Perfect Sight Without Glasses. William Horatio Bates

eyes are shut.

       Up to 1908 the United States required normal vision in recruits for its military service. In that year Bannister and Shaw made some experiments from which they concluded that a perfectly sharp image of the target was not necessary for good shooting, and that, therefore, a visual acuity of 20/40 (the equivalent in feet of 6/12 in metres), or even 20/70, in the aiming eye only, was sufficient to make an efficient soldier. This conclusion was not accepted without protest, but normal vision had become so rare that it probably seemed to those in authority that there was no use insisting upon it; and the visual standard for admission to the Army was accordingly lowered to 20/40 for the better eye and 20/100 for the poorer, while it was further provided that a recruit might be accepted when unable with the better eye to read all the letters on the 20/40 line, provided he could read some of the letters on the 20/30 line.⁵

      In the first enrollment of troops for the European war it is a matter of common knowledge that these very low standards were found to be too high and were interpreted with great liberality. Later they were lowered so that men might be "unconditionally accepted for general military service" with a vision of 20/100 in each eye without glasses, provided that the sight of one eye could be brought up to 20/40 with glasses, while for limited service 20/200 in each eye was sufficient, provided the vision of one eye might be brought up to 20/40 with glasses.⁶ Yet 21.68 per cent of all rejections in the first draft, 13 per cent more than for any other single cause, were for eye defects,⁷ while under the revised standards these defects still constituted one of three leading causes of rejection. They were responsible for 10.65 per cent of the rejections, while defects of the bones and joints and of the heart and bloodvessels ran, respectively, about two and two and a half per cent higher.⁸

      For more than a hundred years the medical profession has been seeking for some method of checking the ravages of civilization upon the human eye. The Germans, to whom the matter was 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 army standards just quoted.

      For the prevailing method of treatment, by means of compensating lenses, 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 ⁹ (shortsight), Dr. Sidler-Huguenin of Zurich, in a striking paper recently published,¹⁰ expresses the opinion that glasses and all methods now at our command are "of but little avail" in preventing either the progress of the error of refraction, or the development of the very serious complications with which it is often associated.

      These conclusions are based on the study of thousands of cases in Dr. Huguenin's private practice and in the clinic of the University of Zurich, and regarding one group of patients, persons connected with the local educational institutions, he states that the failure took place in spite of the fact that they followed his instructions for years "with the greatest energy and pertinacity," sometimes even changing their professions.

      I have been studying the refraction of the human eye for more than thirty years, and my observations fully confirm the foregoing 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 in accommodation offers, in the majority of cases, a plausible method of explanation. According to this theory, which most of us learned at school, the eye changes its focus for vision at different distances by altering the curvature of the lens; and in seeking for an explanation for the inconstancy of the theoretically constant error of refraction the theorists hit upon the very ingenious idea of attributing to the lens a capacity for changing its curvature, not only for the purpose of normal accommodation, but to cover up or to produce accommodative errors. In hypermetropia¹¹ - commonly but improperly called farsight, although the patient with such a defect can see clearly neither at the distance nor the nearpoint - the eyeball is too short from the front backward, and all rays of light, both the convergent ones coming from near objects, and the parallel ones coming from distant objects, are focussed behind the retina, instead of upon it. In myopia it is too long, and while the divergent rays from near objects come to a point upon the retina, the parallel ones from distant objects do not reach it. Both these conditions are supposed to be permanent, the one congenital, the other acquired. When, therefore, persons who at one time appear to have hypermetropia, or myopia, appear at other times not to have them, or to have them in lesser degrees, it is not permissible to suppose that there has been a change in the shape of the eyeball. Therefore, in the case of the disappearance or lessening of hypermetropia, we are asked to believe that the eye, in the act of vision, both at the near-point and at the distance, increases the curvature of the lens sufficiently to compensate, in whole or in part, for the flatness of the eyeball. In myopia, on the contrary, we are told that the eye actually goes out of its way to produce the condition, or to make an existing condition worse. In other words, the so-called "ciliary muscle," believed to control the shape of the lens, is credited with a capacity for getting into a more or less continuous state of contraction, thus keeping the lens continuously in a state of convexity which, according to the theory, it ought to assume only for vision at the nearpoint. These curious performances may seem unnatural to the lay mind; but ophthalmologists believe the tendency to indulge in them to be so ingrained in the constitution of the organ of vision that, in the fitting of glasses, it is customary to instill atropine - the "drops" with which everyone who has ever visited an oculist is familiar - into the eye, for the purpose of paralyzing the ciliary muscle and thus, by preventing any change of curvature in the lens, bringing out "latent hypermetropia" and getting rid of "apparent myopia."

      Fig. 4. Diagram of the Hypermetropic, Emmetropic and Myopic EyeballsH, hypermetropia; E, emmetropia; M, myopia; Ax, optic axis. Note that in hypermetropia and myopia the rays, instead of coming to a focus, form a round spot upon the retina.

      The interference of the lens, however, is believed to account for only moderate degrees of variation in errors of refraction, and that only during the earlier years of life. For the higher ones, or those that occur after fortyfive years of age, when the lens is supposed to have lost its elasticity to a greater or less degree, no plausible explanation has ever been devised. The disappearance of astigmatism,¹² or changes in its character, present an even more baffling problem. Due in most cases to an unsymmetrical change in the curvature of the cornea, and resulting in failure to bring the light rays to a focus at any point, the eye is supposed to possess only a limited power of overcoming this condition; and yet astigmatism comes and goes with as much facility as do other errors of refraction. It is well known, too, that it can be produced voluntarily. Some persons can produce as much as three diopters. I myself can produce one and a half.

      Examining 30,000 pairs of eyes a year at the New York Eye and Ear Infirmary and other institutions, I observed many cases in which errors of refraction either