTION OF MYOPIA
Methods That Failed
The publication in 1867 by Professor Hermann Cohn of Breslau of a
study of the eyes of ten thousand school children first called general
attention to the fact that while myopia Is seldom found In the pre-
school age, the defect increases steadily both in percentage of cases
and in degree during the educational period. Professor Cohn's
investigations were repeated in all the advanced countries, and his
observations, with some difference in percentages, were everywhere
confirmed. The conditions were unanimously attributed to the excessive
use of the eyes for near work, and as it was impossible to abandon the
educational system, attempts were made to minimize the supposed evil
effects of the reading, writing and other near work which it demanded.
Careful and detailed rules were laid down by various authorities as to
the size of type to be used in school books, the length of the lines,
their distance apart, the distance at which the book should be held,
the amount and arrangement of the light, the construction of the
desks, the length of time the eyes might be used without a change of
focus, etc. Face rests were even devised to hold the eyes at the
prescribed distance from the desk and to prevent stooping, which was
supposed to cause congestion of the eyeball and thus to encourage
elongation. The Germans, with characteristic thoroughness, actually
used these instruments of torture, Cohn never allowing his children to
write without one, "even at the best possible desk."[1]
The results of these preventive measures were disappointing. Some
observers reported a slight decrease in the percentage of myopia in
schools in which the prescribed reforms had been made; but on the
whole, as Risley has observed in his discussion of the subject in
Norris and Oliver's System of Diseases of the Eye, "the injurious
effects of the educational process were not noticeably arrested."
"It is a significant, though discouraging fact," he continues, "that
the increase, as found by Cohn, both in the percentage and in the
degree of myopia, had taken place in those schools where he had
especially exerted himself to secure the introduction of hygienic
forms, and the same is true of the observations of Just, who had
examined the eyes of twelve hundred and twenty-nine of the pupils of
the two High Schools of Zittau, in both of which the hygienic
conditions were all that could he desired. He found, nevertheless,
that the excellent arrangements had not in any degree lessened the
percentage of increase in myopia. It became necessary, therefore, to
look beyond faulty hygienic environments for the cause of the
pathological states represented by Myopia."[2]
With the passage of time further evidence to the same effect has
steadily accumulated. In an investigation In London, for instance, in
which the schools were carefully selected to reveal any difference
that might arise from the various influences, hygienic, social and
racial, to which the children were subjected, the proportion of myopia
in the best lighted and ventilated school of the group was actually
found to be higher than in the one where these conditions were worst.
[3] It has also been found that there is just as much myopia in
schools where little near work is done as in those in which the
demands upon the accommodative power of the eye are greater, while in
any case it is only a minority of the children in any school who
become myopic, although all may be exposed to practically the same eye
conditions. Dr. Adolf Steiger, in his recent hook on Spherical
Refraction, bears witness, after a comprehensive survey of the whole
question, to the "absolutely negative results of school hygiene," [4]
and Dr. Sidler-Huguenin reports [5] that in the thousands of cases
that have come under his care he has observed no appreciable benefit
from any method of treatment at his command.
Facts of this sort have led to a modification of the myopia theory,
but have produced no change in methods of myopia prevention. An
hereditary tendency toward the development of the defect is now
assumed by most authorities; but although no one has ever been able to
offer even a plausible explanation for its supposed injuriousness, and
though its restriction has been proven over and over again to be
useless, near work is still generally held to be a contributing cause
and ophthalmologists still go on in the same old way, trying to limit
the use of the eyes at the near-point and encourage vision at the
distance. It is incomprehensible that men calling themselves
scientific, and having had at least a scientific training, can be so
foolish. One might excuse a layman for such irrational conduct, but
how men of scientific repute who are supposed to write authoritative
textbooks can go on year after year copying each other's mistakes and
ignoring all facts which are in conflict with them is a thing which
reasonable people can hardly be expected to understand.
In 1912, [6] and a good many times since, I published the observation
that myopia is always lessened when the subject strains to see at the
near point, and always produced in the normal eye when the subject
strains to see at the distance. These observations are of the greatest
practical importance, for if they are correct, they prove our present
methods of preventing myopia to be a monumental blunder. Yet no one,
so far as I have heard, has taken the trouble to test their accuracy.
I challenged the medical profession to produce a single exception to
the statements I made in the 1912 publication, and that challenge has
stood for seven years, although every member of the Ophthalmological
Section of the American Medical Association must have had an
opportunity to see it, and anyone who knows how to use a retinoscope
could have made the necessary tests in a few minutes. If any did this,
they failed to publish the results of their observations, and are,
therefore, responsible for the effects of their silence. If they found
that I was right and neglected to say so, they are responsible for the
fact that the benefits that must ultimately result from this discovery
have been delayed. If they found that I was wrong, they are
responsible for any harm that may have resulted from their
indifference
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[1] The Hygiene of the Eye in Schools, English translation, edited by
Turnbull, p. 127.
[2] System of Diseases of the Eye, 1897. Vol. II, p. 361.
[3] Brit. Med. Jour., June 18, 1898
[4] Die Entstehung der sphärischen Refraktionen des menschlichen
Auges, Berlin, 1913, p. 540
[5] Archiv f. Augenhlk., Vol. LXXIX, 1915, translated in Archives of
Ophthalmology, Vol. XLV, No. 6, November 1916
[6] Bates: The Cause of Myopia, N. Y. Med. Jour., March 16, 1912...]
- Dr. W.H. Bates, August 1919