Chapter 14
ARE EYE "EXERCISES" OF ANY VALUE?
William Horatio Bates was an eye, ear, nose, and throat specialist who developed methods of treating vision problems based on highly unorthodox theories of how the eye functions. Because of the widespread followiug he attained and the many books that have been written about the "Bates Method," there are many people who will wonder how Bates' theories fit in with the modern-day concept of myopia prevention. For this reason, his work deserves to be included in this book.
Bates was born in 1860 in Newark, New Jersey. He graduated from Cornell University in 1881 and received his medical degree from the College of Physicians and Surgeons in 1885. He was a clinical assistant at Manhattan Eye and Ear Hospital, and attending physician at both Bellevue Hospital and the New York Eye Infirmary. He taught ophthalmology at the New York Postgraduate Medical School and Hospital from 1886 to 1891.
In 1920, at his own expense, Bates published a book entitled The Cure of Imperfect Sight by Treatment Without Glasses. The book is also known by its short title Perfect Sight Without Glasses, which appears on the cover. A number of his followers have written books on the Bates method, but they have not added anything of significance since the original book appeared. Over the years, many schools teaching his methods came into existence, not just in the United States but also in such countries as Britain and Germany.
The best of Bates' theories was his belief that eyeglasses can be harmful - that they are merely a crutch and tend to perpetuate the very refractive error that they are intended to correct. This was the basis of his recommendation to "throw away your glasses." When it comes to putting concave glasses on young myopes, he was entirely correct - such glasses are harmful. It was in his longing to find a better answer that Bates developed theories that were erroneous.
Perhaps his chief error was his belief that accommodation is accomplished by the external muscles of the eyes, and not by the ciliary muscle. He believed that the external muscles caused the eyeball to lengthen or shorten to change its focus. It is now known beyond any doubt that it is the action of the ciliary muscle on the lens that causes the eye to focus. This change in the shape of the lens has been photographed and measured very accurately. The purpose of the external muscles is to turn the eyes.
Bates also believed that the cause of such refractive errors as myopia, hyperopia and astigmatism was "straining to see." He believed that seeing was a passive function and that if the mind could be brought to the proper state of relaxation (to be attained by various eye and mind exercises), these refractive errors and other eye problems would disappear. These theories are still being taught by Bates' disciples even though modern research has not shown any reason to put any faith in them. From the point of view of myopia improvement or prevention, any exercise or occupation that involves looking into the distance rather than looking close would be beneficial. However, the core of any myopia prevention program is the inhibition of accommodation when doing close work. The Bates method does not include this, and for this reason, logic would indicate that it would do little, if anything, to prevent or improve myopia.
There are so many directions and exercises comprising the Bates System that they cannot be covered here. It is difficult to believe that they could bring about a significant improvement in refractive error when put to a strict test. Yet there are undoubtedly thousands of people who feel they have been helped. There are a number of possible explanations for this.
In the first place, in the case of a myope, concave glasses force the eye to adapt to using more accommodation. There is more likelihood of a ciliary spasm developing. If these glasses are removed and the eyes are allowed to relax for a period of time (either with or without relaxing exercises), an improvement in vision can be expected as the ciliary muscle relaxes. The ciliary spasm might relax slowly over a period of several weeks, and improvement could be attributed to whatever therapeutic method the person happens to be following at the time, although it was just the removal of the glasses that initiated the improvement. Sometimes an improvement is noticeable within a few mments after removing the glasses. If the person was given exercises to do during this time, it would be easy to be fooled into thinking that the exercises were beneficial.
In the second place, the mental attitude of many people enables them to believe that an improvement has taken place even when a visual examination indicates that there has been no change in the refractive error. Not everyone is a skeptic. A sincere faith in the efficacy of a proposed treatment can result in a sincere belief that the treatment has succeeded. There are even people who have claimed that they see better with glasses than without them even though they have been given plano lenses.
The greatest value of Bates' work was his insistence that concave lenses "lock" myopia on the eye and tend to make it get worse. In this, Bates was ahead of his time.
In the light of modern knowledge, it is possible to say a lot of negative things about the Bates System, but keep one thing in mind: if you had a child who was beginning to become nearsighted and you had to choose between giving the child Bates exercises to do, or taking the child to an eye doctor for a pair of concave lenses, your child would be far better off with the Bates System. That is an indication of how little the eye care business has progressed. The world is not any worse off because of Bates, but the treatment methods of "orthodox" practitioners have caused untold misery and tragedy to the myopes of the world.
The Baltimore Project. In 1944 and 1945, an investigation, known as the Baltimore Project, was made to determine the effect of vision training because of the public interest in such eye exercises as those offered in the Bates system. It was felt that the value of eye exercises should be determined in a controlled study based on scientific principles.1
The project was carried out by the American Optometric Association. Visual examinations were made of the children who took part in the study 1) before vision training began, 2) immediately after the conclusion of the training, and 3) five months after the conclusion of the training.
The age of the trainees ranged from nine to thirty-two years and there was a wide variation in their general health and intelligence level. They were all myopes with refractive errors as high as -9 D and as low as -0.5 D.
The theory that vision training could improve myopic vision was based upon the belief that myopia is merely a posture or pattern of using the eyes. It was felt that the habitual focusing of the eye for close work results in an improper pattern of eye use that can be broken up, resulting in an improvement in the vision. Myopia was seen as similiar to the hunched, round-shouldered posture that can develop in a bookkeeper or watchmaker. By unlearning bad habits, an improved posture would result.
Various instruments and devices were used in the training. These devices make use of spheres, cylinders, prisms, and assorted targets. They are used to exercise the external muscles of the eyes, to exercise the accommodation, to attempt to see blurred images clearly, etc. Vision training specialists do not like to have the word "exercises" used in describing their work (perhaps because it sounds too much like the Bates Method), but still, in simple terms, vision training consists of various methods of exercising either the external muscles of the eye (which make the eye move), or the ciliary muscle, or both.
Two questions were to be answered by this project:
It is important to understand the difference between these two questions. The first question has to do with the actual refractive error or optical properties of the eye. It can be measured with various instruments to a high degree of accuracy, and is the true measure of the amount of myopia present.
The second question has to do with a person's ability to read letters or interpret figures on a distant chart. Two individuals with the same refractive error may vary considerably in their ability to interpret blurred images. Their visual acuities could therefore be different.
The result of the project was that most of the trainees had achieved a significant improvement in their visual acuity by the end of the program. They had apparently learned to see better in the distance. Unfortunately, when they were rechecked five months after the program ended, many of them had lost much of the improvement. Still, there was no doubt that vision training was able to improve visual acuity to a limited extent.
However, with regard to actual refractive error, the trainees did not experience any significant improvement in their vision. As a method of improving myopia, vision training obviously did not attain the desired goal.2
An unfortunate result of this project was that it was taken by many persons to represent an optometric failure, and was not seen as a worthwhile project that simply did not bring the desired results. It was at least an admirable attempt to do something about the widespread myopia problem, although in the light of present-day knowledge, it was doomed to fail. Because of the eye's built-in mechanism of elongation, myopia cannot be prevented (not to mention improved) without eliminating essentially all prolonged accommodation during the childhood years. The eye only moves in one direction - it gets longer, not shorter.
The Baltimore Project showed only that vision training is not enough to deal with myopia. It does not prove that myopia cannot be prevented, halted, or improved. But for many years afterwards, optometrists make such statements as, "Nothing can be done about myopia - look at what happened in the Baltimore Project." Because of this attitude, they did not get involved in myopia prevention because they did not want themselves or optometry to get "burned" again. Of course, some eye specialists used the failure of the Baltimore Project to improve myopia as a rationalization for their own lack of interest in doing anything to combat myopia. Fitting concave lenses is the "easy" way.
It is important to realize that vision training and myopia prevention are two separate and distinct fields, and they should not be confused. Vision training is not myopia prevention and myopia prevention is not vision training. Eyes that are becoming myopic are not weak eyes in need of exercise. They are becoming myopic because this is nature's sensible way to enable excessive close work to be done without requiring a continuous accommodative effort. The only way to prevent this is to abandon the close work, or, using preventive aids, to do it without accommodation. If the initiators of the Baltimore Project had realized this simple fact, they would have achieved better results. Naturally, the best results are to be obtained with young children in the first stages of myopia. The average age of the Baltimore Project trainees seems to have been about fifteen to twenty years - a little too old for obtaining dramatic improvements by any method.
None of the above is meant to detract from the legitimate use of vision training methods meant to reduce problems of imbalance of the external muscles of the eye, known as strabismus. Optometrists who specialize in this kind of work have had considerable success. Always try this conservative approach to strabismus before turning to surgery. Ophthalmologists downplay the value of such training because they are eager to make money doing the surgery.