Spectacles

Spectacles, the name given to flat glasses, prisms, spherical or cylindrical lenses, mechanically adjusted to the human eyes, so as to correct defects of vision. They are made usually of crown glass or rock crystal ("pebbles"), the latter being somewhat lighter and cooler to wear. They are mounted in xxv. 20 a rigid steel wire or gold frames, with fastening-pieces over the ears; single or double eye-glasses, and hand-glasses, or lorgnettes, being varieties of form, according to the circumstances and the wearer's taste.

## Preserves

Preserves are used to conceal deformities or to protect the eyes in the many conditions where they cannot tolerate bright light, such as ulceration and inflammation of the cornea, certain diseases of the iris, ciliary body, choroid, and retina. They are made of bluish, "smoked," or almost black coloured glass, and are of very various shapes, according to the amount of obscuration necessary.

## Prisms

Prisms are of great value in cases of double vision due to a slight tendency to squinting, caused by weakness or over-action of the muscular apparatus of the eyeball. Prisms deflect rays of light towards their bases. Hence, if a prism is placed in front of the eye with its base towards the nose, a ray of light falling upon it will be bent inwards, and seem to come from a point farther out from the axis of vision. Conversely, if the base of the prism is turned towards the temple, the ray of light will seem to come from a point nearer the axis, and will induce the eye to turn inwards, to converge towards its fellow. In cases of myopia or short-sight owing to weakness of the internal recti muscles, the eyes in looking at a near object, instead of converging, tend to turn outwards, and so double vision results. If a suitable prism is placed in front of the eyes the double vision may be prevented. These prisms may be combined with concave lenses, which correct the myopia, or, since a concave lens may be considered as composed of two prisms united at their apices, the same effect may be obtained by making the distance between the centres of the concave lenses greater than that between the centres of the pupils. Again, to obviate the necessity for excessive convergence of the eyes so common in hypermetropia, the centre of the pupil should be placed outside the centre of the corrective convex lenses; these will then act as prisms with their bases inwards. Where, on the other hand, there is no tendency to squinting, care must be taken in selecting spectacles that the distances between the centres of the glasses and the centres of the pupils are quite equal, otherwise squinting, or at any rate great fatigue, of the eyes may be induced.

Spherical Lenses. - Biconcave, biconvex and concavo-convex (meniscus) lenses are employed in ophthalmic practice in the treatment of errors of refraction. Until recently these spherical lenses were numbered in terms of their focal length, the inch being used as the unit. Owing principally to differences in the length of the inch in various countries this method had great inconveniences, and now the unit is the refractive power of a lens whose focal length is one metre. This unit is called a "dioptric" (usually written "D"). A lens of twice its strength has a refractive power of 2 D, and a focal length of half a metre, and so on.

Concave Lenses are used in the treatment of myopia or shortsight. ' In this condition the eye is elongated from before backwards, so that the retina lies behind the principal focus. All objects, therefore, which lie beyond a certain point (the conjugate focus of the dioptric system of the eye, the far point) are indistinctly seen; rays from them have not the necessary divergence to be focused in the retina, but may obtain it by the interposition of suitable concave lenses. Concave lenses should never be used for work within the far point; but they may be used in all cases to improve distant vision, and in very short-sighted persons to remove the far point so as to enable fine work such as sewing or reading to be done at a convenient distance. The weakest pair of concave lenses with which one can read clearly test types at a distance of 18 ft. is the measure of the amount of myopia, and this fully correcting glass may be worn in the slighter forms of short-sight. In higher degrees, where full correction might increase the myopia by inducing a strain of the accommodation, somewhat weaker glasses should be used for near work. In the highest degrees the complete correction may be employed, but lorgnettes are generally preferred, as they can be removed when the eyes become fatigued. It must be remembered that short-sight tends to increase during the early, especially the school, years of life, and that hygienic treatment, good light, good type, and avoidance of stooping are important for its prevention.

## Convex Lenses

In hypermetropia the retina is in front of the principal focus of the eye. Hence in its condition of repose such an eye cannot distinctly see parallel rays from a distance and, still less, divergent rays from a near object. The defect may be overcome more or less completely by the use of the accommodation. In the slighter forms no inconvenience may result; but in higher degrees prolonged work is apt to give rise to aching and watering of the eyes, headache, inability to read or sew for any length of time, and even to double vision and internal strabismus. Such cases should be treated with convex lenses, which should be theoretically of such a strength as to fully correct the hypermetropia. Practically it is found that a certain amount of hypermetropia remains latent, owing to spasm of the accommodation, which relaxes only gradually. At first glasses may be given of such a strength as to relieve the troublesome symptoms; and the strength may be gradually increased till the total hypermetropia is corrected. Young adults with slighter forms of hypermetropia need glasses only for near work; elderly people should have one pair of weak glasses for distant and another stronger pair for near vision. These may be conveniently combined, as in Franklin glasses, where the upper half of the spectacle frame contains a weak lens, and the lower half, through which the eye looks when reading, a stronger one.

## Anisometropia

It is difficult to lay down rules for the treatment of cases where the refraction of the two eyes is unequal. If only one eye is used, its anomaly should be alone corrected; where both are used and nearly of equal strength, correction of each often gives satisfactory results.

## Presbyopia

When distant vision remains unaltered, but, owing to gradual failure of the accommodative apparatus of the eye clear vision within 8 in. becomes impossible, convex lenses should be used for reading of such a strength as to enable the eye to see clearly about 8 in. distance. Presbyopia is arbitrarily said to commence at the age of forty, because it is then that the need of spectacles for reading is generally felt; but it appears later in myopia and earlier in hypermetropia. It advances with years, requiring from time to time spectacles of increasing strength.

## Cylindrical Lenses

In astigmatism, owing to differences in the refractive power of the various meridians of the eye, great defect of sight, frequently accompanied by severe headache, occurs. This condition may be cured completely, or greatly improved, by the use of lenses whose surfaces are segments of cylinders. They may be used either alone or in combination with spherical lenses. The correction of astigmatism is in many cases a matter of considerable difficulty, but the results to vision almost always reward the trouble.

Convex spectacles were invented (see Light) towards the end of the 13th century, perhaps by Roger Bacon. Concave glasses were introduced soon afterwards. Sir G. B. Airy, the astronomer, about 1827, corrected his own astigmatism by means of a cylindrical lens. Periscopic glasses were introduced by Dr W. H. Wollaston.