Mrs. M. L. P., aged forty-eight years, first applied to me...

C. Henry Brown, M. D.,

The Keystone Magazine of Optometry

Mrs. M. L. P., aged forty-eight years, first applied to me in March, 1900. I found her wearing + .5 cylinders with the addition of + 1 D for presbyopia. Her acuteness of vision was O. D. 20/40 and O. S. 20/60, which was raised to normal by + .75 cylinders. She was able to read with some effort, but the near point had receded to ten inches. This was restored to the normal distance and reading made comfortable by the addition of + 1.25 spheres.

Something more than two years later, in June, 1902, she returned for a change of glasses. I found that all that was necessary was a slight increase in the cylinders and spheres to afford normal vision and supplement the impaired accommodation. This is nothing more or less than a case of hypermetropic astigmatism complicated with presbyopia, such as we meet with every day. It differs in no respect from similar cases.

When we meet with cases of this kind at this age we feel that such persons will be dependent upon glasses for the rest of their lives. The cylinders are required to be worn constantly for the correction of the astigmatism, which as a rule never grows less, but tends to increase somewhat as the person grows older, while the spheres are necessary for the correction of the presbyopia, and must be made stronger from time to time to keep pace with the failing accommodation, which is a natural accompaniment of age.

In the usual course of events this lady was due to return for a reexamination of her eyes about 1905. Imagine my surprise, therefore, instead of coming back, to pass her on the street, and see her pursuing her business, that of a purchasing agent in large department stores, without any glasses. On account of her failure to consult me at the customary time, there was no other inference in my mind than that she had drifted off to some one else, as patients sometimes will do in spite of the fact that the glasses may have been entirely satisfactory.

When I saw her without glasses there was some satisfaction to see that my inference was incorrect and that she had not really deserted me for another. Time passed and I occasionally saw her on the street or in the store, and always without glasses, and I confess I was mystified, and still the wonder grew that in spite of the fact that she was growing older she was still independent of artificial assistance to her sight. I did not presume to speak to her about the matter or to question her in regard to it. It seemed to me her eyes looked heavy and lusterless and expressionless, but perhaps that was due to my imagination and dependent upon the thought uppermost in my mind that this woman needed glasses and needed them badly.

Years rolled around and another surprise came when Mrs. P. walked into my office in February, 1915, a lapse of nearly thirteen years since her previous visit. The story she told me was that she had taken up Christian Science and this had enabled her to discard her glasses, and that she had not worn any for the last ten years until the previous summer, when she procured glasses for reading, which I found to be + 3 D spheres combined with cylinders. On examination I found her acuteness of vision as follows: O. D. 20/20; O. S. 20/30. A + .5 sphere accepted for right eye and + .5 cylinder axis 90° for the left.

This shows the acuteness of vision to be nearly normal and much better than on the occasion of her first visit fifteen years previously, and this in spite of the fact that the refraction of the eyes lessens after fifty years of age, with a consequent impairment of vision and a need for stronger glasses. On examination of near vision she seemed to be able to read in some fashion the larger sized print, but it really required + 3.5 D spheres combined with cylinders to enable her to read clearly and comfortably.

The first point to which I wish to call attention, and which is contrary to the usual conditions, is that in hypermetropic eyes the acuteness of vision at the age of sixty-three should be so much better than at the age of forty-eight. The second point is that she is able to stimulate her accommodation to such an extent as to read for the moment, but this is offset to some extent by the fact that she requires + 3.5 D spheres for reading, which is just about normal for a person of this age. She prides herself on this apparent return to juvenility of sight. She refuses to wear glasses for distance, nor can I insist that she really needs them. She dislikes to acknowledge that she needs glasses even for reading, but she is a sensible woman and is willing to submit to wearing them for that purpose.

This patient seems very happy in her Christian Science belief, and attributes her improved vision entirely to this cause. I have no theory of explanation to offer in this case, except that it seems to be another illustration of the predominance of mind over matter.

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