Eye Treatment in Schools: Methods That Deceived Hopes
No other section of ophthalmology, even on accommodative problems, has been the subject of so many studies and discussions, like the section on the causes and prevention of myopia. Since it was suggested that hypermetropia is due to congenital deformation of the eyeball, and until relatively recently it has been suggested that in most cases, astigmatism is also an innate condition, little action has been taken to find explanations for their origin or preventivemeasures against them - they simply did not think about it. But myopia, apparently, is an acquired condition. Consequently, the solution of this problem, which many outstanding people have dedicated to the years of their work, is of tremendous practical importance.
Extensive statistical data on the incidence of myopia have been collected and are still being collected. About it written whole mountains of literature. But very little that will become clear after a careful review of this material, and most of it will leave the reader in a state of utter confusion. It is impossible even to arrive at any unequivocal conclusion regarding the frequency of complaints about myopia, not only because there is no unity of standards and methods, but also because none of the researchers took into account the fact that refractionthe eye is not a constant state, but is in a continuous change.
There is no doubt, however, that most children, when they go to school, are free of this kind of visual impairment and that both the frequency and degree of myopia invariably increase as the educational process continues. Professor Hermann Cohn, whose report on his studies of the eyes of more than 10,000 children in Germany, first attracted general attention to this issue, found myopia less than 1% of those surveyed in Realschulen, 30-35% in gymnasium and 53-64% in vocational schools. His research has been repeated in many cities in Europe and America and everywhere has been confirmed, despite some differences in the percentage.
Myopia was unanimously attributed to the excessive use of the eyes to work at close range. Although, based on the theory that the lens is the acting power of accommodation, it is difficult to understand why work at close range should lead to such an effect. If we assume that the accommodation is accomplished by lengthening the eyeball, then it is easy to understand why an excessive amount of accommodation should cause its permanent lengthening. But why is the increased need for accommodation power of the lens to produce a change not in the shape of the lens, but in the shape of the eyeball? Numerous assumptions were put forward on this score, but none of them could satisfactorily explain this phenomenon.
With regard to children, many specialists believed that since the membranes of the eye at an early age are more malleable than in the mature years, they are unable to withstand the expected intraocular pressure produced by working at close range. If the patients initially had other refractive anomalies, such as hyperme- tropathy and astigmatism, considered congenital, it was assumed that the accommodative effort for clear vision leads to irritation and stress, which stimulates the development of myopia. When myopia appeared in adults, the explanations were modified accordingly to suit them. The same fact that quite often myopia was observed among peasants and other people who did not use their own eyes to work near, compelled a number of specialists to divide this anomaly into two groups, one of which is related to work at close range, and the other, unrelated toSuch work was conveniently attributed to the influence of hereditary factors.
As it was impossible to abandon the educational system, attempts were made to minimize the alleged harmful effects of reading, writing and other activities close to those required by this system. Various specialists carefully elaborated detailed rules concerning the font size that should be used in school textbooks, the length of lines, the gaps between them, the distance at which books should be kept, the strengths of light and the arrangement of lighting, the design of the desks, the length of time during which the eyescan be used without changing the focus, etc. There were even invented special abutments for the face to keep an eye on the prescribed distance from the desk and prevent stoop that is believed to cause blood clots in the eyeball and thus contributes to its lengthening. The Germans, with their characteristic thoroughness, actually used these instruments of torture. Kohhn never allowed his own children to write without them, "even when they were sitting at the best one can think of, by the desk".
The results of these preventive measures were disappointing. Some researchers noted a slight decrease in the percentage of myopia in schools where these transformations were applied, but, in general, the harmful effect of the educational process was not eliminated.
Further study of the problem only added to the difficulties. At the same time, it revealed a tendency to remove from schools a significant part of the previously attributed responsibility for the production of myopia. For example, the American Encyclopedia of Ophthalmology indicates that "the theory that myopia is caused by work at a close distance, burdened with life in urban settings and poorly illuminated premises, is gradually receding before the statistics".
Studies conducted, for example, in London, where schools were carefully selected to detect any possible dependence of the state of view on the various hygienic, social and racial factors that children are exposed to, showed that the proportion of myopia sufferers in better-illuminated classes was higher, than in classes whose conditions were worse, although higher degrees of myopia were more frequent in the latter case.
It was also found that in schools where a small amount of work is performed at close range, myopia occurs as often as in those schools where the requirements for accommodative ability of the eye were higher. Moreover, only a minority of children become myopic, despite the fact that all of them are subjected to almost the same effects. Even for the same child, one eye can become myopic, while the other one will remain normal. The theory that myopia is the result of some external influences to which the eye is exposed can not explain why in the same conditions of life the eyes of different people and the two eyes of the same person behave differently.
Because of the difficulties in reconciling these facts with previously proposed theories, the tendency of the attribution of myopia to the influence of hereditary factors has become apparent. However, no satisfactory evidence of this point of view was subsequently advanced. A convincing argument against this theory was the fact that savages, who always had good eyesight, as quickly as other people, became myopic when they were subjected to the conditions of civilized life, as happened with an Indian from the Carlay Institute.
The prevalence of myopia, dissatisfaction with all the explanations of its root causes and the futility of all methods of its prevention led some authors to conclude that an elongated eyeball is a natural physiological adaptation to the needs of civilization. Against this point of view, two irrefutable arguments can be advanced. The first is that the myopic eye does not see even at close range as well as normal. The second is that this defect tends to progress with very serious consequences, often with injecting blindness.
If nature has tried to adapt the eye to the conditions of civilization by lengthening the eyeball, she did it not in the best way. It is known that many specialists admit the existence of two types of myopia: a physiological one with a minimum of harmfulness and a pathological one. Since it is impossible to say with certainty whether this case will progress or not, its recognition, even if it is correct, is of theoretical rather than practical value.
Hundreds of years of labor in the wrong direction have plunged us into a mire of despair and controversy. But in the true light the problem turns out to be very simple. Based on the facts, it is easy to understand why all previous attempts to prevent myopia have been unsuccessful. They were all aimed at reducing the effects of stress on the eyes when doing work at close range, forgetting about the effort to see distant objects and completely ignoring the mental strain that underlies the visual tension.
There are many differences between the conditions experienced by the children of primitive people and the conditions in which children of civilized races spend their years of development, not to mention the well-known fact that the latter study books and write on paper, while the former did not. In the process of getting education, civilized children spend hours every day locked in four walls under the supervision of teachers, who sometimes are nervous and irritable. They are even forced to stay for long periods of time in the same position. Those things that they need to learn can be presented in a completely uninteresting way. At the same time they are forced to constantly think more about getting good marks and praise, rather than about acquiring knowledge for themselves.
Some children endure these unnatural conditions better than others. But many can not resist the tension. Thus, schools become breeding grounds not only for myopia, but for all other types of refractive errors.