As I learned about the immediate danger to unprotected preemie eyes from the strong blue and violet components of fluorescent light described in the baby-blinding lights series, I realized that older children might also be vulnerable to these same retina- damaging wavelengths, though in a different way and with a much longer latency period.

The confused reaction of the preemie's retinal vessels to the excess irradiation is due to their early stage of development.  Once this stage is past, normal light exposure does no longer affect the growth of these vessels and causes no retinal detachment.

However, the harsh components of the fluorescent lamp spectrum might cause a slowly accumulating and long delayed harm to the eyes of older children which are also still very transparent to these most damaging wavelengths. 

As we age, our lens yellows from its cumulative exposure to light, just as varnish does, and for the same reason.  This yellowing is very gradual and offers us an effective protection only from about our late teen years or early twenties on.  Until then, the harmful blue-violet irradiation from fluorescent lamps can penetrate unhindered to our retinae.

Although that radiation can no longer affect the growth of the blood vessels in our eyes, it may partly use up the renewal capacity of the photoreceptors in the retina on which our vision depends.

An impairment of this renewal capacity can lead to macular degeneration, a rapidly spreading epidemic of blinding among older people who lose their sight now much earlier than in past decades.  This macular degeneration has often been linked to the lifelong accumulation of debris from light-damaged photoreceptors in the retina of those affected.  Exposure to retina- damaging light is likely to accelerate this accumulation, and to do so in proportion to how much of that light reaches the retina.

It may therefore be significant that the people who are now losing their sight much sooner than in the past are the first generation who spent their school years under the then new fluorescent lamps.

There is so far no "scientific proof" of this proposed link between the age-related blinding and the early unprotected exposure to retina- damaging light.  However, the available circumstantial evidence indicates that fluorescent light blinds not only preemies but could possibly also contribute much to the long-term damage which causes the current epidemic of blinding at the other end of the age spectrum. 

The medical approach to risk is to continue a potentially damaging exposure until its harm is conclusively proven with large- scale controlled studies and statistical near- certainty.  The common- sense approach, on the other hand, would be to protect children during their vulnerable years from needless exposure to that suspected risk until the safety of that exposure is fully proven.

It seems therefore safer to not keep school children under fluorescent lamps while their eyes are most vulnerable to damage from that harsh light.  Or can you blindly trust in the never established long-term safety of that unnatural irradiation which is well known to damage retinae, and bet the future of your child's eyes on that alleged and hoped-for safety?

For further details about this epidemic, read here the relevant page of my March 24, 1997, letter to Professor Harold T. Shapiro, Ph.D., Chairman of the
National Bioethics Advisory Commission and President of Princeton University, whom I tried to alert to the possibility of this danger.

Ignoring the blue-light hazard
in an even larger epidemic of blinding

The pediatric proponents of bright nursery lighting are so committed to the unconditional defense of their current practice that they completely ignore the possible role of fluorescent lamps in yet another epidemic of blinding that affects even greater numbers of people.

This epidemic is only now beginning to come to public attention. It used to be known in the clinical literature as "Senile Macular Degeneration" because it deteriorated the center of the retina, or macula, of predominantly very old people, at the other extreme of the human age spectrum from preemies.

But in recent years, people get this disease much earlier, so this name, initially coined for the typical dimming of nonagenarian vision, had to broaden its scope. According to the article "Losing Sight" by Henry Grunwald in the December 9, 1996, issue of The New Yorker (pages 62-67) :

"(...) a great many people -- exact figures are hard to come by, but in the United States the number may be as high as fifteen million -- are afflicted with this disease. It is formally known as age-related macular degeneration, or A.M.D., because most sufferers are over fifty. It is the most common cause of irreversible vision loss in the Western world. Yet it is one of the least commonly known eye problems; until recently, it was rarely written about in the popular press, or even discussed."

Almost simultaneously, the ABC News medical editor, Dr. Timothy Johnson, introduced his audience to this disease on the 20/20 show "Open your Eyes America" of December 6, 1996. He called it "Macular Degeneration" and said it mostly strikes people 60 years or older:

" (...) this devastating eye disease now affects about 13 million Americans, more than all other eye diseases combined. Every week, one in three seniors is diagnosed with M.D., and scientists predict a huge wave of Americans, the baby boomer generation, will soon be facing M.D. A staggering 30 million boomers may be facing blindness. Despite these mind numbing numbers, little research is devoted to the cause of or cure for macular degeneration. (...) Scientists don't know what causes macular degeneration, but they have identified some risk factors such as smoking, a high fat diet, and the sun's ultraviolet rays."

One of Dr. Johnson's guests, a Dr. David Seftel, added that

"(...) between 55 and 64 years of age, a total of 14 per cent of all people will get macular degeneration. Above that, it goes up to 19 per cent and those are just the current statistics. So we're looking at an epidemic. We're looking at the epidemic of the 21st century."

And if you are looking for factors that may contribute to this epidemic of early-onset macular degeneration, then add up the following facts and clinical comments:

Fluorescent lamps were introduced in 1938/9. The people whose maculae degenerate now so much earlier than in former times are the first generation that grew up under fluorescent lamps in their school rooms.

The eyes of children and adolescents are much more transparent to the retina-damaging blue and violet light so predominant in the spectrum of fluorescent lamps than the age-yellowed lenses of adult eyes.

Epidemiological studies and clinical research link life-time accumulative exposures to blue light not only to cataracts but also to Senile Macular Degeneration.

The blue and shorter wavelength light creates debris on the retina from light- destroyed photo- receptors; this debris builds up at a rate that seems to be proportional to the eye's cumulative exposure to light in short wavelengths, from ultraviolet to blue.

The buildup of this debris accelerates the normal aging of the exposed eyes. When the level of debris in the retinal pigment epithelium reaches the danger limit, the spare renewal capacity of too many photoreceptors is used up, and vision declines.28

Similar comments in the clinical literature include, for instance:

"Free radicals are produced by metabolic processes that involve the absorption of light and the reduction of molecular oxygen. (...) [The retina's] capacity to absorb light and its need for oxygen enhance the probability that damage to membranous structures of the retina will occur from photochemical effects and associated free radicals. (...) These [protective] mechanisms could become less efficient with age. They can also lose efficiency if they are overwhelmed by an overly abundant or sustained production of free radicals -- for example, with excessive or prolonged exposure to hazardous light. If this happens, damage to ocular cells, such as those in the retina or lens, could occur."29
 

"The aging of the eye and the senile regression in visual perception cannot be studied in isolation from the lifelong cumulative effects of optical radiation" (...) The pigment epithelium is a closed system and with increasing age there is a net loss of cells from this layer with a resulting increase in size of those remaining. (...) Senile macular degeneration results from the metabolic disadvantage from the abnormal accumulation of debris between the pigment epithelium and the choroidal blood supply."30

Some doctors have claimed there is no such damage as long as the electroretinograms are normal.  However, these ERGs do not show up such early damage to the light receptors and will signal a reduced amplitude only after massive destruction of retinal tissue. Diabetics, for instance, can have most of their retina coagulated by laser surgery, but they still retain a normal ERG.31

To use a metaphor, imagine the light receptor's ability to react to light is like your ability to breathe: it remains undiminished whether you stand on dry land or in water up to your chin, but once the water reaches your mouth and your nose, your breathing becomes more difficult and then ceases. In this image, the ERG measures your breathing rate, not the water level.

Without excess exposure to blue and violet light, the normal vision decline used to become noticeable sometimes at age 60 and more typically at 70 or later32. It seems more probable than not that this decline must be expected to begin earlier after a history of abundant exposure to blue-violet light from fluorescent lamps during the childhood and adolescent years, when most of this retina-damaging radiation can still reach the retina in full force and there build up debris that uses up much of the spare photoreceptor renewal capacity.

I have no clinical literature reference to offer for that conclusion, no double-blind clinical trial of people kept all their lives under various controlled exposure conditions. Let me cite instead the non-medical motto "better safe than sorry" which suggests in this case to first protect the children's eyes, even before medical science can formally prove the postulated long-term harm from exposing them to eye- damaging light. It is more important to prevent the problem than to establish the detailed dose-response curves for medical textbooks.

The long-standing and uncritically embraced practice of exposing children and adolescents to fluorescent light seems to be a demographical time bomb with a once long fuse that has now burned to the end. The sudden explosion of the macular degeneration epidemic would be easy to predict from the above circumstantial evidence33 if that explosion had not already begun.

But even now as it is unfolding -- have you heard many warnings about the potential danger from that blue- violet light to the children whose eyes absorb it now?

Contrast this modern indifference to the hazards from fluorescent light with the turn- of- the- century reaction when incandescent lamps became first available. A mere eight years after Edison strung up his first commercial light bulbs in New York, the oculists of London petitioned parliament in 1898 to pass laws against the use of unshaded lights, and consequently research was instituted on various types of shades and reflectors34. Or else we might still be looking at bare bulbs.

Meanwhile, almost sixty years have passed since fluorescent lamps took over most of this country's public buildings, and over thirty years since laser researchers discovered and described the retinal hazard from the strong blue-violet component of their light. Yet, the ophthalmologist community as well as the American Academy of Pediatrics, charged by U.S. Congress with the task of watching over the health of the nation's children, have done nothing to warn the public against those well known dangers.

They deliberately close their collective eyes tightly to the abundantly documented hazards from the fluorescent successors of those early incandescent lamps, apparently afraid that admitting this hazard now would expose their failure to have noticed it earlier.

As the French playwright Racine is said to have said:

"Life is a comedy to those who think, a tragedy to those who feel."

Emperors without cover-up have no Clothes

This heads-in-the-sand policy towards the large epidemic of adult-blinding permits the medical community to avoid some highly embarrassing questions about its official junk science in the iatrogenic epidemic of baby- blinding, at least for the moment.

But it does bring up what the humorist Calvin Trillin described as the Davis Conundrum - how to deal with information that may call into question a tenet that is central to a system of belief. He did so in an essay where he discussed the fact that Sigmund Freud had fudged the data for his central theory35:

"The Davis Conundrum takes its name from a wine-tasting test that I'm told is sometimes given at the highly regarded department of oenology at the University of California at Davis. It turns out that under blind-test circumstances the tasters, some of them professional wine connoisseurs, are often unable to tell red wine from white wine. That triggers the Davis Conundrum: does the failure to distinguish red from white undercut all the learned talk you hear about body and vintage and integrity and which side of the hill the grapes came from?"

So what are we to make of nursery doctors whose central doctrine is built on fudged data, and who do not notice the flagrant dangers they create for their patients' eyes and lives? Blindfolded by their mindset, they fail to distinguish the administration of their light treatment from its withdrawal, and they cannot tell a blatantly rigged trial from a legitimate one.

Do those failures undercut all the learned talk you hear about arterial blood gas levels and multifactorial disease and integrity and medical ethics?

President Clinton said in his speech that announced the creation of your Committee:

"Our greatness is measured not only in how we so frequently do right, but also how we act when we know we've done the wrong thing; how we confront our mistakes, make our apologies, and take action."

He ended with the promise:

"... we will no longer hide the truth from our citizens. We will act as if all that we do will see the light of day."

I ask you therefore to please make the President's promise come true and do the right thing for the American people and their most vulnerable children.

*
 

I received only non-responses to this alert from Dr. Shapiro and from other government agencies that are supposed to protect the public against medical abuses, as in the baby- blinding case, or against medical negligence that ignores a highly probable danger, as in the case of early macular degeneration..