Presbyopia: its cause and treatment
In people living in a civilization, in most cases, there is a decrease in the accommodative ability of the eye, until at the age of 60-70 years it is practically lost. A person becomes completely dependent on his glasses for sight near. As for whether such a visual impairment occurred in primitive people or whether it exists in people living in primitive conditions, then there is very little information on this. Some ophthalmologists hold the view that the accommodative ability of the eyes of people using them, mainly at close distances, decreases, if at all, at a slower rate than peasants, seamen and other people who use the eyes primarily for viewing in the distance. Other ophthalmologists claim the opposite.
It is known, however, that people who can not read, regardless of their age, fail in sight near by asking them to look at the printed letters, although they may have excellent near-sight vision for objects they know. Consequently, the fact that such people at the age of 45-50 can not distinguish between printed letters does not justify the conclusion that their accommodative capacity is reduced. The illiterate younger would have done no better. It should be noted that while a young person who easily reads the Latin font at close range, always at first appear symptoms of imperfect vision when he tries to read Old English and Greek letters or Chinese characters.
When the accommodative ability of the eye is reduced to such an extent that reading and writing are difficult, the person is told that he has presbyopia , or, in common parlance, "senile vision".Both among the lay people, and in the scientific community, it is believed that this state is one of the inevitable inconveniences associated with aging.
The decline in accommodative capacity with age is usually attributed to the densification of the lens tissue, the effect of which is believed to be further intensified by the flattening of the lens and the weakening of its refractive state, together with the weakening or atrophy of the ciliary muscle. This phenomenon is so widespread that even special tables are compiled reflecting the near point of clear vision, depending on the age. It is believed that based on this table, you can almost accurately pick up glasses without checking the sight of a person or, conversely, determine a person's age with an accuracy of 1-2 years, based on his points.
According to the disappointing data given in one of these tables, a person by the age of thirty should expect to lose at least half of the initial accommodative capacity of the eye, to forty or two-thirds, and to sixty years it is almost completely lost.
There are, however, many people who do not fit into this schedule. Many people in 40 years are able to read fine print from 4 inches, although, according to the table, they should have lost this ability soon after reaching the age of twenty. Moreover, there are people who generally refuse to become presbyopic.
One such case is mentioned by Oliver Wendell Holmes in his "Autocrat of the Breakfast Table".
"In the state of New York," he writes, "an old gentleman now lives, who, realizing that his vision is weakening, immediately began to exercise it in the smallest font and in this way was able to sufficiently compensate for the shortcomings of nature. Now this old gentleman creates extraordinary things with his pen, demonstrating that his eyes must be truly a pair of microscopes. I want to be precise and therefore I'm afraid to say how much he inscribes into an area less than half a dime of a dime - psalms and the gospel individually or all of this together. "
There are also people to whom vision is again returned at close range after losing it for 10, 15 or more years. Some people have presbyopic vision for some objects, and ideally good for others. Dressmakers, for example, can thread a needle without glasses. The retinoscope shows that their eyes are precisely focused on the object of sight. However, they can not read or write without glasses.
As far as I know, no one before me has investigated the last of these cases, others are known to every ophthalmologist who has some experience. They can be heard at congresses of ophthalmological societies, even read in medical journals. But, apparently, the power of authority is so great that when it comes to writing a book( or article), they are either ignored, or they get rid of them by superficial explanations. Therefore, most tracts first published in the press repeat the old superstition that presbyopia is the "normal result of aging."The dry hand of German science still dominates our minds and prevents us from believing in the most obvious evidence of our sensations. German ophthalmology, as before, is considered inviolable. No facts are allowed to show disbelief towards her.
Fortunately, those who consider themselves called upon to defend the old theories, myopia delay the onset of presbyopia, and the pupil diminution, which often occurs in old age, leads to the same effect of facilitation of vision at the near point. Consequently, from the noted cases, when people over the age of 50-55 years were read without glasses, it will be easy to get rid of, assuming that they, most likely, were myopic or their pupils were extremely narrowed. If such a case is subjected to a thorough investigation, it will be found that this question is not so simple, since it may be that the person in this case was not at all myopic, but for example a hypermetropic or emmetropic and has a normal pupil size. There is nothing left but to ignore such cases.
It is also believed that anomalous changes in the shape of the lens respond to the preservation of the near point of clear vision after reaching the presbyopic age or for its recovery after the initial loss. The swelling of the lens with the incipient cataract makes it possible to very plausibly explain such cases. When premature presbyopia appears, there is the presence of "accelerated sclerosis" of the lens and the weakness of the ciliary muscle. If we take a concrete case with dressmakers who could thread a needle, although they could not already read the newspaper, then there is no doubt that an explanation would be found for him, consistent with the point of view of German science.
The truth about presbyopia is that it is not a "normal result of aging", because it can be prevented and eliminated. It is caused not by densification of the lens tissue, but by force to see at the near point. The appearance of presbyopia is not associated with age, as it sometimes occurs
and in ten years. At the same time, in other cases, it does not occur at all, although a person can long overstep the so-called presbyopic age. The lens does not harden with age, as it happens with bones, but only the structure of its shell changes, but since the lens is not a factor in accommodation, this fact is immaterial. Moreover, in spite of the fact that in some cases the lens becomes thicker or loses its refractive power over the years, there are cases when it remained perfectly pure and unchanged in form up to 90 years. Since the ciliary muscle is not a factor in accommodation, its weakness or atrophy can in no way contribute to reducing the accommodation power.
Presbyopia is in fact only a form of hypermetropia, in which vision is reduced primarily at the near point, although vision is also deteriorating in the distance, as opposed to what is commonly believed. It is not always possible to distinguish between these two states. It may also be that a person with hyper metropia will or will not be able to cope with the small print, while a person in presbyopic age will read it without obvious inconvenience and yet have a poor vision for the distance. And in that, and in another state, vision at both points deteriorates, although a person may not realize this.
It has been shown that when the eyes are straining to see at the near point, the focus always shifts forward( compared to what was before) in one or all of the meridians. By retinoscopy, it can be shown that when a person with a presbyopia tries to read a small print and it fails, the focus always shifts forward relative to the original position. This indicates that failure was caused by stress. Even the very idea of applying such an effort leads to tension, as a result, even before the fine print is considered, refraction can change and pain, discomfort and fatigue appear.
Moreover, if a person with a presbyopia gives his eyes a rest by closing them or by making a palm, he can always read the fine print from 6 inches for at least a few moments, again demonstrating that his previous failure was not relatedwith any lack of eyes, but with an effort to see. If the tension can be removed for a long time, then presbyopia will be eliminated for a long time. This happened not once or twice, but in many cases and at any age - up to 60, 70 and 80 years.
The first patient I cured from presbyopia was myself. Having convinced myself with the help of experiments in the eyes of animals that the lens is not a factor in accommodation, I realized that presbyopia should be curable. But I realized that I can not expect universal recognition of the truly revolutionary conclusions to which I came, while I myself wear glasses due to a condition caused, presumably, by the loss of the accommodative ability of the lens.
At that time, I suffered the maximum degree of presbyopia. I did not have any accommodative capacity at all, so I had to hold a whole set of glasses, because with glasses that gave me the opportunity to read a small print, for example, from 13 inches, I could not read it from 12 or 14 inches. A retinoscope showed that when I tried to see something close without glasses, my eyes focused for a distance and, conversely, when I tried to see anything in the distance, they focused for near-sight.
Then there was the problem of finding a way to reverse this state and make the eyes focus on the point that I need to see when I want it. I consulted with various oculists, but my appeal to them was, like the conversion of St. Paul to the Greeks, stupidity."Your crystalline lens," they said, "is hard as a stone. No one can do anything for you. "
Then I went to the neurologist. He examined me with a retinoscope and agreed with the results of my observations regarding the reverse nature of my accommodation. But I had no ideas whatsoever to do with her. The doctor said that he would consult with some of his colleagues, and asked me to come back to him again in a month, which I did. Then he told me that he came to the conclusion that there is only one person who could cure me, and this man is Dr. William G. Bates of New York.
"Why did you decide that?" I asked.
"Because you seem to be the only person who knows everything about this issue," the answer sounded.
So, being turned to my own ingenuity, I was lucky enough to find a gentleman who did not have medical education, but was ready to do everything in his power for me. After long hours of tedious training, he nevertheless learned to use the retinoscope freely. In the meantime, I was busy studying my case, trying to find at least some way of implementing accommodation at a time when I want to read, and not when I want to see something from a distance.
One day, looking at the image of Gibraltar, hanging on the wall, I noticed on its surface a few black spots. I imagined that these spots were the entrances to the caves, and people were scurrying back and forth in them. When I did this, my eyes focused on the distance of reading. Then I looked at the same image from the distance reading, continuing to imagine that the specks were the entrances to the caves, and there are people in them. At this time, the retinoscope showed that I had made the accommodation. At the same time, I was able to read the inscription next to the picture. So, using my imagination really helped me for a while.
Later I found that when I imagine the letters black, I can see them like that, and when I see them black, I can distinguish their shape. After that, my progress can not be called rapid. It was 6 months before I could read the newspaper with enough comfort, and a year before I reached my current 14-inch accommodation area( 4 inches to 18).But this experience was extremely valuable, because later in other presbyopics I was able to observe every symptom in a pronounced form.
Fortunately for my patients, their cure rarely took me so long as my own. In a number of cases, a complete and permanent cure was achieved in a few minutes. One patient who wore glasses from presbyopia for about twenty years, healed in less than 15 minutes, using his mental representation.
In the case described above, when a patient was asked to read a diamond font, he said that he could not do it, because all the letters seemed to him gray and quite the same. I reminded him that the font was printed with ink and that there was nothing blacker than it. I asked him if he had ever seen a typographic paint. The answer was yes. Does he remember to what extent it was black? Yes. Does he believe that these letters are as black as the paint he remembered? And again he answered in the affirmative. Then he finally read the letters, and since the improvement in his vision was permanent, he said that I just hypnotized him.
In another case, too, the presbyopia of ten years ago was quickly cured by the same method. When the presbyopic was reminded that letters that he could not read were black, he replied that he knew it, but they still seemed to him gray.
"If you know that they are black, and yet you see them gray," I told him, "then you must be representing them like that. Imagine that they are black. Can you do it? "
" Yes, "he answered." I can imagine them black. "And then he was able to start reading them.
Such cases of extremely rapid recovery of vision are rare. In nine cases out of ten, progress was much slower. It was necessary to resort to all methods of achieving relaxation, used in the treatment of other abnormalities of refraction. In the more difficult, cases of presbyopia, people, when they try to read the small print, often suffer from the same illusions of color, size, shape and quantity as people with hypermetropia, astigmatism and myopia, when they try to read letters from a distance on the test table. When they try to see something at a near point, they can not remember or imagine even such a simple thing as a small black dot, but they can do it perfectly if they do not put any effort into seeing it. Their vision for the distance is often very imperfect and always below normal, although they may think that it is fine. As well as in the case of other refractive anomalies, the improvement of vision in the distance improves vision at the near point. Despite, however, the difficulty of this case and the age of a person, it is always possible to achieve some progress. In this case, if the treatment lasts long enough, then the vision is restored completely.
The idea that presbyopia is the natural result of aging is responsible for many cases of poor vision. When people who have reached presbyopic age have difficulty in reading, they are very likely to immediately resort to eyeglasses, on the advice of specialists or without it. In some cases, such people can really be presbyopic. In other cases, difficulties can be temporary difficulties, which they would not think much about, if they were younger, and who would go by themselves, let nature act on their own. But if they once took advantage of the glasses, then in the vast majority of cases they entail the appearance of a state that was intended to be eliminated. If it already existed, then the glasses make it even worse, sometimes, as any ophthalmologist knows, very quickly.
Sometimes, after a few weeks, a person discovers that a large font that he could read without difficulty before he began wearing glasses can no longer be read without their help. After 5-10 years, the accommodative ability of the eye usually disappears completely and if from this condition a person does not pass to cataract, glaucoma or inflammation of the retina, he can consider himself lucky.
Only in rare cases does the eye refuse to submit to the artificial conditions imposed on them. In such cases, they can continue to fight against them for a long time. One woman of seventy, twenty of whom she wore glasses, could still read the font diamond and had good eyesight for a distance without glasses. She said that glasses weary her eyes and blurred her vision. Nevertheless, despite the long temptation to give up glasses, she persevered in wearing them, because she was told that she needed to do this.
If people who find themselves presbyopic, or those who have reached presbyopic ages, instead of resorting to eyeglasses, follow the example of the gentleman that Dr. Holmes wrote about, and will train in reading the smallest font they can find, the ideathat the decrease in the accommodative ability of the eye is a "normal result of aging" is likely to wither away of itself.