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| Myopia: An example of how an uncertain medical theory leads to public ignorance, and industry capitalisation |
(Diagram showing the similarity in optics of an eye and a camera)
Peter Pullicino,
Undergraduate BA/LLB,
Australian National University, Canberra, Australia
The years preceding and immediately following the Revolution saw the birth of two great myths with opposing themes and polarities: the myth of a nationalized medical profession, organized like the clergy, and invested, at the level of man's bodily health, with powers similar to those exercised by the clergy over men's souls; and the myth of a total disappearance of disease in an untroubled, dispassionate society restored to its original state of health. [1]
--- Michel Foucault, 1963, The Birth of The Clinic:
The Archaeology of Medical Perception.
Thank you to Ellen Davis for proof-reading my final drafts. Thank you to the staff at the Sydney Eye Hospital Library, staff of the Canberra Hospital Library and the staff of the Library of Medical Sciences at the John Curtin Research School. Thanks to my lecturer Dr. Thomas Faunce (unit: "Health Law and Ethics") giving me a chance to write something which I’ve been yearning to write. Credit goes to Julian Henschke in helping me analyse my survey results and his long conversations with me on the subject. Thanks to Alex Eulenberg (‘The Case for the Prevention of Myopia" [2] which he prepared for his undergrad in biology in 1996 under David Goss) who read drafts who was influential in starting me thinking about writing. Thanks to Thomas Quakenbush for the frontispiece graphic. Thanks also to the people who participated in my study.
A foreword is necessary to explain why this essay came into being, and the motivations which surround its conception. Thousands of researchers publish papers each year without ever revealing why their paper was written, or whether the subject interested them, and if so, in which way. In contrast, I want to start by saying that I am suffer from myopia and that therefore the finding of a cure, or at least stopping a further progression of myopia, is a subject which is important to me.
I first was prescribed glasses when I came to Canberra from Melbourne. I was then 14 years old. The prescription was very weak. If I remember correctly it was something like RE —0.25D LE —0.5D. [3] From then on my myopia got steadily worse and worse until two years ago and around three or four more prescriptions later I had RE —1.75D LE —2.25D. At that stage it was becoming necessary to wear glasses for reading, but I resisted this instinctively. I also began to wear my glasses almost full time. The time came during my law exams in 1999 when I couldn’t see the print of a book on my lap. I was on the verge of going to get my glasses re-ordered and I knew I was going to have to start reading with them.
I resisted as long as I could, and I am now grateful I did, because on the 4th of November I read something on the internet which was to change my life — a summary of Dr.Bates’[4] methods for improving eyesight. I stopped using my glasses, except for driving, and started palming[5] and sunning.[6] . I also started reading everything I could find on the method. Luckily after exams I went overseas for two months where I practiced the techniques occasionally, especially with an emphasis on taking walks and looking into the distance. I avoided most contact with computers and books, so I was only doing around two hours of near work a day (rather than seven or eight). When I returned from my stay abroad I went to visit my optometrist who prescribed RE —1.50 LE —2.00, an improvement of a quarter of a diopter. I was very glad to have an improvement instead of having to get a stronger pair of glasses.
Three months on from my last test, full of encouragement, I am now getting flashes of clear vision at 20/40 [6/12] [7] (in semi-darkness) upto 20/20 [6/6] in bright sunlight. These last for very short periods of time, but the periods are getting longer and longer as I gain more control over the sensation. I can now control something in my eyes so that at will I can go from 20/100 [6/30] to 20/30, and the results are absolutely amazing for something who has had to live in a blur most of their life. My far point is also constantly being extended, so that now I can see acorns on the ground as I walk to my bus stop. When I first started Bates’ method I used to use the 3rd row at movie theatres as a maximum, currently I can sit in the 15th or 20th row without discomfort.
Progress has been slow and tedious but the results have been worth my time and effort. I am now in the process of trying to understand more and more about my eyes, and how I was prevented from exploring natural therapies. In this particular essay I have tried to use mainstream journals (where possible) to back up my points, as quoting natural vision therapists would become a matter of "preaching to the converted". However I owe a great debt to those people who have paved the way for a more holistic analysis of this area of medicine.
Peter Pullicino, Canberra, May 2000
It is a rule in all scientific endeavour that if a fact is not in concord with a hypothesis then then it is insufficient, and another hypothesis must be found which better suits the facts. Unfortunately this has not been the case when it comes to explaining how accommodation occurs. Accommodation is the process that occurs when an eye focuses on objects of different distances.
The first experiment on accommodation was performed by Von Helmholtz in 1856 using a candle and observing the images that were reflected back from the cornea, lens and retina. He thought he saw the image on the lens become smaller when accommodation occurred at the near-point and hence concluded that the lens must be changing its shape, and that it is the ciliary muscle which controls the process of accommodation. This hypothesis still serves ophthalmologists up to the present day. It has gained status as a time-honoured principle.
As sacred as it may be it must be overturned. For over a hundred years, ever since cataract surgery has been performed, there have been men and women who have been accommodating without the use of a lens (aphakia), or with a hard plastic lens (pseudophakia) [8]. Thousands of these operations are performed each year, and a significant amount of patients regain the power of accommodation, some just days after the operation. How the ciliary muscle is acting on an artificial or no lens at all (!) is unclear,
"Fuchs (who is quoted merely as familiar example of accepted teaching) says that mechanism of accommodation "depends upon the elasticity of the lens". If this is true then no lens, no accommodation. He also says "The aphakic eye, moreover, is destitute of accommodation. The eye is incapable of altering its refractive state". The last statement is of course, not universally true, as there are cases on record of aphakic eyes that could alter the refractive state. [9]
The cause of myopia has troubled medical science since its alarming rise following the increase of civilisation. It is somehow poetic that the further humankind has separated itself from nature the less he is capable of appreciating it,
James Ware as early as 1812 claimed that amongst 10,000 British Guardsmen not a dozen had been rejected for military service for short-sight in the space of 20 years whereas in one college in Oxford 32 out of 127 students were found to be myopic.[10]
Such statements litter ophthalmological journals up to this day. They are indeed worrying. The University of Singapore has 65% of its graduate population myopic.[11] My study of Australian National University students (see Appendix A), confirmed that there are significant levels here also (29%).
There are four main theories to explain the cause of myopia. These are the genetic theory,[12] nutritional theory,[13] the close-work theory[14] and the strain theory.[15] They are all inadequate in some respects. It is not inside the scope of this essay to refute the various theories, as they all have very influential and knowledgeable adherents, and there is ample source material to verify the nature of their weaknesses and strengths.[16] The "nature v. nurture" debate rages in journals up to the present day,
A brief survey of ophthalmic literature suggests that the number of published articles on the topic of myopia development must be in the thousands.[17]
The most convincing theories are hybrid theories between genetic/close-work, and close-work/strain. These are, however, impractical to study because they involve too many uncontrolled variables. The debate is reminiscent of the incessant discussions about the cause of cancer, fluoridation of water and the harmful effects of mobile phones, where every writer simply quotes her/his favourite study.
The most convincing reviews simply acknowledge that there is confusion in this area.[18] It remains to be seen whether any theory will eventually win out, and it will probably be phrased in a hybrid form anyway.
The lack of an adequate and established theory has given rise to the two main forms of ‘treating’ myopia which are based on mechanical solutions to do with bending light before it reaches the internal eye. Because these treatments are only concerned with a mechanical solution, the eye is viewed as an mechanical focussing system rather than a muscular system. The result is effective temporary treatments, but with long term anomalies because of the imprecise technology. The third traditional way, but by far the most unpopular, is behavioural optometry, a science which has the reputation of being primarily interested in the eye problems of children ("lazy eye", "squint"). This third way is the more natural and holistic because it is based upon muscular rehabilitation and re-coordination.[19]
Glasses and contacts are now standard to treat the symptoms of myopia and have a long history dating back to the mediaeval times. They have never been tested by any government body as a method for treating myopia. This is because they are very effective, relatively cheap, and have been socially accepted for centuries. The risks are never mentioned, and anecdotes prevail. Some of these are "the more you wear glasses the worse your sight gets", to the standard "give yourself a few days until you get used to them" delivered by optical dispensers.
It is plain that if the human body is forced to receive information through a medium it will adapt itself to this medium. Glasses can never be made perfectly in shape, size, and focussing power[20] and the resulting degeneration is known to practicing optometrists as well as anecdotally. One optometrist wrote,
One of my clearest impressions in handling myopia cases is that almost all cases of stationary myopia consist of young people who refuse to wear their correction except for those occasions that make a positive demand for normal vision. Conversely, almost all cases of progressive myopia appear to be individuals who adhere most faithfully to the principle that their corrections must be worn constantly. From a clinical point of view, the conclusion would seem inescapable that minus lenses are an important factor among the causes of progressive myopia.[21]
And consider the following from another optometrist,
In 1914, when the state of Maryland secured its optometry law, a clause was inserted to the effect that optometrists could not prescribe minus lenses to children under 15 years of age "except on an order or advice from a physician." In 1938, Neville Schuller, vision specialist of Toronto, Canada, stated, "I would like to have a law established forbidding the prescribing of minus glasses without extenuating circumstances. O.D. Rasmussen, O.D., Kent England, stated in his book, "Myopia, in more than ninety-five percent of cases, begins between five and ten years of age. It increases largely because the myopic eye is given distance lenses for reading.". C.P. Rakusen, O.D., Shanghai, China, said, "from my experience in this land of myopes (i.e. China) I have formed strong prejudices against the evil of weak minus prescriptions in all ages.". Samuel Druker of Brooklyn, N.Y., in the Optical Journal of March 15, 1946, wrote, "The suspicion began to dawn on me slowly that among the causes of progressive myopia it might be necessary to list concave lenses themselves. From many articles that have appeared in the past on the subject of 'Optical Poison,' a familiar term a decade ago, many other optometrists appear to have the same idea."[22]
It is more or less the rule in Australia that optometrists and vendors of glasses work side by side, often within the same office. The financial incentive to prescribe glasses is strong, even in the light of very strong anecdotal evidence that ultimately glasses may cause further myopic progression. The medical literature denies that full-correction harms the eyes and suggests that it may ‘relax’ them. There is no scientific evidence to uphold the claim that correction improves the eyes[23] and there is plenty of evidence that it may actually harm them. It is common sense that placing a piece of glass between a patient and his/her world will affect the image on the retina and how the brain adapts to see this image,
A full correction for myopia, whether a minus lens in an eyeglass or a contact lens, causes near objects focus behind the retina. [24]
Corrective lenses, especially contacts, freeze our eyes into a fixed focus which is applied to every visual task - a focus determined by our worst-case visual need.[25]
The wearing of spectacles confines the eyes to a state of rigid and unvarying structural immobility.[26]
One cannot see through them unless one produces the degree of error they are designed to correct.[27]
The profession "optometrist" exists because the procedure of prescription does not cater for any kind of examination of the real problems which would normally be relegated to proper medical practitioner. To a person on the street the face of "eye health" is the numerous optometrists who are scattered in malls and shopping centres. Consultations are usually fifteen minutes long, and patients are only given two options once diagnosed with an error: glasses or contacts. If glasses are not the fix-all that optometry would have us believe then some big structural changes have to be made to ensure that a more holistic approach is adopted.
Optometrists are mostly free to do and say what they like because they cannot harm a person’s eyes in the same way as a surgeon can with a scalpel. One optometrist suggested that the problem with my eyes was a ‘flattening of the cornea’. Another optometrist, with myself as his last patient for the day failed to give a subjective examination and relied solely on his autorefractascope, the result being that he increased spherical diopters unnecessarily and missed the astigmatism in my left eye. Any slackening of the standard of care is very hard to pick up or prove. The mis-prescription of glasses, even negligently, is hardly actionable due to problems with causation. The eye will adapt itself to the medium it is looking through in a matter of a few hours, if not minutes. Thus is a person who needs a —2D prescription is mistakenly given a —3D prescription and told to "get used to it" then he/she will either reject the glasses[28] or his/her eyes will come to suit —3D, more often the latter. Because of the cost of glasses, upwards of $60, it is most probably the case that people put up with mistakes in prescription until their body adjusts. Sudden blindness never results, objects become sharper, and genetic theories are given to explain away the increasing myopia.[29]
There are optometrists exist who are open-minded[30] to lens-free approaches, which is a positive sign. Jacob Liberman thinks that, at least in the USA, "the profession now seems to be on the verge of a major shift as more and more practitioners are beginning to recognise the benefits of a holistic perspective." I would not be so jubilant at this stage.
Most laser surgery clinics because of their profitability and the elective nature of the surgery offer a free consultation in order to draw clients. I went to a consultation at a branch of the Canberra Eye Hospital, the only clinic of its kind in my area. There are three doctors at this clinic, and they are not present during the initial consultation. I was seen by an orthoptician, an optometrist who specialises in the musculature of the eye. In the consultation room there was one large picture of an eye which was anatomically incorrect, the cornea and pupil occupying a much too large portion of the spherical surface. Furthermore the curvature was emphasised to an almost ridiculous degree. In the information brochure this is how describe the condition of myopia
The short-sighted cornea is too curved, i.e. too powerful a lens for the length of the eye. The laser reshapes the curve, flattening it centrally to reduce the focus power of the eye.[32]
This is an incorrect statement, as any ophthalmological textbook on the subject will verify. Almost unilaterally axial elongation (often coupled with corneal steepening) is the physiological cause of the blurred image that falls on the retina.
This stated by the standard textbook on correction in the field, Duke Elder’s "Practice of Refraction",
In the great majority of cases, certainly in higher degrees, myopia is axial, that is due to an increase in the antero-posterior diameter of the eye… an increased curvature of the cornea not infrequently occurs, but it usually evident as an astigmatic not a spherical error.[33]
Other studies[34] have been more vehement,
... when myopia progresses with time, the progression is due to an increase in axial length not compensated by an increase in lens power …. We conclude that all myopia is axial in origin.[35]
This practice of ignoring axial elongation also evident on websites of refractive surgeons in the USA,[36] take for instance a picture from <http://www.lalasik.com> (the website for a surgery in Los Angeles),
In a general sense, it is quite clear that the impression any reasonable person would come away with as to the condition of their eyes would be false. As the Australian High Court said in Rogers v. Whitaker, "the choice is, in reality, meaningless unless it is made on the basis of relevant information and advice."[37]
Furthermore, on testing my vision with an autorefractascope the orthoptician said my right eye was —2D and my left —3D, overshooting my error by around 1D in my left eye and 0.5D in my right. Hopefully once the patient has paid some money and had the follow up consultation these technical points would be considered more finely. It is interesting to note that —3D puts me in a more suitable group for laser correction, and thus more likely to consider going into the next level of consultation.
If misinformation or biased information is given at a preliminary stage in order to get a patient to pay for a more thorough examination (by which time most would be committed to going ahead) then even if the information is corrected at a later stage, we may be able to say that although the patient has been given correct information, he or she has been given two sets of information or impressions which a contradictory. This contradictory stance from the same clinic may well suffice for a civil action based on lack of true consent.
The consent form I was given thoroughly covers the common complaints of post-operative patients.[38] Risks were disclosed at being well under 1%, although they were not named verbally, and I was referred to the consent form for the specific itemisation. The figure attached to risks was much higher than I expected, most laser surgery advertisements not venturing below 1/500 chance of complications. According to the Melbourne Excimer Laser group the procedure is "extremely safe."[39]
Litigation becomes an option when complications surface this irreversible procedure and the patient realises that he was the "one" in "one-in-a-thousand", and that possibly the risks were too high, or that the statistics did not make sense at the time. That is a risk with all elective surgery which is portrayed as relatively risk-free. Hence we can expect to see more and more litigation in this field,
"I'm getting more calls from people looking for expert witnesses," said Ron Link, executive director of Surgical Eyes, a group that helps refractive surgery patients with problems…. Robert M. Portman, JD, legal counsel to ASCRS, said he does not know how many lawsuits have been filed regarding LASIK but that the is likely to rise with the procedure's increasing popularity. With media attention and "a lot of pretty aggressive claims" come higher expectations, he said…...[40]
A ground for litigation may not only be disclosure of risk, but consent. As suggested above, the patient must be given appropriate understanding of the nature of his/her problem in order to consent to appropriate treatment.
There are less behavioural optometrists in the ACT than there are laser surgeons. The title derives from a further study in a masters once the degree of optometry has been completed. Many behavioural optometrists practice standard optometry (in order to make a living), but are very valuable people because they take more time over their patients and are aware of more problems and how to correct them. Patients need to be motivated to undertake any course of muscular retraining and so this avenue is unpopular. As part of the research for this essay I went to see a behavioural optometrist and was delighted to hear her mention such words as convergence and dominance. The exercise sheet which she gave me (which was pre-printed) mentioned concepts such as "diplopia."[41] It was a good feeling not to be patronised, but to have the accurate terms used. The use of terminology gives the patient scope to consult with the doctor and get interested in her/his problem. Her session lasted 45 minutes and was informative and constructive.
The word used to describe myopia is "short-sightedness." It is one of those strange medical anomalies where the disease is actually given a positive meaning. The word covers up what actually has been lost, which is the ability to see in the distance. The sufferer has always had their shortsighted vision, so it doesn’t make sense to call them "short-sighted." It’s like someone who has a tumour growing out of their neck "big-necked." It is the language of incapacity and complacency. It really should be called "long-blindness," if the colloquialism is to be used. There is a strong case for always using the correct medical term in order to allow patients and potential sufferers access to information, if they choose to learn about their disease themselves. This is not my experience. "Myopia" has never been mentioned to me by anybody in the institutionalised eye-care profession.
The results of study also showed that 10% of myopic respondents identified their condition as "myopia". (See below)
A very interesting decision is the Administrative Appeals Tribunal decision Re: Leslie Theresa Smith.[42] Mrs. Smith was claiming her right to an invalid pension for blindness from the Department of Social Security. The issue here at stake was whether a high degree of myopia could classify as "permanent blindness" for the purposes of the act. It was previously resolved that one did not have to be totally blind in order to receive the pension.[43]
Mrs. Smith had started off with glasses at age 19. At age 38 she had her right eyeball removed due to cancer. When she made her claim she said that her myopia in her left eye was so bad that she could not see faces, was scared to leave the house and often cut herself on crockery and glass. She said she could no longer drive a car. This was confirmed by family and friends.
An expert witness, Dr Hughes, an ophthalmologist, admitted that her vision was "terrible," and that without spectacles she was "as blind as a bat." While he admitted this the ophthalmologist gave evidence in favour of the Department of Social Security by mentioning her ability to read up close,
Her deportment within my surgery - her ability to move about without any observed difficulties as will as her ability (albeit with glasses) to read small print are all evidence that her condition makes her ineligible to qualify for the blind pension.
The doctor suggested that "blindness" should be tested with glasses on, as opposed to a person in their natural state.
Dr. Delaney, another expert, then gave evidence to the effect that Mrs. Smith’s vision had decreased by 65% (corrected) or 85% (unaided).[44] The AAT then considered what measurement should be used, corrected or uncorrected. They relied on the first ophthalmologist’s evidence that with suitable glasses the applicant could read newspaper print and that she "moves around happily, bumps into nothing, pops into the room and out without any trouble." Mrs. Smith was therefore unable to claim the disability pension even though her myopia rendered her incapable for most kinds of work.
Speaking sociologically this decision highlights community attitudes towards spectacles and how myopia can affect someone’s life without being recognised as a severe enough disability to receive a pension.
The most famous book on vision improvement is Aldous Huxley’s "The Art of Seeing" (London,Chatto And Windus, 1943) which was published in 1943. This was a time when the drive for more visual acuity was at a peak because of the need for fighter pilots and entry into various forms of military training. The largest and most useful (in my opinion) is Bates’ system and this was the subject of Huxley’s book. As public interest in natural methods increased the institutional journals were forced to respond. Some contributors were generally positive about finding a place for Bates’ system in their existing practices.[45]
A final word. At odd times I was induced by force of necessity to try some of Dr. Bates’s work, and I must say that though the instances tried were few and the treatment short and casual, I was impressed with some potentialities of the method, not as a cure-all, but as an adjuvant to the correction of visual errors. The establishment of a research centre on this work at some university eye clinic… is I believe the only way to meet Mr.Huxley’s dissertation.[46]
Generally speaking these open-minded scientists were out numbered. In the next issue Pascal was reprimanded by W.H. Crisp in an article which was given three times more space. Crisp ends on a cautionary note by quoting Duke-Elder, possibly the most famous ophthalmologist of last century,
[Bates’ method] may be dangerous in the hands of the impressionable who happen to suffer from glaucoma or detachment of the retina, and undoubtably will be dangerous in the hands of the anxious parent of the myopic child... [47]
It is up to readers to judge for themselves what went on in the discussion which took place at the end of World War II. After the war journals regard the matter as settled in favour of the status quo. It seems that 1943 was a crucial time where natural methods could have been integrated into normal medical practice, but instead they were side-lined.[48]
A prominent natural therapist, and one of the few recently published authors in this area, has highlighted that he does not see natural methods supplanting traditional forms of care and sees no reason why the medical profession should be so protectionist,
All of my students are, of course, advised to be under the care of an eye doctor when pathologies are present---in fact, it is a requirement.[49]
As natural vision therapies involve no drugs or surgery their only great risk is the loss of a chance for a qualified doctor to diagnose a serious eye condition. Current optometrists have the facilities to diagnose glaucoma, whereas natural vision therapists may not have the equipment necessary. This simple fact cannot discredit their practice however.
In the light of my success with natural vision methods, and the accounts of various people around the world on newsgroups, I would strongly recommend that proper consideration be given to integrating natural techniques into the health system. One obvious problem is the cost and time that it will cost to monitor a patient’s improvement and correct use of the methods. They also represent a threat to the wholesale prescription of glasses, an industry worth hundreds of billions of dollars.
As part of the research for this essay, in order to substantiate some claims made herein, I surveyed 68 students in the corrals at Chifley library on the 19th, 22nd, 23rd of April. Chifley is the central library on campus and houses most of the books for use in Humanities.
The form given to the library-users appears in the appendix. It was designed to elicit more that "yes/no" response from the sample group, but this gave rise to problems with interpretation of questions and also of unclassifiable answers. However some useful data emerged and I present it below,
| Number of respondents over 30 years of age | 11% |
| Percentage of group with refractive errors | 57% |
| Readily identifiable as myopic from data provided |
29% (Therefore 51% of all those with refractive error where identifiable as myopic) |
| Of those readily identifiable myopes how many described themselves using the term "myopic" or "myopia" | 10% |
| Of group with refractive errors, | |
| Number of respondents who didn’t/couldn’t/wouldn’t communicate their condition (eg. a typical response, "I can’t see") | 18% |
| Number of respondents with refractive error who put their error down to hereditary theories | 33% |
| Number of respondents with refractive error who put their error down to near work | 23% |
| Number of respondents with some knowledge of laser surgery (ie. know more about it than it just exists) | 61% |
| Number of those respondents with knowledge of laser surgery who mentioned cost | 59% |
| Number of those respondents with knowledge of laser surgery who mentioned risks or had an apprehension of risk | 50% |
The scope of the study was always limited by time and manpower, but in hindsight I wish I had managed to get a better questionnaire prepared. Also I would never have expected the range of responses - some people wrote more than the space provided for them, others just signified "no" or "yes." It is hard to get across the subjective element I feels when I look at some responses. For instance people tended to used the word "burn" when it came the laser surgery, and tended to identify the area of the eye being burnt off as the retina. Other showed good knowledge of their prescription but not their condition, or vice-versa. There is not scope, or experience on my part, to adequately explain these anomalies in the responses.
It is said that to become myopic has a potentially negative impact on self-esteem, career choice, and ocular health. However we have been unable to identify baseline studies which indicated whether myopes themselves feel they have a significantly impaired quality of life.[50]
What a ludicrous statement. The researchers who wrote that should venture outside their offices every once in a while. Myopia disrupts eyesight in a massive chunk of the population, with disastrous effects on vision,
Myopia is really a disease of appalling incidence and damage, affecting in America 70 million and resulting in 12 million cataracts, 5 million detachments, macular degeneration, glaucoma etc…[51]
The problem is severe but not critical for many sufferers because of a quick and easy means of approximate correction. Society is now so dependent on lenses, that is has given the industries which make the problem invisible the power to entrench themselves. It is unfortunate that the lucrative business of lenses and surgery is anti-thetical to any real treatment. Flintcroft in the British Journal of Ophthalmology supported this view in his commentary entitled "Ophthalmologists should consider the causes of myopia and not simple treat its consequences,"[52]
Whilst is certain that refractive surgery will play a major role in the ophthalmological management of myopia in the future, opthalmologists should also take up the challenge of preventing or curing myopia by addressing the cause and not simply treating the consequences
Not only must we call for some real scientific endeavour in this field, first to discover an accurate model of accommodation and secondly in the aetiology of the disease, but also for more information to be given to the public. It seems that either the medical profession must admit its uncertainty, or else transmit it in the form of ignorance. At the ground level people are being prevented from exploring other treatments because of an inherent lack of knowledge coupled with an assumption that the medical authorities have a viable scientific theory. They do not, and admission of this lack scientific consensus is essential for the patient to understand the basis of knowledge on which the treatment he/she is being given.
The majority of patients who receive treatment do not even know what their condition is called. The doctrine of informed consent and disclosure of material risks is a farce when the patient does not even know what is wrong with his or her eye. To understand what the treatment is going to do to one’s body one must first understand what it aims to cure. This becomes fundamental when something as precious as eyesight is being discussed.
Natural solutions should be considered and should always be suggested where the patient has been undertaking some activity which could result in degeneration of the muscles (i.e., Extensive unbroken periods near-work etc…). Natural vision teachers should not be allowed to suffer the same discrimination that the chiropractic profession had to face for many years because of its threat to established medical practice. [53]
In conclusion, it is well to remember that in history many different things have been undisputed medical practice which to later generations seem obtuse and senseless (i.e., lobotomies, shock therapy, bloodletting etc…). There is no doubt that wholesale dispensation of glasses and laser surgery will one day take their place in that list. Nobody is content with the current state of affairs except the money-makers.
[1] Foucault M, The birth of the clinic; an archaeology of medical perception, translated by A.M Sheridan Smith, Routledge, UK, 1993, p.31
[2] <http://www.i-see.org/prevent_myopia.html>
[3] Prescriptions are measured in diopters. A diopter refers to the focussing power of the lense. A Ð0.25 D lense has its focus 4 metres to the rear, a Ð1D lense one metre back etc.
[4] Dr. William H. Bates of New York was an opthalmologist and a musical composer who thought he had discovered the cure for myopia.
[5] The patient puts her/his hands on their face, tips of the finger on the forehead and palms over the eyes, but cupped so they are not touching the eyelids. The darkness is conducive to relaxation.
[6] The most popular form of this is the patient swinging his/her head in the general direction of the sun with her/his eyelids closed.
[7] A Snellen card measurement which most people are familiar with. 20/20 (feet), 6/6 (metres). X/Y = subjective distance/"normal" distance the letter at which it should be seen, so that 20/20 is seeing the 20 foot line at 20 feet, hence normal vision. This test is entirely arbitrary, and many people can see 20/15 [6/5] or even better.
[8] Nakazawa M, Ohtsuki O, "Apparent Accomodation in Pseudophakic Eyes after Implantation of Posterior Chamber Intraocular Lenses: Optical Analysis," Investigative Ophthalmol & Vis Sci, 25:1458 Dec 1984. Also see the references cited, which imply the phenomena is not a ÔfreakÕ event which is relatively unknown.
[9] Horton JJ, "Apparent Accommodation in the Aphakic Eye," American Journal of Ophthalmology, 12:489 1929.
[10] Duke-Elder, S, System of Opthalmology, Henry Kimpton, UK, 1970, Vol 5, p.342
[11] Au Eong, Tay TH, Lim MK, "Education and Myopia in 110, 236 Young Singaporean Males," Singapore Med J 1993: 34: 489-92, quoted by Flitcroft D, 1998, Br J Opthalomol 82: 210-211
[12] The most prominent recent study is Zadnik K, et al. "The effect of parental history of myopia on children's eye size" Journal of the American Medical Association, 1994, 271: 1323-7
[13] This view is not well represented in journals, Gardiner PA, "Dietary Treatment of Myopia in Children ," The Lancet, May 1958, 1151-1152.
[14] There are many professional studies with huge samples (e.g., The Singaporean study by Au Eong et al., ibid). Near work is one of the most popular theories with the most research, and it is not hard to come across articles which find close correlation between near work and myopia, e.g., Morgan et al. "Inuit Myopia: An Environmentally Induced ÔEpidemicÕ," Canadian Med J, 122:575-577 March 1975 ; Simensen B, Thorud LO, "Adult Onset Myopia and Occupation," Acta Ophthalmologica 72:469-471, 1994; Ong E, Ciuffreda K, "Nearwork-Induced Transient Myopia" (also discusses its transposition into clinical myopia), Documenta Ophthalmologica, 91:57-85, 1995.
[15] The main proponent of the strain theory is Bates (ibid).
[16] Eulenberg A, "The Case for the Preventability of Myopia," <http://www.i-see.org/prevent_myopia.html>, `1996.
[17] Sivak JG, "Clinical Experience in Halting Myopia," Opt & Vis Sci 86:826 1991
[18] See Sivak, supra, and Goss DA, "Attempts to Reduce the Rate of Increase of Myopia in Young People- A critical literature review," Am J of Opt & Physio Optics 59:828-841, 1982
[19] The effects of the extrinsic muscles and their effect on the shape of the eye is a theory that has long been ignored. For instance The Guiness Book of World Records 2000 p.154, has a picture of two people making their eyeballs protrude by a 2/5 inch. There have also been documented cases of people producing myopia and astigmatism at will.
[20] for instance they only go up in 0.25D levels.
[21] Drucker S, O.D. Optical Journal-Review, March 15, 1946 (quoted on EulenbergÕs site <http://www.i-see.org/against_glasses.html>.)
[22] Raphaelson J, Spectacle Hobby, OD, 1961, (quoted by Eulenberg, ibid.)
[23] Acknowleged by the leading book on practical optometry, Sir Steward Duke-ElderÕs Practice of Refraction, Churchill Livingstone, UK, 1978, p. X
[24] Wissman D, Angle J, "Myopia and Corrective Lenses," Soc Sci & Med, 14A, 1980, p.474
[25] Liberman, J, Take off your glasses and See, Thornsons, USA, 1995, p.40
[26] Huxley, Aldous, The Art of Seeing, Creative Arts Book Co, USA, 1982
[27] Bates W.H., The Cure of Imperfect Sight by Treatment Without Glasses, Health Research , USA, 1978 (reprint of 1920 edition), p.82
[28] Through headaches etc.
[29] Again, my own personal experience and that of my friends and colleagues.
[30] There is at least one in my area.
[31] Website: <http://www.canberraeyehospital.com.au>
[32] "Information and Request for Excimer Surgery" brochure, given personally to the author at his free consultation.
[33] Duke Elder, S, The Practice of Refraction, Churchill Livingstone, UK (distrib USA, UK), 1978, p.44
[34] See also Adams JA, "Axial Elongation, Not Corneal Curvature, as a Basis for Adult Onset Myopia," Am J Ophthalmol, 64:150-152, 1987
[35] Grosvenor T, Scott R, "Three Year Changes in Refraction and Its Components in Youth Onset and Early Adult Onset Myipia," Optom Vis Sci 1993 Aug 70:8 677-83
[36] Axial elongation is also, apparently, ignored by some doctors involved in Corneal Moulding, another expensive therapy based on reshaping the cornea. See the advert which appeared on the, I-See newsgroup (www.egroups.com), transcribed and posted by Rob Barnett <rbarnett@wsp1.wspice.com> 25 February 1995. For more information on this therapy and its relation to laser surgery see the informative post by Jim H Day, Jr OD, FIOS <JimDayOD@aol.com> on 29 Oct 1995.
[37] Rogers v. Whitaker (1992) 175 CLR 479 F.C. 92/045 as per the majority.
[38] See <http://www.surgicaleyes.com> for biographical accounts from LASIK/PRK/RK patients. For the effect of consent forms on liability in Australia refer to Bronitt S, Faunce T, "Consent Forms Ð Forms Without Substance? A Case for Model Disclosure and Consent Forms," Health Care Analsis, 1996, Vol 4:4 342-352
[39] McCarthy et al, "Comparison of Results of Excimer Laser Correction of All Degrees of Myopia at 12 Months Postoperatively," American Journal of Ophthalmology, April 1996: 372-382
[40] Ellen D Wilson. "Lasik Lawsuits are Preventable, Experts Say." Submitted to author personally. To appear in the April edition of EyeWorld Magazine (published by the American Society of Cataract and Refractive Surgeons)
[41] A disorder of vision in which a single object appears double, "double vision."
[42] Administrative Appeals Tribunal, General Admin Division, Re: Leslie Theresa Smith And: Secretary to the Department of Social Security No. N85/475 AAT No. 2626 (Social Security)
[43] Re Touhane and Director-General of Social Security (1984) 6 ALD 147 overturned Re: James Leach And: Director General of Social Security No. W82/46 Social Security Act which defined Ôpermanent blindnessÕ as total and utter blindness.
[44] What these figures mean is beyond me. What exactly is being measured by this percentage? Snellen chart acuity? What are they being compared to?
[45] Also see Lancaster W.B., "Present Status of Eye Exercises for the Improvement of Visual Funciton" Archives of Ophthalomogy 32:167 Sept 1944
[46] Pascal J.I., Letter to the Am J of Ophthalmol, 26:636, 1943
[47] Crisp W.H., Response to PascalÕs letter in Am J Ophthalmol, 26:872, 1943
[48] A particularly vicious attack was levelled at Dr. Bates by disputing his medical qualifications and misstating his theory, see Patrick Trevor-Roper, "The Treatment of Myopia" , British Medical Journal, 287:1823, 1983.
[49] Thomas R. Quackenbush, author of Relearning to See, Natural Eyesight Improvement/Bates Method teacher since 1983, a personal email to me, published on the I-see newsgroup, 8 May 2000
[50] Rose K, Tullo A, "Myopia," Correspondence in the Br J Opthalmol, 82:1220, 1998.
[51] Wissman D, Angle J, "Myopia and Corrective Lenses," Soc Sci & Med, 14A, 1980, p.479
[52] Flitcroft D.I., Br J Ophthalmol, 82:210-211 1998
[53] See The Complete Copy of Opinion and Order and Permanent Injunction Order in Wilk, et al., V AMA, et al., written by Federal District Judge Susan Getzendanner (1987), included in Wilk C., Medicine, monopolies, and malice, Avery Pub Group, USA, 1996. This book gives a good account of the antitrust litigation.
Response Form for Study on Attitudes to Refractive Error, issued by Peter Pullicino, Undergraduate LLB/BA.
NOTE: All responses are confidential and are part of personal research into my essay for "Health Law and Ethics" a unit run by Dr. Thomas Faunce. I must state that no university body is funding this study, and the research is not affiliated to the ANU; it is my own.
I. Age: (circle) 1-10, 11-20, 20-29, 30+
II. Occupation: _________________________________________
III. Number of years you have spent in
educational institutions (in any capacity): _____________________
1. Do you need prescription glasses/contacts? Y N Possibly
2. Do you wear prescription glasses/contacts? Y N
(if No to both then jump to question 13)
4. Do you know what strength your prescription glasses/contacts are?
Right Eye, ______ Left Eye _____
(if you don’t know exactly
maybe you would like to comment: _______________________________________________________________________________________________________________________________________________)
5. How long have you worn prescription glasses/contacts? _________
6. How many hours a day do you wear them? _________
7. How many hours do you spend on average reading or in front of a computer? ___
8. Can you live your life without them? How hard would it be to get through your average day without them on this scale
No Problem // Easy // Not without diffuculty // Hard // Impossible
9. If you have glasses or contacts, do you like to wear them (e.g., In a fashion sense, tinted lenses etc….)?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
10. Why do you wear prescription glasses/contacts, for what condition?
_____________________________________
11. Do you know/suspect what caused your need for your corrective lenses?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
12. Have you considered the option of laser eye surgery (LASIK etc…)? What has prevented you from following up this option?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
13. Do you know anything about laser eye surgery (for instance cost, what change it makes to your eye’s anatomy etc…)?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
if you know of any risks, list them according to gravity,
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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