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   Blinded by Ignorance about Fluorescent Light, early in life and late:

 

  from baby-blinding retinopathy of prematurity   

to early onset of age-related macular degeneration   

by Peter Aleff, 2011   

 
 

 

1.) Baby-blinding retinopathy of prematurity from fluorescent nursery light

Fluorescent lamps were commercially introduced at the New York World Fair which opened its "World of Tomorrow" on April 30,1939, and they were quickly adopted for lighting a wide variety of large buildings in the U.S. where the electricity savings and longevity they offered outweighed the often perceived unpleasantness of their harsh light. After the Second World War, when normal trade as well as factory building resumed, this new and money-saving technology spread in most other industrialized countries with equal speed. 

In each of those countries, hospitals were among the first to install the new lamps. They welcomed them particularly for the appearance of cleanliness their bright blue-ish light gave to patients' rooms, and for the reputed germicidal properties of the ultraviolet component in their radiation which was back then still deemed desirable, and which many of the early fluorescent lamps did therefore not yet filter out as well as most later models do. 

The first babies to be blinded by the retina-destroying eye damage which is now called retinopathy of prematurity, or ROP, were born in July and November 1940 in Boston. From then on, this mysterious condition quickly appeared in most intensive care nurseries across the U.S., and after the War also in intensive care nurseries in many other industrialized countries, with the first cases reported for England in 1946, Israel in 1947, Australia, Canada, and Sweden in 1948; Switzerland 1949, Cuba, France, Holland. Italy, South Africa, and Spain all in 1950.

Because the disease had appeared so suddenly, some physicians wondered if it had been there all along but had simply not been recognized before. They organized several large-scale retrospective studies on ROP among older blind people. Some of these studies claimed to have found a few possible but uncertain cases, beginning in 1937, but they all concluded that if ROP had existed before 1940 in the U.S.A., or before 1946 in the U.K., it must have been exceedingly rare.

When Dr. Theodore L. Terry, the discoverer of  this new type of eye damage, first described it in 1942, he postulated that "some new factor has arisen in extreme prematurity to produce such a condition", and from 1943 on, he argued that this new factor was excess light. Unfortunately, he soon died, and the doctors who took over the investigation of ROP were convinced they already knew its cause. They still believed in the pseudo-science of eugenics which had been acclaimed as the cutting edge of progress when they went to medical school, and the most influential one among them kept asserting, wrongly but insistently, that he had found the ROP damage already before birth and that it was therefore probably due to defective genes.

In true eugenicist fashion, some of the nursery doctors involved publicly exhorted their peers to rid the world of that blindness-causing “defective germ plasm” by secretly killing the preemies suspected of carrying it.

Indeed, in May, 1949, a speaker in the discussion printed after the lead article in one of the American Medical Association’s flagship journals advised its readers in print against "zealously preserving" the preemies at risk for ROP because they were “defective persons”. He also proposed to ascribe their proposed deaths to “fate”, with his and/or his editor's quote marks around that word already then suggesting the deadly deception these crypto-eugenic opinion leaders had in mind.

The most effective means of preserving the weakest preemies was and is to give them supplementary oxygen which had by then a solid and decades-long track record for saving their lives. Accordingly, some nursery doctors launched a smear campaign against that breathing help to brand it as an “undeserved subsidy” that kept the so indulged babies from having to “fight their own struggle for oxygenation.”

Those terms were clearly recycled from the speeches of the eugenics movement which had opposed all social programs of aid to the poor as damaging distortions of natural selection. They functioned as code words and resonated enough among conservative doctors steeped in eugenic propaganda to make a study of oxygen withholding palatable to them, despite (or rather because of) its predictable risks to the weakest preemies, and despite oxygen's by then decades-long and unblemished track record as the most reliable means to preserve their lives.

Once that study was decided to be held as a big multi-hospital trial, its designers  tried to hide their earlier stated scheme of killing the babies at risk for the blinding. However, their deception was and still is obvious to any attentive reader from the details of their reported study protocol. To prevent the survival of those unworthy “defectives”, they decided to withhold all breathing help for the first two days from all preemies born in the 18 study hospitals.

During this most critical time of greatest need for immediate breathing help, 45% of those born there died in those first two days, compared with, for instance, only 32% of the same birth-weight group who had died in their entire first month in one of those study hospitals during the year before the trial.

Only after so weeding out the weakest preemies with the most vulnerable lungs, who also happen to be those with the most vulnerable eyes, did these doctors enroll the survivors in the study. Not including these pre-enrollment deaths blatantly biased their sample, but they did not acknowledge this heavy thumb on the risk-weighing scale. Instead, they announced with great fanfare their knowingly false and fatal message that oxygen withholding had reduced the incidence of blinding without affecting the mortality rate.

The physicians behind this deception were respected pillars of the pediatric and ophthalmological professions, and they jointly proclaimed their badly doctored trial result with great authority and pomp as the science-backed consensus of the most qualified top experts. They did not mention that they had loaded the dice in their effort to end the surge of blind children that was by then overwhelming many schools in the U.S.. This deception allowed them to slip into the neonatologist doctrine their crypto-eugenic euthanasia program for the early elimination of potential "defectives", under the guise of an allegedly risk-free prevention against the then still new but suddenly most common form of childhood blindness.

The resulting mad rush to oxygen withholding almost instantly ended the ROP epidemic because the babies who would otherwise have survived with eye damage were now dying, and so did many others who would otherwise have grown up normally.

During the first couple of decades after that bogus study, misled neonatologists around the world applied its oxygen withholding recommendation very strictly and with many fatal results. In the U.S. alone, an extrapolated 16,000 babies per year died from the oxygen restrictions. Another estimate cited in the medical literature put the number of extra deaths caused by them at 150,000 in the first twenty years.

This mass infanticide ended an ROP epidemic which until then had affected there about 2,000 children per year and totally blinded up to about a thousand of them. Yet, the strictly applied oxygen withholding policy greatly reduced the annual number of children blinded, and this much touted victory over ROP helped to convince the U.S. Congress to greatly expand government funding for medical research. 

No one counted these early deaths from that first crest of the oxygen withholding wave until many years later. The cost of this alleged victory over ROP remained hidden until the early 1970s when two researchers in England and Wales estimated the number of victims. They used different methods than the above extrapolation from U.S. data but they obtained a remarkably similar result: in their country, the oxygen withholding had caused about 16 deaths for every case of blindness prevented.

There were also reports of a rise in cerebral palsy, spastic diplegia, and other forms of permanent damage to the surviving babies’ oxygen-starved brains. When the magnitude of that carnage and the brain injuries became clear, and the 1960s culture in America as well as in England led to generally more relaxed attitudes, the nursery doctors there tacitly began to relax the oxygen rationing rules a little, and more of the smaller preemies began again to survive.

Despite repeated attempts to replicate the results of that initial oxygen-blaming study, there is no scientific evidence whatsoever for the much asserted link between oxygen administration and blinding. However, the American Academy of Pediatrics never repudiated the original but unconfirmable eugenics-inspired and fraud-based doctrine. Its members know quite well by now that the belief in that link has no scientific or even theoretical basis, but they still restrict the flow of the life-saving gas to many preemies, and the result of their faucet-throttling is still often fatal.

Unfortunately, all this harmful and expensive oxygen management is entirely for naught. Its high costs in lives and disabilities and treatment dollars provide no benefit whatsoever against the blinding because they do not address its real and well documented cause. Many solidly established scientific facts about light damage to eyes compel the conclusion that the above cited Dr. Terry had been right, and that the obvious cause of ROP is the excessively bright and eye-damaging fluorescent lighting which the American Academy of Pediatrics specifies for intensive care nurseries.

Many neonatologists claim that they try to recreate in their nurseries the environment of the womb where the preemies should normally have stayed. They forget that wombs are dark and protect those babies’ still developing eyes from virtually all light during their most vulnerable period.

Even worse, the doctor-specified fluorescent nursery lamps emit a strong spike of radiation output at a wavelength of 435.8 nanometers which is in the blue-violet region of visible light. This spike varies only slightly from one type of fluorescent tube to the next, whether they are called "daylight" or "deluxe" or are engineered to provide different color temperatures. Here is, for instance, a graph of the spectrum from a typical "Cool white Deluxe" fluorescent tube, in this case made by Sylvania:

Cool white deluxe fluorescent tube spectrum

That tallest radiation spike at 435.8 nm is also right in the middle of the narrow spectrum area between 430 and 440 nm which the U.S. Occupational Safety Guidelines have identified as the most retina-damaging in the entire visible spectrum, as documented by countless experiments and observations on animals from mice to monkeys and man.  

Moreover, the fluorescent ceiling lamps in the typical nursery are the same lamps which neonatologists use in slightly increased strength for the treatment of a preemie's excess bilirubin. In that application as "bilirubin lights", those same fluorescent lamps require mandatory eye patching for the babies beneath them because their radiation would otherwise quickly destroy those babies' retinae even in brief exposures.

For instance, in 1970 a group of newborn piglets, chosen for the developmental and pigmentation similarity of their eyes with those of preemies, suffered marked retinal damage under bilirubin lights. One of them lost its eye patch and became totally blind the next day after less than 12 hours of exposure, despite its heavy eyelids and thick eyelashes, and despite the unusually short latency time between the irradiation and the detection of its morbid effects.

These bilirubin phototherapy lamps are fluorescent lamps that shine only about three to five times brighter than the fluorescent ceiling lights in a typical intensive care nursery. However, most American nursery doctors flatly deny that the almost as strong fluorescent ceiling lights could harm any baby, as if they had never heard of the need for safety margins in the dosage of powerful treatments. For comparison, the U.S. Occupational Safety Guidelines usually set exposure limits to toxic agents at about one per cent of the level that causes any discernible damage in test animals.

Due to this willful ignorance among nursery doctors, the typical intensive care nursery ceiling lamps irradiate the unprotected and still developing retinae of the preemies 24 hours a day with an intensity that accumulates there in just a few minutes the gross overdose of blue-light damage that the U.S. Occupational Safety Guidelines have set as the danger limit which adult workers should not exceed in an eight-hour shift.

Nursery doctors administer this gross overdose of the most retina-damaging radiation to the preemies during the time of their greatest vulnerability. All living tissues are at their most vulnerable stage during their initial formation when their cells are still migrating and differentiating, just like those in the retinae of preemies. This heightened vulnerability is further increased by the fact that preemie eyes have none of the defenses against excess light that normally protect older people.

To begin with, preemies cannot turn their head away from the ceiling lights or even from the sunshine that is sometimes carelessly allowed to reach their transparent incubators and even their eyes. In Antiquity, it was considered one of the most cruel punishments to make a condemned criminal stare into the sun, but modern nursery doctors sometimes leave innocent preemies casually exposed to that same painful and quickly eye-destroying torture.

Preemies also stare a lot with their eyes and pupils wide open, and like older babies, they are particularly attracted by bright areas in their field of view. Even when they close their eyes, their translucent eyelids and still mostly unpigmented iris let through most of the relentless radiation.

In addition, the preemies' lenses have not yet begun the varnish-like yellowing which protects adults from the most dangerous blue and violet wavelengths. Until their late teens or early twenties, children’s eyes are more transparent to blue and shorter wavelengths than those of adults. For instance, the age-yellowed lens of a 25-year-old lets through only 46 to 50% of the visible light, and next to nothing in the ultraviolet range. By contrast, the retinae of babies receive about 90% of the visible light above 400 nm plus 80 to 85% of the ultraviolet light down to about 320 or even 300 nm. The hazard value of the violet and blue spectrum region is therefore much higher for children than the blue-light hazard function for adults. Both are shown in the American Conference of Governmental Industrial Hygienists’ Action Spectrum Table of Biological Exposure Indices, as posted at  retinopathyofprematurity.org/coolwhitedeluxe_spectrum.htm .

To make things even worse, preemies are exposed to many powerful sensitizers, such as medications and even high concentrations of oxygen which do no harm by themselves but can enhance the free-radical damage caused by strong irradiation. They are also still deficient in many of the minerals and vitamins which could protect them at least partially against those free-radical reactions or which might help their damaged cells to begin their self-repair.

Electron microscopy also shows that under high magnification,  ROP-damaged retinae look exactly like retinae damaged by light, with the same abnormal adhesions between cells that prevent those in the preemie retinae from completing their migration.

No one has ever disproved any of that copious evidence against bright fluorescent light. However, nursery doctors continue their irrational denial of eye damage potential from fluorescent nursery lamps even after a trial on human babies found that shading their incubators had resulted in much less damage to those babies' eyes:

In late 1982, doctors in two Washington D.C. nurseries placed gray filters over the transparent incubators of the preemies and then compared the incidence of ROP before and after this partial light reduction. Their shading produced the most dramatic reduction in both incidence and severity that any of the non-rigged approaches to ROP had ever shown. For the group of babies with the highest risk of ROP, there was only one chance in a hundred that the eye damage might be a random coincidence and had nothing to do with the light exposure. For all the babies in all the groups together, that chance was given as almost one in twenty.

Unfortunately, for some of the heavier subgroups the correlation fell just slightly short of the magical 95% probability which doctors are trained to view as the so-called statistical significance level that has to be met when evaluating the efficacy of a treatment.

And the study authors had called the shading a treatment instead of what it really was: a reduction in dosage of the almost bilirubin-strength irradiation treatment which they had been administering indiscriminately all along to all babies under the fluorescent ceiling lights. This semantic confusion prevented the authors and their critics from realizing that the safety of the treatment with light, not the efficacy of its withdrawal, was the real issue.

In safety assessments, one does not wait for harmful effects to reach the arbitrary level of "statistical significance" to recognize them as a problem. Safety professionals take even a weak association with harm as a danger signal, and no caring parents would ever accept the standard fluorescent nursery lamps as safe for their preemie if they knew there are almost 19 chances out of 20 that their light could damage their baby's eyes.

However, their baby’s doctors deny any danger because from their semantically inverted perspective they fail to see such a risk to their patients as significant. Yet, the medical cover-up of the facts about ROP had become so transparent that a more authoritative denial was needed. Accordingly, two pediatric retinal surgeons designed and then co-directed in the mid 1990s another bogus study, called LIGHT-ROP, and they rigged it to falsely declare the safety of the nursery lights.

Knowing that the blue-light-damage they pretended to study typically accumulates to harmful levels in just a few minutes, almost as fast as eye damage from staring at the sun, the LIGHT-ROP authors covered the eyes of the babies in their allegedly protected group only after up to 24 hours. All these preemies suffered therefore up to 24 hours of unprotected over-exposure to bright fluorescent light shining straight through their still mostly transparent eyelids onto their still developing and therefore extremely vulnerable retinae.

Predictably, and like several earlier shoddy eye-patching studies with the same crucial delay, the LIGHT-ROP study found no ROP-difference between its two groups since these had been equally over-exposed to the same multiple overdoses of irradiation during their most critical period. This trick allowed the LIGHT-ROP study authors to again falsely affirm the safety of the standard nursery lighting practices, but this time with the commanding authority of a large clinical trial. Their knowingly false study result is now enshrined on the website of the U.S. National Eye Institute as proof for the alleged safety of fluorescent lamps for preemie eyes, and it keeps neonatologists around the world from further questioning that alleged safety. It therefore continues the baby-blinding ROP epidemic and the steady stream of patients ROP supplies for expensive pediatric retinal surgery.

2.) Childhood exposure to fluorescent light suspected of causing latent retinal damage that later leads to the early onset of age-related macular degeneration

The medical community’s defensive denials about the baby-blinding properties of fluorescent nursery lighting have kept it from acknowledging that fluorescent lamps are also likely to be significant contributors to yet another epidemic of blinding that now affects the first generation of Americans who grew up under those lamps in their classrooms. The eye disease now known as age-related macular degeneration used to be called senile macular degeneration because people suffered from it only in their old age, typically in their eighties or nineties, and more rarely in their seventies. Over the past two or three decades, however, this degeneration of the central retina began to start earlier and earlier in the lives of the victims, to the point where millions of Americans now lose their central vision to it in their sixties and fifties, and sometimes already in their forties. Meanwhile, age-related macular degeneration has also become the most common cause of irreversible vision loss in the Western world.

One of the often cited major factors responsible for macular degeneration appears to be the lifetime accumulation of damage in the retina’s photoreceptors from exposure to harmful light. This damage gradually builds up a layer of debris from destroyed photoreceptors between the remaining ones and so uses up the limited renewal capacity of these.

As described above, the most harmful light for mammalian eyes is in the blue to violet range, with wavelengths from 430 to 440 nanometers, and fluorescent lamps emit a large portion of their total energy in that narrow spike at 435.8 nm which is precisely in the most eye-damaging region. Adults are somewhat protected from this damage because our lenses become yellow with age, just as varnish does, and for the same reason: the slow oxidation by free radicals created through long-term irradiation with light.

This yellowing of our lenses from about our early twenties on filters out much of the blue and violet irradiation, but these harmful wavelengths can freely penetrate into the still more transparent eyes of children. There they cause an accelerated buildup of destroyed photoreceptors which diminishes the capacity of these to self-repair and so ultimately leads to the degeneration of the macula.

It is therefore probably no coincidence that the non-senile people who now experience the much earlier onset of macular degeneration are the first generation who spent much of their youth under fluorescent classroom lamps. The issue has not been studied, so there is presently no proven link between this early unprotected exposure to the most damaging light in the visible spectrum and the earlier appearance of the damage generally connected with this type of exposure. On the other hand, basic logic and elementary prudence suggest to limit this potentially harmful irradiation of your children’s retinae until its long-term safety has been established.

This lack of protection in children's eyes against so many short and energetic wavelengths may make you wonder why children playing in sunlight don't get their retinae destroyed as rapidly and severely as their early exposure to all that hazardous UV and blue-violet radiation might suggest. However, no one, including children, looks directly at the sun, or at its most glaring reflections on water, snow, or white sand. These hurt the eyes and are much too bright to encourage staring at the source of that light.  Our instinctive reaction to such brightness is squinting to reduce its intensity, or averting our eyes. 

Also, our pupils adjust to that overall intensity of bright light sources and become smaller to let less of it in. The children's retinae receive therefore not much direct or strongly reflected UV irradiation, only weak reflections. As to the power of weakly reflected sunlight, you don't get a suntan if you sit in the shade although your skin may get lots of reflected light from the adjacent sunny areas. Such weak reflections are also not likely to do as much damage to your or your children's retinae as direct exposures. 

Despite this relative absence of immediately noticeable harm from indirect sunlight, some eye doctors now recommend that children wear sunglasses outdoors. For instance, Dr. Greene at the Stanford University School of Medicine warns on his website: "Excessive exposure to sunlight during early childhood is harmful to the eyes. Sunlight contains harmful UV radiation. The risk for retinal damage from the sun's rays is greatest in children less than 10 years old, although the consequences usually do not become apparent until well after they are adults. Teaching your children to wear sunglasses may be more important than giving them a college fund."

Similarly, Prevent Blindness America offers these tips to protect children from UV rays:  "Buy sunglasses that block the maximum amount (99 to 100 percent) of both types of UV-A and UV-B rays, fit closely to the face and have larger lenses for more coverage.  In addition to sunglasses, wear a hat to reduce overall exposure to UV rays. Don’t look directly at the sun. Limit the amount of time spent outside during the peak sun hours (10 a.m. to 3 p.m.)"

Both these warnings against UV light ignore the well-documented "blue-light hazard" from the blue-violet light in the visible range. Yet, fluorescent ceiling lamps with a high output of that "blue-light hazard" are often in the visual field of those under that ceiling, but their overall intensity is usually not sufficient to make everyone automatically avert their eyes as the sun does. And our pupils adjust their opening in proportion to the overall brightness, not to the local intensity of the narrow emission spike in the most retina-damaging region. That most hazardous component of the fluorescent lamp's radiation reaches therefore unprotected retinae behind wide-open pupils directly and in almost undiminished strength, and it causes there slow photochemical damage in the retina's most light-sensitive area, the macula.

Despite these known dangers from fluorescent light, legislators in several countries and states have recently proposed to replace all incandescent lamps with fluorescent ones for their energy savings. Many other politicians are likely to follow their example with the best of intentions because they are unaware that this technology could bite back and cause much more damage down the road than it appears to prevent now. Some once equally touted technologies have done that, such as bird-poisoning DDT insecticide or brain-damaging lead additives to paint and gasoline or ozone-destroying chlorofluorocarbon propellants and refrigerants, but usually we remember these precedents only after the harm from the latest advance becomes clear. 

The available evidence against fluorescent light as a contributor to macular degeneration is only circumstantial and likely to remain that way because direct evidence would require double-blind controlled clinical trials which are the gold standard of medical research.  Such trials of comparing life-long controlled exposures to harmful irradiation are hard to imagine and impossible to conduct ethically, but even without them, basic common sense and logic suggest that the early exposure of children to fluorescent light in classrooms is likely to be a factor in the later observed accelerated degeneration of their maculae. Waiting for medical research to establish detailed dose-response curves of early retinal light damage for medical textbooks would be just a modern variation on the French playwright Molière’s quip that the purpose of medical science is not to cure patients but only to name their illness in Latin.

Exposing children now not only at school but also at home to the equally eye-damaging light and blue-violet spike of the newer compact fluorescent lamps is likely to make their vision fail even earlier than that of their parents and grand-parents in the current epidemic of early-onset macular degeneration.

Unfortunately, the medical community is so caught up and vested in denying the obvious danger from fluorescent light to the eyes of preemies that it also closes its eyes to the potential danger from the same lamps to the much larger population of virtually all children. Indeed, none of the experts or agencies charged with assuring the health and safety of our children have issued any public warnings about the potential long-term effects of exposing children to now even more fluorescent light. They are not just asleep at the switch, they don’t even want to know that it exists.

Meanwhile, cautious parents will dismiss all these misguided and misguiding "experts" and follow instead the simple and prudent motto of "better safe than sorry".

*

For a detailed documentation of the above account by articles from the medical literature, see retinopathyofprematurity.org/01summary.htm and retinopathyofprematurity.org/maculardegeneration.htm


 
 

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