A STUDY OF THE REFRACTION OF ONE

THOUSAND EYES.

BY C. H. PEETE, M.D., MACON, GA.

The only excuse that I offer for presenting to you a subject so bare of interest to the general practitioner is that it is one affording interest of such magnitude to the ophthalmologist that it cannot be overlooked. The subject of refraction is of as much, if not of more importance, than any one thing presenting itself to the specialist in his daily labors. While other parts of our work require equally prominent places in our minds, the one under consideration requires more frequent application; and I might say, continually claims our attention. It is a condition or disease, so to speak, productive of many forms of disturbances, some of which prove very troublesome to the general practitioner, as well as the patient. It is sometimes made manifest in ways that seem to the ordinary observer to point so plainly to disease of other parts of the body, that this most important branch of surgery is entirely unthought of as even a possible cause of the symptoms. It is not my purpose, at this point, to look into the symptoms and reflexes produced by existing errors of refraction, or to make any suggestions regarding the advantages made possible by their early correction.

It is a subject so important to us as physicians, that it should be kept prominently before us, that we may become more familiar with its dealings with our patients. In my work I do not find it necessary to correct errors of re

fraction in as large a per cent. of cases as some who have made similar reports.

Dr. H. Bert Ellis, writing on this subject, states that 87 per cent. of all his eye cases required correction of errors of refraction.

Dr. George M. Gould, in a paper on this line, states that 93 per cent. of his eye patients required correction of refraction.

While I have not noted the per cent. of cases requiring correction relative to the total number of eye cases, I unhesitatingly say that the per cent. will fall far short of that reported by these gentlemen.

The one thousand eyes, the refraction of which I wish to speak, have been selected from my books consecutively. I have chosen only cases in which a correction of both eyes was necessary, ignoring sex and age, since there are very few presbyopes recorded. In tablet form I first noted the general refraction of the one thousand eyes, 73 per cent. being astigmatic, 27 per cent. non-astigmatic, being somewhat less than 3 astigmatic to one non-astigmatic eye. The tables show that 78 per cent. were hyperopic, 18 per cent. myopic, with 40 eyes hyperopic in one meridian, and myopic in the other.

In the hyperopic cases I found 30 per cent. having simple hypermetropia, while 70 per cent. had astigmatism, simple or compound, the simple amounting to 16 per cent., the compound 54 per cent. of the hyperopic cases. Among the myopes I find 18 per cent. having simple myopia, and 82 per cent, with astigmatism, simple or compound; the simple being 47 per cent, and the compound 341 per cent. of the myopic cases. In my mixed astigmatic cases I find that out of the whole number 40, hypermetropia predominates in 22 eyes, while myopia predominates in 18. It can be seen by the above figures that in my cases of hypermetropic astigmatism the compound outnumber the simple by more than

three times the number, while in the myopic astigmatic cases the simple shows to be one and one-third times as numerous as the compound. Of the 730 astigmatic eyes shown in this report, 74.2 per cent. are hypermotropic, 20.3 per cent. myopic, while 5.5 per cent. have mixed errors. When considering the axes of the 730 eyes, I found 43 per cent. to be hypermetropic, with axes at 90 per cent.; 10 per cent. hypermetropic, with axes at 180 per cent.; 24 per cent. hypermetropic, with axes oblique, that is the axes being anything other than at 90 or 180.

I found 10 per cent. to be myopic, with axes 180; 4 per cent. myopic, with axes at 90, and 9 per cent. myopic, with axes oblique.

Of the 237 simple hypermetropic cases, only 27 required a correction of .50 D. or less, and 134 required 2.00 D. or less.

Of the 33 simple myopic cases, 2 required a correction of .50 D. or less, and 17 eyes, or 50 per cent., required 2.00 D. or less, and 8 eyes, or 24 per cent., had between 5.5 and 18.00 D.

While this is true regarding the correction of high degrees in myopia, I only found 8 eyes, or 3 1-3 per cent. of the hypermetropic cases requiring a correction of 5.50 or

more.

As I have stated, out of the one thousand eyes, I found 730 astigmatic, 40 being hypermetropic in one meridian and myopic in the other. There were 502 hypermetropic astigmatic eyes, and 148 with myopic astigmatism. Of all astigmatic eyes, hyperopic and myopic combined, 72 per cent. required correction of .75 D. or less, and 88 per cent. required 1.75 D. or less; 46 per cent. of all astigmatic eyes had axes at 90, 21 per cent. had axes at 180, and 33 per cent. had axes oblique.

Of the hypermetropic astigmatic eyes, 57 per cent. had

axes according to the rule at 90, 14 per cent. had axes against the rule at 180.

Of the myopic astigmatic eyes 46 per cent. had axes according to the rule at 180, and 15 per cent. had axes against the rule at 90; 38 per cent. with axes oblique against 30 per cent. of hypermetropic with axes oblique, making in my case the oblique relatively more numerous in the

myopes.

In the deviation of the axes from 90 and 180, the tendency in the hyperopic eyes is to 90, and in the myopic to 180.

In addition to the above, I give below a table of the one thousand eyes divided according to the conditions existing, giving the number of eyes and per cent. of the whole existing in each condition relative to the number examined:

In 40 mixed A. M. predominates in 18.

It will be noticed that in my simple hypermetropic cases

only 27 were given a correction of .50 D. or less, and in my simple myopic cases only 2 were given as low as .50 D., while in all I have reported 88 per cent. required 1.75 D. or less. While it is true that sometimes small errors cause more trouble, produce more trying symptoms, and are harder made comfortable, I do not think it wise or best to correct all errors found. It may seem to some who correct every error of refraction found that this statement is without reason; surely, he will say, no error should go uncorrected, even to the .25 D. in hypermetropes. We know from experience that the youth is hypermetropic and becomes myopic as he develops in literary and scientific pursuits. Let us take this fact into consideration, and in cases where it can be withheld, to give such assistance as we can without the cumbersome appliances sought by so many. I grant you that when a patient presents himself to me, who is constantly taxing his eyes with close, fine work, and who, after the use of his eyes for such work, complains of symptoms we can readily attribute to their use, I would not hesitate, after finding no other cause for the suffering, to supply him with proper glasses, it matters not how small the degree.

In astigmatism I find it necessary to correct small errors much more frequently than simple errors of a much larger degree; in fact when there are symptoms warranting a correction at all, I always correct fully the amount of astigmatism found.

Leaving a great deal unsaid that might be of interest to the refractionist, I will add a few remarks relative to the reflexes. I have not taken the pains to notice in tabular form the percentage of the different reflexes, but in a very large majority of cases, I have been confronted by complaints of headaches of fronto-temporal variety, accompanied in most instances by a blurring of the vision; in a few of the cases there appeared after reading a few moments to be a perfect blank. In most cases of the headaches there proved