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A Resource for Vision
EDITORIALS
board. The Advisory Board for Medical Specialties is disposed to set up a minimum of five years training before certificates can be granted. In a recent paper (Archives of Ophthalmology, 1937, volume 17, page 399), Lancaster has pointed out the difficulties associated with excessively hasty and enthusiastic attempts at advanced standardization. He points out that at the present time there are probably not less than 500 physicians who are preparing themselves for the practice of ophthalmology, whereas in the length and breadth of the United States there are not more than three institutions which can offer complete training such as would meet the requirements of the Advisory Board for Medical Specialties. "To set up and insist on a requirement which there is no provision to meet is futile, irrational and stupid." Realizing that those who contemplate the practice of ophthalmology often experience difficulty in obtaining satisfactory guidance with regard to the pursuit of their studies, the American Board of Ophthalmology has recently laid plans for creation of a Preparatory Group of prospective candidates for its certificate.'] Both graduates and undergraduates of approved medical schools are eligible for membership in this group, and those whose applications are accepted will be furnished with various information, including syllabuses of study and advice as to textbooks. Members of the Preparatory Group will be required to keep a summarized record of their activities from year to year, such record to be incorporated in the final application for examination and certification. W. H. Crisp.
t Those who desire to register with this Preparatory Group should communicate with the Secretary of the American Board of Ophthalmology, Dr. John Green, 3720 Washington Boulevard, Saint Louis.
531
A RESOURCE FOR VISION The nautilus, belonging to an ancient type of animal life, has an eye that consists of a cup, lined with retina, to which light is admitted through a small opening. This permits the light from one object to make an impression on only one part of the retina, so that each part of the retina receives the impression of only one object. Euclid and Aristotle understood that in a dark room or dark box, light admitted only through a small hole would give a picture of objects outside in a strong light. This kind of dark room (Latin, camera obscura) was used by magicians and charlatans of the Middle Ages to interest and astonish their followers. For this purpose the effect was increased by placing a convex lens in front of the opening. From this has developed the photographic camera of today. Without any lens but with a strong light, a very small aperture, and by means of a long exposure quite good photographs may be obtained in this way. With the usual photographic lens, the small aperture and long exposures give photographs of deep objects; such as the eye in a deep socket, or an exophthalmos, where one part will have a very different focus from another. Kepler, in about the year 1600, explained that the eye is a camera obscura. The improved vision obtained with a contracted pupil is thus explained, and this accounts in part for the better vision we have with strong light. Heretofore, we have not taken full advantage of this principle, as we learn from the article by Dr. D. H. Rhodes, published in this number of the Journal. Stenopaic spectacles have been described and used before, but not with the brilliant results achieved in this case. To know that such results are possible is a new resource for giving patients better vision. The Esquimaux, Indians, and
532
EIJITORIALS
others dwelling in the Far North have used wooden spectacles with a hole or slit to protect their eyes from the reflection of bright sunlight on the snow, and thus get better vision in the arctic regions. But the great gain of vision possible with a wider field of vision, by using multiple small apertures, has never received such a practical demonstration. Working from the side of physiologic optics, Prof. Guthrie had demonstrated the possibility of such an apparatus to improve vision; and Dr. Rhodes has demonstrated that it may make the difference between economic blindness and good useful vision with economic independence. An appreciation of what this may mean to some patient should be in the mind of every practical ophthalmologist. It might be thought that multiple apertures would cause multiple images and monocular diplopia. But with apertures of proper size, placed at appropriate distances, this trouble will not occur. The different images formed on the retina should be of different objects, in diffe rent parts of the field of vision. In good light, they need cause no serious confusion to one who has become accustomed to working with them. In general. to apply this new resource there must be careful study of each eye and of the needs of the individual patient. It has been suggested that such apparatus might, in some cases, replace the common use of lenses. But the cases in which this would be possible will be very few, if the comparison is made with lenses carefully chosen by the best practical methods. There is one class of patients, the albinos, for whom it has heretofore not been possible to do very much. Most albinos have rather high errors of refraction. Rut the worst defect of such eyes is the absence of pigment, which permits an excess of light to enter the eye through
the choroid, sclera, and lids. The shutting out of the light with the assistance of substituting a small aperture for the unpigmented iris and pupil may be a positive boon to such patients. The plan of using a silver plate blackened by oxidation seems a very practical suggestion that can be applied to the benefit of albinos. It is to be hoped that careful studies and experiments will be made in this direction. The best general definition of glare is, light entering the eye that does not help in vision. This new resource applied in the manner shown, to meet best the needs of the individual case, will be a great advance over the widely advertised expedients to reduce glare. Edward Jackson. "VOORKOMING V.\i'J BLTNDHEID" The University of Leiden, one of the most famous institutions in the world, was founded by the Prince of Orange in recognition of the great bravery of the Burghers in resisting the Spaniards in the siege of the year 1574. The 362d anniversary of the founding of this ancient seat of learning was celebrated on February 8th of the present year, and an address with the above title was given by the Rector Magnificus Professor van der Hocve. At a time when America was little more than a wilderness and was still largely in possession of the Indians, the Dutch were already people of advanced culture. The address made on this occasion is one of special interest to American ophthalmologists. The president of the 13th International Ophthalmological Congress, who is also the present rector, is well known in this country. In 1921, Dr. van der Hoeve was guest of the American Academy of Ophthalmology and Otolaryngology at the meeting in Philadelphia. From the university of which he is
board. The Advisory Board for Medical Specialties is disposed to set up a minimum of five years training before certificates can be granted. In a recent paper (Archives of Ophthalmology, 1937, volume 17, page 399), Lancaster has pointed out the difficulties associated with excessively hasty and enthusiastic attempts at advanced standardization. He points out that at the present time there are probably not less than 500 physicians who are preparing themselves for the practice of ophthalmology, whereas in the length and breadth of the United States there are not more than three institutions which can offer complete training such as would meet the requirements of the Advisory Board for Medical Specialties. "To set up and insist on a requirement which there is no provision to meet is futile, irrational and stupid." Realizing that those who contemplate the practice of ophthalmology often experience difficulty in obtaining satisfactory guidance with regard to the pursuit of their studies, the American Board of Ophthalmology has recently laid plans for creation of a Preparatory Group of prospective candidates for its certificate.'] Both graduates and undergraduates of approved medical schools are eligible for membership in this group, and those whose applications are accepted will be furnished with various information, including syllabuses of study and advice as to textbooks. Members of the Preparatory Group will be required to keep a summarized record of their activities from year to year, such record to be incorporated in the final application for examination and certification. W. H. Crisp.
t Those who desire to register with this Preparatory Group should communicate with the Secretary of the American Board of Ophthalmology, Dr. John Green, 3720 Washington Boulevard, Saint Louis.
531
A RESOURCE FOR VISION The nautilus, belonging to an ancient type of animal life, has an eye that consists of a cup, lined with retina, to which light is admitted through a small opening. This permits the light from one object to make an impression on only one part of the retina, so that each part of the retina receives the impression of only one object. Euclid and Aristotle understood that in a dark room or dark box, light admitted only through a small hole would give a picture of objects outside in a strong light. This kind of dark room (Latin, camera obscura) was used by magicians and charlatans of the Middle Ages to interest and astonish their followers. For this purpose the effect was increased by placing a convex lens in front of the opening. From this has developed the photographic camera of today. Without any lens but with a strong light, a very small aperture, and by means of a long exposure quite good photographs may be obtained in this way. With the usual photographic lens, the small aperture and long exposures give photographs of deep objects; such as the eye in a deep socket, or an exophthalmos, where one part will have a very different focus from another. Kepler, in about the year 1600, explained that the eye is a camera obscura. The improved vision obtained with a contracted pupil is thus explained, and this accounts in part for the better vision we have with strong light. Heretofore, we have not taken full advantage of this principle, as we learn from the article by Dr. D. H. Rhodes, published in this number of the Journal. Stenopaic spectacles have been described and used before, but not with the brilliant results achieved in this case. To know that such results are possible is a new resource for giving patients better vision. The Esquimaux, Indians, and
532
EIJITORIALS
others dwelling in the Far North have used wooden spectacles with a hole or slit to protect their eyes from the reflection of bright sunlight on the snow, and thus get better vision in the arctic regions. But the great gain of vision possible with a wider field of vision, by using multiple small apertures, has never received such a practical demonstration. Working from the side of physiologic optics, Prof. Guthrie had demonstrated the possibility of such an apparatus to improve vision; and Dr. Rhodes has demonstrated that it may make the difference between economic blindness and good useful vision with economic independence. An appreciation of what this may mean to some patient should be in the mind of every practical ophthalmologist. It might be thought that multiple apertures would cause multiple images and monocular diplopia. But with apertures of proper size, placed at appropriate distances, this trouble will not occur. The different images formed on the retina should be of different objects, in diffe rent parts of the field of vision. In good light, they need cause no serious confusion to one who has become accustomed to working with them. In general. to apply this new resource there must be careful study of each eye and of the needs of the individual patient. It has been suggested that such apparatus might, in some cases, replace the common use of lenses. But the cases in which this would be possible will be very few, if the comparison is made with lenses carefully chosen by the best practical methods. There is one class of patients, the albinos, for whom it has heretofore not been possible to do very much. Most albinos have rather high errors of refraction. Rut the worst defect of such eyes is the absence of pigment, which permits an excess of light to enter the eye through
the choroid, sclera, and lids. The shutting out of the light with the assistance of substituting a small aperture for the unpigmented iris and pupil may be a positive boon to such patients. The plan of using a silver plate blackened by oxidation seems a very practical suggestion that can be applied to the benefit of albinos. It is to be hoped that careful studies and experiments will be made in this direction. The best general definition of glare is, light entering the eye that does not help in vision. This new resource applied in the manner shown, to meet best the needs of the individual case, will be a great advance over the widely advertised expedients to reduce glare. Edward Jackson. "VOORKOMING V.\i'J BLTNDHEID" The University of Leiden, one of the most famous institutions in the world, was founded by the Prince of Orange in recognition of the great bravery of the Burghers in resisting the Spaniards in the siege of the year 1574. The 362d anniversary of the founding of this ancient seat of learning was celebrated on February 8th of the present year, and an address with the above title was given by the Rector Magnificus Professor van der Hocve. At a time when America was little more than a wilderness and was still largely in possession of the Indians, the Dutch were already people of advanced culture. The address made on this occasion is one of special interest to American ophthalmologists. The president of the 13th International Ophthalmological Congress, who is also the present rector, is well known in this country. In 1921, Dr. van der Hoeve was guest of the American Academy of Ophthalmology and Otolaryngology at the meeting in Philadelphia. From the university of which he is