Ординатура / Офтальмология / Английские материалы / Relearning To See_Quackenbush_2000

The universe is not to be narrowed down to the limits of understanding, which has been man's practice up to now, but the understanding must be stretched to take in the image of the universe as it is discovered.

—Sir Francis Bacon

B A T E S ' " I N T R O D U C T O R Y "

Bates' "Introductory" is the first chapter in his seminal work on natural vision improve- ment, Perfect Sight Without Glasses.

INTRODUCTORY

Most writers on ophthalmology appear to believe that the last word about problems of refraction has been spoken, and from their viewpoint the last word is a very depressing one. Practically everyone in these days suffers from some form of refractive error. Yet we are told that for these ills, which are not only so inconvenient, but often so distressing and dangerous, there is not only no way to reverse them, and no palliative save those optic crutches known as eyeglasses, but, under modern conditions of life, practically no prevention.

It is a well-known fact that the human body is not a perfect mechanism. Nature, in the evolution of the human tenement, has been guilty of some maladjustments....

But nowhere is she supposed to have blundered so badly as in the construction of the eye. With one accord ophthalmologists tell us that the visual organ of man was never intended for the uses to which it is now put Eons before there were any schools or printing presses, electric lights or moving pictures, its evolution was complete. In those days it served the needs of the human animal perfectly. Man was a hunter, a herdsman, a farmer, a fighter. He needed, we are told, mainly distant vision; and since the eye at rest is adjusted for distant vision, sight is supposed to have been ordinarily as passive as the perception of sound, requiring no muscular action whatever. Near vision, it is assumed, was the exception,... necessitating a muscular adjustment of such short duration that it was accomplished without placing any appreciable burden upon the mechanism of accommodation. The fact that primitive woman was a seamstress, an embroiderer, a weaver, an artist in all sorts of fine and beautiful work, appears to have been generally forgotten. Yet women living

under prirnitive conditions have just as good eyesight as the men.

When man learned how to communicate his thoughts to others by means of written and printed forms, there came some undeniably new demands upon the eye,...

affecting at first only a few people, but gradually including more and more, until now, in the more advanced countries, the great mass of the population is subjected to their influence. A few hundred years ago even princes were not taught to read and write. Now we compel everyone to go to school, whether he wishes to or not, even the babies being sent to kindergarten. A generation or so ago books were scarce and expensive. Today, by means of libraries of all sorts, stationary and traveling, they have been brought within the reach of practically everyone. The modern newspaper, with its endless columns of badly printed reading matter, was made possible only by the discovery of the art of manufacturing paper from wood, which is a thing of yesterday. The tallow candle has been but lately displaced by the various forms of artificial lighting, which tempt most of us to prolong our vocations and avocations into hours when primitive man was forced to rest, and within the last couple of decades has come the moving picture to complete the supposedly destructive process.'

Was it reasonable to expect that Nature should have provided for all these developments, and produced an organ that could respond to the new demands? It is the accepted belief of ophthalmology today that she could not and did not,3 and that, while the processes of civilization depend upon the sense of sight more than upon any other, the visual organ is but imperfectly fitted for its tasks.

There are a great number of facts which seem to justify this conclusion

For the prevailing method of vision care, by means of compensating lenses, very little was ever claimed except that these contrivances neutralized the effects of the various conditions for which they were prescribed, as a crutch enables a lame man to walk. It has also been believed that they sometimes checked the progress of these conditions; but every ophthalmologist now knows that their usefulness for this purpose, if any, is very hmited. In the case of myopiab (shortsight), Dr. Sidler-Huguenin of Zurich, in a striking paper recently published,0 expresses the opinion that glasses and all methods now at our command are "of but little avail" in preventing either the progress of the error of refraction, or the development of the very serious complications with which it is often associated.

These conclusions are based on the study

aThe unnatural strain of accommodating the eyes to close work (for which they were not intended) leads to myopia in a large proportion of growing children.—Rosenau: Preventive Medicine and Hygiene, third edition.

The compulsion of fate as well as an error of evolution has brought it about that the unaided eye must persistently struggle against the astonishing difficulties and errors inevitable in its structure, function and circumstance.—Gould: The Cause, Nature and Consequences of Eyestrain, Pop Sci Monthly, D e c , 1905.

With the invention of writing and then with the invention of the printing press a new element was introduced, and one evidently not provided for by the process of evolution. The human eye which had been evolved for distant vision is being forced to perform a new part, one for which it had not been evolved, and for which it is poorly adapted The difficulty is being daily augmented.—Scott: The Sacrifice of the Eyes of School Children. Pop Sci Monthly, Oct., 1907.

bFrom the Greek myein, to close, and ops, the eye; literally a condition in which the subject closes the eye, or blinks.

cArchiv f. Augenh, vol. Ixxix, 1915, translated io Arch. Ophth., vol. xlv, No. 6, Nov., 1916.

of thousands of cases in Dr. Huguenin's private practice and in the clinic of the University of Zurich, and regarding one group of individuals, persons connected with the local educational institutions, he states that the failure took place in spite of the fact that they followed his instructions for years "with the greatest energy and pertinacity," sometimes even changing their professions.

I have been studying the refraction of the human eye for more than thirty years, and my observations fully confirm the foregoing conclusions as to the uselessness of all the methods heretofore employed for the prevention and improvement of errors of refraction. I was very early led to suspect, however, that the problem was by no means an unsolvable one.

Every ophthalmologist of any experience knows that the theory of the irreversibility of errors of refraction does not fit the observed facts. Not infrequently such cases recover spontaneously, or change from one form to another. It has long been the custom either to ignore these troublesome facts, or to explain them away, and fortunately for those who consider it necessary to bolster up the old theories at all costs, the role attributed to the lens in accommodation offers, in the majority of cases, a plausible method of explanation. According to this theory, which most of us learned at school, the eye changes its focus for vision at different distances by altering the curvature of the lens; and in seeking an explanation for the inconstancy of the theoretically constant error of refraction the theorists hit upon the very ingenious idea of attributing to the lens a capacity for changing its curvature, not only for the purpose of normal accommodation, but to cover up or to produce accommodative errors....in the case of the disappearance or lessening of hypermetropia, we are asked to believe that the eye, in the act of

vision, both at the near point and at the distance, increases the curvature of the lens sufficiently to compensate, in whole or in part, for the flatness [short from front to back] of the eyeball. In myopia, on the contrary, we are told that the eye actually goes out of its way to produce the condition, or to make an existing condition worse.

A normal, emmetropic eye is said to be "at rest"; it has a spherical shape and sees clearly in the distance. Light rays from a far object focus properly on the retina. In order for an emmetropic eye to see near objects clearly, there must be some mechanism by which the diverging light rays from a near object can be focused onto the retina. The changing of the eye to see clearly up close is called accommodation.

Conventionally, accommodation is attributed only to the lens, which supposedly acquires more curvature on its front side by the

contraction of the ciliary muscle. Bates (and others) attributed accommodation to the action of the two oblique muscles producing an elongated eyeball.

A hypermetropic ("farsighted") eye is too short from front to back; it does not see clearly near. (Or far, but near objects are usually less clear than far objects. Many farsights are surprised to see their distance vision improve while improving their near vision.)

A myopic (nearsighted) eye is too long from front to back; it cannot see clearly in the distance. Light rays from near objects focus correctly on the retina of a myopic eye.

In a multitude of debates about eyesight, virtually all authorities agree on these three facts:

1. The normal, "at rest" eyeball is in a round shape; in this state, far objects are clear and close objects are not clear.

2.The myopic (nearsighted) eyeball is elongated; near objects are clear, and far objects are not clear.

3.The hypermetropic ("farsighted") eyeball is foreshortened; near objects are not clear.

Continuing with Bates' words from Perfect

Sight Without Glasses:

In other words, the so-called "ciliary muscle," believed to control the shape of the lens, is credited with a capacity for getting into a more or less continuous state of contraction, thus keeping the lens continuously in a state of [greater] convexity which, according to the theory, it ought to assume only for vision at the near point.

To clarify what Bates said about the conventional position on accommodation:

Normally, the lens is said to be in the flatter (less convex) shape when "at rest." As just discussed, the emmetropic (spherical) eyeball at rest sees clearly in the distance. When the ciliary muscle contracts, the front side of the lens is said to gain more curvature, which would allow the spherical eyeball to see clearly up close. This is the orthodox explanation of normal accommodation.

The hypermetropic (foreshortened) eyeball does not see clearly near. With a foreshortened eyeball, and an "at rest" lens in its normal flatter shape, light rays are focused "in back of the retina; light rays on the retina are "out of focus." Theoretically, if the ciliary muscle contracts, the front side of the lens could gain greater curvature and would be able to focus light rays from far objects clearly onto the retina.

Bates again from Perfect Sight Without

Glasses:

These curious performances may seem unnatural to the lay mind; but ophthalmologists believe the tendency to indulge in them to be so ingrained in the constitution of the organ of vision that, in the fitting of glasses, it is customary to instill atropine—the "drops" with which everyone who has ever visited an oculist is famil- iar—into the eye, for the purpose of paralyzing the ciliary muscle and thus, by preventing any change of curvature in the lens, bringing out "latent hypermetropia" and getting rid of "apparent myopia."

In other words, when atropine is used, the ciliary muscle loses any possible contraction power to change the curvature of the lens, and, theoretically, the lens relaxes into its normal, "at rest," flatter shape for distance vision. The "true" condition of a person's

sight, i.e., the amount of myopia or hypermetropia due to the eyeball being non-spher- ical, can then be determined.

From Perfect Sight Without Glasses:

The interference of the lens [without the instillation of atropine], however, is believed to account for only moderate degrees of variation in errors of refraction, and that only during the earlier years of life. For the higher ones, or those that occur after forty-five years of age, when the lens is supposed to have lost its elasticity to a greater or lesser degree, no plausible explanation has ever been devised.

Above, Bates presents one of his primary arguments against the lens being the mechanism of accommodation. To recap:

The conventional explanation for hypermetropic (farsighted) young people improving their sight is not that the eyeball returns to its normal round shape, but that the lens gains greater (than normal) curvature to see clearly near and far again. Hypermetropia is considered to be congenital and irreversible.

A problem with this conventional position is it cannot explain how hypermetropia improves or is eUminated in elderly people, in whom the lens is said to become rigid and inflexible. A Natural Vision Center consultant, who has seen numerous elderly people who have natural clear vision near and far, refers to such people by quoting an ancient Chinese phrase—"Returning of Youth." This consultant states that conventional eye specialists have "no set answer" to explain how people can maintain clear vision well into their seventies. Are the elderly people who keep clear vision all of their lives keeping their "youth" somehow? I believe Bates,

many Natural Vision teachers, and many natural vision students would say, "Yes."

Another consultant, an ophthalmologist, agrees that the multitude of people who have clear vision near and far long after the socalled presbyopic age is confusing to the orthodox. As Bates pointed out, nearly all experienced eye specialists have seen such cases.

If the lens is the only mechanism of accommodation, as stated conventionally, it should be easy to demonstrate that these older people are accommodating with the lens. In this case, the lens has obviously not become rigid enough to prevent normal accommodation.

If the lens has become so rigid the ciliary muscle can no longer produce accommodation, the two oblique eye muscles must be producing accommodation, in which case the lens is obviously not essential for accommodation.

Note that the refractive power of the lens of a camera remains fixed.

Continuing from Perfect Sight Without

Glasses:

Examining 30,000 pairs of eyes a year at the New York Eye and Ear Infirmary and other institutions, I observed ... many cases in which errors of refraction either recovered spontaneously, or changed their form, and I was unable either to ignore them, or to satisfy myself with the orthodox explanations, even where such explanations were available. It seemed to me that if a statement is a truth it must always be a truth. There can be no exceptions. If errors of refraction are irreversible, they should not recover, or change their form, spontaneously.

In the course of time I discovered that myopia and hypermetropia, like astigma-

tism, could be produced at will; that myopia was not, as we have so long believed, associated with the use of the eyes at the near point, but with a strain to see distant objects, strain at the near point being associated with hypermetropia; that no error of refraction was ever a constant condition—

In seeking for light upon these problems I examined tens of thousands of eyes, and the more facts I accumulated the more difficult it became to reconcile them with the accepted views. Finally, about half a dozen years ago, I undertook a series of observations upon the eyes of human beings and

the lower animals, the results of which convinced both myself and others that the lens is not a factor in accommodation, and that the adjustment necessary for vision at different distances is effected in the eye, precisely as it is in the camera, by a change in the length of the organ, this alteration being brought about by the action of the muscles on the outside of the globe. [The focal length—the distance between the lense and the film—of a camera is increased to focus near objects clearly. The focal length is decreased to focus far objects clearly. As noted above, the curvature of a camera's lens never changes.] Equally con-

vincing was the demonstration that errors of refraction [nearsightedness, astigmatism, and farsightedness], including presbyopia, are due not to an organic change in the shape of the eyeball or in the constitution of the lens, but to a functional and therefore reversible derangement in the action of the extrinsic muscles.

In making these statements I am well aware that I am controverting the practically undisputed teaching of ophthalmological science for the better part of a century;...but I have been driven to the conclusions which they embody by the facts, and that so slowly that I am now surprised at my own blindness. At the time I was improving high degrees of myopia; but I wanted to be conservative, and I differentiated between functional myopia, which 1 was able to reverse, or improve, and organic myopia, which, in deference to the orthodox tradition, I accepted as irreversible.

Note that the problem of the lens not being able to accommodate, from the conventional viewpoint, is only an issue after the age of forty, when supposedly the lens has become rigid. This is commonly referred to as presbyopia. This means that the mechanism of accommodation does not need to be known, and is irrelevant, if the elongated myopic eye is brought back to its normal shape. The same is true if the hypermetropic and astigmatic eyes are brought back to their normal shapes.

Stated another way: nearsightedness, farsightedness (at least before the age of forty), and astigmatism do not have anything to do with the front side of the lens not being able to acquire more curvature.

B A T E S A N D S I M U L T A N E O U S

R E T I N O S C O P V

One of the key principles of natural vision is motion, or movement. Most people's sight is tested when they are not moving. Bates showed that vision blurs when a person is still for too long. His advanced discoveries about natural vision were largely possible because he studied the vision of people and animals as they were moving.

In Chapter Two of the ground-breaking work, Perfect Sight Without Glasses, Bates dis- cusses how the retinoscope made such research possible.

Much of my information about the eyes has been obtained by means of simultaneous retinoscopy. The retinoscope is an instrument used to measure the refraction of the eye. It throws a beam of light into the pupil by reflection from a mirror, the light being either outside the instrument— above and behind the subject—or arranged within it by means of an electric battery. On looking through the sight-hole one sees a larger or smaller part of the pupil filled with light, which in normal human eyes is a reddish yellow, because this is the color of the retina, but which is green in a cat's eye, and might be white if the retina were diseased. Unless the eye is exactly focussed at the point from which it is being observed, one sees also a dark shadow at the edge of the pupil, and it is the behavior of this shadow when the mirror is moved in various directions which reveals the refractive condition of the eye....This exceedingly useful instrument has possibilities which have not been generally realized by the medical profession....

For thirty years I have been using the retinoscope to study the refraction of the eye. With it I have examined the eyes of

tens of thousands of school children, hundreds of infants and thousands of animals, including cats, dogs, rabbits, horses, cows, birds, turtles, reptiles and fish. I have used it when the subjects were at rest and when they were in motion—also when I myself was in motion;.. .1 have used it in the daytime and at night, when the subjects were comfortable and when they were excited; when they were trying to see and when they were not; when they were lying and when they were telling the truth; when the eyelids were partly closed, shutting off part of the area of the pupil, when the pupil was dilated, and also when it was contracted to a pin-point; when the eye was oscillating from side to side, from above downward and in other directions. In this way I discovered many facts which had not previously been known, and which I was quite unable to reconcile with the orthodox teachings on the subject. This led me to undertake the series of experiments already alluded to. The results were in entire harmony with my previous observations, and left me no choice but to reject the entire body of orthodox teaching about accommodation and errors of refraction.

ON THE BATES METHOD

Mary Dudderidge writes in the January 12,

1918, issue of Scientific American:

The revelations regarding the physical condition of the American people which have resulted from the examination of men for military service under the Draft Law have come as a shock to the nation, but are no more than was expected by those who had previously been giving attention to such matters. Even under a liberal interpretation of the lowered standard which

we adopted in 1909, when we abandoned the attempt to raise an army and navy with normal vision, defective eyesight has been one of the leading causes of rejection for service in both the Army and Navy, if it has not actually headed the list. In 1915 it was by far the most common of the defects found among applicants for enlistment in the Navy and Marine Corps. The total number refused for this cause among 106,392 was 12,374, while flat feet came next with only 8,188 cases. This too was under a standard which, while higher than that of the Army and Navy is only three-quarters normal.

The fact is that defective sight is a worldwide plague, making its appearance along with civilization, and increasing just in proportion as modern modes of living are adopted—

At the present time the general attitude of the medical profession toward this evil, which we have learned to take lightly only because it is so common, is one of hopelessness. Writers of books on the subject, practicing ophthalmologists and others, while admitting the inadequacy of the eyeglass, all assure us that it is the only [solution] for errors of refraction; while the only means of prevention they can suggest is that of sparing the eye as much as possible from the close application necessitated not only by the modern educational system, where most of the trouble begins, but by many of the employments upon which human life now depends. Some have even concluded that nature, who could not have been expected to provide for such a tremendous change as has taken place in the environment of the human animal, was not in a position to make the eye properly, while several scientists of repute have held that a moderate degree of myopia is a kind of a natural adaptation, and should not be

looked upon as abnormal... .defects of vision are accepted as irreversible, and no means of alleviating them are suggested except the one, fraught with peril to the soldier, of placing convex or concave glasses before the eyes.3

... We were all taught at school that the accommodation of the eye depends upon an alteration in the curvature of the crystalline lens. Now defects of vision have been found to be associated with deviations from the normal in the shape of the eyeball, which ought to be a perfect sphere; and such deformations are always supposed to be permanent. In nearsightedness the sphere is elongated, so that it can be focused accurately only on near objects. Rays of light coming from a distance are focused in front of the retina instead of upon it. In farsightedness the eyeball is too short, and the light rays are focused behind the retina. In astigmatism the eyeball becomes lopsided, the deviation from the normal curvature not having been uniform. In an effort to overcome these conditions the crystalline lens is supposed to alter its curvature, through the agency of what is known as the ciliary muscle; on which theory the unfortunate muscle would have imposed upon it not only the ordinary labors of accommodation, but the duty of compensating for refractive errors; and from these labors it would practically never be free so long as the eye was open. The thought is really an appalling one, and is enough to drive the victim to eyeglasses, even if the physical discomfort of the situation did not do so.4

FUNCTIONA L P R O B L E M S — E R R O R S

he said, are caused by chronically tense extrinsic eye muscles. Since these are not "organic" problems, he, and others, have said they are reversible.

Strain in one's eye muscles is similar to holding your fist tightly for a long time. The muscles are tense, there is less mobility, and the hand does not function properly. Holding the fist tight for many years, and putting a brace on it, would likely lead to more problems. The arm and shoulder become tight, and for some, the breathing becomes shallow or irregular. The tight fist becomes a holistic problem.

What is the solution? Letting go. Everything returns to its normal, relaxed, flexible state. Everything functions correctly again.

ERRORS OF REFRACTION

When light rays do not focus on the retina correctly, the eye cannot see objects clearly at all distances. In this state the eye is said to have a refractive error. The three errors of refraction are nearsightedness, farsightedness (including presbyopia), and astigmatism.

Like the farsighted eye, the presbyopic eye has refractive error, but unlike the farsighted eye, presbyopic refractive error is said, conventionally, to be caused not by a foreshortened eyeball, but by the hardening of the lens. Bates said the cause of presbyopia is the same as the cause of farsightedness—tense recti muscles.

STRABISMUS, AN ERROR OF CONVERGENCE