Oculo-Neuro Therapy

A Prescription for the Maintenance of Good Health

By

Victor J. Brumer
8 / 9/ 19 02 t o 2 2 /10 /1 98 2

This manuscript was accepted for publishing after his death, although this was not subsequently proceeded with by his Estate.

Author of:
The Therapeutics of Ocular Refraction (1942) Eye-Strain Its Cause, Consequences and Treatment (1953)

Copies of the above Books and Manuscript are stored in the Library Archive Section of the Royal Australian & New Zealand College of Ophthalmologists at the Ronald Lowe Library of the Royal Victorian Eye & Ear Hospital, Melbourne, Australia. Catalogue reference: Archives WW 320 BRU

Contents

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

In the Beginning ...................................................................... Energy Conservation ................................................................ The Eyes at Birth ...................................................................... Residual Refractive Deciency R.R.D................................... Conventional Spectacle Prescribing ......................................... The Cause of Eye-strain............................................................ Control and Prevention of Eye-strain ....................................... Energy is Life-Force .................................................................. Devitalisation from Eye-strain .................................................. Headaches and Migraine .......................................................... The Planning of Visual Care ..................................................... Diseases of the Eye ................................................................... Myopia..................................................................................... Senile Cataract ......................................................................... Glaucoma ................................................................................. Watering Eyes ........................................................................... Squint and Binocular Vision ..................................................... The Physiognomy of Eye-strain How to look 60 at 40 .......... Sunglasses for Photophobia ...................................................... Visual Acuity ............................................................................ Contact Lenses ......................................................................... The Optometrist-Opticians....................................................... The Ophthalmologists .............................................................. Medical Pioneers of Ocular Therapeutics ................................. Fournet..................................................................................... Reviews .................................................................................... Epilogue ................................................................................... Glossary ...................................................................................
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1 3 4 5 7 8 9 12 18 20 23 28 29 34 38 40 41 43 47 49 52 54 57 59 65 70 73 74

Sir Stewart Duke-Elder

The collection of works by Sir Stewart Duke-Elder embracing ophthalmology is no mean achievement by any standards. It is presently the universal and outstanding reference work for this most important subject. Hence several quotations in these pages have been unavoidable and are duly acknowledged. Duke-Elder gives generous and deserved mention to numerous pioneers in the vast eld of ophthalmology, who are assured of a permanent place in its historical records. His numerous volumes carry a massive bibliography and by its very nature tends to distract from authoritative presentation. The profusion of speculative contributions is in reality a form of gossip, rather than the presentation of hard core scientic evidence, hence this extensive literature is apt to indicate and result in confusion, rather than progress.

iv

Preface

The story within these pages is intended to convey the authors life long clinical experience and research in the mitigation of civilised mans greatest scourge and potential afictions resulting from what is commonly known as eye strain. The fragmentary knowledge of the lay public on the vital visual sense is merely derived in part from the pseudoscientic blurb of magazines and press contributions of similar standard. There is practically no literature in existence to explain to the enquiring public the functioning of the eyes and guidance for visual care, which no doubt is due to the relevant professions largely being concerned with crisis management, rather than the tenet of preventive medicine. A considerable volume of literature exists for the guidance of health problems in respect of dietetics and sexuality amongst others, but the void on visual functioning is responsible for this vital sense being activated and aided in the crudest possible fashion. Successful investigation of the eye strain problem is not possible, until it is realised, that the eyes are one of the principal terminals of the nervous system. They exert an almost overriding role in the maintenance of health and the serenity of features and mind. When a doctor is consulted for some nebulous symptom of the body or mind he will usually order every possible diagnostic test, but rarely a visual analysis, which in every case should be No. 1. The mere elucidation of letters on a test chart is insufcient to indicate tension free functioning. The resourcefulness of the visual apparatus can absorb and withstand considerable abuse without disclosing obvious disabilities. The motive impelling me to write these notes is largely engendered by what I consider to be the two outstanding consequences resulting from uncontrolled visual functioning, namely myopia and migraine. In myopia (shortsight) there exists the present perverse procedure of applying negative lenses to make the eyes progressively more shortsighted and increase the burden on the physiological economy of the organism. To slap on a youngster the rst pair of negative single vision lenses is akin to the application of blood sucking leeches in old time medical practice. The authoritative medical view on migraine acknowledges, that its aetiology is unknown and any available treatment is purely empirical. A more dismal prognosis
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is hardly possible. Most migraine symptoms are related visually. Blind people are not subject to them. The distressing symptoms can be permanently and completely relieved using spectacles prescribed having regard to the energy needs of visual functioning. These short notes are not intended as a do it yourself manual, nevertheless the reader would need some direction in seeking to obtain appropriate relief and guidance. A patient will obtain a more comprehensive examination and analysis from the ophthalmologist, than the spectacle seller. In discussing his symptoms and possible treatment, the perusal and study of these pages should make him a more informed patient instead of a completely raw penitent. Regrettably the economics of the present day medical service are not conducive to obtain the treatment, which some patients may need for their eyes, often abused from long standing neglect, in a 15 minute appointment. Effective visual treatment may entail physical and psychological reconditioning, that can be time consuming beyond a single routine examination period. Presently the community is getting very poor value for their vision dollar and some changes in thinking, practice and procedure are overdue. Since my retirement I have no pecuniary professional interests whatsoever. I am solely concerned, that my ndings and suggestions will stimulate the improvement of clinical practice in the provision of visual care.

In the Beginning
The most important document we expect with the delivery of a new motor vehicle is the owners manual. It instructs us in its maintenance, service needs, fuel requirements, tyre pressure and so forth. Furthermore the makers command strict adherence to the servicing directions to prevent voiding their guarantee. But even in the most mundane of everyday appliances such as cookers, dishwashers or refrigerators we expect and get the most prolic literature for their efcient functioning and durability. Would it not be wonderful then, if the stork carried in his beak an up-to-date owners manual with each new delivery. Food manufacturers, drug companies and others have sought to ll this void, biased however, by their particular vested interests, with literature and publicity recommending the management of the newborn baby. We must of course acknowledge the onward march of medical science with its vast records of literature, which often exhibits more evidence of confusion, than progress. And hence by a process largely evolved by trial and error we manage to evolve the basis and foundation, hopefully, for a healthy and durable life-span. The obviously most vital need for the functioning of the organism is adequate nourishment, hence dietetics is of primary importance in the management of our health program. It is only in recent years, that the consciousness level of this important subject has been raised. The publications on dieting are legion and weight control has generated into big business. However the recommendations of various authorities are often contradictory and confusing and diet schemes can be varied for every day in the year. Most dieticians however, are fairly unanimous, that smaller meals means lesser weight. There are of course substantial exceptions to this rule in respect of people being underweight or average, eating carelessly in respect of volume or foods discouraged in diet programs. Problems of overweight or underweight are then an early indication of metabolic imbalance through energy loss or devitalisation.
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Energy loss or leakage is then the primary factor responsible for the devitalisation of the organism. This process early on in life will initiate and predispose disease to manifest itself at any time in a persons life-span. Hence the search for potential energy loss and its avoidance becomes of prime importance in preventive medicine.

Energy Conservation
The closing years of the twentieth century have alerted us sharply to the need of energy conservation and it is most relevant to assume the same care in the physiological functioning of the human body. The visual function has been indicated as the greatest possible source of needless energy dissipation; it cannot be inhibited consciously without voiding the seeing process completely. The eyes are one of the principal terminals of the nervous system and their uncontrolled use is a primary cause of energy leakage and consequent devitalisation. The resultant eye-strain is initiated in the visual act from the very moment both eyes are opened. The very nature of the visual apparatus is such, that it cannot consciously inhibit its functioning unless indeed the eyes are closed. The eyes, unlike other sense organs, are in a dominating position of obtaining a preferential supply of the available power from the common energy fund. The physical necessity of adequate vision is obvious and the psychologically conditioned instincts for this are so strong as to reject anything less within the scope of the visual apparatus. The two principal functions involved to complete the visual act are accommodation and convergence. To enable the focusing of vision from far to near objects entails the increasing convexity of the crystalline lens in the eye, which is brought about by muscular contraction. For the fusion of both ocular images, convergence of both eyes is entailed, to the distance of the object viewed. Hence as the visual range is progressively shortened from innity to near viewing, i.e. reading or close work, the convergence of both eyes must be increased accordingly; if both functions of accommodation and convergence failed to be complemented simultaneously, the visual act would be incomplete and give rise to strain and stress.
3

The Eyes at Birth

Additionally, however, there is a third element involved, which predisposes the eye-strain problem. It is necessary to consider the nature of our visual organ, which we receive at the commencement of our journey. To describe a normal, organically healthy eye at birth, it is essential for us to acquaint ourselves with the shortcomings, that Nature has unwittingly endowed it with. The construction and functioning of the eye is frequently compared to the camera. The comparison for the purpose of demonstration is quite useful, but it is important to remember, that the camera is produced by mechanical means; its lens system along with its ability to alter the foci to varying distances is well-nigh perfect, particularly with the ever advancing technology. Eyes, however, are not produced by mechanical means; Nature invariably endows its creations organically in a correctly compensated manner, but not of symmetrical shape. This undeniable fact is of paramount importance for us to remember, when evaluating the focusing mechanism of the eyes. The demonstration of some examples is useful to appreciate Natures inability to construct symmetrically. Consider a bowl of eggs, all laid by the very same bird, at a glance all eggs appear to be alike; then compare each egg individually, and you will nd, that they all vary in shape, dimensions and shading. The same can be said of fruit; a basket of apples, the harvest of a single tree, collectively all look alike, but closer inspection will again reveal variations in shape, dimensions and shading. The very same principles apply to the human body. Consider your own shortcomings. It is not uncommon, when buying shoes to be aware, that one shoe ts better than the other; your tailor will point out, that one shoulder is higher, than the other. Observe the positioning of the nose and invariably you will nd a deviation to the right or to the left. The eye can therefore be no exception to the result of Natures asymmetrical construction.

Residual Refractive Deciency R.R.D.

The ability of the eye to overcome its asymmetrical construction in order to evolve a point focal perfect image is both fascinating and dramatic. The eye is the rst sense organ developed in the embryo. It is vertically elongated and remains so, albeit to a lessening degree, until the time of parturition. Visually this means, that parallel rays of light will focus behind the retina i.e. a refractive condition of far-sight (hypermetropia) will exist. It is generally agreed, that the eyes of a new-born infant are invariably far-sighted. Visually, this is a necessary feature in the development and functioning of the eye. Nature does not go to work with a spirit-level and plumb-line, hence it is quite impossible for it to construct a faultless symmetrical and spherical organ. If in fact it arrived too close to this ideal it could quite likely err to the opposite condition and produce a short-sight (myopia) situation through over-development. A myopia at birth is unthinkable, as this would produce an impediment for clear distance vision and Nature understands its work far better than this. The hypermetropia existing at birth is Natures measure of assuring a visual apparatus capable of giving effective clear vision at all distances from near to innity. It is a negative reserve since the complex visual apparatus cannot function from a zero datum line, it is a refractive deciency, but at the same time indispensable to enable the accommodative mechanism to level out irregular refraction due to the asymmetrical construction of the eye. The hypermetropia is not necessarily of equal extent to all planes of the eye. Invariably it is greater at one plane as opposed to the other and the condition known as astigmatism exists, largely vested in the irregular curvature of the cornea. It is only the extent or degree of hypermetropia and astigmatism, that vary at birth. Regardless, therefore, whether the hypermetropia is of large
5

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or small extent, it is a misnomer to describe this physiological condition as a refractive error or even bad sight. I have termed this condition existing at birth the Residual Refractive Deciency of the eye. It is here, that the resourceful nature of the crystalline lens comes to the rescue to compensate for this deciency. The range of accommodation is normally adequate to deal with the greatest possible R.R.D. existing at birth and any additional needs for close vision, thus providing an optical structure capable of giving clear vision at all distances. In providing these remarkable facilities Nature has aimed at and accomplished the almost impossible. Within the rst few months of life the R.R.D. becomes completely submerged within the refracting system of the eye. As has already been explained, the inability of Nature to construct a symmetrical organ makes this condition and procedure inevitable, if the eyes are to focus properly. This process can be termed the post-foetal development to complete the functional structure of the eye. An early diagnosed substantial hypermetropia is invariably permanently established and no evidence exists, that its extent is subsequently reduced. This refractive deciency is also later increased with advancing age, due to the shrinkage of the lens-substance and the decreasing refractivity of the eye as a whole. The residual refractive deciency of the eye must also be normally adequate to cover the needs for conditioning vision for near distances, when it is inadequate, then unless early preventive measures are taken the initiation of myopia will commence.

Conventional Spectacle Prescribing

Frans Cornelis Donders, the eminent ophthalmologist of the 19th century is the originator of the system for spectacle prescribing in use today throughout the civilised world. There has literally been no change in practice or conception since the publication of his monumental work in 1864 On the Anomalies of Accommodation and Refraction of the Eye. Donders pioneering work was a landmark in the realm of ophthalmology in his day. By and large, however, the data of his optical measurements and his directives considered visual functioning to be a static procedure. He was primarily concerned with compensating visual anomalies for distance or near vision. The aspect of prolonged or uncontrolled functioning of the visual apparatus was not given adequate consideration in his work. The fallacy of treating the visual function as a static procedure is the primary cause for the failure to cope with the many grave consequences arising from uncontrolled and prolonged functioning. The mere identication of test type letters at distance or near, at a single examination session of a few minutes duration, cannot unlock the faultily conditioned visual apparatus of several decades duration, which often dates back from birth. Hence the visual assistance provided is invariably inadequate in respect of convex lens prescriptions, but disastrously harmful, when the use of negative lenses is resorted to.

The Cause of Eye-Strain

Visual functioning commences the very instant both eyes are opened. The visual axes from a state of complete divergence, when at rest, glide into position for convergence and the alignment of both eyes, and accommodation of the crystalline lenses is in action for affecting the necessary foci. Although we see apparently or invariably without conscious effort, the energy depletion involved is considerable. It is not the lack of visual acuity, but the effort to achieve and maintain it, that is the cause of eye-strain. Everybody, regardless of age or sex, can be subject to eye-strain and in fact most people are. In comparison our hearing sense is practically passive, hence you never hear of people coming from concerts with ear-ache as against from pictures with eye-ache. Eye-strain symptoms can manifest themselves in very early life, although admittedly they are as yet not recognised as such. The dynamic nature of visual functioning varies in degree and intensity relative to the proximity of the object viewed. As the eyes shorten their visual range, so the effort involved increases, hence it is at the near vision, that the effort is greatest and most prolonged. Already, therefore, where the R.R.D. is small or negligible, considerable effort is needed for energising the visual effort at near vision. It is questionable, whether the evolution of the visual apparatus over aeons of time has been rapid enough to cope with the frantic demands of present day technological innovations and its relevant attendance and study at near vision, hence it is not surprising that of all human disabilities, eye-strain and its associated symptoms, is the most prevalent.

Control and Prevention of Eye-Strain

To adequately cope with the eye-strain problem, visual aids have to be prescribed and used, having regard to the energy needs of visual functioning. The means on hand are the convex lens to assist accommodation and the base-in prism to ease convergence. To resolve this problem in a rational manner the visual range must be divided into three planes, namely, distance, intermediate and near vision. The distance vision, permitting a visual range up to innity, comprises all our outdoor activities including, of course, long vision needs at the cinema or similar occasions. The intermediate distance with a limiting range of approximately 100cm covers all needs for indoor use, excepting where additional assistance is indicated for intensive near vision or insufcient accommodative amplitude. The division of the visual range into three planes makes it possible for every case to be assessed within these limits. Assistance for visual functioning is prescribed on the basis of energy needs. For distance vision a person has to meet the energy needs for the R.R.D., for intermediate vision the energy demand is increased to equal the use of an extra 1.D. of accommodation and at the near vision of 3.D. approximately. How the effort at near vision is increased can be illustrated by the following examples. Supposing the effort of innervating 1.D. accommodation for one hour equals the lifting of a 1 lb. weight, then R.R.D. of 1.D. would for a period of 16 hours for innity vision alone use 16 lb. hours effort, if 10 hours of this period are spent at intermediate vision, the effort will be increased to approximately 26 lb. hours and if 4 hours of this period are used for intensive near vision the effort is increased to 34 lb. hours. A convex lens of 1.D. used constantly would reduce this effort to 18 lb. hours, if a lens of 2.D. is used for the indoor period including time spent in close vision the effort is reduced to 8 lb. hours. Thus by taking adequate measures the effort is reduced to approximately 25 per cent. On the same basis of time a
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OCULO-NEURO THERAPY

R.R.D. of 2.D., if unrelieved, would need an effort equal to 50 lb. hours. Other cases can be calculated on a similar basis. The prevailing method of spectacle prescribing is based entirely on the acuity system. If the eyes were static organs and visual acuity dened as best vision at the longest distance the only consideration, such a procedure might be justied. The eye is however a dynamic organ and the process of vision is an energy consuming function and hence, the energy expenditure involved and its effect on the organism as a whole must be taken into consideration in the prescribing of visual aids. Both aspects of the problem cannot be justied simultaneously. It must, of course, be acknowledged, that all convex lenses, even when purely prescribed on the acuity factor, are benecial to a degree. Their shortcomings in the removal of symptoms are invariably due to their inadequate provision. A vital distinction must be made between the process of vision and the act of vision. The Donders procedure concerns itself entirely with the act of vision by striving to give it the clearest vision at the longest distance, which leaves the habitually faultily conditioned state of the eyes undisturbed, and completely ignores the visual needs between innity and arms length. The alternative to this procedure can only be found in a changed conception, recognising the act of vision as a learned and, therefore trainable function. To take the extraordinary facilities of our eyes for granted is not in line with our other functional activities. The use of our hands, legs and speech are all subject to a certain amount of training involving neural, mental and other co-ordinating factors. There is much more in playing the piano, than tapping the keyboard in the intelligent use of our eyes there is also much more, than opening and closing them. Our eyes are in action intermittently roughly two-thirds of a 24-hour period. Could we possibly perform a similar feat standing on our legs? Of course not we have to resort to rest periods either sitting or lying down. No such rest periods are available to our eyes, except by closing them and inhibiting vision completely. It is in this respect, that the provision for intermediate aid is vital. Firstly, it provides relief for the plane of vision, where the eyes are vocationally in the greatest use; secondly, as the degree of the habitually accommodated state is lessened, they ensure clearer vision up to innity with the distance glasses; and thirdly, the most important, they enable the eyes to have a plane of vision at which complete relaxation is possible, when they are projected as they frequently must be beyond their limiting range. Neither the distance nor near vision glasses prescribed by conventional methods are able to full this vital need.

CONTROL AND PREVENTION OF EYE-STRAIN

11

The complete relaxation afforded to the eyes with the intermediate glasses simultaneously ensures the avoidance of an important, possibly the most important component of stress, by cushioning the nervous system as a whole. The consultant, under conventional practice, primarily tests the visual acuity range of the eyes, but most assuredly not their staying power. This latter aspect, the most important one, is left to the individual to ascertain, very often by a painful process of elimination. It is worth to quote here an interesting case, that springs to my mind. A proofreader with the then Manchester Guardian consulted numerous authorities with his problem to cope with eight hours exacting work to check galley proofs. I readily solved his difculty with two pairs of glasses, one for the rst shift of 4 hours and a stronger pair for the second shift of 4 hours. It will thus be seen, that little reliance can be placed on the prescribing of visual aids based solely on the guide of clearest vision at the longest distance. It is no exaggeration to say, that the endeavour to identify the smallest distant test-type during an eye examination is a highly dangerous procedure devoid of any physiological basis. It is useful solely as a means of recording conventional acuity values, but not as a basis of prescribing visual aids to relieve uncontrolled functioning. Conventional procedure prescribes glasses for distance and/or reading, which in effect completely ignores visual requirements for intermediate distances. We are today a near vision civilisation; virtually most livelihood tasks are performed at or near arms length, which around middle age particularly, nds many tradesmen severely handicapped or almost sightless. It is at around 4 to 6 feet distance, that the stress position can become critical and precipitate a stroke or seizure. The convergence function in particular becomes increasingly more burdensome from around middle age onwards and whilst the accommodation is given some assistance, the convergence function is completely ignored throughout the whole life-span. It is among latin races, who feature particularly wide pupillary separation, that the convergence effort is even greater. From around 1934 onwards I have regularly prescribed convergence aid for middle age and older patients in amounts from 2D to 8D divided between both eyes. Prismatic lenses are custom produced and during the 2nd World War caused me considerable supply problems. My lens makers in Manchester always informed me, that my orders for those lenses exceeded the total demand from all their other customers and they wanted an explanation. I told them, that most of the patients coming to see me had two eyes.

Energy is Life-Force
A rational understanding of the functional needs and failings of the human organism can only be obtained from its study as a comprehensive entity. The treatment and relief of disease can only be properly investigated by studying the requirements of the body in its healthy state. What then are the vital prerequisites necessary to assure the normal functioning of an organism? Life itself cannot be explained, but this need not in itself be a deterrent to investigate the functional needs of the body. Modern science has established on a practical basis the fact, that the physiological work of the body is comparable to that of a machine, and that the development of energy or the capability of producing work with which the human body, as well as that of all other living beings is endowed, is governed by the physical law termed the Law of the Conservation of Energy. This law, which has been established by various investigators towards the end of the eighteenth and the beginning of the nineteenth centuries, constitutes the fundamental basis of both physical and physiological science. The human body is no exception to this law. Its outstanding signicance as regards visual functioning and its inuence on other physiological processes of the body, has, as yet, been little understood and appreciated by contemporary medicine. The human body cannot manufacture energy, but must receive it in the form of food, the raw material and basis of its energy. Food is to the body what fuel is to our engine. Neither can continue to function unless it is fed. Food contains large stores of potential energy, which the mechanism of the body has the power of liberating. In the tissues of the body there is a considerable reserve of potential energy, reserve capital so to speak, which can be drawn upon if necessary, i.e. during periods of food shortage or during sickness, when abstention from food may be desirable in order to save the
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ENERGY IS LIFE-FORCE

13

energy used by the digestive functions, which will aid, thereby, the total power available in order to combat the symptoms and disabilities from which the body may happen to suffer. This expediency, however, can only be resorted to for a limited period, as thereby the reserve capital and consequently the body itself progressively depreciates and wastes away. If, on the other hand, more food than is necessary is partaken of, the surplus may be stored in the form of heat. For the most part heat derived from food is not wasted, as adequate temperature is required for well-being and survival. It cannot be sufciently emphasised, however, that an indiscriminate intake of food is denitely harmful. Food may only be supplied up to the limit of the ability of the digestive organs to cope with it. Consideration must be given to the wear and tear of the digestive organs and the fact, that the energy absorbed by their processes is derived from a common energy fund. The energy, vitality, nerve power or nerve force or whatever else we wish to call it, which energises the human organism and all living matter and spontaneously creates life for the reproduction of the species cannot be synthesised or substituted. The energy vital for life or, as I shall henceforth term it, Life-Force can be transferred and changed from one medium to another, but it cannot be substituted or synthesised. Life-Force is the motive power to a living organism as other forms of energy are the driving force for a machine or an engine. Without food or its energy values the body would be lacking the means to perform its multifarious functions. Similarly to the fuel of an engine, food for the body is merely the raw material, which its digestive processes have to break up and change into its constituent needs. The digestive processes of the body change the food into forms of energy necessary for its adequate functioning. Likewise, however, compared to an engine, the energy producing capacity of the body is strictly limited, hence the mere increase of fuel cannot envisage an increase of power beyond the capacity of an engine or the digestive resourcefulness of the body. The over-riding energy source, which alone makes life possible on our planet, is the sun. Without it, life of any kind would not exist. For an unaccountable time it has laid up great stores of energy for us in various forms, e.g., coal, oil, etc., bottled sunshine in fact, and it continues daily to supply the means for providing us with food in its various forms. Without the sun there would be no food, energy or life itself. It is the conservation of energy therefore in every possible form, that is the vital means for maintaining health and prolonging life.

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Providing then that the fuel intake, i.e. food for the body, is adequate and balanced, sufcient energy should be available for the normal and healthy functioning of the organism. Every part of the living body has some particular function to perform. However simple or complex any of these parts may be, it is so constructed as to facilitate the work it has to do. Each distinct part may be considered as a little engine, which is put in motion by means of energy to enable it to function. This motive-force or energy is conveyed from the place where it is generated through conductors called nerves, motivating the blood supply to the part where the function is performed. The efciency of a particular function is dependent upon an adequate supply of motive-force or energy. It must then be recognised, that the efcient or healthy functioning of our body is dependent upon an adequate distribution of Life-Force. An adequate energy fund is necessary to maintain the normal and healthy functioning of the organism as a whole. This, however, in itself is not sufcient. The body has to generate daily a given amount of energy to meet the needs of its multifarious functions, let us say for example, 1,000 units per day. None of this energy can in any way be regarded as surplus or superuous. The total energy income is necessary to adequately meet all the needs and to build up reserves. If these needs are kept within the energy income, then we can safely say that the body is adequately vitalised and is functioning in a normal and healthy manner. Hence conservation of energy becomes the rst prerequisite for the maintenance of health and the prolongation of life. The moment an organism is projected into life, it commences to live and simultaneously commences to die. The span of life as between birth and death is simply and solely dependent upon energy conservation. Health can then simply be dened as a state of adequate vitalisation. In ill-health we have precisely the opposite condition, i.e. devitalisation. How then does the body change from a state of adequate vitalisation to a state of devitalisation? There is only one simple answer by exceeding the energy income or capacity of the body. Let us take a simple analogy. If a person is consistently exceeding his nancial income he must ultimately nish up in a state of bankruptcy and similarly, if a person is consistently exceeding his energy income he must ultimately be faced with a bankruptcy of his health. In actual practice it is quite impossible to draw a dividing line between physiology and pathology, i.e. between health and disease. The functioning of the organism as a whole is a constant process, which cannot be inhibited during life for one moment; its normal or abnormal functioning depends entirely on the index of its vitality content. The change-over from health to disease is only

ENERGY IS LIFE-FORCE

15

indicated by the state of well-being in the former as against the manifestation of symptom complexes in the latter. The recognition of abnormality is only possible by an understanding of normality. The bodys struggle between health and disease is a never ending ght lasting throughout life, from birth to death. It is analogous to the struggle in the ethical eld between good and evil. If we wish to avoid evil with all the disastrous consequences it can entail then we must constantly ght for the preservation of good. Just keeping within the law is not quite good enough. The safety margin is not sufcient. By just keeping within the law, the moral sanctity of the individual is not sufciently strengthened against the temptation of various precipitating conditions. Likewise, it is not possible to keep our bodies in a state of health indenitely without having an appreciable safety margin for its adequate normal functioning. From a point of view of symptom complexes, only two alternatives can be recognised health or ill-health, i.e. the functioning of the organism is either normal or abnormal. It is normal when it is adequately vitalised it is abnormal when it is devitalised. It is, however, very important to recognise a third state, where the organism is just functioning within the energy income, a kind of hand to mouth existence, the absent safety margin results in a constantly precarious balance between health and disease. This period may be termed the pre-diseased or incipient diseased state. Although a diseased condition may not exist, an organism in a normal state may either be weak or strong. It is precisely the weak or strong condition of the organism in the pre-diseased state which determines its resistance. It is the weak, but non-diseased state of the organism which is dened by the medical term of asthenia. The asthenic individual is readily recognised by the experienced observer, the esh and skin are abby and limp, hair may be lifeless, thinning and greying, he is usually underweight and mentally highly strung, a premature ageing process is clearly discernible. It is in the pre-diseased state, where an individual may be subject to a host of minor disabilities, i.e. recurrent colds, catarrh, boils, etc., without manifesting any specic symptom complexes or organic abnormality. A person may just not be feeling well or up to the mark or on the other hand positive sickness may exist, the diagnosis of which, i.e. the christening of the symptom complex, may be completely bafing to the doctor. These cases are usually described as being of idiopathic origin, which may sound very intelligent to the patient, but is in fact very unhelpful to give him relief. Latterly an attempt has been made to place this type of patient on a more scientic footing by encouraging the study of allergy. The study of

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OCULO-NEURO THERAPY

text-books dealing with the latest advances in the subject of allergy is quite an entertaining affair, providing you have a sense of humour and you are not allergic. It is not denied, of course, that some persons can be allergic to certain foods or to mere contact with certain animals and plants, which would not normally affect others. All that this signies, however, is a devitalising process, manifesting itself in a lack of resourcefulness in the digestive and respiratory organs of the sufferer concerned. The reader must surely have had experience of such cases, either of himself, his family or his friends, where cases of ill-health have deed diagnosis by all the armamentarium at the disposal of the doctor. Blood and water tests, blood pressure levels, nerve reex tests, X-ray examinations, etc. etc., are all negative and fail to give the slightest clue to the patients disability. These cases are usually a special source of frustration to the doctor and perplexity to the patient and they will continue to be so as long as devitalisation is ignored as the sole source of sickness. I feel quite sure that the economics of physiological functioning will one day form the basis of a new science, but at the moment there is as yet no instrument which will measure the energy content of the nerve-cell. The part played by heredity in the existence of disease is almost negligible. The heredity factor, congenital malformations and traumatic conditions arising from birth are fortunately so rare, that we can generally say all children are usually born organically sound and normal. Similar diseased conditions may of course be found in children as existing in their parents or grandparents; but the real signicance of such cases lie in the predisposing and not in the precipitating factors. This distinction is vital. The predisposing cause of devitalisation is of course similar in all cases, there is however an additional consideration, which may be said to have some hereditary signicance. The strength of a chain, it is said, is only as strong as its weakest link; likewise, the weakest link of the body varies with individuals, which is sometimes determined by latent inherent characteristics. That is not to say, however, that such heredity factors must inevitably lead to similar diseased conditions. There is no unavoidable process involved so long as devitalisation is prevented from becoming operative. Any disease condition, then, manifesting itself during life and not existent at birth, is of non-congenital or hereditary signicance and may be termed a functional disorder. Devitalisation is invariably the cause of all acquired functional disease. The symptom complexes arising therefrom do not run a stereotyped course. They may vary from one individual to another there

ENERGY IS LIFE-FORCE

17

may be twenty different symptom complexes in twenty cases but their origin is always identical. It is, of course, quite contrary to the conventional conception of attempting to nd a cause for every disease. To illustrate further, then, why symptom complexes or diseases vary from individual to individual, although devitalisation is the sole cause. Supposing we constructed twelve chains from precisely similar material and methods and exerted in turn, tension on each chain until it snapped, it would be quite impossible to foretell which link or links of the chain would be affected. It is beyond the scope of the most scientic method to construct a chain with every link of identical strength. When tension is therefore exerted any unpredictable link may prove to be the weakest. If we visualise, therefore, the human body as an organism similar to a chain, with every link representing one of its structures or functions, a progressive strain will ultimately exhaust whatever happens to be the weakest link. This may be the respiratory, circulatory, or digestive organs, or it may be rheumatism, diabetes mellitus, heart disease, cancer or mental derangement. Any one link may be weakened to fall victim to the inroads of a destructive bacteria. The precise nature of a disease ultimately arising from devitalisation is unpredictable.

Devitalisation from Eye-Strain

During the course of 30 years intensive practice and research I have concluded, that uncontrolled visual functioning is the most potent source of energy leakage and consequent devitalisation of ill-health. From early childhood onwards, the health can be impaired by mild or severe symptoms in which eye-strain can play an obscure, but nevertheless decisive role. There is no childhood disease of any kind, which can be excluded from the predisposing cause of eye-strain and its resultant devitalisation. What other explanation can there be for all bodily and mental ill-health in youngsters of tender age born normally, tended with loving care, endowed with ideal living conditions and having an adequate and health giving diet? I have supplied the answer hundreds of times by irrefutable demonstration unsuspected leakage of Life-Force. Thus to escape the frustration encountered in dealing with child ailments is far too frequently sought in tonsillectomy. I quote from my book Eye-Strain 1953: The whole procedure of tonsillectomy is assuming such scandalous proportions, that the present position cries out to heaven for relief. Approximately every fourth child is made to undergo tonsillectomy. The medical conception of this problem is so crude, that it is quite impossible to speak of any rational or reasoning basis for this procedure. Although these observations applied to conditions in the United Kingdom 30 years ago, we have recently witnessed similar anxieties in Australia. The lunacy of tonsillectomy is so rmly established, that even, when enlargement does not exist, it is nevertheless recommended as a therapeutic measure for the removal or prevention of other symptoms. Because the function of these organs is not properly understood by doctors, they are pointed out by them as useless vestigial remains, that the body can quite well do without. One can hardly imagine, that parents would so readily consent to indiscriminate removal of a childs septic nger. Quite true a source of pain may be removed thereby, but not its predisposing cause.
18

DEVITALISATION FROM EYE-STRAIN

19

Too often do we nd, that the other bodily ills, which the operation was intended to relieve, continue to persist and not infrequently the child is actually worse. Disabilities of the tonsils are of precisely similar signicance as all other symptoms of functional disease. The functions of tonsils and similar glands full the role in the human machine not unlike that of resistances in the circuit of an electrical system. If they go out of order, it is a sign of an overloading of the energy supply. The symptoms manifested by tonsils should be taken as a danger signal their surgical treatment does nothing to remove the predisposing cause, on the contrary, unexpected complications can arise and fatal risks cannot be excluded. The reader may naturally pose the question: Does it mean, that everybody using his visual function in an uncontrolled manner must be subject to eye-strain and its consequent share in devitalisation? This is most precisely so. It is only a matter of time when conscious symptoms of eye-strain will catch up with the individual. It may reveal itself at any time from early childhood onwards. The devitalising effect on the organism as a whole may make inroads on its resistance far earlier, than the localised symptom so clearly associated with the eyes. As we progress from childhood to full maturity and beyond the physical peak of the late twenties, we can become subject to every physical, social and environmental problem, which can be generated and initiated by the devitalising process of uncontrolled visual functioning. Every facet of human relationship and behaviour is impinged upon from the inexorable exhaustion of eye-strain. First and foremost of course are the stress, tension and anxiety situations, which can be triggered by a hundred and one different causes to shake and demolish the weakened fabric of the organism. The management and re-education of every possible social and human aberration should be preceded by an analysis in depth, if energy loss is indeed a predisposing or contributory cause for the symptom complexes of drug addiction, alcoholism, sexuality problems and not least in violence and crime.

10

Headaches and Migraine

Everybody at some time in life must suffer to some degree the consequences resulting from energy loss, but without ignoring the more serious disabilities, which can arise headache is the commonest symptom associated with eye-strain; it may manifest itself in varying forms and degree. The precise process of how a headache is brought about must be largely a matter of conjecture. It has most probably a twofold bearing, rstly the excessive innervation causes an irritation of the relevant nerve centres, and secondly the excessive ow of blood necessary to meet it must cause a certain amount of friction and overheating of the blood vessels. Some people are only affected by an occasional or periodic headache, but there are others who have been life-long sufferers and many of them are never entirely free from them. The suffering and misery caused by simple uncomplicated headaches alone, can only be properly comprehended by experienced observers and the patient himself. It is in the symptom complex of migraine, however, that the most distressing type of headache is met with. Migraine is really a covering term for a whole series of symptoms, which can embrace the whole being of the patient. Attacks may be preceded by depression, irritability and restlessness, a fatiguing exhaustion will reduce the efciency and capacity for work. The attack itself will produce physiological breakdown of varying severity due to neural malfunctioning. The main features of an onset are invariably a paroxysmal headache and visual disturbances. Vertigo is experienced prior to and during the attack and paraesthesia may occur in the limbs and face. A feeling of nausea and sickness is occasionally apt to lead to vomiting. The most signicant and pertinent symptoms however, are those associated with the visual apparatus. The visual disturbances are manifold and embrace every physiological function dependent upon the supply of neural energy. During the onset the patient may experience scintillating scotoma, photophobia,
20

HEADACHES AND MIGRAINE

21

hemianopsia, blurring of vision, contraction of the visual elds and in acute cases a sensation of complete blindness. The severity of the physiological breakdown may vary considerably; in migraine of minor standing there may even be an absence of headaches and in migraine of major standing the symptoms can be exceptionally involved and severe. The visual symptoms unquestionably indicate the predisposing cause of migraine. It is brought about by an overloading of the nervous system resulting from uncontrolled and prolonged visual functioning. Migraine attacks occur periodically, but not necessarily at regular intervals; their onset can be sudden, like epilepsy, which in reality has not dissimilar predisposing factors. The intervals between attacks are dependent upon the absence of precipitating factors in the nature of strain and stress, which can have a contributory effect of overloading the nervous system through excessive demands. The duration of a physiological breakdown during an attack may vary from 15 minutes to an hour, complete recovery of well-being is however considerably longer delayed. It may need a few hours or a good nights rest to overcome all symptoms, indeed, some sufferers have to seek complete rest in bed for periods of up to a week. During and after the attack it is advisable to seek quietness, seclusion and a darkened room, not merely for the exclusion of light to relieve glare, but to encourage relaxation of the visual functions, which is of overriding signicance in the treatment of migraine. The only possible means to completely prevent and relieve the distressing symptoms of migraine sickness will be found in the management of uncontrolled and prolonged visual functioning. To achieve this it is essential to prescribe and use spectacles giving a limiting range, particularly for indoor use, approximating to a visual acuity of 6/18. It is at the intermediate distance, where the greatest demands for the energy needs of visual functioning are made. The limiting range of a 6/18 visual acuity provides a plane of vision, which intermittently enables complete relaxation of the visual process without the need to close the eyes and the consequent inhibition of sight. The efcacy of this treatment has been proved over a period of 30 years. I have successfully treated migraine patients, who have suffered from adolescence onwards for 30 years and longer. The quintessence is to provide the sufferer with a visual plane at which complete relaxation is possible. Medical opinion is practically unanimous in the view, that the causation and relevant treatment of migraine have not yet been denitely established. Apart from the usual symptomatic treatment, which cannot prevent the onset of migraine, medical therapeutics are completely impotent to deal with the condition. Some doctors do of course recommend spectacles for so-called

22

OCULO-NEURO THERAPY

errors of refraction, which in respect of convex lenses are invariably inadequate and, if dispensed with concave lenses, merely aggravate the eyestrain problem. Non-medicinal or surgical therapeutics are of course not favoured in the medical world and hence, it is not surprising perhaps, that Sir Stewart Duke-Elder in his monumental System of Ophthalmology fails to allocate the term migraine in the index of ophthalmic optics and refraction, Volume V. Apart from the signicant fact, that blind people are not subject to migraine symptoms, the energy control of visual functioning provides vital clues and pointers in the realm of therapeutics. Insomnia, for example, can be considerably mitigated by the use of eye shades to completely exclude any light the eye lids themselves are not sufciently opaque to do this. The shaking palsy in Parkinsons disease ceases completely in sleep. The recording instrument of an electrical encephalograph discloses almost doubled cerebral activity, when the patients eyes are closed during a test. The mysticism envisaged by canny Indian gurus to popularise so-called Transcendental Meditation for which some formidable claims of health cures were recently publicised, were primarily derived from the periods of closing the eyes; undoubtedly benecial, but everything else in the act of Transcendental Meditation is pure fantasy and showmanship. A Melbourne psychiatrist specialising in meditation procedures has recently claimed the successful reversal of cancer symptoms in one of his patients. The relaxation segment in meditation is unquestionably helpful in energy conservation to fortify the defence mechanism and recuperative process of the organism. In any case, however, cancer is not a fatal disease, that distinction must be exclusively reserved for the exhaustion of Life-Force. When the cause of the common cold has been ascertained, it will double up for the cancer problem. The depletion of the generative forces may represent itself in numerous disease conditions other than cancer.

11

The Planning of Visual Care

The use of our eyes and the prevention and relief of eye-strain should be a planned procedure throughout life. Everybody from the tenderest age onwards is subject to eye-strain. Indeed, it is only a question of time, when conscious symptoms of the eyes themselves become manifest through impaired vision, eye-ache or headache. The patient who early in life becomes conscious of eye-strain symptoms is indeed very fortunate to have his attention drawn to a source of energy leakage, while a timely rectication and sealing off will prevent much suffering and the initiation of chronic disease. On the other hand, where persistent and recurring sickness makes itself apparent in any other function or part of the body and although conscious eye-strain symptoms are absent, an investigation of the eyes and their potential visual needs should be investigated without delay. It is a good axiom to say, that the eyes should be made the rst line of defence in health and the rst line of attack in disease. As soon as practicable a childs eyes should be refractively examined to determine the extent of the R.R.D. existing at birth. If the eye-strain problem is properly understood by a competent consultant, he will be able to adopt a suitable technique and stratagem, which make a thorough analysis possible with the application of cycloplegia and plan thereby, the visual needs of the child for the rst ve or six years. The benets of an eye examination early in life are invaluable. It will immediately indicate the potential myope and squinter and permit the adoption of preventive measures, which cannot be invoked too soon. Even though either of these disabilities may never mature, an early eye examination can prevent a great deal of sickness to the body and mind of the youngster, where a considerable R.R.D. is disclosed. Although the eye is constructed to overcome the visual effects of all, but the steepest R.R.D. usually met with
23

24

OCULO-NEURO THERAPY

early in life, the potential energy loss represented thereby will inexorably exact its toll sooner or later. Throughout school life and adolescence particular regard must always be had to the effectual needs of close work. Young children, particularly, have physical limitations by virtue of having shorter arms and smaller build, hence may invariably adopt a much shorter range for their close work, and very often have their nose close enough to print or writing, which must double the adults energy needs for visual functioning. Although devitalisation is a prime cause of disease, it must of course be recognised, that even the most meticulous sealing off of all potential sources of energy leakage cannot possibly prevent the ultimate wearing down of the organism as a whole. The energy resources of the human organism are a constantly and progressively shrinking asset. The peak of tness and stamina is probably reached in the late twenties or early thirties. A heavyweight boxing champion may probably live to a ripe old age, but in his late thirties he is already an old man in respect of his professional career. Hence the investigation and provisioning of visual aids assumes still greater importance from middle age onwards. The intelligent care and use of the eyes will virtually promote health and life and retard disease and death. The conservation of energy or Life-Force can make life sweeter and happier and the unavoidable burdens and stresses of modern life will become more tolerable and bearable. The avoidance of explosive neurosis will make home life more contented and even economic hardships will not bear down so hard on healthy and vitalised people. If all these matters pertaining to the eyes were properly understood and acted upon, the need for these notes would not arise. Unfortunately people are still prejudiced about visual care and the need for glasses, and hence partial, let alone adequate, relief is delayed to the last possible moment. An annual checkup of your visual needs is a safeguard, which no intelligent person should overlook. When early preventive measures against eye-strain have been neglected, it is never too late to do something about it at any age. Every person engaged in close work, regardless of the nature of their occupation, i.e. clerks, typists, tailors, engineers and others, who have to spend the whole day visually glued on their job at close range undoubtedly need some help. It is important to point out, that eye-strain arising from close work is not necessarily relative to a painstaking job, i.e. threading a needle or sewing. Peeling potatoes or preparing other vegetables and similar chores requires precisely the same physical visual demands, as threading a needle, although admittedly the degree

THE PLANNING OF VISUAL CARE

25

of concentration is lessened, accommodation and convergence of both eyes are necessary to the precise plane of vision. Excepting the management of specic problems, as associated in myopia, single vision glasses are adequately compatible for the rst four decades of life. The minimum requirement should be a prescription suitable for reading and close work, also to double up for constant indoor use, i.e. to provide a pegged plane for vision to enable the possibility of complete relaxation beyond the limiting range. If a basic prescription for long vision is called for, then an extra pair of spectacles is needed, entailing the use of two pairs, i.e. one for outdoor and the second pair for indoor use. Commencing from the early forties onwards the best solution for comfort and convenience is to be found in bifocal glasses. The rst pair should be dispensed for long and near vision. Where the reading prescription is within the limit of the intermediate range, a single vision pair would be found acceptable for this purpose, as the alternative for indoor use alongside the bifocals for outdoor purposes. However, when the necessary prescription for reading commences to exceed the indoor or intermediate range, then two separate pairs of bifocals are called for, i.e. the alternative bifocal glasses have the top section dispensed for intermediate range. The reader may quite likely be aware, that trifocal lenses are available, which incorporate an intermediate section. They would however be inadequate to provide the limiting range necessary to achieve complete relaxation. An alternative lens to the conventional bifocal or multifocal lens is currently available, which has the attractive feature of avoiding the division of foci in a bifocal lens. This is particularly attractive to the vanity of the ageing patient. The computation and manufacture of this lens is little short of the miraculous, but it literally entails very serious side effects, when the eyes are laterally rotated, gross distortion becomes manifest. Furthermore the vertical graduation of increased power is not satisfactory to effect a pegging plane for intermediate vision, hence this lens is not recommendable for adequate vision control. Improved living conditions, sanitation, diet, working conditions and living standards generally have brought about a progressive extension of the span of life, and therefore, problems of health and disease are assuming greater signicance in the whole range of functional diseases, which a devitalising organism is faced with from the sheer process of ageing. This fact is amply borne out by statistics, which show a progressive expansion of the Health Services in all respects, simultaneously with an ever increasing demand for

26

OCULO-NEURO THERAPY

them, always in excess of all the prevailing facilities and resources intended to cope with them. Efcient eye-care can do a great deal more than relieve the most obvious symptoms of eye-strain. The utmost refractive resources should be invoked rst and foremost before surgical operations, with their often irrevocable consequences, are embarked upon on such eye diseases as squint, cataract and glaucoma. Where the health of the patient has been gravely impaired resulting in continuous and chronic sickness and disease, the eyes can be made the medium for the most vital steps for energy conservation through the sealing off of the needless dissipation of Life-Force from their uncontrolled use. The intelligent use of our eyes can be made into the most formidable medium in the realm of preventive medicine, which is as yet largely virgin ground. Around 1940 I founded methods to deal with this problem and the resultant treatment I have termed Oculo-Neuro-Therapy. The benets obtained from this treatment are all the more signicant insofar as the results achieved are usually in cases which have already exhausted all the resources of conventionally accepted treatment. Its potency may be more readily appreciated, if it is realised, that the eyes are one of, and possibly, the most important terminals of the nervous system, that Life-Force cannot be substituted or synthesised and that the complete elimination of energy waste from eye-strain represents a nest egg for its positive application against all forms of disease. When uncontrolled visual functioning with the consequent faulty conditioning of the eyes has been of life-long standing, coincident with a serious disease problem of the organism, then Oculo-Neuro-Therapy must be invoked to correct this long standing process. It is the most radical method, which may be employed at any age, intended to reach back to the basic refractive condition of the eyes at birth with a view to unlocking the submerged R.R.D. existing at that time. Assuming the patient has his visual needs provided for the respective three planes of vision, then the additional procedure with O.N.T. is to step up progressively in small stages with convex lens power, until an amelioration of symptoms is achieved. In my English practice I initiated a set of clip-ons in a variety of powers from +0.25D upwards. These could be attached to the patients existing glasses, providing an immediate increase of power and prescription. Let us assume we are treating a migraine case of long standing. The symptom complex may well have existed for several decades since puberty. We have here a situation not

THE PLANNING OF VISUAL CARE

27

unsimilar to a piece of paper, which has been tightly rolled for years one single stroke of the hand will not permanently uncoil it. Several persistent efforts would be needed to restore its original state. Likewise the faultily conditioned visual apparatus has to be coaxed to return to a normal relaxed state. The aim is to provide the necessary aid, which will neutralise the symptoms complained of; remarkably enough, this is not an improvised procedure, but has an accurately calculated basis, which the patient controls himself. To demonstrate the procedure more graphically, let us assume an old fashioned balance scale, where on one side we have a bag to weigh a measure of sugar and on the other side a given weight. When the last grain of sugar needed to equal the given weight is added, the scale will balance precisely. Let us imagine then the migraine symptoms on one side of the scale and the visual aid on the other in weekly or monthly instalments we add a +0.25D or +0.50D until the symptoms have been completely relieved. Vision control as envisaged in O.N.T. is virtually a form of visual dieting. By seeing less you see longer. The energy control will reect itself in the revitalisation of every part of the body. The consultant in command of this technique is able to bring about a redistribution of Life-Force within the organism and thereby its direct application to the symptoms indicating the weakest point. The relief of eye-strain, particularly by the incisive method of O.N.T. literally liberates the natural healing power of the organism, without which recovery or even life itself is impossible.

12

Diseases of the Eye

Most eye diseases are usually of a functional nature, i.e. they are conditions, that make themselves manifest subsequent to birth. Congenital eye diseases are extremely rare and hence they need not be considered in relation to the eye-strain problem. Every new organism projected into life is usually perfectly normal and any disabilities that arise subsequently are of a functional order. It has been my overwhelming experience to observe, that all functional disorders or diseases of the eye are the results of uncontrolled visual functioning. Disorders can make themselves manifest very early in life. The range of symptoms to which the eye can be subject is considerable. Every structure of the eye, the appendages and surrounding tissues can be involved either through exhaustion, devitalisation, inammation, or mechanical derangement from stress and strain. Every age period from childhood to senility produces its own phase of symptoms. They cover practically the whole range of ocular pathology from the minor conditions of conjunctivitis and styes, to the more serious ones of glaucoma and senile cataract. Their incidence is invariably due to eye-strain and their treatment should be similar throughout life. Indeed, variations in treatment are only a matter of degree, having regard to the conditions involved, the vocational needs and the age of the patient. Only the most common conditions with which the lay public is largely conversant are described in the following notes.

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13

Myopia
The condition of myopia, commonly described as shortsight exemplies more than any other ocular anomaly the terrifying lack of understanding of the fundamental principles involved in visual functioning. It is the classic example of the dire dangers in the symptomatic treatment of disabilities arising from uncontrolled visual functioning. No other ocular condition has aroused so much speculation and discussion; but the general fallacious conceptions of visual functioning and anomalies has hitherto prevented any rational conclusions on the subject of myopia. Hence this condition is still regarded by general consent as a rst-rate ocular problem. Myopia is so widespread and its implications so serious, that an exhaustive discussion of this subject is vital. The myopia problem has been of particular interest to me since my early practice days, in view of the fact that I was myopic from my early school days onwards and every other member of my paternal family was likewise affected. It should be stressed from the outset, that myopia (shortsight) is not an opposite condition to hypermetropia (longsight). The physiological and anatomical structure of the eye is not devised to function on a zero datum line, that alternates between longsight and shortsight. As has already been stated, the eye has been constructed and endowed right from birth to cope with every problem and self generated deciency, i.e. the R.R.D., excepting gross abuse and uncontrolled functioning. Ironically, however, it is the eyes with the least R.R.D. i.e. most perfectly dimensioned, where the uncontrolled use at near vision, will faultily condition the crystalline lens, resulting in its inability to relax speedily and consistently for long vision, hence the blurred vision, i.e. myopia. Nature can hardly be imagined to have envisaged a refractive condition like myopia as normal, because its far-point of clear vision is already considerably curtailed even in cases of moderate degree; 1 dioptre of myopia already restricts the far-point of clear vision to 100 cm. Unquestionably, therefore
29

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OCULO-NEURO THERAPY

myopia must be recognised as a disability and handicap. In contrast to this it will be noted, that the R.R.D. of even considerable extent can be neutralised by the accommodative amplitude of the crystalline lens, at any rate, at least for the rst two or three decades of life. It is universally accepted, that all eyes at birth are farsighted. The suggestion of a post-foetal development of the eye in extension along its horizontal axis to initiate myopia is untenable, as the condition can be reversed, providing suitable stratagem is employed. Myopia making its appearance even early in life is of functional signicance. It may well be asked how can such a view be maintained, when such vocational causes of uncontrolled visual functioning as reading, writing or other close work cannot very well apply to an infant? A child of one or two years of age quite rightly does not engage in sewing or other close work, but nevertheless, it is exposed to far greater eye-strain, than an adult. A childs arms are so very much shorter and consequently it is compelled to hold all objects such as rattles, toys, picture books and other objects at a far closer distance from the eyes than an adult. In practice an infant handles such objects at a few inches from the eyes and the effort of visual functioning is thus approximately three times as great as that of an adult, but worse still its resourcefulness for maintaining the effort is inversely so much less. The efforts of uncontrolled functioning in the infant other than its eyes, is of course, already recognised. No one in his right senses would suggest fried sh and potatoes to be a suitable diet for infants, and later on when the infant commences to toddle and walk it is keenly appreciated that his legs are not yet sufciently strong enough to afford over-indulgence in their exercise. The eyes, however, have the facility of obscuring symptoms and effects for a longer time, than is good and safe, and it is perhaps on this account, that especial foresight and care is called for during their early development. If the development of myopia is avoided in early childhood, then school-life offers the most fertile opportunity for its onset. Parallel with a vital period in the childs growth and development the extra burden of prolonged close work spent in reading, writing, drawing and other studies can represent the last straw for the ocular apparatus to avoid the vision becoming myopic. There are two phases in the development of myopia to be considered. The prevailing method of treatment is to immediately prescribe negative lenses to improve long vision and as these glasses are then inicted on the patient for constant use, they obviously increase the burden at near vision with the consequent further progressive deterioration of long vision. This progressive myopia increase then continues until the total amplitude of the crystalline lens

MYOPIA

31

has been engaged; and as the available amplitude in a young person can be as high as 14D., this then is the myopic extent, that can be reached in the rst phase of development. As the available amplitude of the crystalline lens diminishes progressively throughout life, the development of myopia during the rst phase is restricted approximately to the rst 30 years of life. The average extent of myopia during this period is 3 to 4 dioptres, equalling the necessary accommodative effort at near vision, which is sometimes referred to as pseudo-myopia. The second phase in the development of myopia involves the whole structure of the ocular globe. When the initiating causes of the faultily conditioned crystalline lens are permitted to remain, the excessive energy expenditure in uncontrolled functioning will be reected in a general loss of tonicity of the rest of the globe. The resulting devitalisation will cause disturbances in the nutrition of the sclerotic and other vital parts, tending to soften them and lessen their mechanical support. Additionally, possibly too, the pressure of the rectus (converging) muscles in conjunction with the ciliary (accommodative) muscles will bring about that structural elongation of the eye, that may then be termed axial-myopia. The resultant distortion of the ocular globe from the progressive escalation of the negative lens treatment may quite well reach a plateau of between 20 to 30 dioptres. I have even observed considerably higher specimens at the lens makers, where scientic instrumentation for accurate measurement became unavailable; and the system and means for prescribing these monstrosities were likewise dubious to say the least. It will, therefore, be seen that the ultimate condition of myopia is, in fact, a mechanical derangement of the whole ocular structure. When this derangement is of long standing the eye must be looked upon as a crippled organ, not entirely disabled it is true, but with permanent shortcomings nevertheless. This fact is of great importance and must be constantly borne in mind for the whole of the subsequent treatment of the myopia patient, which in many cases may resolve itself in little better than a salvaging operation. Cataract and retinal detachment are by far some of the gravest risks, which may be generated by the existing myopia treatment. However, after having endured the handicap of 20 or more dioptres myopia for years a successful cataract removal will result in considerable relief for the patient. When a youngster has had a visual check-up early in life and a low R.R.D. has been ascertained, the very rst preventive step should be to prescribe a 1 dioptre convex lens for constant indoor use. The effect of this measure is to give near vision aid and to provide a peg on the visual range, which is most

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OCULO-NEURO THERAPY

effective to prevent the initiation of myopia. This procedure I had adopted for my three sons. Beginning approximately at the age of three, they were all tted with 1 dioptre convex lenses for continuous indoor use. None have developed myopia and signicantly have avoided tonsillectomy. The two principal types of lenses available for refraction are termed concave and convex respectively. The functional distinctions of both types are of vital consideration. Concave lenses have the sole function of giving symptomatic relief for the impaired visual range caused by the habitually accommodated crystalline lens and the mechanically deranged ocular globe in myopia. They cannot, however, relieve or prevent uncontrolled visual functioning. Convex lenses solely have the ability to do this. Concave lenses have the opposite effect to convex lenses and, therefore actually increase the burden of uncontrolled visual functioning. The beginning of school life represents a particularly vulnerable period for the potential myope. The demands for both distance and near vision are now consistently alternating i.e. blackboard and school desk. As far back as 1938, I realised, that the only possible solution for this situation was the use of bifocal glasses, which proved to be exceptionally successful with the school youngsters. Dr. T. Stuart-Black Kelly F.R.C.S. in his myopia research project in 1975 acknowledges my pioneering work in the use of bifocals for myopia control and conrms their efcacy in preventing progression. It is never too late to reverse or mitigate the escalating use of negative lenses, for which the myopia sufferer has been subjected to. Indeed it is not the myopia patient, who has the inherent characteristics for progression; the problem is vested with his prescriber, who blithely increases the negative lenses periodically. This process is unquestionably reversible. I was initiated to the myopia process in my early school days. Simultaneously I had to suffer a tonsillectomy, and without the benet of anaesthesia, if you please! It was in 1942, that I nally managed to t the last piece in the jig-saw puzzle of the myopia problem and I was literally staggered by the outrage and abomination of applying negative lenses to the human eye. After the continued use of negative lenses for twenty-ve years, I immediately proceeded to de-escalate my negative glasses. Ever since and up to this very moment I use convex lenses constantly. My present basic prescription being approximately +4 Dioptres. The rst thing to remember in the reversal process is the avoidance of any injudicious use of negative lenses. All myopes have an effective nearpoint and in most cases the glasses can be immediately discarded for reading

MYOPIA

33

and near vision. For the intermediate distance, the long vision prescription should be reduced by -1D. The most convenient management may be sought in the use of two sets of bifocal glasses, i.e. one for long vision or outdoor use and the other for intermediate and indoor use. One of the rst steps in the de-escalating process of a myope is to equalise the prescription of both eyes, i.e. the apparently most short-sighted eye must not have a stronger lens, than the less short-sighted eye. This dictum is completely opposite to the management of R.R.D. or longsight, where the refractive needs are a result of a physiological deciency, but in myopia the anomaly between both eyes is due to the differential accommodation of the crystalline lenses, which is initiated by the prescriber coaxing the acceptance of ever stronger lenses, apparently sharpening the visual acuity at distance and simultaneously deteriorating near vision. In effect the accommodative amplitude of the eye is acting as a sponge soaking up the negative lens inicted upon it. To illustrate the aforementioned rule and the reversibility process in myopia the following stark clinical details are an apt example. In 1976 my advice was sought by Mr. J.D., chartered accountant, who is now aged 42. He suffered tonsillectomy at 5 years of age and received his rst concave glasses at 6 years of age. He underwent operative treatment for a retinal detachment in his right eye in 1972. In 1976 he was prescribed by Dr. H.J., for constant use, the following glasses: R 16.00S = -2.00C x 170 L 5.00S = -1.50C x 170 His present prescription ordered in 1979 is as follows: Distance R.L. 4.50S = -1.00C x 170 Dispensed in two sets Intermediate R.L. 3.50S = -1.00C x 170 of bifocals. Reading R.L. 1.25S = -1.00C x 170 The prescription in 1976 following the operative treatment for retinal detachment in 1972 is beyond comment.

14

Senile Cataract
Cataract is the most prolic pathological condition of the eye, which has hitherto entailed the need of surgical intervention. Senile cataract is an interesting and signicant subject in the realm of ophthalmology. In considering the underlying causes of senile cataract, it must be recognised that a variety of other known clinical types exist. It is however not within the compass of this restricted treatise to ennumerate them in detail. The crystalline lens, which is the seat of the cataract problem is composed of layers of lens-bres not dissimilar to the folds of an onion. The maintenance of healthy tissues is dependent on the regular and normal supply of nutritive elements. The lens is no exception to this prerequisite of a healthy functioning organ. Due to the obvious necessity of transparency, there are no blood vessels fullling this function. Nevertheless, there are nourishing liquids circulating between the layers of lens-bres fullling the additional duty of easy displacement in the process of accommodation. As already stated, all acquired diseases of the eye are the result of uncontrolled and prolonged functioning. The symptoms arising therefrom do not run a stereotyped course and may manifest themselves in a variety of conditions. Having regard to the relevance of various age groups, senile cataract becomes a prolic condition, if we live long enough. Few people, indeed, are completely free from incipient symptoms from the sixth decade of life onwards. A cataract is an opacity of the crystalline lens arising from the degeneration of the lens-bres, due to an alteration or interference with their nutrition. The pressure on the lens-substance during accommodation must be considerable and cannot possibly be without effect on the circulation of the nourishing liquids between the lens-bres. I observed incontrovertible evidence of this process as far back as 45 years ago. In my 1942 book The Therapeutics of Ocular Refraction I supplied 39 detailed case records of senile cataract in various stages of development, also very precise clinical procedures.
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SENILE CATARACT

35

Those sections of the lens where the lubrication and nourishing of the bres are impeded are the rst to be affected. The nourishing liquid in these sections becomes coagulated and atrophies the sections of the lens-bres under tension, which then become opaque. The affected sections of the bres coalesce and cause ssures to appear in the lens, which gradually increase in size, forming a space to be lled with the debris of perished lens-substance. A most interesting and signicant phase in this respect may be observed in some cases of incipient cataract; the striations grouped as spokes and silhouetted against the red fundus reex will have a particularly substantial black spoke superimposed upon them, which appears to be positioned immediately beneath the lens-capsule. In some cases this opacity traverses the whole lens and in others it only covers its lower portion. It is a ssure particularly lled with debris and is indicative of the plane of the lens being subjected to the greatest tension, i.e. highest refraction. It is on the identical plane with the concave-cylinder axis correcting the astigmatism, which may be as low as 0.50D. I have designated these substantial markings axis opacities, which appears to be an appropriate term for their identication. Axis opacities in themselves are irrefutable evidence to substantiate the accommodation theory in the causation of senile cataract. The prevailing cataract treatment has not deviated materially for the past 100 years. No attempt is made to provide effective visual aids to relieve the predisposing cause of senile cataract. On the contrary the refraction is often symptomatically prescribed by reducing the existing convex glasses and even prescribing concave glasses, which will aggravate the faultily conditioned state of the crystalline lens and accelerate the cataracting process. Unless the cataract patient is therapeutically prescribed for with visual aids, the opacication process can prevail for decades or even the whole life-span. He is periodically informed, that the cataract is not yet mature for operative removal. A consultants restricted refractive technique frequently causes him to cease the prescribing of further visual aids, excepting advising the patient to obtain a magnifying glass for reading. Magnifying glasses cannot create an image, but only enlarge an existing one, hence their usefulness proves the possibility of prescribing satisfactory reading glasses. The term cataract has an unfortunate connotation and a premature diagnosis has often a devastating effect on a patients peace of mind. Subconsciously he can be burdened needlessly for many years. The most successful operation for senile cataract cannot by any stretch of imagination be termed a cure. It is true, that in a majority of cases the symptoms are removed and vision is restored, but it is not a restoration of normally existing conditions prior to the disease. Very often it creates more

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OCULO-NEURO THERAPY

problems, than it solves. This is particularly manifest in the removal of a monocular cataract. The operation converts a dynamic visual system to a static one, making the fusion of both visual images completely incompatible. The different sized images, coupled with the two incompatible lens systems, one dynamic and one static, makes the prescribing of satisfactory post-operative spectacles impossible. In recent years the use of a contact lens has been resorted to for the operated eye, which has somewhat diminished the fusion problem; but the successful management of the contact lens with insertion and removal, also aseptic maintenance, is not everybodys cup of tea. Furthermore additional spectacles are still necessary at least for near vision. In the wake of the recent mode for spare parts for worn-out components of the human body, a replacement for the enucleated crystalline lens has been evolved. It is designated a lens transplant. This expedient again minimises the fusion problem, nevertheless ensuing complications are possible, which can involve repeated surgical procedures. No operation procedure should be contemplated, whilst the patient possesses modestly useful vision. A binocular acuity of 6/18 for distance would be reasonable. The visual act is the sum total of both eyes, quite irrespective of one eye having poor or negligible vision. It is still vitally important in enhancing the quality of binocular functioning. Similar as walking is a two legged phenomena, a partially crippled leg still affords some help in balance and movement. Very regrettably, there is a prevalent tendency for some ophthalmologists to resort to premature operative treatment in monocular cataract cases, which for reasons already explained causes the patient needless inconvenience in coping. It is unfortunate, that the medical world is not very partial to non-medical or non-surgical remedies, which particularly in the case of diabetic cataract patients is a safer solution. The opacication process in senile cataract is completely reversible in all incipient cases, when adequate visual aids are provided, which will effectively prevent uncontrolled functioning. Since initiating this treatment in 1937, none of my patients have suffered a relapse or had to resort to surgery, whilst adhering to their prescribed regime. Duke-Elder in his Text-Book of Ophthalmology, Vol. 1 1932, states the following: The investigation and treatment of disease should ideally resolve itself into an exercise in advanced physical science; but when we, as surgeons, take up the knife, we are in so doing merely confessing our failure as

SENILE CATARACT

37

physicists and chemists, and admitting that, as yet, our laboratory is too complicated for us to understand, our reagents too complex for us to manipulate and our knowledge too fragmentary and inadequate for us to apply it systematically. Nothing has occurred in the treatment of senile cataract during the past 50 years to revise this statement.

15

Glaucoma
The average lay reader has undoubtedly a degree of awareness of the eye disease of glaucoma. Hearsay has provided him with a healthy respect for the possible dire consequences of neglected glaucoma symptoms. To describe the condition of glaucoma succinctly, it is probably enough to say, that a state of tension exists through an obstructed drainage of ocular aqueous, which will cause a cupping of the disc (head of the optic nerve) and consequent diminution of the visual elds. Any diminished or complete loss of vision cannot be subsequently recouped by any expedient, refractively, medically or surgically. A glaucoma condition is invariably the result of life-long visual neglect. The avoidance of extreme eye-strain conditions would in itself be adequate to prevent the initiation of the disease. And yet the standard text-books give the barest possible mention to the signicance of tension relief from uncontrolled visual functioning. Apparently the time is not yet for recognition of the therapeutic relief, which positive visual aids can provide. At the very rst awareness of being a glaucoma sufferer, the patient must seek the widest possible assistance of spectacles prescribed according to the energy needs of visual functioning. Doctors, however, are reluctant to supply prescriptions for spectacles, whilst the patient is undergoing treatment for a diseased condition. This is most regrettable, particularly in respect of glaucoma. Any undue delay will merely prevent the arrest of further visual impairment. The prognosis of chronic glaucoma is not particularly bright. Sir Stewart Duke-Elders System of Ophthalmology Vol. XI 1971, states: All the surgical procedures at present available are imperfect since all of them are liable to affect the visual function and allow a return of hypertension, while most of them leave the integrity of the eye considerably impaired.
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GLAUCOMA

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In my practice days, I invariably prescribed the best possible refractive aid prior to referring the patient for medical or surgical intervention to the nearest eye hospital. An interesting glaucoma case springs to my mind, which needs to be recorded. His name was Michael, aged 12, an intelligent scholar, his right eye had no vision anymore and his left eye registered an acuity of 1/18 i.e. he could only see at 1 metre, which should be seen at 18 metres. His mother owned a shoe store not far from my rooms in Manchester. She periodically brought Michael for spectacle dispensing prescriptions from an ophthalmologist of St. John Street (the Harley Street of Manchester). On his last visit in 1960 a prescription of R.L. -4.00D was produced. Michael had now commenced learning Braille. I refused to dispense this prescription and I asked Michaels mother to kindly take this elsewhere. I had on several previous visits explained the issues involved; with a heavy heart Michaels mother decided to let me prescribe, whatever I considered to be appropriate. All I would promise them was Churchills war-time dictum of Blood, sweat and Tears. I prescribed for constant use R.L. +3.00D and an additional powerful spectacle for reading. Approximately 6 months later Michael and his mother revisited me. She calmly informed me, that due to pressurising from friends and family she had made an appointment to consult the previous St. John Street specialist. I was in a high state of expectancy to receive a bombshell verdict, but quite the reverse. The doctor assured Michaels mother, that he was very pleased with his condition. Michael was most certainly more stabilised and at grips with his problem. I enquired about the doctors observations, if any, on Michaels new glasses, but the mother assured me, there was no comment. I could hardly have expected a more vociferous tribute.

16

Watering Eyes
The tear glands and ducts (lachrymal apparatus) full a vital role in maintaining asepsis and lubrication of the conjunctiva. If the tonicity of the tear glands becomes diminished, inammatory conditions could arise, i.e. conjunctivitis, necessitating the application of synthetic eye lotions. A depleted tonicity of the ocular appendages can also impair the muscular control of the tear glands, resulting in excessive or precipitate outow. The excessive emission of the tear glands can also be initiated from emotional spasms of joy or sorrow. Also caustic odours emanating from gas, paint or onion peeling can temporarily insensitise the muscular control of the tear glands. Once a chronic situation arises of the excessive watering of the eyes, it is frequently presumed to be caused by a blockage of the tear ducts and probing is resorted to for relief. Precipitate treatment of this nature should be resisted until all means to enhance the tonicity of the eyes have been effected. The tear ducts cannot cope with an excessive tear ow, regardless of the cause. It is a similar situation of the water drains being unable to absorb a heavy sudden rainfall. Excessive lachrymation is primarily the result of lowered tonicity arising from uncontrolled visual functioning; should this disability in fact originate from this cause, probing, which is a most unpleasant procedure and not without risk, will always show negative results. To re-establish the balanced control of the lachrymal glands, it is essential to restore normal tonicity. Effective results cannot always be achieved immediately, even by the most thorough and complete refractive aid, as the condition may well be of very long standing and the eyes will need a commensurate period for recuperation and recovery.

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17

Squint and Binocular Vision

The visual act entails the simultaneous functioning of both eyes. Stereoscopy or depth perception depends on the precise fusion of both images. When this requirement cannot be fullled the overlapping images give rise to double vision (diplopia) and under extreme stress one offending image has to be eliminated by squint or by acuity deterioration. The fusion of both images in the visual act entails the convergence of both eyes to the precise point of vision anywhere from innity to near. This is a very formidable action, as it should be remembered, that the visual axes are completely divergent, when at rest. Convergence is a simultaneous function of accommodation in the visual act and the closer the point of regard, the greater the angle and effort of convergence involved. The accommodation synergically induces convergence. Under certain conditions, however, this can cause an excess convergence termed esophoria. This is primarily a disability of young children, where a R.R.D. neglected at birth can evolve into a squint (Innervational Esotropia). As soon as a convergent squint has become manifest the use of fully prescribed spectacles is essential. Should they fail to correct the squint deviation, then bifocal glasses are indicated, particularly for school use. In the course of a few years it is possible for the tendency of excessive convergence to weaken and thus to lessen the onset of the squint. Should the spectacles in fact provide a complete rectication, they would still be necessary for eye-strain relief, even when no squint had ever existed. During my practice years in the U.K. operative treatment for squint correction was a prevalent procedure. I understand it is still resorted to today in Australia. It is understandable, that anxious parents will accede to any precipitate measures to relieve their childs deformity and only to a lesser degree the ostensible odium of spectacles. They should be warned however, that normal fusion, i.e. binocular vision cannot be restored by force. Operative treatment may quite well prove to be a cosmetic solution, but normal fusion is
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OCULO-NEURO THERAPY

not effected and to all intents and purposes the child will remain one-eyed. In fact, with nearly perfect results, there exists the possibility of chronic diplopia. The convergence function in the visual act is a mighty procedure. It is a non-stop innervational effort of varying degree occupying the waking day in the complete life-span. It should not be surprising therefore, that exhaustion symptoms are a possibility to recognise. Clerks, artisans, tailors and similar occupations entailing prolonged application to delicate and minute near vision processes are in need of precise evaluation of their visual abilities. When indicated, assistance must be provided. The most practical means is prismatic convergence aid. A method of exercises has been evolved to enhance convergence efciency. This can increase the range of performance, but not its duration. An athlete can train to run a mile a minute, but hardly 10 miles in as many minutes. It must be recognised, that the convergence function is in a state of exercise from birth onwards, and as the accommodation weakens towards middle age, assistance becomes a wise precaution for everyone. This can only be available henceforth by prismatic addition to the spectacle prescription. The average person would have exerted at near vision approximately 20 M.A. of convergence for several decades and it is not unreasonable to ease this effort by 10 to 20 percent with the addition of 1 to 2 D. Base in for each eye. An unrelieved convergence effort from middle age onwards will contribute in great measure to strain and stress, and although a conscious recognition may be absent, numerous symptoms of varying severity can ensue. I feel convinced, that the consistent tension must be a precipitating cause for a breaking point resulting in a seizure. The possibility of a progressive monocular cataract cannot be excluded. A complete fusion breakdown may result in a vertical displacement of both images termed hyperphoria for which horizontal prism aid must be provided for permanent relief. The convergence aid, as indicated here, has proved to be for decades an indispensable component in easing tension and cushioning the whole nervous system.

18

The Physiognomy of Eye-strain

How to look 60 at 40
The cosmetic effect of not wearing glasses or the equivalent not satisfactory glasses has probably never received quite the same consideration as the question of the cosmetic effect of wearing glasses. We often speak or read about a persons beautiful eyes or sad looking eyes or what the eyes tend to convey and so forth. It is quite impossible for the eyes to portray any message or characteristics, this is solely due to the eyes appendages and surrounding tissues. Prove it for yourself cover the face with a sheet of paper, leaving two holes for the eyes and without the facial characteristics, the eyes will convey neither sadness nor gladness. The eyes themselves are completely devoid of expression. They exert however a powerful impact on the appendages and surrounding tissues. The devitalising process initiated by their excessive energy demands creates a toll of varying severity, that portrays a picture of ravages common to behold. The most apparent signs are the crows feet at the canthi, the bags under the eyes, the black shadows and the discoloration of the skin. In the 3rd or 4th decade of life these initial depredations become rmly established and spread further aeld and encompass all the features in line with the tip of the nose. It is almost, as if death was stalking out of the eyes. The ageing process is unmistakable. Use a sheet of paper to cover the upper half of the face. The lower half could be entirely free of wrinkles or blemishes, then cover the lower half to reveal an ageing difference of approximately 20 years. The reader may try this experiment for himself with friends or relatives, or failing this with photographs. Illustrations in newspapers and magazines offer further opportunities for noting this irrefutable evidence of the ravishes of eye-strain.
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The despoliation process can encompass a variety of benign tumours. A mild type is the milium, a small yellowish-white elevation, the size of a pins head. These tiny tumours may appear singly or in considerable numbers, usually situated in the region of the cheek bones. Xanthelasma is a particularly disguring benign tumour. It has the appearance of a superimposed skin mole, lemon or yellow-brown in colour, and may be conned to the upper and lower lids and to the inner and outer canthus. It is a fairly frequent condition and makes its appearance with middle age, more in evidence with women, than men. Their removal, when once they have become established, cannot be effected by the most thorough refractive treatment, although their extension can be checked by this means. I have further experienced the mitigation and complete relief, by the prevention of uncontrolled visual functioning, of several other tenacious conditions, such as acne, psoriasis and rodent ulcers, whose lesion usually occurs on the upper part of the face. Cases that withstand all other forms of treatment for years have responded in the course of a few weeks. Cosmetic depredations arising from eye-strain will not yield to any treatment other than the removal of their cause. Cosmetic hygiene or beauty treatment of any description will be of no avail. At best, cosmetics can only camouage for the depredations incurred. It is a truly pathetic sight to observe otherwise attractive looking women waging a losing battle, by staving off the use of glasses for any purpose, in the mistaken belief of preserving their features. In fact, quite the opposite is taking place, the exhaustion incurred is working inexorably in the despoliation of their school-girl complexions. If the exhaustion process is of long standing, the more deep rooted will its manifestations become and their retardation and removal, where possible, will be commensurately long. Premature greying and loss of hair are all a part of the same story. In some cases an apparent diminution of the eye ball is caused by a shrinkage of the orbital fat (a clue for general weight loss) and in advanced cases a very considerable cavity is noticeable below the eyebrows. It must be generally agreed that health means beauty Nature would hardly have willed it otherwise. I will, in fact, go so far as to say that all ugliness is a disease. This is, in fact, supported by a medically recognised condition known as acromelagy. An affected persons features and limbs will, during the course of this pathological process become coarse and repellent. Medical text-books show illustrations of once handsome men or women progressively deteriorating until the features are nally coarse and ugly, when only the xed characteristics remain to give evidence that the pictures concern the one and same person.

THE PHYSIOGNOMY OF EYE-STRAIN HOW TO LOOK 60 AT 40

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There still exists a deep rooted prejudice against wearing glasses, primarily due to vanity and ignorance as to the real meaning and use of spectacles. Ophthalmology has so far failed to advance its thinking from Donders over 100 years ago, and grudgingly recommends spectacles for so-called errors of refraction and presbyopia due to old age. This formula, particularly in respect of errors of refraction is completely untenable, as it presumes a static refracting system functioning from a zero datum line from which myopia (shortsight) and hypermetropia (longsight) progresses in opposite directions. The errors of refraction theory is an arrogant presumption of the fallible evolution of Homo Sapiens. Evolution or the Great Maker have made no errors of refraction. As previously described, the visual apparatus is a wondrously ingenious construction, both with foresight and hindsight for any possible shortcomings. The terminology of emmetropia and ametropia, for so-called perfect and imperfect vision respectively, is devoid of any scientic or physiological basis. The visual apparatus at birth is a completely functioning organism, capable of neutralising the R.R.D. to give unrestricted clear vision from innity to near. The errors of refraction in respect of myopia are a subsequent, self inicted endowment. The problem of presbyopia is a diminishing amplitude of accommodation due to the ageing process. Print or near objects have to be held progressively further from the eyes. An extensive amplitude is no indication however, that even a small part can be subject to uncontrolled or prolonged functioning. Hence consideration must be given to visual aid in the pre-presbyopic period. My advice on the importance of visual aids has often been challenged with the observation, that we are not born with glasses on and by the same token, nor we were born with anything else on either. Nevertheless, as shown in their magazines, even nudist devotees succumb to their need of sunglasses. The anthropologist says, that mans ability to produce tools is his distinguishing mark from an animal. All tools produced by man are intended for his comfort, protection and advancement. Spectacles cover precisely the same role, they are a landmark in the civilising progress of man. They are not a sign of visual impairment or a crippled organism or as sometimes suggested a crutch. They are a measure of the users intelligent appreciation for his comfort. They are less dispensable, than wearing shoes, but completely useless for people that cant see. Vanity is a considerable impediment for adequate visual care with men, no less than women. This is particularly apparent with public gures and politicans. You see them photographed working at their desks and perusing

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papers, being virtually blind without their glasses. Amongst politicians and media commentators we have Sir Phillip Lynch, Don Chipp and Sam Lipski as outstanding examples displaying the cosmetic toll of eye-strain. Andrew Peacock and Bob Hawke use their spectacles very surreptitiously and as they are both shortsighted, this happens to be commendable. Men dont make passes at women with glasses. And, rightly or wrongly, many women of all ages are still extremely sensitive to spectacle wearing. The sunglass vogue has made some inroads to lessen this prejudice. Womens sensitivity and prejudice to encumbering their features with spectacles gave me a great deal of concern in the 1930s. This attitude was to a certain extent not unwarranted. Spectacles available to that point of time were identical in style and format for men and women or their scaled down counterparts for children. England would still be making the nest hand crafted spectacle ware up to the beginning of the second world war. This was exemplied in hand wrought steel, solid gold and particularly tortoiseshell, nevertheless they remained indistinguishable utility items. Some glamour was called for to sweeten the pill. The earrings, necklaces and other facial adornments with which women beautied themselves from time immemorial, drew my attention to elevate spectacles into line as glamour objects. I spent 2 years designing and evolving jewel mounted eyewear designated Specta mountings Patent No. 500244, registered 11th May 1958. This then saw the birth of ladies fashion eyewear in the world, as glamour items distinguishable from masculine styles. The world of ladies fashion eyewear has never looked back since. Regrettably, however, England and the U.S.A., who made beautiful gold and rolled gold eyewear in the rst quarter of this century, have now had to cede pre-eminence in styling and quality to Germany in the rst place, with France and Italy as close seconds.

19

Sunglasses for Photophobia

Light sensitivity is an associated problem of uncontrolled visual functioning. A persistent sufferer of this disability should seek an analysis of his refraction needs, as white glass alone, already reduces light transmission by approximately 8 percent. The subject of photophobia is considerably confused by commercial exploitation. The public is grossly bamboozled with the emotive use of such terms as infra-red and ultraviolet rays of the spectrum, in spite of the fact, that no scientic evidence exists, that the emission of natural light has detrimental effects and should therefore be manipulated by absorption lenses in sunglasses. Under normal conditions of light, protective sunglasses are unnecessary for acclimatised people. Their evergrowing use has degenerated into a fad and cult, they have been promoted into fashion accessories, which is not without its inherent disabilities in creating the very symptoms it is sought to relieve. Infra-red radiation from sunlight can only predispose harmful effects, when the sun is looked at directly, particularly at eclipse periods. Harmful exposure can also occur in industries, where the smelting of metals and glass manufacture are in progress. Ultra-violet rays, however, are not present in sufcient intensity in ordinary sunlight to cause any problems, excepting, when compounded by reection from snow or extensive surfaces, which act as a mirror. Polarising lenses however, are more effective for these conditions. Precaution is also advisable, when engaged in electric welding, exposure under arc lamps and ultra-violet light in health procedures. In all other normal conditions of light and illumination, however, sunglasses are unnecessary for healthily conditioned eyes. The trade in sunglasses has now developed into a multi-million dollar rip-off. The efcacy of relief from sun-glare is irrelevant irrespective of their cost. A $5 pair can be as useful or useless as a $50 or $100 outt. The vendors of sunglasses now range from supermarkets, garages, boutiques, pharmacists
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etc.; the nadir of media publicity has surely been reached, when one current product lauds its quality, to resist destruction from being sat on. In respect of reected glare however, which is beyond the ability of ordinary tinted lenses to cope with, the Polaroid product of sunglasses and clip-ons are recommendable to be highly effective, particularly for shing, winter sports and motoring. Driving at sunset has always been trying to me and I have a Polaroid clip-on always on hand in the glove box. It cannot be sufciently emphasised, that the injudicious use of sunglasses can and does create light sensitivity. More and more people are using them all day and night, regardless of the season or light conditions. I am vividly reminded of a special case to illustrate this warning. One Saturday in my Manchester city practice, a gentleman led his wife by the arm into my rooms. The ladys eyes were blindfolded with a white handkerchief and in his left hand he was holding a black velvet bag containing an assortment of sunglasses, from which he selected a pair with Crookes B2 lenses, which was the darkest possible tint available. He inquired, if a darker tint was available. I facetiously suggested to dispose of all the glasses and commission the velvet bag. After their protracted trials, which their spectacle collection portrayed, they were more than willing to heed my advice. 4 hours later the wife walked out of my rooms unaided, tted with white lensed spectacles. I can still remember it was a substantial prescription of convex lenses. The distortion of normal light transmission has recently been the subject of a serious warning from the Department of Motor Transport about the effects on trafc safety caused by tinting the windows on motor vehicles. There are strict limitations on the tinting of all windscreens and windows. Tinting should not obstruct the primary clear view. This basically requires, that there be 85% visible light.

20

Visual Acuity
The act and art of seeing involves dioptral, retinal, neural and mental co-ordinating factors. The R.R.D., retinal sensitivity, neural resourcefulness and mental interpretation all play their part and must receive due consideration. The quality of visual acuity is also a variable factor. The visual apparatus is not fully conditioned in early childhood and peak sensitivity may take some years to develop, in senility reduced acuity must be expected through impaired transmission. The identication of test-type letters at the minimum distance for which they are designed is taken as an indication of normal average vision. 6/6 is a conventional term indicating normal vision, i.e. reading a letter subtending an angle of 5 minutes at 6 metres. In practice, however, visual acuity of 6/6 must only be regarded as an average. Apart from injuries or diseased conditions the signicance of varying degrees of visual acuity is purely physiological. To suggest to a person, that his vision is subnormal because his acuity with or without glasses is less than the average 6/6 is incorrect. We might as well say that because one man can swim or walk twice as fast as another one, the latter is only fty percent efcient in swimming or walking, these differences are merely inherent in the muscular tonicity and physiological resourcefulness of the particular individual. It will thus be seen, that little reliance can be placed in the prescribing of visual aids based solely on the guide of clearest vision at the longest distance. It is no exaggeration to say, that the endeavour to identify the smallest distant test-type during an eye examination can lead to disaster. It is a highly dangerous procedure devoid of any physiological basis. It is useful solely as a means of recording conventional acuity values, but not as a basis of prescribing visual aids to relieve uncontrolled functioning.
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The conventional practice of estimating acuity values exists entirely for clearest vision at innity; is in complete contradiction to the needs of our near vision civilisation. The diagnostic examination procedure itself is orientated to stimulate instead of relaxing the visual apparatus. The subjective examination process consistently interrogates the examinee with Is it better or worse? The nal prescription then ignores completely the visual needs from innity to near vision. It is at the intermediate vision, that the whole business of seeing is performed for the best part of the 2/3rd waking day. Hence no provision exists to prevent uncontrolled functioning. It is only by curtailing the visual range for innity to some degree, that the provision of a pegging range will exist. The slight impairment of acuity at innity is a measure of self discipline for which the immediate comfort to be derived is an essential ingredient for the reconditioning process of the organism as a whole. If you dont discipline yourself voluntarily, then Nature does it compulsorily, which is invariably more drastic and unpleasant. The energy conservation engendered thereby validates my slogan see less, see longer. An examination procedure largely deployed at innity to cope with the needs of our near vision civilization appears to be and is in fact a contradiction in terms. To cope with this anachronism I developed over the years a near distance testing technique which has proved itself highly satisfactorily to this very day. It was adequately described in my book The Therapeutics of Ocular Refraction 1942. The visual requirements for motorists have a generous provision to accommodate for relaxed vision in driving. The minimum requirements are 6/12 vision in one eye and 6/60 in the other. A relaxed driver with an acuity of only 6/9 is far safer, than one with 6/4 vision and keyed up to breaking point. Controlled visual comfort is an important ingredient for road safety. Appertaining to visual acuity, I had a most startling experience with a patient many years ago at my St. Helens practice, which incidentally is still in existence at 23 Bridge Street. He was aged around 40, a bricklayer, dapper and articulate. A myope, who was enduring spectacles of minus 21 dioptres, when he called to consult me. I managed to reduce his prescription to minus 17 dioptres, the lenses were dispensed in high refractive index glass to reduce thickness and were tted in a handcrafted shell frame. When the tting day arrived my client was delighted with his spectacles and I was similarly animated with the result. He had his bicycle parked near the door and as I opened it for him, he removed his new glasses and placed them in his case. I was quite shaken and shocked and when challenged, he calmly replied he could ride

VISUAL ACUITY

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his bicycle quite safely without and only used his glasses, when he required detailed and precise vision. He assured me, he could see miles away without glasses, he clearly saw the moon at night. As this occurred about 30 years ago, I cant recall, if in fact he used glasses at work.

21

Contact Lenses
The introduction of contact lenses as visual aids in comparatively recent times has created a great deal of interest for spectacle wearers. Various types have been evolved during the past 30 years, but the minute corneal plastic lens has proved to be the most popular. It is important to remember at the outset, that a contact lens is not an alternative kind of spectacle lens. In the realm of visual aids it assumes a designation of an anatomical tment similar to dentures, articial limbs or indeed an intra-ocular implant in cataract removal. Hence additional spectacles are still indicated under various circumstances. Contact lenses have attained a considerable degree of popularity, largely due to an erroneous perception as offering an alternative to spectacles. The incentive to acquire contact lenses is primarily due to cosmetic considerations. The principal appeal is amongst myopic young ladies, who obtained their rst spectacles during school attendance and are now anxious to glamorise themselves in the outer world. Usually they are mostly low degree myopes and the effect of the subsequent contact lenses is to deeply condition their myopia, as the aim is to achieve long periods of tolerance. These potential contact lens users usually assume typing, secretarial or receptionist duties involving considerable periods of close work. The contact lenses cannot be as readily inserted and removed as spectacles, hence the strain involved by the needless use of negative lenses at near vision can and does lead to a veritable crippling of the visual apparatus. Most readers will have experienced annoyance from a foreign body in their eyes, possibly no larger than a pin point and contact lenses are in fact foreign bodies, hence a user must be prepared for varying problems to eventuate. Even the most stabilised contact lens user has at some time to resort to the ancillary use of spectacles, either for intermediate distance, reading or merely
52

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sunglasses, hence the myth of non-dependence on visual aids is immediately destroyed. Apart from the supposed cosmetic appeal, contact lenses offer no therapeutic advantage over spectacles. There is, however, a considerable management problem in respect of efcient asepsis and also possible loss of a lens in what can often occur in the most embarrassing circumstances. The use of contact lenses for the minor degrees of myopia in young people is little better, than a gimmick. In most cases their glamour and visual problems could be assuaged more satisfactorily by alternative treatment. It certainly is completely unrelated to any health problem justifying huge and generous contributions from Medibank to subsidise the inated costs of tiny pieces of plastic. A timely deletion of this largesse from the overburdened health funds is indicated. The original incentives in the evolution of the contact lens were not intended for cosmetic reasons. The early pioneers were concerned with the relief of various anomalies and pathological conditions of the cornea. This has had a substantial measure of success for a condition named conical cornea, which as the name implies is a distortion of the eyes window, very difcult to correct with spectacle lenses. National Health support for these conditions is fully justied, also in respect of post-operative cataract patients.

22

The Optometrist-Opticians
A certain amount of enlightenment is warranted in respect of the available services for the supply of visual aids. The indigenous variance in the local spectacle trade is twofold. The denomination of optician is solely indicative of the dispenser or spectacle maker, who is restricted under State laws not to engage in sight testing. The Optometrist, certied by registration for sight testing, has in order to safeguard the lucrative side of dispensing for himself, adopted additionally the time honoured title of Optician, hence the double designation of Optometrist-Optician. I believe this denition is an exclusive rst for Australia. The antecedents of opticians in the English speaking world at least were primarily watchmakers, jewellers and pharmacists, but with all due regard to their status, they have attempted to progressively elevate and expand their standing. Probably due to the colonial connection in respect of the old country, the local opticians inherited the philosophical base of their craft from England, which has not deviated for decades. The optometrist in line with his English cousin, is solely concerned with the problems of correcting errors of refraction or in other words, amending shortcomings in the physical range of vision at innity or near. The causes of eye-strain are still the subject of immature assessment. He prescribes correcting glasses, providing the eyes are healthy, but when confronted with a case of eye disease, he immediately divests himself of any responsibility by referring the patient to an ophthalmic surgeon. The precise direction laid down for practice in the U.K. health service stated as follows: ophthalmic optics is concerned with healthy eyes and the correction of their anomalies of vision; ophthalmology is concerned with unhealthy eyes and the treatment and cure of disease. This is roughly the premise of the indigenous optometrist, which is a complete denial of the therapeutics inherent in relieving glasses. Surely, if they are the means of comfort in a healthy individual, they must be far more
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55

essential in a diseased condition. A comparable situation would exist as though the science of meteorology could be divided into that of good and bad weather. There are other limitations in the optometrists service, that can make themselves manifest at both ends of the life span, i.e. in the realm of pediatrics and geriatrics, when conditions can exist necessitating the application of drugs for a comprehensive examination. Optometrists are prohibited by State laws to use drugs for eye testing and the tting of lenses. This is a severe limitation, when the early planning of visual care for a youngster is called for. Nevertheless, for the minimal professional service of assisting the patient in elucidating the test chart letters, the optometrists training course is of 4 years duration, producing the meagre result of certication to prescribe spectacles for refractive errors. His training has made no advance on the Donders precepts. There is no attempt to assist and promote preventive medicine. No attempt is made to instruct and educate the community to mitigate the universal eye-strain problem. There is no ongoing research worthy of the name. The optometric-optician designation has currently proved to be a providential windfall. The optometrists aim is to progressively elevate his professional standing, accordingly he has modied shop window displays and abrogated media publicity. He is reaching for a cut above spectacle selling, without, however, dispensing with the lucrative element involved. Under the inception of Medibank he has been placed on par with the ophthalmologist to receive an adequate examination fee. The ophthalmologists fee however is his total remuneration for a comprehensive examination and diagnosis. He receives no additional income from the sale of spectacles. The optometrist, after testing his clients eyes, then assumes his optician identity and proceeds to dispense the glasses he recommends at a mark up of approximately 200 to 300 percent on intrinsic laboratory costs. His income per patient escalates 2 to 3 times the remuneration accorded to the ophthalmologist for little more effort, than assisting the patient to identify letters on the test chart. There obviously exists a conict of interest in this situation. The prescriber should not double up as a dispenser. The cognoscenti of the optical establishment has recognised this situation and is ostensibly endeavouring to separate spectacle sales from sight testing. Accordingly a shadow rm owned by the optometrist manages the dispensing business. The subterfuge works in several ways. Where two shop windows are available one publicises dispensing and the other sight testing. However, some premises have two separate doors connecting to the same establishment.

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The spectacle selling enterprise is likewise not inhibited by professional ethics and it continues to use the media for advertising, which in effect is pimping business for the optometrist.

23

The Ophthalmologists
The doctor, having decided to specialise in ophthalmology, is obviously conditioned by his basic medical training to deal with all ailments and disease on a symptomatic basis. His work is largely entailed in crisis management. The patient needs immediate relief for conditions, that have often taken decades to develop. Hence the symptomatic treatment for the most prolic conditions, which call for his assistance. The myope is made more myopic. Watering eyes are still submitted to the barbarity of probing the tear ducts. Cataract patients with one efcient eye are nevertheless operated on, which subsequently makes the use of both eyes intolerable. Photophobia is made a chronic disability by the prescribing and injudicious use of tinted lenses. Children are still operated on for squint, resulting in the permanent destruction of binocular vision. The prognosis in post-operative glaucoma cases is invariably uncertain. The therapeutic element of relieving tension and eye-strain is almost completely ignored. Doctors do of course prescribe glasses, but hesitantly and grudgingly. They are undoubtedly imbued with some inherent prejudice, which is not easily explained. Their bias against visual aids manifests itself in several ways. Whilst the doctor is treating his patient for a diseased condition, he will usually delay the prescribing of spectacles until treatment is completed. Similarly, most doctors are reluctant to prescribe for what they term as small errors, i.e. small degrees of hypermetropia, which can easily be overcome by the accommodative amplitude. A +0.25 D convex lens is the most important item in the test case, it will often be the nal degree of aid to banish symptoms from uncontrolled functioning. Against the prejudice in respect of small errors calling for a +0.25 or +0.50 D convex lens, such prescriptions for concave lenses are prescribed with alacrity, as the visual effect is spectacular. Such treatment is commonly allocated to young clerical workers, whose protracted close work will have reduced their visual acuity to approximately 6/18; they receive their rst concave lenses instead of convex, which increases their burden and subsequently qualies them as candidates for contact lenses.
57

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Medical thinking and logic can be exasperatingly frustrating. A recent example is worthy of notice. The Age on 18th October 1980 published an article from their science reporter Peter Roberts. He interviewed Dr. Paul Martin, a clinical psychologist at Monash University. Dr. Martin was engaged on migraine research at Prince Henrys Hospital, commissioned by the International Journal of Mental Health. After commencing his research project he developed migraine symptoms himself. He states a combination of eye-strain and over-exertion usually precedes his own migraines. Apparently a mild affair, as its course does not exceed six hours. In spite of his precise diagnosis as to the precipitating causes of his migraine he goes on to say we do not know what triggers headaches, Research has shown us more what we dont know rather than what we know. Around the turn of the century there was a formidable body of medical opinion, which unequivocally and lucidly dealt with the scourge of the eye-strain problem. A selection of verbatim extracts are cited in the next chapter. The question comes to mind, why has this pertinent body of opinion all but faded away. There surely appear to have been few medical advances since, which could have made these views obsolete or irrelevant. Possibly recent medical advances have been more scientic and consequently incompatible with the elementary tenets of men like Clarke, Ranney, Gould and Prentice. At this point it should be fairly obvious, that a far greater responsibility rests on the ophthalmologist, than mere symptomatic treatment of eye disease and the correction of so-called errors of refraction. In the so far virgin elds of preventive medicine his position must unquestionably become paramount. The therapeutics, as yet slumbering within his grasp will eventually mature fully for the benet of computer-age man. As I have already stated, the economics of physiological functioning must have an irreplaceable niche for the ophthalmologist.

24

Medical Pioneers of Therapeutics

The medical mens conception of functional disease is, or rather was, not entirely unanimous. A signicant minority of them have held opposite views. These are important enough to be stated at some length.

AMBROSE L. RANNEY, A.M., M.D.

Eye-strain in Health and Disease, 1897 If the view that eye-strain is a frequent cause of functional nervous derangements proves to be the correct one, beyond the possibility of a doubt or cavil, it is not difcult to see that a hope of marked relief or of ultimate recovery is practically extended to many hopeless sufferers upon whom drugs have exerted little or no benet. Should investigation end whenever microbes or toxic materials are discovered in the human economy? Should the causes of a diseased condition be regarded as determined so long as the underlying factors that enable this cause to exist and ourish are ignored? Which is the most important in medicine to ascertain what adventitious agent can do damage, under favourable conditions, or to so improve the nervous power of a patient as to enable the body to resist the seeds of disease? So long as we are incapable of ghting our foe (when once established with a rm foothold within the human economy), what have we gained, from the standpoint of the sufferer, by simply knowing the name, exact appearance, or seat of the enemy? I would not be construed as decrying the scientic results obtained by careful, painstaking bacteriological or pathological research. They undoubtedly tend to furnish the medical practitioner with some knowledge, after the chaff has been eliminated and the wheat carefully collected, that may, in time, aid
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in the prevention of disease, and possibly facilitate its cure. But while these investigations are going on, while with great rapidity theories are being hatched and exploded, while the views of today may not be those of tomorrow, is it not the duty of every earnest practitioner of medicine to listen with attention to clinical facts that are capable of absolute verication, that are often fraught with immediate results to suffering humanity, and that open a wide eld for the treatment and relief of obscure nervous diseases? To anyone who delves in the medical literature of the past, and who reads the theories that have ourished and been forgotten, it becomes at once apparent that the tendency of this age is to seek for the causes of disease, and, as far as possible, to remove them. If it can be shown that defective nerve-power may cause healthy organs to act imperfectly and spasmodically in the human body just as a low steam-pressure in a mill would affect the running of complicated machinery is it not wise to correct that defect before the machinery (or organs) be tampered with? If it can and has been scientically demonstrated that a leak of nerve-force often exists in patients whose digestive functions have for years been faulty, is it not best to stop that leak? We can, then, look for an improved condition of those organs, without drugs, as soon as the reservoir of nerve-force has been lled by nature to a proper level. Does every physician think, when he advises an adult patient to rest and travel or a child to be taken from school, that much of the benet that may follow is probably due to the relief from eye-work?

GEORGE M. GOULD, M.D.

Biographic Clinics, 1905 Ocular inammations, ocular operations and the ocular results of systemic disease these were the limits of its interests (Ophthalmology). Even in recent text-books on medical ophthalmology, there is no thought of any other relations of general medicine and ophthalmology than those morbid ocular ones originating outside. That the eye is the starting point of systemic disease was unsuspected. In the latest, greatest, best and most ofcial text-book on medical practice, that of Allbutt, there is not a word from the rst page to the last which hints at the ocular origin of any systemic disease, not even headache. There are today neurologists, diagnosticians and physicians of international renown who wholly deny that eye-strain causes reex diseases of any kind.

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61

What are the relations of the new and the old ophthalmology. They are most intimate, sociologically and clinically. In a word, the scientic correction of ametropia prevents almost all inammatory and surgical diseases of the eyes I should say about nine-tenths of them. In the many diseases of the eye there is at last but one disease. There was plainly an overhasty recourse to surgery when the surgical disease could have been prevented. As has been well said, an ancient hunger for the miraculous has come down to our times and to our medical science, and operation is the modern medical miracle. In neurology there is almost no limit to what the refractionist may justly claim. And posterity will allow it, although the neurologist of today is unconscious and contemptuous of the truth. One of the more subtle but still easily recognisable methods in which eye-strain works perniciously is by a slow and general denutrition and reduction of mental and physical vitality whereby the resisting powers of the system are reduced to such a degree that it becomes the easy prey of infections, and of general and terminal diseases. This makes eye-strain a factor in the tuberculosis and pneumonia crusade.

CHALMER PRENTICE, M.D.

The Eye, Mind, Energy and Matter, 1905 The occasional overtaxing of a function may not result in much observable injury to other parts; but through oft-repeated and continued experiences the excessive function becomes a habit, and more or less continues in its excessive demands on the common energy-fund, continuously depriving other parts of a healthy functioning power. Thus we can readily see that organs can be diseased without the cause being in them or their governing nerve centres. Of all organs in the body, the eyes are the most capable of demanding and getting an excessive share of the general fund of nerve-energy from the human powerhouse, for the following reasons: 1. The feeling of vision is the most acute of all senses, because it is actively aroused by one of the most imponderable elements known to science light. By the impact of its delicate waves our consciousness is made to feel shape, motion and colour. Its rays, reected from various objects, pass through the cornea, the aqueous humor, the crystalline lens, the vitreous body and there reach the retinal nerves. The delicacy of this touch, or impact, on the retinal nerves is beyond the conception of the human mind; yet it establishes from this point an impulse which is conveyed to the sight centres at the base of the

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brain, which with no uncertainty determine form, colour, motion, quantity and space. Here we have the most positive sense or feeling known to man, produced by the most imponderable agent known to science. 2. This work of seeing, requiring energy, is kept up continuously for sixteen out of twenty-four hours or two-thirds of our entire life. 3. The dynamos governing the function of vision are the largest in area of any of the human brain, and the most extensively distributed. 4. The conductors from the dynamos to the eyes are very large, and capable of conducting much energy. 5. The distance between the eyes and their dynamos is short thus offering little resistance to the transit of energy. We have been wont in the past to use the word reex to account for certain diseases in distant parts of the body originating from eye-strain and other local points of irritation, but when we view these disorders from the nerve centres we have a better understanding of how one diseased condition of the body may arise from another. From the most minute cells to the largest organs of a healthy body every part has a place in the general economy, and a function to perform. Each part is a motor or anatomical engine, which is set in motion, or whose function begins when they receive their working power, and ceases when that working power is withdrawn. Any alteration from the normal nerve currents will relatively disturb and alter the function of a part. A natural query would be, What class of diseases are due to eye-strain, and can be relieved by removing the cause? A general answer best meets this question. All diseases are emphasised or made worse by anything that irritates and depletes the nervous system; and, naturally, any disease will be more or less relieved by correcting nerve strain. There is a remedy for those whose occupations are such that they cannot take advantage of open-air life, but are forced to continue at a close range of vision, which is to aid the vision so that when it is being used at a near point the eyes have about the same adjustment as they would in looking over the open country, and consequently the brain would be as free from strain. The above statements are undoubtedly startling, and a good reason ought to be given why such radical effects on the general system are to be attained through the medium of vision. The principal reason is this: more than one-third of the grey matter of the brain is utilised to perform the functions of the eyes. This vast and sensitive area of the brain is under the command of the modern oculist. So by the aid of glasses, through the eye, he can inuence and curtail the work in these large brain centres; and, as all nerve centres are

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63

connected by association bres, it can be seen that nerve centres governing other parts of the body would be inuenced. Mechanical glass-tting, according to the accepted methods of the day, is responsible for many serious conditions to the eyes and nervous system. Glasses that bring about perfect vision may be exceedingly injurious. The physiological aspect of vision should always be carefully studied in adjusting glasses for sight.

ERNEST CLARKE, M.D., B.S. (LOND.)

Refraction of the Eye, 1892 Nerve-Power Waste; Nerve Exhaustion; Neurasthenia; Brain-Fag. This is a manifestation of eye-strain that is as common as it is subtle. Subtle it must be, as every possible cause has been cited as the origin of the various groups of symptoms which are exhibited, except the eyes. It has not been sufciently recognised that in a large majority of those cases called neurasthenia the real trouble is a constant nerve-power leakage or waste of nervous energy, and in a large number of cases eye-strain is the cause. This nerve-waste may exist in a person of robust nervous temperament without much, if any, harm, but in one whose nervous conditions are unstable it must in time show itself. Even perfectly robust individuals showing no symptoms of eye-strain may manifest it when under altered conditions, such as shock of any kind, or lowering of the general vitality from any cause. The physician who is called upon to treat a so-called functional nerve disorder, and fails to eliminate the element of eye-strain, fails in his duty both to himself and his patient, for there is no functional trouble that may not be due to eye-strain. The depression attending nerve-waste may lead to the alcoholic habit, and the irritability so often present in those suffering from functional nerve disorders often induces the sufferer to resort to sedatives, such as morphia. The patient suffering from nerve-power waste has a low resisting power to all disease germs, and is in what one might call a pre-germ stage, so that he is more liable to any infection than the more normal person. There can, therefore, be little doubt that the correction of eye-strain takes a very prominent place in preventive medicine. The chief reason why the eyes are so seldom suspected of being the cause of neurasthenia, brain-fag, and the different varieties of functional nervous

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troubles, is that the majority of patients have either good sight or they are already wearing glasses which apparently correct their refractive errors. At the Oxford Ophthalmological Congress July 1917, Clarke made this statement: One thing I am sure of, and that is, that we have reached nearer an exact science in refraction work than in any other department of medicine, and that, if we do this work conscientiously and carefully, we are more likely to benet the human race than by tons of physic.

25

Fournet
In concluding my story on the eye-strain problem past, present and future, it is impossible to ignore recalling the work of Fournet. The following is a reprint of Chapter I from my rst book The Therapeutics of Ocular Refraction 1942. FIFTY YEARS AGO On the 3rd of January, 1907, at the early age of 49 years, there passed away an optician by the name of Aristide Antoine Marie Fournet. He was of French origin and the son of a lens grinder. Fournet from his early boyhood spent his life in England, brought up to his fathers trade and felt proud of and akin to the country of his adoption. That M. Fournet was a genius of outstanding ability and industry there can be no doubt. The library of the British Optical Association contains ve books dealing with his activities. Three were written by Fournet himself and the other two were compilations by two of his grateful patients. A perusal of these books gives a startling insight to his activities, the evidence discloses Fournet to have been a man of unbounding energy and honesty of purpose in the pursuit of his ideal, which he himself termed to be The Benefaction of Mankind. His most ambitious literary work The Philosophy of Sight, published in 1889, that is just over 50 years ago, is a book of sound logic and plain facts, which could not be improved upon today in any particular way. Fournet was recognised in his day as a master of refraction without equal. He unfortunately never published his theories and methods, but a close scrutiny of the available evidence supplies sufcient clues to furnish a picture of Fournets thesis on refractive problems. Fournet was an able student of cause and effect. He believed that glasses alone made the virtues of an organically healthy eye manifest. He realised to the full the therapeutic value of convex lenses and convergence aid by means of
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prisms. He prescribed lens combinations in his day, which even today are not universally appreciated and understood. His prescription houses were often hard pressed in the execution of his instructions. His patients, many of whom were distinguished people, as for example Rear-Admiral Arthur H. Smith Dorrien, who championed his methods and testied that their health was marvellously improved by wearing his glasses. He was alive to the value and meaning of accurate refraction, which probably provided the incentive for his refractometer of which he was the inventor and secured for him a patent as far back as 1883. He demonstrated his instrument before a meeting of the Ophthalmological Society at which Sir George Anderson Critchett was present. Fournets refractometer must surely have been the forerunner and inspiration for the modern refracting units. He scorned the use of drugs in refraction and publicised his ability of performing better refraction work without drugs as a source of strength rather than weakness. Fournet was distinctly biased against the use of tinted lenses. He set his face against all cant and humbug and his views of the modern orthoptist would have been interesting, for he said in as many words, if a person needed convergence aid it was useless attempting to reconcile the patient by assigning to the conditions a fancy name for a mythical complaint. Fournet would have smiled at the contortions of the contemporary investigators into the Myopia Problem. Fifty years ago he was already prescribing Franklin Bifocals for cases of Progressive Myopia. He strongly urged the use of special glasses for vocational use and he was aghast in his day that drivers of trains and omnibuses, amongst others, were all presumed to be with perfect sight. Fournet had a profound knowledge of the effects of the accommodative system in relation to eye disease and he exercised the courage of his convictions to the full. Small wonder then, that his patients assumed his glasses to be almost magical in effecting cures of cataract, glaucoma, corneal ulcers and other diseases, after the so-called eminent surgeons of his day had failed with their drops, lotions and operations. Fournet was conversant with the cosmetic effect of not wearing glasses. Madam, he once said to a beautiful patient, You are a beautiful woman now. In ten years if you dont wear your glasses, you will be a miserable old hag. He is reputed to have treated the poor without charge and to have demanded and obtained hundreds of pounds for his services from his wealthy patients. Fournet was an enfant terrible to the medical fraternity of his day. He literally terrorised the best known ophthalmic surgeons, the eye hospitals and every medical organisation from the Medical Defence Union Ltd., to the General Medical Council. Petitions were prepared and presented by his patients and

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himself to draw attention to the utter ineptitude of the medical men in the prevention and treatment of eye disease. His patients realised, that if Fournet possessed a technique capable of redressing their ills, when the best-known surgeons in the land had failed, then there was something seriously amiss in the training and practice of the medical profession, constituting a danger and detriment to the public wellbeing, which was in urgent need of redress. The medical people asserted that Fournet was a danger to the public, but they were not prepared to test his opinions in public. Sir George Anderson Critchett, the kings oculist, stated that the profession is always open to receive knowledge from all sources, but when Fournet offered to bring his claims before The General Medical Council and the Royal College of Surgeons they declined forthwith. What a formidable danger this man presented to the surgeons: if he was right in his contentions then their whole prestige and eminence was at stake. Their nancial success was vested in medical and surgical treatment, their psychological background was primarily created by their training in surgery and the more operations they performed the greater was their prestige and renown. What was Fournets teachings likely to offer them? Therapeutic action by means of refraction; how could they possibly stoop to that and remain true to their teachings and their profession? Heresy pure and simple! Besides, glory is not as easily come by with refractive work as with surgery, even a perfectly refracted and satised patient could never represent such a spectacular performance as an unsuccessful operation. The patients faith in his surgeon is not shattered even after an unsuccessful operation resulting in blindness, for did not the brilliant surgeon do his best to pull him through under conditions which were perilous and desperate? And more than that no man could do! True, the surgeons of 50 years ago also dabbled half-heartedly with refraction and Fournet published many instances of their complete ineptitude four of these cases were published by him in The Optician of the 15th February, 1894. The medical professions attitude was, that they could only investigate novel healing techniques brought forward by men who were members of their own charmed circle. A specious argument from a powerful body of men and possibly the cause of many of their weaknesses. They were not prepared to accept the truth of a thesis which originated from a man whose line of thought was not cradled in orthodox medicine. Nevertheless, Fournet carried the war right into the enemys camp and scored successes and acknowledgments. He must have caused them untold humiliation, as many of his patients had their consulting fees returned to them from various surgeons, including Sir George Anderson Critchett, F.R.C.S. (Edin.), the Kings oculist, on the grounds implying that

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they could not perform or equal the services of Fournet. What an admission of abject failure, ignorance and obstinacy. Fournet believed his thesis of refraction must revolutionise matters in the medical world. Apart from the wellbeing of the eyes he considered it had an effect in nervous and mental disorders, i.e., paralysis, St. Vitus dance, epilepsy, etc. He was repeatedly asked to publish his theories, but he believed such a course would have been futile. Fournets estimation of his contemporary optical practitioners must have been zero; despite his differences with the medical fraternity, he recognised them exclusively as the representative profession, that should adopt his theory and technique. In this viewpoint he was assuredly wrong, but quite possibly the optical representatives of his day were such that discussion, let alone encouragement, would have been useless. He therefore persevered to bring his views before the heads of the medical profession in order to achieve recognition for his treatment, otherwise it could never have been adopted, so he said, as it interfered with nearly all their methods of his day. The oculists were right up to a certain point, but afterwards they were wrong. If he published his methods it would only lead to a great deal of quackery all over the country and only parts of his teaching would be adopted. It was the whole method or nothing. All the medical men, however, did not adopt the narrow and stupid view of their profession, and one eminent doctor of Harley Street often sent patients to Fournet, but he was nally threatened with expulsion, so he sent no more. The path blazed by Fournet was obliterated with his death. How is it possible that the optical interests which followed Fournet could not have continued and elaborated his work? One is led to the inescapable conclusion that the optical practitioners representatives were either asleep or they had not yet conceived the true importance of their profession. Progress over existing conditions in all spheres of ophthalmic science is overdue and pressing; will it be perceptibly achieved during the next 50 years? ________ Forty years have now elapsed since I posed that question; no signicant changes have materialised in that period. My own professional experiences were not unlike those of Fournet. Pioneering against the accepted practices of the Establishment does not make for ready acceptance or popularity. I was accorded my fellowship of the British Optical Association in 1929 and within the rst two years of practice I quickly realised, that something was seriously amiss with conventional refraction theories. I determined to

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satisfy myself as to the real basis of the refractionists work and the causes of eye-strain. Hence, I embarked on a post-graduate course, which involved combing the extensive library of the British Optical Association. I loaned every week or two, 4 to 5 volumes and scanned their indexes for clues of relevant information. I endeavoured to make a fresh start by obliterating from my mind the basic theories imbibed during lectures at the Manchester College of Technology. I decided to seek information on the state of the eyes at birth and furthermore, what precisely occurred to embrace the visual act. I eventually concluded there existed only one refractive condition at birth, namely what I have termed the R.R.D., and the muscular movements in the visual act were represented by accommodation and convergence. Accordingly I found it necessary to improvise procedures in my examination routine to harmonise with my nding. In 1942 I completed my book The Therapeutics of Ocular Refraction. Over a period of 12 years I persistently pondered the myopia problem and in 1942 I nally satised myself, that myopia was not a refractive error, but a disability resulting from uncontrolled and prolonged visual functioning. I had intended to publish my revised ndings then, but due to extreme wartime conditions, this proved to be impossible. Extracts of numerous reviews are listed following this chapter. The British Optical Association refused to review my book and in spite of numerous requests from fellow members it likewise declined to place my name on the rota of lecturers. Upon taking up residence in Melbourne in 1962, I approached the College of Optometry with a view to demonstrate my work under controlled conditions, but I was informed that no opportunity for this was available. They kindly informed me however of a great need for locum-tenens and recommended me to ll this role for a Mr. Semmens of 35 Melrose Street, Sandringham, which I readily accepted. Mr. Semmens, who practised pharmacy and optometry, was absent on an extended vacation. On his return he offered me a permanent situation, but I was not ready to resume 32 years of hard work, which involved the physical and psychological reconditioning of each patient. I never compromised my work for expediency the patients welfare was my only consideration, regardless of rules and conventional acceptance. Nevertheless my professional life gave me a great measure of satisfaction and I am grateful for the providential circumstances, which enabled me to enjoy this experience.

Reviews

A selection of English and American reviews of THE THERAPEUTICS OF OCULAR REFRACTION From Dr. H. G. Noyes, A.B., A.M., M.D. August 1, 1942 Optical Journal Review This is altogether an outstanding contribution to optometric literature. 527 Fifth Avenue, New York, N.Y. 19th October, 1942 From Dr. Elmer E. Hotaling Reviewer for The American Optometric Association Journal Dear Mr. Brumer, Just a few words of commendation for your recent book. It is excellent and could not help but be of inestimable value if all optometrists would read it. We have reviewed it for the Journal of The American Optometric Association. I feel that you have produced a book of rare value. Very truly years, Elmer E. Hotaling April, 1943 From Dr. Harris Gruman, B.S., O.D., D.O.S. The Pennsylvania Optometrist. Brumer is no Yes man. He writes with the punch of a Winston Churchill. The reader must either become a convert or (if he is honest with himself)
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advance good and sufcient reasons for his refusal. In either event, the volume will prove a specic for ones mental cobwebs. Regardless what school of thought one may subscribe to, he is bound to prot by a careful perusal of this thought provoking book. December 21, 1942 From Dr. E. LeRoy Ryer, The American Optometric Association Dear Mr. Brumer, It was not difcult to foretell that your views would seem radical and dogmatic to many. To me they were highly stimulating sufciently stimulating in fact to cause me to act and incorporate some of them in my procedure. Sincerely yours, Dr. E. LeRoy Ryer, National Director General March, 1942 From E.F. Fincham The Refractionist Mr. Brumer tells us that his book is not intended to serve as an elementary text-book for students entering the profession. This is perhaps a wise warning, but the reader cannot help feeling that if the technique which is advocated can bring the relief to the patient which is claimed, it should form the basis of all refraction teaching. February 6, 1942 Review in The Optician The authors experience has patently convinced him that refraction has much bigger latent possibilities than most refractionists have ever imagined. If this conviction can be substantiated, and the attempt should be made, it will necessarily exert a profound inuence upon the future of refractionists and upon the future welfare of a considerable proportion of the general public.

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OCULO-NEURO THERAPY

July 3, 1942 From L. A. Swann, (F.B.O.A.) Hons. The Optician His chapter on cataract is an original thesis. February 8, 1946 From, H. P. Southcott The Optician Sir, I should like to endorse the opinion of Mr. H. Brooks that V. Brumer is a pioneer in our midst. His teaching and theories reect in everyday practice to the benet and gratication of patient and practitioner alike. The results are truly amazing. The Therapeutics of Ocular Refraction is a work of outstanding importance and deserves wider recognition. June 12, 1942 From A.N. Boscow, M.P.S., F.S.M.C., The Optician To those who have read The Therapeutics of Ocular Refraction by Brumer, it will come as no little surprise to nd that the application of his near distance testing technique is achieving most unexpected and yet most desirable results in unmasking latent hypermetropia, preventing the over-correction of myopia, and producing really accurate corrections in those cases where the best physiological visual acuity is subnormal.

Epilogue
Many readers may rightly feel sceptical or incredulous as to the many statements and claims I have made and it would be nothing less than human to ask for some proof in addition to logic and facts. On a short-term basis it is relatively simple to give undeniable proof, but not so on a long-term basis. To prove on a long-term basis that a person would have a longer span of life through the adequate prevention and relief of eye-strain he would obviously have to live twice, but to the less sceptical person the short-term proof is a relatively simple matter. I will just state a single example, which any reader can prove to himself in a matter of minutes. Lift a 10-lb. weight and see how long you can hold it in your hand before it commences to ache and then how long before the burden becomes intolerable. Immediately you discard the weight you will feel relief from the burden. The easement of strain on any other function of the body produces 1ikewise immediate results, although in respect of other than localised symptoms, their conscious or manifest easement may not be immediately apparent. The possibility of the immediate easement of bodily ailments causes me to recall the case of a medical student, aged twenty, who had taken 230 units of insulin daily since twelve years of age. After using efcient visual aids for a short period his daily insulin intake made possible a reduction to 80 units; as soon as he discarded his glasses the necessary insulin intake reverted to 230 units daily. In the nal resort, however, all proof rests with the patient himself. He alone is capable of giving a nal verdict on the results of energy conservation through the prevention of uncontrolled visual functioning. At the very least the guidance provided within these pages should enable the reader to avoid the worst possible excesses in the market place of visual care.

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Glossary
Accommodation. This function enables the eye by means of the crystalline lens to alter its focal length. The effort needed to achieve this increases in ratio to the proximity of the object viewed. Amblyopia. Denes a condition of reduced vision in an eye unaffected by ocular disease. It may arise from hereditary, congenital or acquired causes. Commonly described as a lazy eye. Asthenopia. Embraces all symptoms diagnosable as eye-strain. Astigmatism. Usually due to unequal curvatures of the corneal meridians. Cataract. The atrophy and in the nal stage the complete destruction of the crystalline lens. Ciliary Muscles. Meridional and circular muscles responsible for the functioning of the crystalline lens. Conjunctivitis. Inammation of the conjunctiva, transparent membrane covering the inner surface of the eye-lids. Contact Lenses. Lenses tted directly over the cornea of the eye. Convergence. Is in association with accommodation one of the principal functions of the visual apparatus making stereoscopic vision possible. The effort of convergence increases in ratio to the proximity of the object viewed. Devitalisation. Wastage of Life-Force. Dioptre. (Abbr. D.) Unit of measurement determining the refracting values of lenses. The focal length of a 1 D. lens equals 1 metre. The deviation caused by a 1 D. prism lens at 1 metre equals 1 centimetre. Diplopia. Double vision arising from the mis-alignment of the visual axes. Glaucoma. A disease of the eye, characterised by increased intraocular tension. Prompt relief in order to avoid grave and irreparable damage to the sight is essential.
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GLOSSARY

75

Lachrymal Apparatus. Its various components are responsible for maintaining the aseptic condition of the exposed portion of the eye. Lenses. The two principal types are termed convex and concave. Convex lenses increase the refractivity of the eye and therefore have a therapeutic effect. They are thicker at the centre and thinner at the edges. Concave lenses reduce the refractivity of the eye and must be used with the greatest possible caution. They are thinner at the centre and thicker at the edges. Migraine. Term commonly associated with the onset of violent and often sick headaches. It should, however, denote all symptoms resulting from an overloading of the nervous system caused by uncontrolled visual functioning. Myopia. A functional condition of the eyes, commonly known as short sight. Oculo-Neuro-Therapy. A system of therapeutics founded by the author. Orthoptics. An inclusive term dealing with all aspects and treatment of the functioning and alignment of the visual axes. Photophobia. Light sensitivity. Presbyopia. Senile failure of accommodation, commonly termed old age sight. Refraction. The deviation of light through a refracting medium, e.g. glass. The science identifying the opticians work in regard to eyes. Residual Refractive Deciency. (Abbr. R.R.D.) The authors denition of the normal refractive state of the eyes at birth. Retina. The internal membrane of the eye responsible for transmitting the image to the brain. Strabismus. Dislocation of the visual axes. Commonly known as squint. Therapeutics. The art and science of healing. Uncontrolled Visual Functioning. The authors denition of the cause of eye-strain. Vertigo. Dizziness or swimming of the head.