Errors of Refraction and Their Sequele

In theory no doubt any existing refractive error should be found and treated, so that the individual may enjoy the most perfect optical conditions possible. But it must always be borne in mind that the eyes are only part of the living organism, dependent on the whole, deriving from it and adding to it. This may modify the position. A comfortable and efficient ocular mechanism depends on much more than an accurate optical system. The variable factor of physiological fatigue plays a large part as in any other activity of the organism. Ocular symptoms may be the expression of a general state of affairs, and not due to "eyestrain" at all, and as a corollary to this, an uncorrected error of refraction may in some cases play a large part in symptoms not directly connected with the eyes. It is obviously right that an error of refraction should be sought for in any individual whose signs or symptoms could suggest the presence of such, or where treatment has failed to relieve symptoms even though they may seem remote from the eyes. If any error be found, however, its significance and treatment must be carefully judged in each individual case. No one would deny that glasses should be prescribed for the case with a gross error leading to defective vision, obvious symptoms, or both. It is in the case of the patient with a small error where sound judgment is needed, and it is as unbalanced to suggest that such an error never needs correction as to insist on it being the cause of most of the ills that mankind is heir to. Perhaps the latter is the direction more commonly taken, and there must be endless cases where glasses have been ordered for a small error of refraction to the exclusion of treatment for a much greater derangement of the patient's affairs. Apart from consideration of the error of refraction in relation to the patient's state as a whole, other factors, social and economic, have sometimes to be considered quite seriously before the individual should be advised to wear spectacles. Opinion must often be given where the patient almost insists on getting glasses, or having a change made in an existing correction. Wearisome though it may sometimes be, each case must be judged on its own merits for the real good of the individual. As a side issue, these considerations make a very strong argument against the prescribing of glasses by opticians who, however good may be their refraction work, have not the training to assess every case as a whole rather than as a limited optical one.