Maurice Brumer, O.D. Bayside Shopping Center, Frankston, 3199 Australia
(Background: The history of this paper is interesting and revealing. Maurice Brumer is a second-generation optometrist and has been in continuous practice in Australia since 1967. Concerned about the mistreatment of myopic children by their eye doctors, he asked to present a paper in 1977 on this subject at the 48th ANZAAS (Australian & New Zealand Association For The Advancement Of Science) Congress in Melbourne. The organizing committee rejected his paper as "inappropriate." Dr. Brumer attended the congress anyway and, in his outrage, staged a protest and disrupted the Presidential Address. Dr. Brumer then took his case to the media and the parliament, creating a national uproar. Because of this public pressure, he was allowed to speak on January 26 at the 1979 Congress in Auckland, New Zealand.
Because he made this a public issue, Maurice came under attack by organized optometry. As published in "Insight", Australia's Newspaper of Ophthalmic Optics, in March, 1978:
The AOA (Australian Optometrical Association) considered the matter and decided to reprimand Mr. Brumer, sending him a letter to this effect without holding a hearing at which Mr. Bumer was present.
Mr. Brumer wrote to the AOA, asking that the hearing be reopened, he be allowed to attend, he be told the charges and be allowed to put a defence. A brief note came back to him, saying, amongst other things, that the situation of caution and remand does not require other than a council discussion and decision. Then the Victorian Optometrists Registration Board took an interest in the matter, having received a letter of complaint about Mr. Brumer's actions signed by 28 Victorian optometrists.
The Board wrote to Mr. Brumer on 20th January asking him to submit a written explanation saying that it considered that his conduct during ANZAAS and in subsequent reports and interviews could amount to infamous conduct.
Fortunately, they were unable to take away Mr. Brumer's license to practice optometry, but they did their best to silence him. We are pleased to share his paper with you:
On the third of January, 1907, at the early age of 49, there passed away an optician by the name of Aristide Antoine Marie Fournet. This man of genius was the first to grasp the consequences of our modern age - that primitive man, before he became a farmer, used his eyes mainly for distant seeing, using his eyes for near seeing only occasionally and for short periods. The mode and requirements of seeing for mankind have changed since men became farmers, weavers, tool makers and readers of books. Man now uses his eyes more and more for prolonged near seeing and little or not at all for distant seeing.
Our eyes do not just see, they work to see. Seeing is to our eyes as walking is to our legs. A proper amount of walking is necessary and will do us good. A small proportion of fast walking or running will do us no harm. But too much fast walking or running will tire not only our legs but our whole body. The same is true for our eyes. Distant seeing, where our eyes are relaxed, is like walking. Nearer seeing is like fast walking. Very close seeing is like running; it will tire and affect not only our eyes but our entire body. Prolonged and intensive near seeing is eyestrain; it is not good for our eyes and it is not good for our health. Conventional optometric care has totally ignored eyestrain and has sought only the correction of visual defects, that being the prescription of glasses for the attainment of good distance vision and the assumption that eyes with good distance vision are perfect and that perfect eyes need no assistance for prolonged and intensive near seeing. They would give eyestrain the credit for no more than the occasional "red eye". This is a very harmful and wide-spread fallacy. It is this eyestrain which wears out our eyes, causes blindness, nervous disorders, headaches, learning disabilities and general bodily malaise.
The path blazed by Fournet was obliterated by his death. He had a profound knowledge of the effects of eyestrain in relation to eye disease. His patients, many of whom were distinguished people, championed his methods and testified that their health was marvelously improved by wearing his glasses. He was the first, 90 years ago, to prescribe the bifocal (eye-strain-reducing) glasses for myopic (shortsighted) children. Indeed, his influence at that time was so widespread that his teachings led to bifocal control of myopia in Australia as far back as 1895. Fournet was an "enfant terrible" to his colleagues. His patients realized that if Fournet possessed a technique to reduce the ravages of eyestrain, then there was something seriously amiss in the training and practice of the eye care professions, constituting a danger and detriment to the public well-being. The only response of the eye care professions to the challenge set by Fournet was to assert that Fournet was a danger to the public while at the same time not being prepared to test his work in public.
A succession of practicing optometrists have followed Fournet to this day, all convinced of this major shortcoming in eye care. They have all been successfully ignored or treated as cranks and heretics and the issue has remained at this level for 90 years. The clarion cry of the eye care professions has been "show us proof of the relationship of eyestrain and eye disease". I will now demonstrate that no shortage of this proof exists. At the 1973 Annual Meeting of the American Academy of Optometry, a paper entitled "Bifocal Control of Myopia" was presented by Francis Young, Director of the Primate Research Center at Washington State University, and Kenneth Oakley, an ophthalmologist from Bend, Oregon. Their study found that the effects of properly fitted bifocals (eye strain reducing glasses) on young myopes are to drop the rate of progression of this condition from an average of about one half a diopter per year to about one fortieth of a diopter per year. This study involved control and experimental subjects who were matched for age, sex, initial refractive error and duration of wearing bifocals so that most of the possible causes of failure to achieve results with bifocals were controlled. There was a significant number of subjects, 226 in the bifocal group and 192 in the control group, to assure that the results were consistent and effective over time. The effect of the bifocal was uniformly to reduce the rate of progression even in children who had already achieved as much as 4 or 5 diopters of myopia before they were fitted with bifocals. In other words, the control group moved into myopia at a rate 20 times faster than the bifocal (eyestrain-reduced) group. The implications of such results are obvious and sinister when it is considered that myopia is the third largest cause of blindness in western society.
The visual disability in high myopia is usually considerable and I shall include this description of the condition as felt by its victims so that you here may put yourselves for a moment into their situation:
"Apart from the visual incapacity, the high myope is not usually comfortable in the use of his eyes. When corrected, the small, sharply defined and bright images are annoying; much use of the eyes brings about a feeling of strain and fatigue. The degenerated and liquefied vitreous gives rise to a multitude of "muscae volitantes" and floating opacities, and these, throwing abnormally large images upon the retina owing to its backward displacement, cause a great deal of distress and anxiety to the patient although their actual significance is small. Most of these patients are naturally anxious. Their disability is obvious and may have excited sympathy. The memory of admonitions to care for the eyes lingers into adult life. Thus matters tend to progress slowly and relentlessly, the patient all the while never using his eyes with comfort or without anxiety until finally no useful vision may remain or until the occurrence of a sudden calamity such as a gross macular lesion, a hemorrhage or a retinal detachment brings about a more dramatic crisis." (I thank Sir Stewart Duke-Elder for this description).
The complications of myopia are numerous and grave, frequently resulting in blindness. The degenerative changes appear typically in adult life after the myopia has been fully established for some years.
The complications are:
Choroidal thrombosis and hemorrhage. Such hemorrhages may be recurrent, and when they occur in the central area as they habitually do, each leading to the formation or extension of scarred atrophic areas, their cumulative effect upon vision is frequently disastrous even if they are individually small, larger hemorrhages being correspondingly more tragic.
Vitreous opacity, always present in some degree in high myopia, may suddenly increase to become a serious complication. The vitreous may even fill with blood.
Retinal detachment is the most dreaded and one of the most common complications of myopia, occurring with considerable frequency in all degrees of the defect but showing a progressively greater tendency the higher the myopia. Sir Stewart Duke-Elder states that 5% of myopes develop retinal detachment.
Simple glaucoma is a further complication of high myopia, occurring in the higher degrees after mid-life.
Few of these people, faced with the prospect of blindness in old age, realize that their problems actually began in childhood when they were first fitted with the first pair of corrective (negative) lenses by someone who was probably unconcerned about the tragic, long-term results of that action. Few of these people realize how their situation became more precarious each time their glasses were strengthened and nothing was said about prevention. Now, when it is too late for prevention, they find themselves in the hands of surgeons who are making their living from someone else's mistakes by trying to patch up steadily deteriorating retinas. The patient has been a lifelong victim of ignorance and exploitation.
The cause of myopia is further clearly indicated in a study of 1200 Eskimos in Barrow, Alaska, published in the American Journal of Optometry in September, 1969, which showed that in one generation the Eskimo population had moved from no myopia to approximately 65% myopia among the offspring, and that neither the grandparents nor parents over 40 had any myopia. Thus the first generation between grandparents and parents was similar in that myopia was nonexistent, but in the second generation between the parents and their children, suddenly myopia occurs in a surprisingly high number of children. As a matter of fact, of 53 offspring who were in their early 20's, 88% had myopia. Such a sudden and great degree of change cannot readily be accounted for on the basis of heredity, especially when there has been no identifiable force which could have brought about this obviously considerable mutation in the genetic composition of the offspring. The obvious difference between the parents and the children is the amount of near work which is currently being done by the children. About the time of the second World War, the white man intruded into their lives, requiring the development of education among a population which was uneducated and illiterate. The Eskimo has become an avid reader because of his environment. While he spends a great deal of time out-of-doors in the warmer, daylight summer months, he spends relatively little time out-of-doors in the cold, dark winter months.
In presenting these studies, I would emphasize that these represent only a small (even if spectacular) part of the evidence available today which demonstrates the blindness and suffering caused by present-day eye care. While continuing to ignore a massive body of evidence, the eye care professions continue to ask to be shown proof that myopia results from excessive close work and that the prescription of corrective lenses causes the myopia to increase more rapidly that it otherwise should. It is assumed from the start that the burden of proof is on us and that we are expected to raise money and conduct endless studies that will somehow convince everyone that we are right. In many cases, this is like trying to convince a tobacco company executive that smoking causes lung cancer. No amount of testing will convince those people who prefer to believe what pleases them most or what is more lucrative to them.
Recently in Australia, a debate on these matters has taken place and has reached out to involve every member of our federal parliament. They have been written to by our only two Professors of Optometry - Professor J. Lederer, Head of the School of Optometry, University of New South Wales, and Professor B. Cole, Head of the Dept. of Optometry, University of Melbourne - and they have presented to the parliament their views on this situation at the request of our national president of the Australian Optometrical Association. As they have stated that there is absolutely no merit to the ideas I have brought forward, analysis of their arguments is therefore important to the credibility of this paper, for the charges I have been making are so grave and outrageous that their refutation should be easy and conclusive.
Professor Cole points out in his letter that these treatment concepts have been rejected because of lack of scientific evidence, and he refers to the Young and Oakley study which I have quoted here and states that it shows a very small but statistically significant reduction in the rate of myopia in the group treated with bifocal glasses. As the reduction is by a factor of 20 times, I would agree that it is statistically significant, but to say it is very small is to speak a different language from the one I use. He goes on to quote the study by Mandell, "Myopia Control with Bifocal Correction" in 1959, which showed no reduction in myopia with patients who used bifocals and he makes this the cornerstone of his belief. However, in this study the patients fitted with bifocals had an average initial refraction of -2.75 diopters with an average initial age of 14.3 years, while the control patients had an average initial refractive error of -1.48 diopters with an average initial age of 17.1 years. Clearly the subjects who were fitted with bifocals were progressing at a higher rate since they had developed almost twice as much myopia by age 14 as the control subjects had by age 17. Also, since myopia is supposed to more or less stop progressing in the late teens, one would expect the 17-year-olds to show less progression with or without bifocals than the subjects who were wearing bifocals.
Professor Lederer's letter pleads ignorance and he makes the point that there is no evidence known to him which supports the views I hold. Obviously he has never heard of the studies I have referred to. He further makes the point that he has tested and evaluated methods of myopia control, finding them to be totally ineffective. Not only has he failed to publish these important findings, he has subsequently declared his unwillingness to discuss them with anyone under any circumstances. The world is the poorer for his shyness. He does admit to a form of pathological myopia which leads to blindness but states it is fortunately rare. However, I respectfully would point out that in terms of people who go blind it is exceedingly common and I quote British Government Statistics, "Incidence and Causes of Blindness in England and Wales, 1963-1968". Out of a total of 13,242 cases of blindness, 1,854 (14%) were due to myopia; indeed, myopia was the third main cause of blindness after diabetes (15.7%) and congenital defects (14.2%).
These letters represent a desperate attempt to cover up a tragic and horrible situation. They mislead the public and, significantly, the parliament of my country. They have been unsuccessful in their purpose, however, and a question now lies on notice in the parliament in Canberra to the Minister of Health for Dr. Klugman (opposition spokesman for health) asking him to appoint an inquiry into the matters I have raised.
The eye care professions have resisted change irrationally and fearfully, unwilling to admit that what has gone on before has been wrong and harmful, and by doing so they have unleashed on the public they serve a cataract of horror. This continued situation is a tragedy for the public and a disgrace for optometry. While it is understandable that optometrists will not find it easy to admit that what they have been doing is wrong and harmful, especially for those academic university optometrists responsible for the education of our graduates, to preserve the current horrors to protect our professional prestige and privilege is an abdication of our responsibilities, ethics and morality. I can make no apology for causing embarrassment to my professional colleagues. The interests of the public are paramount and must be served. The purpose of this paper is to direct the future to end the disgrace of the past.
Note: Mr. Brumer has his own website at Maurice Brumer. And in 2008, the reactionary forces that tried to silence him for so many years lost the battle. Read about his vindication at Insight Article .
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Myopization - "The Crime against humanity", the tragedy which has no parallel, even on the global scale, the case which emergently deserves to be addressed to the tribunals such as the EU Court of Justice, these are some of the words by which dr Kasia Viikari, PhD describes the situation in the eye care practice.