The Myopia Myth

Chapter 18

As I see it, there are three groups that have the ability to change the present intolerable mistreatment of myopia. These are 1) the International Myopia Prevention Association, 2) the small number of concerned vision specialists who are trying to prevent myopia in their patients, and 3) the public - especially the parents of school-age children. If each of these groups does its part, the necessary changes can be made. Let us look at the role that needs to be played by each group.

1. International Myopia Prevention Association. The goals and activities of IMPA have already been well covered. These activities are being intensified now that the marvelous Internet enables us to bypass the doctors, the media, and the government and talk directly to the people. IMPA is not dependent on some higher power for operating funds. Its welfare does not conflict with the public's welfare and there will be no compromising of its consumer-oriented policies.

2. Vision Specialists Engaged in Myopia Prevention. Concerned doctors must speak emphatically to their patients about the consequences of ignoring myopia prevention measures. Patients must be informed about the dangers of high myopia. The doctor should tell every parent, "If I prescribe concave lenses, I'm going to ruin your child's vision and increase the risk of detached retina in later years. Is this what you want me to do?" Here are some other things that prevention-minded doctors can do: Take every opportunity to inform the public that myopia can be prevented. Go on TV and radio and talk to parent-teacher associations and other local groups. Use such words as "myopia prevention specialist" on letterheads, on business cards, and other suitable places. Criticize backward colleagues and convince them to change their ways. Make myopia prevention literature and this book available to patients. The doctor who does these things will soon earn the gratitude of his or her patients.

3. The Public. If we are going to insure that no child becomes myopic, we must get the schools invlved. Fundamental changes must be made in our schools, and the school boards will only act if the public demands such changes. Since schools in the United States are for the most part locally controlled, a determined group of individuals in a community can accomplish a great deal. You must consider the schools as destroyers of our children's vision. Lighting must be made better. Desk tops should not be too high in relation to the height of each student. Teachers must be educated not to allow any child to read too long or with the book held too close. Close work must be broken up by periods of distant work to relax the eyes. There is a growing trend in schools toward the adoption of computer-assisted teaching. If the monitor screen is positioned at a reasonable distance of perhaps three feet from the eyes, this would be much more desirable than looking at a book. Pinhole glasses should be freely available

If your school has a vision consultant who is ignorant of myopia prevention, arrange to have the person educated in myopia prevention or removed from that position. A prevention-minded consultant is a necessity. Since we cannot expect all parents to have the knowledge and motivation to see that their children get proper treatment for myopia at the proper time, it is up to the schools to establish periodic vision testing. Our schools are shirking their responsibility, allowing myopia to develop while compulsory education is being enforced.

We also need new laws which would prohibit any doctor from prescribing minus lenses for a beginning myope, except under special circumstances. The eye care professions will not police themselves and it is up to the people to protect their own health. Our health is too important to place the responsibility for its preservation solely in the hands of the medical establishment.

Malpractice. The present treatment of myopic children is malpractice at its worst. There is an important lesson to be learned from a case in the State of Washington where an ophthalmologist was found guilty of malpractice for not detecting glaucoma in a thirty-two-year-old patient until after irreversible loss of visual field had occurred. She had been cared for over a period of years as a myopic, contact lens patient. The ophthalmologist was sued for negligence in not diagnosing and treating the glaucoma earlier. Part of the defense's reasoning was that it was not standard practice to test for glaucoma in patients of this age since it is so rare in young persons. The Supreme Court of the State of Washington, however, in overruling the decisions of two lower courts, stated that even though the doctor acted in accordance with the usual standards of his profession, he could have prevented the disease from progressing had he diagnosed it at the appropriate time.

This case firmly establishes that if a doctor has the means of preventing irreversible loss of vision, it is considered malpractice not to do so. The doctor was held liable even though he may have acted in the manner of any "prudent specialist." The court ruled that "It is the duty of the courts to say what is required to protect patients under 40 from the damaging result of glaucoma." In other words the doctor's actions are not to be judged against what the majority of his colleagues are doing, but against what proper health care dictates that a doctor should be doing. Reviewing this case in the April, 1975 issue of Optometric Management, attorney Harry J. Doyle perceptively states that this decision is:

".. a product of a court with a moderate image, one not especially known for breaking new legal ground. Their holding is, at bottom, a consumer decision moored to the times, based upon an awareness that, given liability insurance, the practitioner and not the patient should bear the loss. . . .The consumer movement breeds distrust towards any supplier, including suppliers of health services. Professional licensing boards are considered mere restraints of trade which enable providers to control and increase costs. Professional standards of care are minimal strictures tied to the economics of practice and not to the care of patients. The patient's only access to genuine peer review is through malpractice actions where the provider should appropriately bear the loss. Fueled by the diminishing power of the wage earner's salary, consumerism has translated these indictments into rhetoric and political clout."

With the above in mind, let us look at the myopia situation. All across the country, children are being fitted with concave lenses. Nothing is said to them about the true cause of acquired myopia or how to prevent it. As the public is made more and more aware of the visual damage being done by this outmoded treatment of myopia, a malpractice suit could occur at any time. If the suit is successful, the eye care professions could face a deluge of such suits, since ruining the vision of young myopes is so widespread. It is not an isolated occurrence as in the glaucoma case. One can almost hear the words of the plaintiff's attorney echoing in the courtroom:

"This child has had his vision permanently damaged by the prescription of stronger and stronger concave lenses. He is now forced to go through life with a crutch on his nose in order to function with any semblance of visual efficiency. Many jobs and professions are now closed to him. Why was nothing ever said about methods of preventing myopia? We have presented as evidence the testimonies of numerous scientists engaged in myopia research. We have presented reprints of papers published in many professional journals. We have presented the results of scientific studies which prove conclusively that myopia can be prevented and is being prevented, but this doctor has chosen to ignore all of this knowledge and to act in a way which, although lucrative to himself, is harmful to his patients. The defense, in attempting to show that myopia is inherited, has done nothing more than present a few studies showing that myopic parents tend to have myopic children. We have presented evidence which shows clearly that this tendency, when it is evident, is due to the similar environment of the parent and child. In those situations where the visual environment is different, as when the parents are illiterate and the children are literate, we have shown that there is no such relationship."

If this kind of malpractice suit could be brought merely for allowing myopia to develop, imagine what the attorney's words would be if the plaintiff's myopia had progressed to the point of detached retina and blindness. Imagine the amount of money that could be awarded to the plaintiff.

Is all this farfetched? I don't think so. The doctor who starts a beginning myope down the road of irreversible deteriorating vision by prescribing concave lenses is crippling that child for life just as surely as if he were to cut off the child's fingers. If the myopia never goes beyond a moderate stage, it is naturally not as crippling as losing one's fingers. If the myopia progresses to the stage of retinal deterioration and blindness, it is obviously worse than losing one's fingers.

A malpractice suit, distasteful as such suits are to everyone concerned, would probably be one of the best ways to focus public attention on the myopia problem. All that is required is a victim who is sufficiently motivated and sufficiently informed about the harmful treatment that most myopes receive. A successful suit would have the same effect as a new law, forcing eye doctors to begin treating myopia properly.

Those in the eye care business are obviously not going to take the lead in this revolution. They want to continue "fitting glasses to the masses", but change will soon be forced upon them by forces outside their closed circle.

I hope that you now share my conviction that the majority of the world's vision specialists are engaged in activities which in a more enlightened future will be considered illegal and will result in the loss of a license to practice. Furthermore, the specialists are engaged in an inexcusable cover-up that prevents their victims from learning the truth about the billions of eyes that are destroyed by their actions.

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