|Year : 1957 | Volume
| Issue : 3 | Page : 51-54
The first graph of accommodations of the people of India
Victor C Rambo
Depts. of Ophthalmology, Christian Medical College, Vellore; Christian Hospital, Mungeli, Madhya Pradesh, India
|Date of Web Publication||9-May-2008|
Victor C Rambo
Depts. of Ophthalmology, Christian Medical College, Vellore; Christian Hospital, Mungeli, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rambo VC. The first graph of accommodations of the people of India. Indian J Ophthalmol 1957;5:51-4
It gives me pleasure to present the first graph, to my knowledge, ever made of the average accommodations at different ages of Indian males. Women's accommodations are not given but sufficient accommodations of females have been taken for me to state that they are close indeed to their male counterparts.
I tested about fifty persons (one hundred eyes) in each of ten groups from ten years of age, including the age groups of 15, 20, 25, 27½ , 30. 32½, 35 . , 37 ½ and 40.
Only those whose birthdays were within six months of the age given were included in our study. Birthdays are not well remembered in the villages, but using every precaution this was determined as closely as possible.
The age groups from 42½ on. including the ages 45, 47½ , 50, 55, and 60, have fewer numbers of eyes in the investigation but sufficient for statistical accuracy.
The work was done, with very few exceptions, by me personally. 1 had with me my trial case and trial frame with occluder, Snellen's distant charts, a half meter measure rod and a suitable fixation object.
The fixation object was a cross with 5 mm. lines made with an ordinary pen on white paper preferably backed with cardboard so it could be more easily slipped along the measure.
I worked in the village streets, schools, court house verandahs. in towns, in bazaars, under trees, wherever boys and men were gathered.
There were blacksmiths, judges, kotwals, farmers, students of course, the retired, the merchant and the labourer. It was an exhilarating experience to meet so many people of good will and able to enter into the examination. Many-the majority, of course-of the people we met could not be placed in my study because they were not in the accepted age groups. Others had vision too poor for inclusion or for other reasons could not be used.
Each boy or man had to have vision 6/6, or better. Each was in good health, that is, up and around and apparently well.
The method of taking the accommodation was as follows. The fifty centimeter measure was held horizontally in front of the eye being tested, the other eye being occluded with an occluder in a trial frame. The end of the measure was placed so that it touched the skin over the temporal side of the orbit at the position of the limbus.
The fixation object was given into the hand of the patient and the hand with the object carried out to about 40 cm. along the measure away from the eye. He was then asked to bring the object closer to the eye till the object began to blurr. This measure was disregarded for reasons I expect to discuss in another paper when further investigations have been completed.
The object was now brought right close to the eye so that much blurring of the object was noted and this fact admitted by the patient. He was now asked to bring the object out along the measure until it reached a position where the object was very clear. The number of centimeters that this position was from the limbus was then recorded and the figure 100 was divided by this number. The result was the amount of accommodation which the patient had in that eye. For instance, if the distance was ten cm. the accommodation would be ten diopters. If the distance was 25 cm. the accommodation would be 4.0 D. for that eye. A conversion table giving the accommodations for different distances was at hand for reference.
The accommodations of those in the presbyopic age, that is with three diopters or less. I obtained by introducing a plus three lens for the examination before the eye being examined. The accommodation was taken as it would have been for a prepresbyopic eye and the three diopters deducted from the total. This gave the accommodation of the patient.
[Figure - 1] shows two lines. The upper one shows Duane's findings on patients whose origins were, I believe, from the middle lattitudes of Europe. The lower line shows my findings on Indians.
The presbyopic age is arbitrarily accepted as the age when only 3.0 D of accommodation remains. From [Figure - 1] it will be seen that in the Indian group the presbyopic age is reached at 37½ years while in the "Mid-Europe" group it is reached At 46 years.
It will be seen that there is, after a practically equal start at ten years, a definitely more rapid fall in the Indian line. Then both lines proceed slowly down, almost parallel, to the age of 37½ when the Indian line goes down more rapidly till it reaches the level where there is no further depression of either line at the end of accommodation failure. This the Indian group reaches at the age of 45 years. whereas the mid-European group reaches at the age of 55 years.
This establishes the scientific correctness of the practice of ophthalmologists in India, reported by me in 1950 at the international Congress of Ophthalmology in London, of giving earlier corrections for presbyopia to the people whose origins are in India than have to be given to the people whose origins are in countries from which Duane obtained his patients for study.
In [Figure - 2] a histogram is given showing the various groups of accommodations obtained from persons at the age of 37 ½ from which is determined the mean, or average for this age (the Indian presbyopic age).
This shows that individuals at 37½ and at other ages, particularly from the age of 30 to the age of 45, must as a working rule have their individual accommodations taken to find a possible presbyopia.
It will not be right to say that every person at 37½ has 3.55 D accommodation because this is the average for the age on our graph. It is necessary for each individual to be examined separately as an individual to find his accommodation after his distant prescription for glasses has been determined. Then and then only may the ophthalmologist say that the individual does not or does need an addition for clear close work and how much.
I believe this graph shows further evidence that the means or averages of accommodations of different groups on the earth's surface are different.
[Figure - 1], [Figure - 2]