SIGHT, The Story of Vision2

So by manipulating the peripheral image you can either slow down or speed up the rate of progress of the eye. So we have run studies now with a thousand children in China and hundreds of children in Sydney to show that we can slow the rate of progress of myopia by about 40%. And if you do that, you decrease the number of people with high myopia by about 70%. That means there will be 70% less people heading to high myopia and the risk of blindness and the associated eye diseases. What the future holds is a new way of thinking about how to control the growth of the eye, how to prevent high myopia and it's consequences in terms of blindness by adopting a whole series of characteristics for optical devices and a series of interventions around the behavior of children. We know that children in Australia have a lower level of myopia. There's sunshine, there's outdoors, there are plenty of games, there's a lot of chance for the eyes to relax and view the horizons of life. If you are in a kindergarten in China at age three, studying very closely complicated letters then you're driving the myopia process. So, behavior is important. Outdoors and exercise is important. What this means, is that if we use all of the techniques that we now know... myopia controlled spectacles, myopia controlled contact lenses, and even myopia controlled therapeutic drugs... we can help in reducing the risk and slowing the process and progress of myopia.” Brien Holden, OD PhD. 101

CHAPTER 8 Getting Framed Mark Mattison-Shupnick, BA, ABOM, Director, Education, Jobson Medical Information LLC“Eyeglasses seem like such a simple thing, after all, they’ve been around since the late 13th century. In fact, by the middle 1400’s, tens of thousands of pairs were being shipped from Venice and Florence to the Levant and all across the known world. Eyewear has been described as one of the most important of mankind’s inventions. From it’s early days, frames and lenses have continued to undergo change from the ideas of artists, philosophers and scientists. 102

Today is no different - they remain a simple solution to the problems of refractive error and presbyopia in clear and sun lenses. However, they have also added the complexity of invention and modern technologies. That makes them unlike they’ve ever been before.WE HELP PEOPLE SEE, WE HELP THEM FEEL BETTER ABOUT THEMSELVES00:00 / 00:00 “The fashion component of vision correction is critical...” Rob Lynch, former Optical Industry Executive 103

According to VisionWatch, a survey of about 120,000 US eyewear consumers, 82.9 Million pairs of prescription eyeglasses were sold in 2015. Of those, about 5.9 Million pair were purchased for a child. Most consumers only buy eyewear about once every 26 months so knowing what is best requires good advice. Getting the right advice about the best eyeglasses requires training, accumulated knowledge and experience. That’s because the variety of lens materials, designs and treatments chosen must take into account your prescription and the frame you choose.”TECHNOLOGY DRIVES CHANGE IN EYEWEAR “Most consumers appreciate lenses that are thinner, lighter and more durable when purchasing new eyewear. As a result, lens materials like polycarbonate (about 52% of all lenses) and high index (about 10%) have great popularity. Traditional plastic today is only about 30% of sales. Polycarbonate and Trivex are the most chosen materials for children’s lenses because of their superior impact resistance. Like long-playing records, glass is available for the purist and is about 1% of all lenses sold. Be sure to ask your optician to explain the benefits of the thinner and lighter lens material choices that best match the frames chosen. CHOOSE THINNER AND LIGHTER LENS MATERIALS 104

00:00 / 00:00 In this comparison, standard plastic and a super high index lens material are compared. The result is a lens noticeably thinner and because it is so much thinner, it is much lighter. Image, courtesy ABS Smart MirrorAbout half of all lenses are single vision i.e., only one focus. That correlates pretty closely with the distribution of age in the US i.e., those under 45. They are used for far vision and sometimes as reading glasses. Single vision lenses are available in standard and digital form. Digital lenses are specially lens processed so that vision, from lens edge to edge is sharper. They deliver a wider clear field of view. As a result, they cost more than standard lenses but when worn are preferred. The rest of the population is about 45 years or older and typically has presbyopia, a difficulty focusing to read or see things close. Progressive lenses are the most popular solution for presbyopia. They provide clear vision at all distances and look like single vision lenses i.e., no tell-tale lines when viewed by people looking at you. For the presbyope, progressives have more benefits than traditional bifocals and are also available in standard and digital forms. Digital progressives, like digital single vision improves the 105

overall clarity of vision across the whole lens. In fact, it is estimated that about 60% of all progressives are digital, clearly preferred for their better vision. There are different levels of progressive lens customization and depending on your prescription and the frame, your optician and doctor will advise on the best choices.Progressives are easier to learn to use than traditional bifocals, provide continuous and all distance vision and can be personalized for the way that your wear the lenses. For example, if you are a cyclist or love to fish, wrap around sports glasses can be made with progressives (or single vision) because of modern digital designing and cutting technologies. They can customize the lens surfaces so that frames that require steeper lenses and extreme lens angles are no problem. Vision through these glasses is virtually the same as flatter, more common shaped frames. The two images below show the extremes made possible by digital processing. Digital technology has also changed the way that progressives can be customized for the way that we use our eyes, at work and at hobbies. For example, I’ve worn progressive lenses for 25 years. So, I rely on them completely to read and see clearly at arm’s length. When working on this book, I spent hours at the computer, looking at two different screens at two different distances but also reading paper documents and viewing other items all over my desk. I wear ‘computer progressives’, a kind of 106

work lens customized for the distances I need using my prescription as the starting point. That ensures that I can see all those distances clearly and that the width of clear vision is the width of the computer screen or page I am viewing. Just like we wear different shoes (dress, athletic) eyewear today can be tuned to the way that they’re used. The result is comfortable vision and its benefits are a worthwhile purchase. DIGITAL PROGRESSIVES IMPROVE THE FIELD OF VIEW 00:00 / 00:00 Digital technology allows a variety of choices to better improve vision. This simulation shows standard, premium and how tailor made (customized) digital progressives improve the way that progressives deliver clearer, wider fields of view and therefore, better vision. Image, courtesy ABS Smart Mirror.The more traditional solution for presbyopia was bifocals and to an even lesser extent trifocals. They are still sold but with less benefit than progressives. Bifocals have two different foci (far and near), trifocals, three different foci (far, arm’s length and near) but have visible lines that most wearers prefer not to have visible. 107

PROGRESSIVE LENS00:00 / 00:00 BIFOCAL LENS00:00 / 00:00 SINGLE VISION LENS 00:00 / 00:00There is a wide range of lens costs when choosing lenses. You may also have a managed vision care insurance benefit available to purchase glasses. A quick review of these choices will make you better at asking questions about what delivers the most benefits for the dollars spent.” 108

ANTI-GLARE LENSES, A MUST“Last, like cupcakes, where the icing makes them even better, eyeglass lenses provide more benefit when anti-glare, photochromic and for outdoors, polarized lenses are purchased. Regular lenses have surface reflections that get in the way of light passing through the lens for vision. Depending on the material, that could be between 8% to 15% of light lost. Anti-glare lenses virtually eliminate surface reflections and let more than 99% of all the light through. That makes them the clearest lenses possible. New anti-glare technologies make them as scratch resistant and durable as glass. Did you know that about half the people purchasing eyewear purchase anti-glare lenses?Anti-glare lenses cost more, but ensure that the lenses, especially when digital, see all that these highly technical designs can deliver. Anti-glare lenses are better for night driving and oncoming headlights. Self-tinting (photochromic) lenses offer the most convenience in an everyday pair of glasses. They get darker outdoors in sunlight and clear completely indoors. For those that want the benefit of lenses that adjust to your everyday activities, photochromic or self-tinting lenses deliver comfort and convenience. EYEWEAR IS A FASHION ACCESSORY 109

00:00 / 00:00 The old stigma of being called four-eyes is no longer a part of mainstream society. “There probably isn’t a movie today that doesn’t feature a popular eyeglass or sunglass frame..., Holly Rush, former Fashion Eyewear Executive . “Today, for sports, it’s almost mandatory to wear eyeglasses...”, Dr. Raymond Heinen, former Optics Manufacturing ExecutiveTHE PURPOSE OF LENSES AND THEIR FRAME“The right eyeglass lenses ensure that you see well at all the distances needed. That also means great vision from lens edge to lens edge. New digital lenses help us do that better than ever before.The purpose of the frame is to position the lenses correctly in front of our eyes. Of course, the frame also adds style, fashion and for many, attitude. Before we talk about style, lens position can significantly affect vision if incorrect. There are five measurements that ensure that lenses work as your doctor intended. Some you might already know some of them. 110

To position lenses correctly, the optical axes of each lens should be in line with your line of sight. That’s called PD or Inter-Pupillary Distance. The optician measures the horizontal distance between your lines of sight. Measurements for each eye separately are more accurate (monocular). It is also normal that the monocular measurements for each eye are slightly different.The height of the optical lens axis vertically is also important, especially if the lenses are progressives or bifocals. This ensures that the reading portion can be accessed easily with just the eyes turning down without extremes of a chin up. The optician will mark or measure this height and apply their experience to determine what works best.There are three other measurements that also affect how the lenses see. They are pantoscopic tilt, the angle of the lens, top to bottom when the frame is being worn after its been adjusted for fit and comfort. Next is faceform or wrap, the way that the lenses are angled horizontally realtive to your line of sight. Last is the distance that lenses are from the front surface of your cornea; that is called back vertex distance.In digital lenses, we can adjust the lens’ actual surface design in the laboratory to take into account these positions. By accounting for these measurements, we can make lenses that are more customized to the frame chosen and the way in which it is worn. Image, courtesy Carl Zeiss Vision 111

As you can see, frame measurements actually aren’t simple. Just PD can make an adequate pair of glasses, especially if you have a minor prescription. But, for higher power prescriptions, using all the measurements, to customize a pair of lenses, for the frame that was chosen, adequate can be turned into exceptional. That is true for progressive, single vision and even bifocals. Image, courtesy Carl Zeiss VisionIn the image above, a digital software program and an iPad, can derive all the measurements for the frame chosen.”The purpose of the frame“As we said, the frame’s job is to position the lenses correctly (and of course, make you look terrific). That means that the quality of the frame also matters i.e., the quality of the frame’s material, construction of the hinges, coatings on the screws so they don’t fall out, metal platings so they are hypoallergenic and fit and work well for the about 26 months that the average person wears a pair of glasses!This means that , like all other consumer products, there are a variety of different qualities that make up an inexpensive frame and one that is perhaps more hand-made or of precious materials. Last, the brand and the style (trendy) also have an effect on cost. Balance all these and the right or personal frame 112

choice can be made. Your optician will know the DNA of the frames they carry in their office. Use your eyecare professional to understand frame costs and their differences. FIT AND FASHIONAs an optician, customers often ask, “How do I pick a frame, where do I start, what shape/color/material is best for me, there are so many it is overwhelming...”.I think it can be simplified. If you like your frames to bring attention use contrast to your advantage i.e, round and oval face,choose angular frames and cat eyes; have an angular face, try round and oval frames. Want the frame to disappear, it’s the opposite,choose similar shapes. Also, frame style and color can bring attention or blend with your complexion to disappear, your choice. Here’s what we mean, images from the education program, Frames Advisor, courtesy of LuxAcademy by Luxottica. FRAMES ADVISOR1. Look at only the jawline and chin, choose your face shape.2. Frame shapes are angular or rounded. 113

If you like your frames to bring attention use contrast to your advantage i.e, round and oval face, choose angular frames and cat eyes; have an angular face, try round and oval frames. 4. A frame shape in contrast adds balance and proportion. 114

5. Next, eyebrows should be visible above the glasses.6. Last, choose the frame color according to the skin’s undertones. Again, contrast brings attention, similar tones can blend and disappear. 115

Images, courtesy of LuxotticaFollow these simple 6 steps to get started on your next frame purchasing adventure. Ask your optician for guidance.” READERS“Over the counter ready-made readers can be a good solution for presbyopia as long as you’ve had your eyes examined and your prescription is about the same. By the time we are 45, it is time to get a baseline check for glaucoma, retinal conditions, any affects of diabetes, etc. to rule out any disease and required treatment. There are more than 50 million pairs of readers sold each year. If you use them, you probably have a pair in the car, at the desk, in your pocket... They are inexpensive and pretty effective. That’s the good news. Here’s the other consideration. Perhaps you haven’t had an annual eye exam, instead changing the power of the readers by trial and error. You might be missing something and that’s why your vision is changing. Astigmatism is normal and readers don’t correct for astigmatism. Without that correction in your glasses, reading for any length of time may be tiring. Last, readers’ lenses are positioned for an average PD and that may 116

not be yours. In low powers, it may not matter but in stronger lenses it makes a difference.If you have not had an annual eye exam and/or your readers just aren’t working as well as you’d like, it’s time t see the eye doctor.”RESOURCES Learn all about eyeglasses with this comprehensive collection of articles on eyeglass frames and lenses, all written by experts in the eye care industry. 117

Sunglasses“Sunglasses are a benefit for all ages. If you as an adult go outside and you notice that wow these lights are bright, I'm really uncomfortable, I'm concerned about ultraviolet protection. The same thing goes for your kids. Their as uncomfortable in bright lights as you are. Their eyes can be damaged by ultraviolet even with these early exposures just like your adult eyes might be later on. We hear a lot about early protection of skin with respect of ultraviolet damage that early sunburns have downstream consequences for the health of the skin and the eyes are no different. So sun glass protection at any age is something that can be beneficial.” Donald Mutti OD, GLARE AND LENS TREATMENTSDirect glare from a principal source like the sun, projectors or a photoflash can be debilitating because of its intensity. Reflected glare bounces off shiny surfaces like sand, water and snow. Regardless of the source, glare reduces visibility while it causes discomfort and even pain to the eyes. 118

Lens treatments that reduce glare are tints, mirrored surfaces, anti-reflective treatments, polarizing films and photo-polar combinations. Table 1 describes the benefits of each of the treatments.First, Tinted Lenses have a variety of advantages yet can also miss some important characteristics of high quality sunwear. For example, tinted plano lenses reduce glare i.e., excess light but their ability to absorb UV for example is a function of the base material itself and the dye that created the tint. It’s possible that a grey 3 plastic lens is not 100% UV absorptive. Confirm that your sunlenses provide 100% UV absorbing plastic tinted lenses.Grey lenses deliver true color and are advisable for extended periods of use in extreme conditions. Yellow lenses enhance brightness absorb blue light and the ‘dazzle’ is effective for some users (driving during the day for seniors, skiing in fog). However, yellow is not advisable when the light is intense or for those with less than optimal vision. Yellow lenses are not a good solution for night driving in very dark conditions. Yellow lenses absorb too much of the ambient light. 119

Brown lenses improve contrast and image resolution. Ideal in changing light conditions, brown tints also absorb harmful blue light. Amber lenses brighten cloudy, hazy, or foggy skies are excellent for contrast and help to minimize eyestrain. Lastly, they are good for hunters, pilots and snow skiers. Rose lenses enhance contrast and are perceived as relaxing and are best in green or blue environments (water, grass) and can reduce blue light. Lastly, green lenses provide better contrast and a more precise and relaxed vision. To know the exact absorption characteristics, ask your supplier for transmission charts of the variety of lens colors in the materials in which they are supplied.Polarized lenses provide comfort for patient’s eyes by reducing glare, most importantly eliminating blinding glare (intense flat surface reflections) enhancing contrast and clarity as well as being 100% UV protective. The result is reduced eye stress and strain. POLARIZED LENSES ELIMINATE BLINDING GLARE 00:00 / 00:00For all the reasons that you wear sunglasses, blinding glare masks so many critical things. Premium polarized sunglasses ensure that you see all that is important to you. 120

Image, courtesy of ABS Smart Mirror SOLAR LENS PROTECTION INDEXA helpful chart might be the Solar Protection Index (SPI) used in Europe and is part of the required markings for sunglasses sold. The Index categorizes the darkness of the lenses and recommends use based on environmental conditions. As we can see the protection index have 5 categories that increases as light intensifies. The SPI starts at Category 0, when there is very little light absorption and is used for safety lenses and as cosmetic or fashion. Category 1, which allows from 80% to 43% transmission is for indoor and cloudy days. Category 2 reduces light transmission to 18% is for standard illumination. When it gets very sunny, as is the case at the seaside or the mountains, suggest Category 3, which lets only 8% of light through. Last is Category 4, this allows from 8% to 0% of light and is used when there is intense illumination, for example high altitude trekking. It must be noted that Category 4 is not suitable at all for driving. 121

Like the European standard, ANSI Z80.3 also includes traffic signal recognition as a requirement. This is especially important since most traffic lights and lighted warning signs are LEDs which some sunlens colors can obscure. Holly Rush, former President, Luxottica Wholesale, No. America“So the purpose behind what we do, it's not all fun and fashion. There is a real medical need, a necessity to raise the level of awareness for why glasses are important, and why protecting the eyes is absolutely critical. And one of the greatest causes that we believe so strongly in is the protection of eyes, your most vital organ, from UV damage. When we think about the education awareness that's been built in other industries, for example, cosmetics with sunscreen. There's a heightened level of sensitivity of awareness by consumers today that you don't go outside when the sun is shining without a proper SPF, you certainly don't send your kids to the beach without wearing sunscreen. But it's interesting to note that only 20% of children are protecting their eyes from a parent’s standpoint, from the harmful glare and rays of the sun. So, we have an obligation as an industry to raise the level of awareness of the importance of protecting the eyes from the harmful UV rays. UV damage does a tremendous amount to impact the eyes at a very young age. About 85% of all the damage you do is done before the age of 21 and that exposure to UV can cause cataracts, macular degeneration, and other concerns in the eye 122

over a lifetime. That's something that most parents, and most people today aren't aware of. So, they choose cheaper sunglasses if they wear glasses at all and we believe that quality matters. Quality frames and quality lenses to protect the eye. Children are the next generation of opportunity, and today as a society, as a population, we don't think to bring our children before they enter school for a comprehensive eye exam. The impact of not doing that has many many consequences to us as a society manifest in learning disabilities, or social and psychological challenges as time goes by.”WHY CHOOSE PREMIUM SUNWEAR? What is the difference between two sunglasses, one priced about $220, the other $10 respectively?There are 6 factors that define the characteristics of premium versus generic for sunwear. They are UV protection, visual clarity, lens quality, frame quality, warranty and branding.UV Protection – Some sunglasses are marked “UV Absorbing”, “UV Protective” and “Blocks most UV light”. Not sure what that means. Sunglasses sold in the United States are regulated by the Food and Drug Administration and are required to conform to safety standards. The recommended U.S. standard is ANSI Z80.3-2010, which includes three transmittance categories. According to the standard, the lens should have a UVB (280 to 315 nm) transmittance of no more than one per cent and a UVA (315 to 380 nm) transmittance of no more than the visual light transmittance. Lenses of course must pass the drop ball test. The best you can do is choose premium brands you trust that guarantee 100% UV protection.Visual Clarity - Premium lenses have ophthalmic quality surfaces i.e., optically correct with no distortion, ensuring clear vision. Low quality lenses may have local distortions or prism that contribute to blur or discomfort. This can lead to headache, fatigue, even 123

nausea. “Consistency is a concern with lower-priced glasses. You might find one pair that offers great clarity and another that’s the very same brand and model and highly distorted”. (Peter H. Kehoe, O.D., Former President of the AOA).Premium sunlenses ensure surface and centering accuracy. A small amount of prism is required for plano non-prescription wrap sunglasses to ensure comfortable binocular vision. Look for the increased nasal versus temporal thickness, that means that the lenses are optically correct. Premium sunlenses with proper lens surfaces ensure that the potential damaging elements of sunlight and distortion are reduced or eliminated. The filter reduces or eliminates squinting from glare for greater visual comfort.Lens and Frame Quality – Perceptions of lens quality include ‘how dark’ or are based on style and looks. Lens and frame quality is based on more than that. Lens durability for example, a part of its inherent value to the wearer, is augmented by a scratch resistant or mirrored front surface, an anti-reflective rear surface and the overall impact resistance of the complete lens. The performance of each of these characteristics is tested extensively by subjecting the lenses to boiling, artificial sweat, cycling heat and humidity and outdoor weathering. The same trust developed for lenses needs to be created for frames. Frame quality requires that it pass endurance testing (temple or front bending, opening, closing) and tarnish or corrosion resistance (sweat, weather, temperature). Choice of materials that are hypoallergenic, durable, hold adjustment and maintain long lasting color vibrancy is essential. If the frame is coated and/or painted, it will not peel or chip. Higher quality frames can be distinguished for their better quality hinges (won’t wear fast making the temple loose), hinge attachment and finish around the hinges as well as the reliability of spring hinges. All this results in a frame that fits better and provides longer lasting 124

comfort.Warranty and purchase satisfaction is always a consumer expectation. When you purchase generic eyewear and it breaks, what can you do? Are there spare parts? Can you return it? Maybe. Maybe not. By purchasing premium eyewear, customers are making an investment. With some manufacturers, this includes a 2-year manufacturers limited warranty and certificate of authenticity. It also includes an information leaflet like SPI index.Brands - As the late Karl Lagerfeld once said, “People are great at remembering brands and logos.” We have to remember that a large part of tour desire for great sunwear comes from the brand name and the prestige that those brands possess. Have you ever purchased an item that cost more because of the brand? Brands have grown to guarantee quality, fit and identity. Choose the brands that appeal to a specific as well as the broad range of customer segments. EVOLUTION SOLVES A PROBLEM - INSECTS WITH SUNGLASSES!Dr. Ivan Schwab describes the Owlfly and their unique adaptation to be able to see day and night. “Owlflies can be active at night and active during the day. They can also be active at the twilight time called corpuscular so they are con-temporal, meaning their active all the time, or potentially active all the time. They have a compound eye like other insects like wasps and flies and those things that bother you at picnics. But those animals can only be active during the daylight. So how does an Owlfly become active at night? Doesn't that cause problems for their eyes? Well it would except they have a wonderful solution. Evolution has found this. 125

Image: thatbugguy.comThey have nocturnal compound eyes. Those eyes can be found in moths for example. There is a special name called a superposition eye. These are eyes that do better at night. An Owlfly has an eye very much like a moth. But that wouldn't permit it to be active during the day because all that light would create glare so that they wouldn't be able to see well during the day. How do they get around it? They get around that with sunglasses. Well not the kind that you buy in the supermarket but essentially what they do is they coat each individual unit (of the compound eye), around the lenses as well as part of that unit with pigment. What happens when there is light? Well the pigment clumps so that it doesn't interfere with capturing light to see at night. But during bright light it spreads out to create a coat around each one of those individual units. They are called ommatidia. It's greek and it means little eyes. Here is an animal that wears sunglasses so they it can be active at night, as well as during the day. Now moths do the same thing but they have a slightly different system. In other words, this different system works from below and comes up to do the same kind of coding and the two aren't related. So this is something that has evolved a couple of times.” Ivan Schwab MD, Professor of Ophthalmology, UC Davis.RESOURCES 126

Sunglasses All About Vision, Consumer Guide to The Vision Council. Choosing Sunglasses 127

A Brief History Of EyeglassesAs one of the Executive Producers of the SIGHT Project and a critical member as Chairperson of the Advisory Board, David Fleishman, MD has been instrumental over the past nearly 15 years investigating and coordinating historical discoveries, as well as communicating between museums and their collections on behalf of those who study the fascinating history of spectacles. Dr. Fleishman is also the architect/creator of the unique website Antique Spectacles.com. Click on the image below to visit. This extensive website can help you learn more about vision aids beginning with their origins. David is very passionate about this subject. He is oftentimes heard saying, \"Eyeglasses are one of the greatest inventions of all time and yet they're mostly taken for granted by everyone. Their developmental history is truly a fascinating journey which has 128

been under-appreciated for far too long. In addition, watch the Second Screen segment with Dr. Fleishman showing many beautiful and rare pieces from the over 730 years of eyewear history. John Amos, OD, MS, a member of the SIGHT Advisory Board and President of the Optometric Historical Society put together this list of notable events any historian would want to know. His perspective though, as part of our project, is more important. He says, “To me, one of the important aspects of the film should be to acknowledge the remarkable impact corrected vision has had on society, that’s the past. Not just in the United States but around the world. However, that being said, we should discuss how to provide eyecare to the millions of people with no access. That’s the future”NOTABLES... (images provided by AntiqueSpectacles.com) 129

Nimud or Layard Lens, oval rock crystal inlay which was ground and polished on a flat rotating surface, about 870-612 BC, British Museum, London Alhacen (965-1040), Arabic optician, mathematician, astronomer, scientist, philosopher, wrote “Treasury of Optics”; is considered the Father of Modern Optics; explained that vision occurred when light hit an object and then entered the human eye; thought the eyes could be helped by the use of appropriately cut optical lenses. Plano Convex Magnifier. Roger Bacon, a Franciscan monk, scientist and philosopher, published his “Opus Majus” in 1268 describing plano-convex lenses placed on the page to help older people see. The invention of eyeglasses is attributed to an unknown artisan near Pisa, Italy, from blown glass balls, where similar discs were cut, c. 1286-87 Giordano da Rivalto, a St. Catherine’s Dominican monk was the first to use the term “occhiale” (eyeglasses) stating in a sermon in Florence in 1306 “it is not yet 130

twenty years since there was found the art of making eyeglasses which make for good vision, one of the best arts and most necessary that the world has”. This has led to the year 1286 being identified by some as the beginning of the use of spectacles. An inscription on a tombstone in Florence states “Here lies Salvino d’Armati of Florence, the inventor of spectacles. Died in the year of our Lord 1317. This memorial is often cited as evidence for this Italian being the inventor of spectacles the year being about 1285. This claim has been proven false. St. Catherine’s Dominican friar Alessandro della Spina, in his 1313 death notice in Pisa stated, “a monk of most excellent character and acute mind…..whatever has been made, when he Spina saw it with his own eyes, he too knew how to make it; and when somebody else was the first to invent eyeglasses and was unwilling to communicate the invention to others, all by himself he made them and good-naturedly shared them with everybody”.Two facts stand out here: 1. the date is pinpointed as being close to 1286, and 2. there is a close relationship between the church and spectacle making. This is a relationship readily understood when one realizes that most of the reading and writing of the time was done in monasteries. The recommended reference for the early history of spectacles is Rosen, Edward. \"The Invention of Eyeglasses.\" Journal of the History of Medicine, v. 11, 1956, pp. 13-46, and pp. 183-218. This is considered the definitive paper on this important topic. 131

Rivet spectacles, type 1, wood frame, circa 1330, Kloster Wienhausen, Germany; considered to be the earliest example in the world, these were not even discovered until 1953 Rivet spectacles, type 1, bone frame, late 14th century, Bergen-op-Zoom, The Netherlands Cardinal Nicholas of Rouen, holding a single low-power lens on a handle in order to read a book, painted by Tomaso de Modena, 1352, Chapter Hall of Dominican Monastery, San Nicolo in Treviso, Italy Cardinal Hugo of Provence, wearing rivet spectacles, painted by Tomaso de Modena, Chapter Hall of Dominican Monastery, San Nicolo in Treviso, Italy 132

St. Paul, tinted rivet spectacles, in the initial D from a 1380 French Bible, Bibliotheque Nationale, Paris St. Luke, artist Konrad von Soest, 1404, behind the high altar in Niederwildungen, Germany The invention of the Gutenberg Press in Mainz Germany around 1450 saw the introduction of moveable type printing as the radical improvement over the earlier handwritten manuscripts. Oil based ink for books soon replaced water-based inks on manuscripts. This led to the unrestricted circulation of information which rapidly spread to the masses. Up until the mid-15th century, only the wealthy and the clergy had nose spectacles because they had the time and the money. Mostly Italian glasses were available and they were relatively expensive. But the sharp increase in literacy spread and it was followed by a growth in demand for glasses by people of all ages. So cheap glasses came to the market and spectacle peddlers began to surface everywhere selling German and Dutch single- wire and also leather-framed spectacles, starting in the late 15th century. Florence and Venice had been shipping eyeglasses now for almost 50 years. Lenses for myopia had just come into use. There was an increased demand for clerks; literacy among the young and artisans advanced; there was a spread of education and book-keeping, as all types of information disseminated. This 133

information revolution was certainly the greatest in the history of mankind. In turn, this contributed to the Renaissance, the Reformation, the Beginning of Humanism as well as the Scientific Revolution.So, initially, there had been very few educated people and only a limited number of books available to read. Printing began and soon everyone everywhere needed to have glasses to gain knowledge about all sorts of subjects. Roman poet Vergil, artist Ludger tom Ring the Elder, circa 1530, Westfalisches Landesmuseum fur Kunst und Kultureschichte Munster St. Jerome, the Patron Saint of spectacle-makers in France, painted by Ghirlandaio, 1480, Church of the Ognisanti, Rome With the advent of the printing press, books moved outside of 134

monasteries and so did spectacles. There are many examples of notables wearing or holding spectacles used primarily for reading. Next, came the “Theory of Vision” beginning with the Italian painter, sculptor, anatomist and inventor Leonardo da Vinci (1452-1519) who identified the crystalline lens as a refracting body Pope Leo X with his Nephews, painted by Raphael, shows a strong lens for myopia, 1518, Uffizi Gallery, Florence, Italy Felix Plater (1536-1619) a physician and professor of anatomy at the University of Basel identified the retina as the receptive layer of the eye Francesco Maurolyco (1495-1575) several years before Kepler, explained myopia and presbyopia on the basis of an analogy with spectacle lenses Johannes Kepler (1571-1630) a German mathematician and astronomer began the origins of optics, and laid the scientific background for what would evolve into contemporary eye care, with the publication, in 1611 of his treatise on optics entitled Dioptrice. This book described the mathematical basis of lenses, prisms and mirrors and scientifically explained the process by which the eye received and formed an image. He explained that light entered the eye and was refracted by the cornea and lens and formed an inverted image on the retina. Previously it had 135

been held that light emanated from the eye outward. He also explained the optical basis of the Galilean and Keplerian telescopes The Holy Family, Baby Jesus is holding leather-framed nose spectacles, painted in Naples, Italy; circa 1630; definitely qualifies as the greatest anachronism in history. The First Four Articles of the Apostle’s Creed, wool and silk slit tapestry, Flemish, probably Brussels, circa 1475-1500, 168 1/8 x 328 in., MFA Boston (08.441), Gift of Mrs. John Harvey Wright in memory of her son Eben Wright and her father Lyman Nichols. Dr Fleishman siggests, “Considered also as the greatest anachronism in existence because it shows St. Peter wearing rivet spectacles in the Garden of Eden and what could be earlier than that?” Christoph (Christopher) Scheiner (1575-1650), a Jesuit priest, physicist, and astronomer, measured the indices of refraction of the eye. He was the first to demonstrate that if one looks at an illuminated surface through two pinholes whose distance apart is less than the diameter of the pupil, one can observe two partially 136

overlapping diffusion circles (Scheiner’s experiment formed the basis of many 18th and 19th experiments), the curvature of the cornea, and confirmed the inverted nature of the retinal image Masterpiece Spectacles, made by Paulus Bayr in Nuremberg, 1707, Optisches Museum, Jena, Germany: these were made to gain access to the rank of “Master” and thus become a “Brillenmacher”. These ornamental glasses had a fragile hand-carved horn frame and were never for customers to order and wear. Only about three dozen Nuremberg examples exist in all the world. No Regensburg examples are known to have survived from the 17th century. Slit bridge nose spectacles, horn frame with darkly tinted lenses, circa early 18th century; this modification provided added flexibility and comfort. Early book with Nuremberg single copper wire spectacles and Nuremberg magnifier in the front cover, late 17th century. 137

Spina frontalis spectacles, baleen frame (horny, keratin-like material which forms fringed plates that hang from the upper jaw of the baleen whale), 18th century. Benito Daza de Valdes (1591-1634), Notary of the Spanish Inquisition who published in 1623 the first book on spectacles. He described the state of spectacle making and the fitting of lenses at that time. From a professional point of view he may be considered the world’s first optometrist and optician, the “Father of Optometry”. Sir Isaac Newton (1642-1727) an English physicist and astronomer, developed a telescope and wrote on the theory of color vision. Hans Kloti, moved from Regensburg Germany to Orangeburg S.C. in 1720, brought these glasses with him. The first major treatise on the prescribing of lenses (described as fitting of spectacles) was published by Benito Daca de Valdez in 1623 (also referred as Valdes by some authors). Valdez (1591-1636) was a notary in the Holy See in the city of Seville, Spain. Some have considered Valdez the “father of optometry” because 138

his work discussed the prescribing of presbyopia based on age as well as the differentiation of congenital and acquired visual defects. Most optometrists give that title to Prentice (see later). Two pages from the Regensburg Regulations, one shows spectacles with straps while the other shows Masterpiece spectacles,, about 1580, German National Museum Library, Nuremberg Small optical guilds had formed as early as the 14th century in Italy. Later, they were known in Antwerp, Belgium, the Netherlands, and especially Nuremberg and Regensburg, Germany from the beginning of the 15th century as a cottage industry was starting there. Later in 1629, the Worshipful Company of Spectacle Makers was chartered and signed and sealed by King Charles I and countersigned by Cardinal Wolsey in London, England. William Molyneux (1656-1698), the Irish philosopher, astronomer, and mathematician also wrote a book paying tribute to the importance of spectacles and one the prescribing of spectacles published in 1692 and entitled Dioptrica Nova. He described the prescribing of lenses for myopia and presbyopia. Edward Scarlett trade card, 1714-1727, newly- 139

discovered and the earliest of three known examples, Bodleian Library, Oxford; this shows the first illustration of side arms with spiraled endings. The inventor of temples for spectacles. Scarlett temple spectacles, circa 1730, the British Optical Association Museum of the College of Optometrists, London; considered the world’s earliest example Ayscough double temple hinge, invented 1752, with Martin’s Margins, invented 1756, notice the horn inserts inside the frame to block about 30% of the light entering the eye Solid gold temple spectacles, worn by King Louis XV (1710-1774), circa 1770, Musee de la Lunettes, Morez, France Martin’s Margins, ‘X’ bridge, late 18th century, probably Dutch or French, quite unusual. 140

Ornate spectacles with hand-carved mahogany and boxwood case, Italian, late 18th century, British Optical Association Museum, London; unique. Benjamin Franklin (1706-1790) printer-publisher, scientist, inventor, and statesman is frequently credited as the inventor, or at least the improviser, of “double lenses” or bifocals sometime in the 1760’s or 1770’s. Levene (Clinical refraction and Visual Science) has also raised the possibility that his good friends, the painters Sir Joshua Reynolds and Benjamin West, may have played some role in their invention as well. Split lens bifocals (Franklin-style), silver frame, English, 1790s. Split-lens bifocals, steel frame with turn-pin sides, circa 1790, provenance the Hugh Orr Collection. 141

Doge Giovanni Moncenigo eyeglasses and case, blond horn, worn between 1763-1778, Venice. William Porterfield (1696- 1771) was a physician who described the optometer in 1737 and later described the instrument in his two volume Treatise on the Eye published in 1759. His work provided the foundation for physiological optics and ophthalmic optics in Great Britain.EXCERPT, SECOND SCREEN, THE RICH HISTORY OF EYEGLASSES 00:00 / 00:00Dr. David Fleishman describes Ben Franklin, Addison Smith, John Richardson and others contributions to the technology, style and visibility of eyewear. . From Second Screen, Select Highlights in the Rich History of Eyeglasses. 142

Addison Smith, first ever spectacle patent, 1783, notice the second pair of lenses flip down from above, English patent #1389. John Richardson, fourth spectacle patent, 1797, notice the extra set of lenses swing in from the sides. Adam’s Patent spectacles, English patent # 2155, 1797. From the patent, \"Spectacles upon an entire new principle\", which \"relieve the temples and nose from any kind of pressure whatsoever when in use\" and \"the spectacle eyes may be varied or moved in any direction as occasion may require\". 143

Thorowgood Smith wearing Adam’s Patent Spectacles, anonymous artist, circa 1808, City of Baltimore, MD Recommended reference for the early history on the correction of vision problems (refractive error), Levene, JR. Clinical Refraction and Visual Science. Butterworths, 1977. In spite of its misleading title, it is primarily about historical research related to a variety of topics including detection and correction of simple refractive errors (myopia and presbyopia), inventors of the bifocal and trifocal, and astigmatism. Levene received his Ph.D. in history from Oxford University. Silver eyeglasses with sinuous sides, fold at the nose bridge and also twice along each side, 1818-1838, French. 144

Triple spectacles, the additive effect of the lenses might have helped far, arm’s length and also reading vision needs, 1830s. Accordion style silver ‘side-pieces’, today called temples, early glass cemented on (Canadian balsam), bifocal segment, tortoiseshell frame, mid-19th century, perhaps French, probably unique. John McAllister, Sr., (1753-1830) had the first optical shop in Philadelphia, PA in 1796 after he bought a stock of eyeglasses. He is recognized as the “Founder of the Profession of Opticianry” in the US and was said to be the first person in Pennsylvania to measure a pair of eyes for glasses. His son John, Jr. joined the business in 1807 and soon after the 1812 embargo they were manufacturing and then marking their own frames. William Young McAllister (a grandson) and his partner James W. Queen, were credited as teaching ocular refraction to the first oculists in Philadelphia in the 1870’s. The family firm, which had developed from the making of spectacles into optometry continued on for five generations, a span of 173 years, and helped to make Philadelphia the center for the 145

development of optometry in America. Although Thomas Young (1773-1829) was the first to describe astigmatism in 1800, it was in 1827 the astronomer George Biddle Airy and the optician Fuller fabricated a cylindrical lens for the optical correction of astigmatism in England. An ocean away the Reverend Chauncey E. Goodrich in the United States independently discovered and corrected the same anomaly in his own eye. It is generally assumed these lenses were ordered or fabricated by John McAllister in 1827. Predecessor companies of what would eventually become one of the largest optical company in the United States were first consolidated in 1833 and would become American Optical in 1869. Click on the image below and take a 360 degree tour of the Optical Heritage Museum. 146

To visit the Optical Heritage Museum, contact Dick Whitney, Carl Zeiss Vision, Manager of Industry Standards, Executive Director of the Optical Heritage Museum, ([email protected]) John Jacob Bausch opened an optical shop in 1853 at Rochester, New York. He was joined, after the Civil War, by his partner Henry Lomb in 1886 to form Bausch and Lomb which is still in business today. Lomb had financed part of the business during his years of service during the war. Frans Cornelius Donders (1818-1889) was born and educated in Holland and became a physician and professor of anatomy and physiology. In 1864 he published his famous book On Anomalies of Accommodation and Refraction of the Eye, with a Preliminary Essay on the Physiological Dioptrics of the Eye. This book is perhaps best known for describing the action of accommodation and the refractive condition of hyperopia and its optical 147

correction with convex lenses instead of lotions and eyewashes. Carl Ferdinand Ritter van Arlt (1812-1887) first in 1846 and later in 1868 encouraged the medical profession to fit spectacles and eye glasses themselves instead of leaving so important a matter to the opticians. van Arlt’s concerns proved to become a reality. By the end of the 19th century the refracting optician was becoming firmly established by providing a neglected service to the public. This same service was also being provided by some oculists. This overlap in responsibilities led to the legal establishment of the profession of optometry. The first attempt at passing an optometry practice act was led by Charles F. Prentice in 1896 in the State of New York. As a result of this initial legal effort Prentice is regarded by most optometrists as the modern “Father of Optometry”. The English Mathematician and Optician Charles Babbage invented the concept of the ophthalmoscope (1847) but had his idea turned down by a famous physician of the time and did not pursue its further development. Fortunately, Hermann von Helmholtz (1821-1894) who was a physician, professor of physiology and later anatomy and physiology at Bonn did recognize its importance. Helmholtz realizing this instrument’s potential refined the concept and published a paper describing the instrument in 1851. Helmholtz was also famed for the publication of his three volume book entitled Physiological Optics. The first volume appeared in 1858 and the third in 1866. 148

Pince nez, late 19th, early 20th century The first original optometry practice act was passed by the State of Minnesota in 1901 and subsequently by every state or territory in the contiguous United States and the District of Columbia by 1924. In 1916 the American Board of Ophthalmic Examinations was organized and incorporated on May 3, 1917. Its name was later changed to the American Board of Ophthalmology. It was the first, or one of the first, specialty boards so approved. The first ophthalmology residency programs in the U.S. were in combination with otolaryngology and thus these physicians were referred to as specialists in EENT. At some time in the 1940’s, I believe, ophthalmology residency training programs began being offered as separate and distinct residency education programs. Early development of modern contact lenses began in the 1920’s and continued through the early 1940’s. These lenses were primarily scleral in design. Development of corneal contact lenses from small rigid lenses made of polymethylmethacrylate (PMMA) material, gas permeable materials, and soft (hydrogel) materials began to make contact lenses more comfortable and popular with the 149

public. Continual refinement in lens material and design led to a rapidly evolving field that continues today. Development of instruments for examination of the eye (including but not necessarily limited to) are the applanation tonometer, biomicroscope, gonioscope, binocular indirect ophthalmoscope, and pre-corneal lenses. Some of these instruments existed before the 1950’s but they became an integral part of every ophthalmic practice during this period as a result of advancement in design, greater availability, or change of practice art allowing utilization of drugs for the use of some of these instruments. Evolution of spectacle lenses from glass material to hard resin, polycarbonate, Trivex and high index and the development of various types of multifocal lenses, including the progressive addition lens (PAL). Increase in scope of practice and better coordination/cooperation among the professions involved in eye care. Continuing development of many new prescription and non-prescription ophthalmic medications for the treatment of eye conditions/ diseases. Development of new and better surgical techniques for ocular surgery. Among these one must include the dramatic advancements in cataract surgery procedures and use of intraocular lenses, refractive surgery (progressing through radial keratotomy (RK), photorefractive keratectomy (PRK), and laser refractive surgery (LASIK); retinal detachment repair and many other types of retinal surgery as well as surgery for strabismus, glaucoma, and many other conditions. Other methods of management or therapy for refractive errors, or other conditions, and vision rehabilitation for patients with low vision, traumatic brain injury or binocular vision problems. 150