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  • The truth about accommodation

    The data of my experiments proved to me that the lens of the eye is not a factor in accommodation. This is confirmed by numerous studies of the eyes of adults and children with both normal vision and refractive errors, amblyopia( vision impairment with non-obvious cause), as well as adult eyes with cataracts removed from the lens. We have already said that the inoculation of atropine into the eye is aimed at preventing accommodation by paralyzing the muscle responsible for controlling the shape of the lens. The fact that this really produces such an effect is allowed in every textbook of ophthalmology and therefore atropine is used daily for the selection of glasses in order to exclude the supposed influence of the lens on the refractive state of the eye.

    Somewhere in 9 out of 10 cases, the condition obtained by digging atropine into the eye corresponds to the theory on which its application is based. But in these tenth cases, the state obtained as a result of atropinization does not correspond to its theoretical basis. Every ophthalmologist knows by experience about the existence of such cases. Many of them have been described in the special literature and met with me when conducting my own observations. According to the theory, atropine should reveal latent hypermetropia and apparently normal or apparently hypermetropic eyes, provided, of course, that the patient is at an age when the lens is supposed to retain its elasticity. However, it is known that atropinization sometimes causes myopia or converts hypermetropia into myopia. In people older than 70 years, when the lens is supposed to be as severe as a stone( as in cases with an early stage of cataract, when the lens is also severe), atropine can cause both myopia and hypermetropia. In patients with clearly normal eyes after using atropine, hypermetropic, complex myopic or mixed astigmatism develops. In other cases, this medicine does not interfere with accommodation or, at any rate, a change in refraction. Moreover, when sight was worsened by atropine, patients often succeeded, having just relaxed their eyes, to read the font of diamonds( the smallest size of the commonly used font, now known as a small printable font at 4 1/2 points) from 6 inches. Nevertheless, it is believed that atropine gives the eyes a rest, relieving the load from the overworked muscle.

    In the treatment of strabismus and amblyopia, I have often used atropine in the best eye for more than a year to stimulate the use of the amblyopic eye. By the end of this period, while still under the influence of atropine, such eyes became capable in a few hours or less of reading the font diamond from six inches. Below are examples of many similar case histories.

    The boy of ten years had hypermetropia of both eyes. At the same time, the left( best) eye had 3 diopters. When atropine was injected into this eye, hypermetropia increased to 4.5 diopters and vision decreased to 20/200( 200/200 is the norm, the numerator of the fraction is the distance from which the patient could see the letter on the check table, and the denominator-distance, from which he had to see her, if he had normal vision).With a convex lens in 4.5 diopters, the patient gained normal vision in the distance, and with the addition of another convex lens in 4 diopters he was able to read the font diamond from 10 inches. Atropine was used for a year, the pupil expanded again and again to the maximum. Meanwhile, the right eye was treated with my own methods, which will be described later. Usually in such cases the sight of the eye, which is not treated in a special way, improves to some extent with the sight of the other eye, but in this case it did not happen. By the end of the year, the vision of the right eye became normal, and the visual acuity of the left eye remained the same, exactly as it was at the beginning, amounting to 20/200 without glasses for distance. With such a vision of the left eye, reading without glasses was impossible, because the degree of hypermetropia did not change. Still under the influence of atropine, with a pupil dilated to maximum, this eye was now treated separately. Literally in half an hour his sight became normal both close and far. The font of the diamond was read from 6 inches without glasses. According to generally accepted theories, the ciliary muscle of this eye should be at this time not only completely paralyzed, but also in such a state of complete paralysis for a year. Nevertheless, this eye not only overcame 4.5 diopter of hypermetropia, but also added 6 diopters of accommodation, amounting to a total of 10.5 diopters. It remains only to ask those who adhere to generally accepted theories, how such facts are consistent with them.

    Equally, if not more noteworthy, there was a medical history of a small six-year-old girl whose right( best) eye had 2.5 diopters of hypermetropia, and the other - 6 diopters of hypermetropia with a dioptric astigmatism. With the best eye exposed to atropine, and the pupil dilated to maximum, both eyes have been treated together for over a year. By the end of this period( when the right eye was still under the influence of atropine), both eyes could read the font diamond from 6 inches, with the right eye doing it, at any rate, better than the left one. Thus, despite atropine, the right eye not only overcame 2.5 diopters of hypermetropia, but also added 6 diopters of accommodation, amounting to 8.5 diopters. In order to exclude any possibility of latent hyperopia in the left eye, which originally had 6 diopters, atropine was now used in it, and the use of atropine in the other eye was discontinued. The training of the eyes continued as before. Under the influence of the medication, there was a slight return to hypermetropia, but vision again quickly became normal and, although atropine was used daily for more than a year, and the pupil was extended again and again to the limit, the font was read from a distance of 6 inches without glasses throughout this period. It is difficult for me to understand how the ciliary muscle of this patient accommodated, being under the influence of atropine a year and moreover in each eye separately.

    According to the conventional theory, as I said, atropine paralyzes the ciliary muscle and, thus preventing the change in the curvature of the lens, interferes with the accommodation. Therefore, when the accommodation process takes place after a prolonged use of atropine, it is obvious that this is possible due to a different factor or factors than the lens and the ciliary muscle. The evidence given by the histories of diseases, against the generally accepted theories is undeniable. Equally, these theories do not explain the other phenomena described in this article. All these facts, however, fully correspond to the results of my experiments on the muscles of the eyes of animals and to the investigation of the behavior of images reflected from various parts of the eyeball. They also perfectly confirm the results of experiments with atropine, which showed that accommodation is not prevented completely and permanently, unless the atropine is injected deep into the orbit so as to reach the oblique muscles-the actual muscles of accommodation. At the same time, hypermetropia could not be prevented when the eyeball was stimulated by an electric current without the similar use of atropine leading to paralysis of the rectus muscles( see the figure).

    MISCELLANTS OF THE EYE

    It is well known that after the removal of the lens due to cataracts, the eye is often able to accomodate exactly as before the operation. In my studies, I have observed many such cases. Patients at the same time not only read the font diamond with their glasses for distances from a distance of 13, 10 or less inches( it is most difficult to read at very small distances), but one patient could do it without glasses at all. In all cases, the retinoscope showed that a real accommodation is taking place, not by any of the intricate ways that this "inconvenient" phenomenon usually explains, but by an exact adjustment of the focus to the corresponding distances.

    To clinical experiments directed against the conventional theory of accommodation, it is possible to include the elimination of presbyopia. According to the theory where the lens is considered a accommodation factor, such a change would be simply impossible. The fact that eye rest improves vision in presbyopia has been noted by other doctors. They explained this by the ability of the rested ciliary muscle to act on the hardened lens for a short time. This can be tolerated in the early stages of presbyopia, and even then for a short period of time. But it is unthinkable to suggest that a permanent positive effect can be obtained in this way, and that a crystalline lens, hard as a stone, can succumb to some, even short-term exposure.

    The truth is strengthened by the accumulation of facts. A working hypothesis can not be recognized as true if it does not agree with any fact. The conventional theories of accommodation and the causes of refraction anomalies get rid of a lot of facts by superficial explanations. With more than thirty years of experience in clinical work, I have never observed a case that contradicts the claim that the lens and ciliary muscle have nothing to do with accommodation and that the changes in the shape of the eyeball on which the refractive errors depend are not unchanged. My clinical studies alone are sufficient to demonstrate the truth of such an assertion. They are also sufficient to show how it is possible at will to cause abnormalities of refraction and how they can be eliminated temporarily in a few minutes and forever after a long treatment.