Diapositiva 1

1
Prevention of Refractive Defects of Vision by
Means of Evolutionary Medicine Giacinto
Libertini  www.r-site.org/ageing
www.programmed-aging.org   giacinto.libertini_at_tin
.it
2
Preamble
What is Evolutionary Medicine?
3
Evolutionary or Darwinian Medicine 1-6 comes
into being in 1991 1, but there are some known
forerunners 7 (e.g. 8) and others not
generally cited as forerunners 9,10.
1 Williams GC, Nesse RM (1991) The dawn of
Darwinian medicine. Quart. Rev. Biol. 66,
1-22. 2 Nesse RM, Williams GC (1994) Why we get
sick. New York (USA), Times Books. 3 Stearns SC
(ed) (1999) Evolution in health and disease (1st
ed.). Oxford (UK), Oxford University Press. 4
Trevathan WR, Smith EO, McKenna JJ (eds) (1999)
Evolutionary Medicine. New York (USA), Oxford
University Press. 5 Trevathan WR, Smith EO,
McKenna JJ (eds) (2008) Evolutionary Medicine
new perspectives. New York (USA), Oxford
University Press. 6 Stearns SC, Koella JC (eds)
(2008) Evolution in health and disease (2nd ed.).
Oxford (UK), Oxford University Press. 7
Trevathan WR, Smith EO, McKenna JJ (2008)
Introduction and overview of Evolutionary
Medicine. In Trevathan WR, Smith EO, McKenna JJ
(eds) Evolutionary Medicine new perspectives.
New York (USA), Oxford University Press. 8
Eaton SB, Shostak M, Konner M (1988) The
paleolithic prescription a program of diet
exercise and a design for living. New York (USA),
Harper Row. 9 Price WA (1939) Nutrition and
Physical Degeneration. New York London, Paul B.
Hoeber. 10 Libertini G (1983) Ragionamenti
Evoluzionistici. Naples (Italy), Società Editrice
Napoletana English Edition (2011) Evolutionary
Arguments. Crownsville (USA), Azinet Press.
4
Evolutionary Medicine is not an Alternative
Medicine (like homeopathy, iridology, ayurvedic
medicine, naturopathy, traditional Chinese
medicine, energy medicine, etc.) but a Medicine
that is more thoroughly scientific in that it
involves the concepts of Evolutionism.
A medicine that ignored the principles of
chemistry, for example, would be partially
scientific. Similarly, a medicine that
ignores the principles of evolution is partially
scientific.
5
So, the contrast is not between
Current Medicine
Alternative Medicines
but between
Evolutionary Medicine (which is a more
thoroughly scientific medicine)
Current Medicine (which in most cases ignores
Evolutionism)
However, the first practical question is
immediate Is this difference only a theoretical
/ verbal nicety? or Does this difference have
strong and significant implications for the
structure of medical studies and for health
organization?
6
Evolutionary Medicine involves many concepts and
applicative consequences. Here, I develop a
practical application of a simple concept, the
mismatch 1,2, to the genesis of refractive
defects of vision.
The concept of mismatch is simple but with huge
implications
If a species is adapted to a certain range of
conditions (including diet, environmental
conditions, interrelations with other living
beings, etc.), called for brevity ecological
niche, any change in the ecological niche
potentially is a source of disfunctions
(diseases), because there is no adaptation to the
new conditions. This is defined as "mismatch.
1 Eaton SB, Shostak M, Konner M (1988) The
paleolithic prescription a program of diet
exercise and a design for living. New York (USA),
Harper Row. 2 Libertini G (2009) Prospects of
a Longer Life Span beyond the Beneficial Effects
of a Healthy Lifestyle, in Bentely JV, Keller MA
(eds) Handbook on Longevity Genetics, Diet
Disease, New York (USA), Nova Science Publishers
Inc.
7
Refractive Defects of Vision in the Context of
Evolutionary Medicine
Step 1 - Epidemiological study of modern
populations Refractive defects (myopia,
astigmatism and hyperopia) are a group of related
diseases with frequency - very common 1-3 -
varying greatly from population to population
(e.g. The prevalence of myopia in Asia is as
high as 70-90, in Europe and America 30-40, and
in Africa 10-20 1)
1 Fredrick DR (2002) Myopia. BMJ. 324,
1195-9. 2 Dirani M et al. (2010) Prevalence of
refractive error in Singaporean Chinese children
the strabismus, amblyopia, and refractive error
in young Singaporean Children (STARS) study.
Invest. Ophthalmol. Vis. Sci. 51, 1348-55. 3
Chow YC, Dhillon B, Chew PT, Chew SJ (1990)
Refractive errors in Singapore medical students.
Singapore Med. J. 31, 4723.
8

• Step 1 - (CONTINUED)
• - varying greatly within the same population with
  changing conditions 1-3
• varying greatly within a population over a short
  time 2,4,5 (see Figure)

(From 2) Figure 1. Moderate
myopia (1.005.00 D) by age in Indians and
Eskimos of the Yukon and NorthWest territories.
Adapted from Morgan Munro (1973) (5)
1 Rose KA , Morgan IG, Smith W, Burlutsky G,
Mitchell P, Saw S-M (2008) Myopia, lifestyle, and
schooling in students of Chinese ethnicity in
Singapore and Sydney. Arch. Ophthalmol. 126,
527-30. 2 Cordain, L, Eaton, SB, Miller, JB,
Lindeberg, S, Jensen, C (2002) An evolutionary
analysis of the aetiology and pathogenesis of
juvenile-onset myopia. Acta Ophthalmol. Scand.
80, 12535. 3 Garner LF, Owens H, Kinnear RF,
Frith MJ. (1999) Prevalence of myopia in Sherpa
and Tibetan children in Nepal. Optom. Vis. Sci.
76, 282-5. 4 Edwards MH, Lam CS (2004). The
epidemiology of myopia in Hong Kong. Ann. Acad.
Med. Singapore. 33, 34-8. 5 Morgan, RW, Munro,
M (1973) Refractive problems in northern natives.
Can. J. Ophthalmol. 8, 2268.
9

• Step 2 - Comparison between the frequency of a
  disease in modern populations and the frequency
  of the same disease in populations
• in primitive conditions
• The study of primitive peoples shows that these
  defects are very rare or nonexistent among them.
• As regards Australian Aborigenes The marvelous
  vision of these primitive people is illustrated
  by the fact that they can see many stars that our
  race cannot see. In this connection it is
  authoritatively recorded regarding the Maori of
  New Zealand that they can see the satellites of
  Jupiter which are only visible to the white man's
  eye with the aid of telescopes. These people
  prove that they can see the satellites by telling
  the man at the telescope when the eclipse of one
  of the stars occurs. It is said of these
  primitive Aborigines of Australia that they can
  see animals moving at a distance of a mile which
  ordinary white people can not see at all. 1
• As regards Yakuts (a Siberian people) Many
  travelers observed what some of them call
  telescopic eyesight among these peoples. A
  Yakut distinguished with the naked eye stars in
  the Pleiades not usually seen without a
  telescope. The Yakuts say there are many stars in
  this group, but only seven large ones 2

• 1 Price, WA (1939) Nutrition and Physical
  Degeneration. New York London, Paul B. Hoeber.
• 2 De Hutorowicz H, Adler BF (1911) Maps of
  Primitive Peoples. Bull. Amer. Geogr. Soc. 43,
  669-79.

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• Step 2 - (CONTINUED)
• As regards two hunter-gatherer populations
  Using a retinoscope and cycloplegia, Holm (1937)
  refracted 2364 members (aged 2065 years) of
  several hunter-gatherer tribes in Gabon (formerly
  French Equatorial Africa) in 1936. Of the 3624
  eyes examined, only 14 were classified as myopic
  (nine eyes from -?0.50 to 1.00 D five eyes from
  -?3.00 to -?9.00 D), thereby yielding a myopia
  incidence rate of 0.4. Similar low rates for
  myopia were reported by Skeller (1954), who
  refracted the eyes of 775 Angmagssalik Eskimos as
  part of a comprehensive anthropological study
  carried out in 1954. Retinoscopy in conjunction
  with cycloplegia demonstrated that of the 1123
  eyes examined, only 13 (1.2) were classified as
  myopic (nine eyes -?1.00 D four eyes -?1.25
  D). 1

a number of lines of evidence strongly reject
the notion that a recent (in evolutionary
terms) relaxation of natural selection pressures
could be responsible for the high incidence of
myopia in modern, technological societies.
1 Data from Step 1 and Step 2 indicate that
refractive defects are surely a group of diseases
caused by environmental factors, i.e. by
presumable mismatch phenomena.

• 1 Cordain, L, Eaton, SB, Miller, JB, Lindeberg,
  S, Jensen, C (2002) An evolutionary analysis of
  the aetiology and pathogenesis of juvenile-onset
  myopia. Acta Ophthalmol. Scand. 80, 12535.

11

• Step 3 - Hypotheses on the possible changes in
  the ecological niche underlying the disease and
  on possible pathogenetical mechanisms
• Excessive near work, especially using artificial
  lighting, an improbable condition in the
  ecological niche to which we are adapted, is a
  common hypothesis regarding the causes of
  refractive defects, in particular myopia 1,2.
• Against this hypothesis In an earlier study of
  977 school children (617 years of age) on the
  remote South Pacific island of Vanuatu, Garner et
  al. (1985) found that only 1.3 of subjects had
  myopia greater than -?0.25 D, despite engaging in
  about 8 hrs of school work per day. 3
• Another hypothesis ascribes the epidemic of
  myopia incidence to dietary alterations, in
  particular the increase in high glycaemicload
  foods 3. But, in two homogeneous populations
  with no detectable difference in dietary habits,
  incidence of myopia was very different 4.

1 Zylbermann R, Landau D, Berson D (1993) The
influence of study habits on myopia in Jewish
teenagers. J. Pediatr. Ophthalmol. Strabismus 30,
31922. 2 McBrien NA, Adams DW (1997) A
longitudinal investigation of adult-onset and
adult-progression of myopia in an occupational
group. Refractive and biometric findings. Invest
Ophthalmol. 38, 32133. 3 Cordain L, Eaton SB,
Miller JB, Lindeberg S, Jensen C (2002) An
evolutionary analysis of the aetiology and
pathogenesis of juvenile-onset myopia. Acta
Ophthalmol. Scand. 80, 12535. 4 Rose KA ,
Morgan IG, Smith W, Burlutsky G, Mitchell P, Saw
S-M (2008) Myopia, lifestyle, and schooling in
students of Chinese ethnicity in Singapore and
Sydney. Arch. Ophthalmol. 126, 527-30.
12
Step 3 (CONTINUED) A study was made of two
homogeneous groups of 6-7-years old children of
Chinese ethnicity, living in Singapore and in
Sidney, respectively, with the same frequency of
myopia in their parents Children in Sidney read
more books per week (P lt .001) and did more
near-work activity (P .002). Children in Sidney
spent more time on outdoor activities (13.75 vs
3.05 hours per week) (P lt .001). The prevalence
of myopia was 3.3 in Sidney and 29.1 in
Singapore 1. This suggests that the critical
factor is the outdoor activity, alias the
exposition to natural light, a hypothesis
confirmed by other studies 2,3. In particular
Higher levels of total time spent outdoors,
rather than sport per se, were associated with
less myopia 2. In these studies, near-work
activities appeared to be an independent
aggravating factor, but not the main cause of
myopia 2,3.
1 Rose KA, Morgan IG, Smith W, Burlutsky G,
Mitchell P, Saw SM (2008) Myopia, lifestyle, and
schooling in students of Chinese ethnicity in
Singapore and Sydney. Arch. Ophthalmol. 126,
527-30. 2 Rose KA, Morgan IG, Ip J, Kifley A,
Huynh S, Smith W, Mitchell P. (2008) Outdoor
activity reduces the prevalence of myopia in
children. Ophthalmol. 115, 1279-85. 3 Dirani M,
Tong L, Gazzard G, Zhang X, Chia A, Young TL,
Rose KA, Mitchell P, Saw SM. (2009) Outdoor
activity and myopia in Singapore teenage
children. Br. J. Ophthalmol. 93, 997-1000.
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Step 4 - Study of the mechanisms linking
alterations of the ecological niche to the
pathogenesis of the disease It is known from
experiments on chickens - that the application
(for 7 days, beginning at 5 days of age), of
spherical defocus lenses or of translucent
occluders to one eye, or exposure to constant
light, cause astigmatism associated with myopia
or hyperopia. In control birds, astigmatism is
normal at birth and disappears, or decreases,
over the following days 1. Similar results were
obtained in monkeys 2. In our species too,
astigmatism is normal at the birth and disappears
in the first years of life Infants have a high
incidence of clinically significant astigmatism.
Of 28 children who had large amounts of
astigmatism in the first year, all showed
elimination or a large reduction in the amount of
the cylindrical error by 4 years 3 Full term
newborn babies are known to be on average
hypermetropic at birth. Preterm babies tend to be
myopic when examined at an age corresponding to
term 4
1 Kee CS, Deng L (2008) Astigmatism associated
with experimentally induced myopia or hyperopia
in chickens. Invest. Ophthalmol. Vis. Sci. 49,
858-67. 2 Kee CS, Hung LF, Qiao-Grider Y,
Ramamirtham R, Smith EL 3rd. (2005) Astigmatism
in monkeys with experimentally induced myopia or
hyperopia. Optom. Vis. Sci. 82, 248-60. 3
Gwiazda J, Scheiman M, Mohindra I, Held R (1984.
Astigmatism in children changes in axis and
amount from birth to six years. Invest Ophthalmol
Vis Sci. 25, 88-92. 4 Varghese RM, Sreenivas
V, Mammen Puliye J, Varughese S (2009).
Refractive Status at Birth Its Relation to
Newborn Physical Parameters at Birth and
Gestational Age. PLoS ONE 4(2) e4469.
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• Step 4 (CONTINUED)
• Thus, at birth, the eye is imperfect. The image
  is focused either too far forward or too far
  behind the retina. There is also a deformation of
  the image on one plane versus the other
  (astigmatism).
• The genetic program of eye development means
  that, at birth, an eye will have only approximate
  vision. Immediately after birth, it is activated
  another program that modulates the further
  development of the eye in order to achieve
  optimum vision.

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Step 4 (CONTINUED) In other words, these data
indicate that, at birth, the eye is hyperopic (a
little too short) or myopic (a little too long)
and astigmatic (different curvature on the
vertical vs the horizontal plane). In the first
period of life, by means of neurological and
morphogenetic mechanisms, the length and the
curvatures of the eye are adapted to obtain the
achieve the best possible vision
(emmetropization). It is like a camera with a
very sophisticated autofocus capacity in its rest
position (remote viewing) when it comes out of
the factory, it is not focused, but it achieves,
by itself, an optimal hardware focusing for
remote viewing IF WE RESPECT THE MANUFACTURERS
INSTRUCTIONS (e.g. do NOT point the camera at
anything which is too dark or too bright!).
Well, our eye / camera has a hardware focusing
capacity only in the first period of life, and it
is essential that the conditions are similar to
the those to which our species is adapted. In
different conditions, proper functioning is not
guaranteed and malfunction is probable!
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Step 5 Possible restoration of the normal, i.e.
primeval, conditions or possible compensatory
conditions
Under modern conditions of life, particularly in
urban areas with high population densities, it is
"normal" that babies do not grow up outdoors,
with exposure to natural light. It is a
widespread belief that babies should be protected
as much as possible from the external
environment, in particular from direct exposure
to sunlight, as this will damage them in some
way. Many infants spend their first months of
life almost exclusively indoors, only exposed to
artificial lighting, with uneven and weak
brightness, and, in all cases, under conditions
quite different from those to which our species
is adapted.
For proper eye development, babies should be
exposed as much as possible to natural light
conditions sunlight should not be avoided and
conditions should be as similar as possible to
the original ones.
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Step 6 - Analysis of the results achieved and
ideation and proposal of further improvements
Such measures should be applied on a large scale,
because evidence indicates that the current
epidemic of refractive defects is caused by
alterations in the exposure rate to natural light
in infants and children.
Selected groups of infants and children, growing
up under various conditions of compliance with
these guidelines, should be carefully monitored
from an ophthalmologic point of view and compared
with control groups that fail to comply with
them. It would be essential to know how much the
exposure to natural light is needed to prevent
the occurrence of refractive defects.
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First Objection Before applying these measures of
prevention on a large scale, observation of
controlled groups in order to confirm their
validity is necessary. But this objection would
be generated by a contradiction of current
Medicine. In fact, when a new drug is proposed,
we rightly expect a series of experiments, in
several stages, before its use is authorized.
Meanwhile, the NON-use of the drug is considered
to be due and NOT subject to preventive
experimentation.
On the contrary, in the case of a new habit of
life, alias a change of the ecological niche, the
new habit is introduced and accepted WITHOUT any
trial that demonstrates its safety. Now, If a new
NOT tested habit of life is suspected of causing
illness, the indication to stop this habit of
life is rightful and proper. Why, before its
suspension, should we demonstrate its harmfulness
and the benefits resulting from its suspension?
19
Such an absurd principle has been used for
decades to extend the use of smoke without that
smokers were at least warned of the deadly risks
they were running. Again, a new habit (smoking)
was introduced without any evidence that proved
its safety and for decades it was claimed that
its harm should be proved before taking action
against it.
After many scientific tests (while the slaughter
continued)
20
Any change of the ecological niche to which a
species is adapted must be considered potentially
harmful until the contrary is proved. In the
case of a new drug, this principle is
observed! Precautionary principle
But for other modifications of the ecological
niche, no precaution is taken. It is presumed
irrationally and stupidly, because of
non-scientific evaluations that a modification
must not be considered harmful until the
experience proves the contrary! Imprudence
Principle
21
The correct scientific logic would be to take
steps against a change in the ecological niche on
the sole grounds of the suspicion that this
change is bad and BEFORE the sure demonstration
in irreproachable scientific terms.
Afterwards, the results in populations (or
fractions of populations), which pursue - to a
greater or lesser extent - the restoration of
more physiological (alias natural) conditions
must be compared both to confirm the expected
results and for evaluating other possible
measures. But one should not expect the results
of test samples before applying the aforesaid
preventive actions on a large scale.
22
For refractive defects the case is analogous. It
is not acceptable to wait decades of
experimentation to prove that the restoration of
conditions closer to the natural ones can
dramatically reduce the incidence of refractive
disorders. Measures of increased exposure to
natural light conditions from the newborn age
must be propagandized and applied on a large
scale.
Afterwards, the results in populations, and
fractions of populations, which apply to a
greater or lesser extent the restoration of more
physiological, alias natural, conditions must be
compared both to confirm the expected results and
for evaluating the necessary degree of exposure
to natural light for optimal results. But one
should not expect the results of test samples
before applying the aforesaid preventive actions
on a large scale.
23

• Second Objection
• The refractive defects should be attributed to
  the combination
• of environmental and genetic factors.
• This is a misleading way of describing the case.
• Certainly, when an individual is exposed to an
  ecological niche to which its genes are not
  adapted, in the diseases that are caused by the
  altered ecological niche, his genes, which are
  more or less resistant to the onset of diseases,
  come into play.
• But, we cannot and should not consider the genes
  that are less resistant to the diseases as
  pathological they are entirely normal genes that
  in new conditions, to which the species is not
  adapted, have responses that are more or less
  effective against the onset of pathological
  changes.
• For example, our species is certainly not adapted
  to smoking.
• If, in smokers, some suffer respiratory failure,
  others chronic bronchitis and others cancer, it
  is not correct to say that those who develop
  these diseases have bad genes that somehow must
  be corrected, or for which it is necessary to
  develop opportune treatments.
• The logic says that we must avoid the alteration
  of the ecological niche and thus prevent the
  development of diseases that result from it.
• It should be noted that in some cases refractive
  defects are actually due to a genetic alteration.
  In these cases any preventive measure is not able
  to prevent the disease. But, if we refer to data
  from the study of populations living under
  primitive conditions, the incidence of such cases
  is less than 1. Therefore, the attribution of
  responsibility to genetic factors should not be
  an excuse to diminish or avoid to address the
  most attention and efforts on prevention.

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Conclusion

• Refractive defects involve significant costs
  arising from the adoption of artificial means to
  correct refraction (lenses, contact lenses,
  lenses inserted artificially, laser surgery or
  other methods).
• In cases where the defects are of high grade,
  there are complications that involve additional
  costs, worsening vision and often involve the
  loss of sight.
• Even in cases where there is no loss of sight,
  artificial means of correction only partially
  remedy the defect and are a source of limitation
  or disability for many activities.
• Overall, refractive defects involve significant
  costs and reduced quality of life.
• Current Medicine is directed to pursue means of
  correction that are increasingly sophisticated
  and refined.
• But the best goal would certainly be to minimize
  new cases of refractive defects, reserving the
  cures to exceptional cases.
• This would limit the degradation of quality of
  life, a lot of suffering, and - last but
  something to be reckoned with - rising costs.
• This is possible with the correct application of
  trivial principles of Evolutionary Medicine.

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Conclusion - (CONTINUED)
Modern doctors, largely unaware even of the most
basic principles of Evolutionism, do not know
these possibilities. At the same time,
evolutionary biologists are unaware of the
extreme importance of these possibilities for a
rational organization of a health system that
should primarily prevent diseases. It is
therefore essential the integration of the
knowledge of Evolutionism into the active body of
current Medicine, transforming it into
Evolutionary Medicine.
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Thanks for your attention
This presentation is on my personal pages too
www.r-site.org/ageing (e-mail
giacinto.libertini_at_tin.it)