Review of Tetralogia by Ophthalmologist Aune Adel

‘Suomen Lääkärilehti (Finn Med J) 6/74, Tetralogia -nakemys oftalmologiasta’
(translation)
Tetralogy -A view on ophthalmology

This book is intended to ophthalmologists, the author herself beig an ophthalmologist. It should, however, interest specialists in other fields since an enterily new approach to ophthalmolgy is presented. This study breaks the traditional narrow boundaries of ophthalmolgy penetrating into the most central fields of medicine as a whole.

This book is not a doctrinal! work based on theoretical speculation nor is it a product of an unusual imaginative power. On the contrary, it is the anatomy of the work at a private practice during a period of years. The rerults of this work, however, did not fully satisfy the practitioner. Instead they seemed continously to leave the door open to crticism leading to the search for new ways and methods. The ideas of the book, it seems to me, started with an intense questioning. Why does this particular patient show this kind of a refrative error, ananisometropia, a heterophoria, an increased intraocular tension etc. When the answer finally emerged the symptomatic treatment was resolutely given up. Thus”the exact correction” of a refractive error, the operative measure, the hastily written prescription for lowering the tension were abandoned. With the etiological factor found, the recognized academic measures no longer proved rational. Logical thinking combined with longterm clinical observation led to new methods and to therapy in conditions which, until now, have been considered beyond treatment.

The central theme of “Tetralogy” is the refraction of the eye, its determination, variations and its effect on the organism as a whole. Contrary to the textbooks, which divide refractive errors into three groups, the author believes that there is only one refractive error, hyperopia, together with its various grades. Thus myopia and astigmatism are distortions, artifacts, due to the corrective mechanisms of the eye, the accommodation performed by the ciliary muscle with its autonomous innervation. Under continuous strain and a presumable overexcitability the result may end not only in pseudo-myopia and pseudo-astigmatism but at same time in over-activation  a possible sensitization of the entire autonomous nervous system. This is manifested in clinical symptoms as headaches, migraine, epilepic attacks, attacks of pseudo-angina pectoris, intestinal spasms, to mention only a few. Ocular symptoms include accommodative spasm, often combined with pseudo-myopia and pseudo-astigmatism, anisometropia, nystagmus, conjunctival irritations, photophobia, even detachments and degenerative conditions of the retina. Treatment is always solved once the etitology is found. Thus refractive error should not necessarily be corrected by prescribing lenses giving the best visual acuity at distance but by correcting the latent hyperopia as thoroughly as possible. Seemingly paradoxically, plus lenses are prescribed for pseudo-myopia the idea being, of course, relaxation of the accommodative spasm. The hazards of minus lenses are clearly brought out in the clinical material of the book.

Further the book shows clearly that applying optics as such into a living organism, the eye, may have a clearly damaging effect. Correction of the refractive error at the moment of an examination is a relatively simple procedure by present methods. Thus correction of a refractive error according to the retinoscopy or refractometer findings and prescription of lenses giving the best visual aquity at five to six meters is easily performed. In practice this has led to certain schematism and nonchalance.  Prescription of lenses comes easily (touring ophthalmologists prescriptions by opticians). On the other hand, a procedure that consists in a nearly mechanical measuring  may easily become tedious. Many ophthalmologists therefore consider refraction the least interesting part of their field. It has even become a negation, it may be omitted entirely or left in the hands of the least experienced practitioner or of an optician. The results may be disastrous.

Adoption of the ideas of Tetralogy may not come easily. For an ophthalmologist it means a change of attitude and abandoning hypothesis already crystallized to axioms. But once adopted they offer the possibility of really helping the patient. They not only give significance to determination of refraction so often considered trivial but at the same time open up new dimensions invisible to both the retinoscope and the ophthalmoscope -a fact for which an ophthalmologist cannot be but grateful. The author has not by customary scientific methods attempted to prove her achievements. Every practicing ophthalmologist, however, will be able to find the observations true provided he has the desire to “see wood for trees”. Tetralogy, in my opinion, is more than a more scientific work. It breaths the joy of a basic perception having its full applicability in practice. This joy the author wants to share with her colleagues. What importance Tetralogy will have on medicine as a whole can so far only be envisaged.

Aune Adel Ophthalmologist

(Finn Med J) 6/74, Tetralogia – näkemys oftalmologiasta – lataa suomenkielinen pdf
(translation)
Tetralogy -A view on ophthalmology

This book is intended to ophthalmologists, the author herself beig an ophthalmologist. It should, however, interest specialists in other fields since an enterily new approach to ophthalmolgy is presented. This study breaks the traditional narrow boundaries of ophthalmolgy penetrating into the most central fields of medicine as a whole.

This book is not a doctrinal! work based on theoretical speculation nor is it a product of an unusual imaginative power. On the contrary, it is the anatomy of the work at a private practice during a period of years. The rerults of this work, however, did not fully satisfy the practitioner. Instead they seemed continously to leave the door open to crticism leading to the search for new ways and methods. The ideas of the book, it seems to me, started with an intense questioning. Why does this particular patient show this kind of a refrative error, ananisometropia, a heterophoria, an increased intraocular tension etc. When the answer finally emerged the symptomatic treatment was resolutely given up. Thus”the exact correction” of a refractive error, the operative measure, the hastily written prescription for lowering the tension were abandoned. With the etiological factor found, the recognized academic measures no longer proved rational. Logical thinking combined with longterm clinical observation led to new methods and to therapy in conditions which, until now, have been considered beyond treatment.

The central theme of “Tetralogy” is the refraction of the eye, its determination, variations and its effect on the organism as a whole. Contrary to the textbooks, which divide refractive errors into three groups, the author believes that there is only one refractive error, hyperopia, together with its various grades. Thus myopia and astigmatism are distortions, artifacts, due to the corrective mechanisms of the eye, the accommodation performed by the ciliary muscle with its autonomous innervation. Under continuous strain and a presumable overexcitability the result may end not only in pseudo-myopia and pseudo-astigmatism but at same time in over-activation  a possible sensitization of the entire autonomous nervous system. This is manifested in clinical symptoms as headaches, migraine, epilepic attacks, attacks of pseudo-angina pectoris, intestinal spasms, to mention only a few. Ocular symptoms include accommodative spasm, often combined with pseudo-myopia and pseudo-astigmatism, anisometropia, nystagmus, conjunctival irritations, photophobia, even detachments and degenerative conditions of the retina. Treatment is always solved once the etitology is found. Thus refractive error should not necessarily be corrected by prescribing lenses giving the best visual acuity at distance but by correcting the latent hyperopia as thoroughly as possible. Seemingly paradoxically, plus lenses are prescribed for pseudo-myopia the idea being, of course, relaxation of the accommodative spasm. The hazards of minus lenses are clearly brought out in the clinical material of the book.

Further the book shows clearly that applying optics as such into a living organism, the eye, may have a clearly damaging effect. Correction of the refractive error at the moment of an examination is a relatively simple procedure by present methods. Thus correction of a refractive error according to the retinoscopy or refractometer findings and prescription of lenses giving the best visual aquity at five to six meters is easily performed. In practice this has led to certain schematism and nonchalance.  Prescription of lenses comes easily (touring ophthalmologists prescriptions by opticians). On the other hand, a procedure that consists in a nearly mechanical measuring  may easily become tedious. Many ophthalmologists therefore consider refraction the least interesting part of their field. It has even become a negation, it may be omitted entirely or left in the hands of the least experienced practitioner or of an optician. The results may be disastrous.

Adoption of the ideas of Tetralogy may not come easily. For an ophthalmologist it means a change of attitude and abandoning hypothesis already crystallized to axioms. But once adopted they offer the possibility of really helping the patient. They not only give significance to determination of refraction so often considered trivial but at the same time open up new dimensions invisible to both the retinoscope and the ophthalmoscope -a fact for which an ophthalmologist cannot be but grateful. The author has not by customary scientific methods attempted to prove her achievements. Every practicing ophthalmologist, however, will be able to find the observations true provided he has the desire to “see wood for trees”. Tetralogy, in my opinion, is more than a more scientific work. It breaths the joy of a basic perception having its full applicability in practice. This joy the author wants to share with her colleagues. What importance Tetralogy will have on medicine as a whole can so far only be envisaged.

Aune Adel Ophthalmologist