The Use and Abuse of Spectacles
Boston Medical and Surgical Journal
The introduction of the new doctrines and the placing the choice of glasses in the hands of the ophthalmic surgeon followed in our own country somewhat slowly. In 1861 the Eye Infirmary in this city possessed no trial case of glasses, a few battered frames containing glasses of high power for the use of patients who had been operated on for cataract comprising its entire resources in this line. And in 1862 a leading American ophthalmic surgeon wrote thus : " When possible, any one desiring
... y one desiring glasses should go in person to select them from the establishment of a good optician." With the return from Europe of the younger men of this day, a different system soon began to prevail. The prescription of glasses was now recognized to be properly within the province of the surgeon, and in his hands it has by right ever since remained. In the beginning his task was a simple one. Near sight and old sight, myopia and presbyopia, had been the only conditions recognized by the public at large as requiring the use of glasses. Hypermetropia now first came into prominence as a common form of refractive error, and its neutralization greatly increased the number of glasses worn in the community. Astigmatism was still comparatively unknown. Discovered and described as it existed in their own eyes by Thomas Young in 1793, and later by the astronomer Airy in 1836, the condition was long regarded as an anomaly of infrequent occurrence. Donders published his monograph on this subject in 1862. At this time no trial case, even though made in Germany, contained any cylindrical glasses. The first pair ordered in Boston were prescribed in 1863. The order had to be sent abroad to be filled, and the patient himself walks our streets today. Muscular asthenopia, first brought forward by Graefe in 1862, and with its domain much widened by the researches of Stevens, of New York, has rendered the prescription of prismatic glasses, either alone or in combination, quite a frequent occurrence. The busy practitioner of today finds it hard to imagine the comparatively small number of prescriptions for glasses but little more than forty years ago. It would be well if this matter of ordering glasses had remained in the hands of the educated physician. But with the increase in the number of recognized anomalies of refraction, opticians themselves multiplied. Optical institutes became the fashion, and proffered instruction on easy terms and extending over but a brief period, in some cases offering to teach by correspondence, to examine candidates_for degrees in the same manner, and then to forward the degree itself on the receipt of a stipulated sum. A little knowledge soon proved a dangerous thing. The shop windows in our principal streets teemed with placards, announcing that eyes were examined free of charge ; while the rural districts were soon raided by peripatetic sellers of spectacles, who furnished ill-fitting and worse made glasses at a heavy cost, professing to hail from some well-known institution or infirmary, or giving some other false address. The prescribing of glasses by incompetent and often unprincipled individuals is an abuse that cannot easily be corrected. To the honor of the better class of opticians in a city like our own be it said that they prefer to fill orders sent them, and as a rule avoid the selection of glasses on their own responsibility. If the case be a complicated one, or if the lenses previously worn have been ordered by a surgeon, they refuse to prescribe or change, and urge the patient to seek professional advice. More could not be asked of them, for they naturally cannot be expected to turn away customers who are willing to bear the burden of making their own selections. Ordered, then, authoritatively or carelessly, the use of spectacles has enormously increased within the past generation. One may walk the streets of Boston and almost fancy himself in some city of Germany or Russia, so numerous are the wearers of glasses. Particularly is this to be observed among young children, both here and abroad. The German writer Seidel has written a little poem in which he pictures two old people sitting together and discoursing about the good old times of their youth, when the world wore so different an aspect. They enumerate many things that were better in those days. And at last one says : " The children then were not so pert, No spectacles they wore."1 The attention of the laity has therefore also been attracted to this state of things. It is of but little use to allude to the mistakes made by ignorant opticians, or the impositions practised on the public by those greedy of gain. The writer has recently seen a case of simple hypermetropia set down as one of compound astigmatism, and a correspondingly complicated and costly glass ordered; he has seen prisms given where there was no muscular weakness, and cylindrical lenses furnished in emmetropia. He has known a presbyopic patient, suffering from tobacco amblyopia, to be provided with a weak concave lens for reading purposes. The tendency to swell the profits of the store by the sale of a compound glass at a high price is to a certain class of dealers irresistible. Such conduct on the part of opticians it is easier to deplore than to prevent. But how is it with ourselves ? Does the ophthalmic surgeon of the day make no mistake ? Do we not, with the best intentions, occasionally order glasses in cases where their use is not strictly needed, and by enjoining their habitual employment create a dependence on artificial aid that ultimately grows into a necessity ? Do we sufficiently consider the moral effect on children, the ridicule the boy or girl at first experiences from his or her companions ; the consequent effect on many a sensitive nature ; the cosmetic 1 " Die Kinder waren nicht so keck, Sie trugen keine Brillen."