Managing accommodation strain

Among all the problems that face the humankind, it would be difficult to find another causal relationship that is so simple and so easy to manage as accommodation strain, its fateful consequences and the ensuing tragedies!

The only difficulty is that the abilities dictated by the structure of a child’s eye will in no way adjust to the increased demands of our time, while the parents are reluctant to learn about the requirements of this process and to submit to them.

I would also say that you really cannot ask any more of a child without the support of the parents, but as the parents understand spoken language, they must learn about the progress of this physiological process.

From times immemorial, human children have been born dominantly hyperopes, which met the needs of early humans (considering their life span and the amount of close work they had to do). As a result the accommodation muscle, or musculus ciliaris, in our eyes must work continuously in order for us to perform close work.

When a muscle never gets sufficient rest, it unavoidably ends up in a cramp. If this cramp is never released, the muscle is locked in a spasm. This also continuously tightens the cramp and the eye slides towards myopisation; to begin with, it exceeds the zero point of refraction, which is called emmetropia.

At that point, the eye focuses rays of light exactly on the retina, with no external assistance and with the muscle in a relaxed state.

After this, m. ciliaries keeps on contracting towards greater levels of minus dioptres, finally reaching extremely high figures of up to 25 or 30!

When the dioptres no longer increase, this only signals that the muscle has reached the maximum of its ability to contract – which indeed exists.

The younger we are when we develop this cramp – and today, it happens at increasingly young ages – the more elastic the eyeball is. Its structure then becomes axially elongated as required by the situation. The eyeball becomes irreversibly stretched, and at this stage, destructive consequences also start appearing: retinas that are torn or even completely detached, which result in complete blindness, haemorrhages, changes in the vitreous humour, and clouding of the lens.

Fortunately these consequences can be treated better and better as the techniques improve, however only externally and with very limited scope when additional tissue damage has already been caused.

We must learn to understand that it is never too late, especially as ageing causes changes in dioptres in close vision, to alleviate the situation at least a little by treatment.

Over time, the requirement of doing close work has increased dramatically, and now that digitalisation is advancing irrevocably all the time, accommodation strain is rampant.

As a consequence, younger and younger people need stronger plus glasses. Young children start drawing, colouring and looking at pictures and books – and above all, fiddling with different types of mobiles and tablets – at the very early ages of 1½ to 2 years, while their parents watch over them proudly!

These natural needs inherent in our children cannot be kept in check by any power in the world – and neither is it necessary!

As a consequence, the wearing of plus glasses must start very early. My slightly exaggerated statement, according to which our children should be born with plus glasses on their noses, thus is not quite so far-fetched!

While most children at this stage can more or less cope with their need to see, it is difficult to get them to understand why they should put up with the nuisance of glasses.

Consequently, a key role is played by the child’s parents, who could after all be expected to understand the message! But this is where we hit a rock wall!

No particular intervention is needed and very little in the way of examination, as long as the pupillary distance (PD) is measured as the child grows older, and the dioptres of the glasses are increased evenly as much as he or she can manage. But this will not succeed without a good bit of persuasion by the parents, and in this respect, parental patience is again required.

But surely the parents would do anything for the best of their children!

Not a word about operative interventions! No permanent improvement can be achieved by them– on the contrary, they would constitute criminal butchery of healthy eyes!

As we grow older, the physiology of our eye can change considerably. Operative interventions cannot keep up with this change or achieve permanent results, and an eye that has once been “messed with” will never be the same!

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Over time, the optical industry will no doubt produce a wide variety of products to get their hands into the parents’ purses, but that must remain the parents’ own concern – even though these products as such will, of course, be completely unnecessary!

Kaisu Viikari