CONTROVERSIES IN REFRACTIVE EYE CARE

Next to the brain, the eye is the most complex organ in the human body. Like most any delicate and enormously intricate human body mechanism, unfortunately, the eye does not always function properly. Almost half a million people in the United States are legally blind and many others suffer from a wide range of visual disorders. They are especially subjected to refractive problems including myopia, hyperopia, presbyopia, and/or astigmatism.
Over the past decade, dramatic breakthroughs have been made in medical scientists* understanding of the eye. Vision experts are attaining more knowledge concerning the cause of eye difficulties, new scientific instruments to help detect eye trouble have been developed, and meaningful breakthroughs entailing surgical techniques to cure visual disorders have taken place. Yet, with all the breakthroughs in a diversity of eye care fields, controversy among people rendering professional health care services has arisen. Competition is keen. Sometimes the many contentions, particularly between optometrists and ophthalmologists or between optometrists and opticians or among opposing groups within the separate professions themselves are bitter and combative.
Disagreements among these eye care professionals, in particular those who treat refractive problems, are based upon the von Helmholtz theory. About 126 years ago Herman Ludwig Ferdinand von Helmholtz, M.D., the inventor of the ophthalmoscope, came up with the concept of accommodation on which orthodox ophthalmology and optometry are founded.  Dr. von Helmholtz claimed that accommodation is effected by the change in shape of the lens. In turn this change is governed by the action of the ciliary muscles, although he did not offer any reasonable explanation as to how the ciliary muscles operated. He also admitted that his theory was merely a probability because the image obtained on the lens was so variable and uncertain that to use his own words, it is “most usually so blurred that the form of the flame could not be definitely distinguished”.
Dr. von Helmholtz declared that nearsightedness and farsightedness, as well as most other errors of refraction, were fixed states. He stated unequivocally that these conditions could not be corrected. He believed that somewhere along the line either through birth or another reason these faults existed and there just was no cure for the situation. The only means of help, von Helmholtz said, was to wear artificial lenses so ground as to counteract the refractive error of the crystalline lens.
From the time of Dr. von Helmholtz’s statement to now, the entire medical profession and its various branches dealing with vision, such as ophthalmologists, opticians, and optometrists have accepted and followed the long standing principle. Millions of people around the world today wear lens corrections because of the von Helmholtz theory. Furthermore, the intraprofessional and interprofessional controversies arising from the theory’s interpretation for treatment have tended to alienate colleagues from each other.
*23/127/5*

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Posted on Tuesday, September 14th, 2010 at 2:29 pm and is filed under General health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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