Article: Bates Method

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The Bates Method is a controversial system of practices that are claimed to improve sight and reverse ocular disorders to normal by eliminating "mental strain" and restoring the "natural habits" of seeing. It is the backbone of the natural vision improvement movement, and was first described in 1920 by ophthalmologist William Horatio Bates in a book entitled Perfect Sight Without Glasses, then subsequently in his monthly magazine entitled Better Eyesight.

Bates claimed that various types of "mental strain" were responsible not only for refractive errors (such as myopia, hyperopia, astigmatism, and presbyopia), but also for other abnormal eye eye conditions including strabismus, cataracts, glaucoma, amblyopia, conjunctivitis, blepharitis, and diseases of the optic nerve and retina.[1] According to Bates, "relaxation" was the only cure for each type of strain.[2]

Although many people claim to have been helped by the method, the efficacy of the Bates Method is rejected by mainstream medicine.[3]

His theory that the eye does not focus by changing the power of the lens, but rather by elongating the eyeball, through use of the extraocular oblique muscles, is contradicted by mainstream ophthalmology.

Bates' theories

Accommodation by extraocular muscle squeezing

Accommodation is the process by which the eye increases optical power to maintain focus on the retina. So when the eyes change from viewing a distant object to a near object accommodation is taking place.

Bates rejected the orthodox view that accommodation was brought about by the action of the ciliary muscle on the eye's crystalline lens[4], and claimed that focus was maintained by varying elongation of the eyeball caused by the extraocular muscles. Although subsequently contradicted by experiments using modern equipment, Bates claimed that the lens played no part in accommodation and reported that the extraocular muscles, and in particular the oblique muscles, squeeze the eyeball to obtain focus by elongation. Excessive tension of the recti muscles may also make, according to Bates, the eyeball too short (leading to hyperopia, and excessive tension of the oblique and recti muscles makes the eye astigmatic).

Bates regarded the superior and inferior oblique muscles as "the muscles of accommodation".[5]

Refractive errors due to extraocular muscle squeezing

Bates regarded the refractive state of the eye as variable and disregarded the notion that permanent changes in the shape of the eyeball caused refractive errors. Instead, he stated that the shape of the eyeball responded instantaneously to the action of the extraocular muscles upon it.[6]

Bates claimed that straining to see at the near-point led to shortening of the eyeball resulting in hypermetropia (farsightedness), and that straining to see at the far-point led to lengthening of the eyeball leading to myopia (nearsightedness). At first this seems back-to-front, but by straining to see at the near-point Bates did not mean habitual close-work, or even tensing of the muscles, he meant 'straining' in a mental sense. He makes this clear in his chapter entitled 'strain' where he says, "if the muscles respond to the minds desire, they do so without strain". Some have assumed that Bates saw prolonged tension in the extraocular muscles as directly causing eyeball deformation [7]. His 'mental strain' is quite unconnected with muscle tension, and he sees the maladjustment as being in the brain, not the eye^{[citation needed]}.

Bates concluded that myopia was related to apprehension, or what some may call "anxiety". He reportedly felt that good vision was nature's way, and that any other way was a strained way of seeing. Bates believed that it was impossible to consciously relieve the eyes of this tensing, and instead developed his method as a means of effecting subconscious relaxation.

Close work

Bates Method advocates believe that viewing books, computer monitors, and other near-vision activities are harmless, in fact a good exercise, as long as a person maintains correct vision habits. They also note that eyeglasses are at best a crutch and at worst actually make vision with the naked eye worse.

Eyeglasses

Bates wrote: "At their best it cannot be maintained that glasses are anything more than a very unsatisfactory substitute for normal vision" [8]. He claimed that eyeglasses injured the eyes and did not restore normal vision [9]. The refractive condition of the eye, he maintained, is constantly changing, from day to day and from hour to hour, and so the prescribing of corrective lenses can only ever be right at the time they are fitted, after which they force the eye to adjust to them. Ophthalmologists acknowledge this phenomenon, referring to 'hysteresis', an observed phenomenon of the eye taking time to restore its range after extended use at one distance^{[citation needed]}. They also observe that hysteresis is greater in myopic subjects, who they find cannot adjust their focus so quickly as normal subjects^{[citation needed]}. They would not regard this as 'injuring the eye' to any significant extent though.

Bates cited many disadvantages to eyeglasses, maintaining that they adversely affected color perception, contracted the field of vision, and caused dizziness and headaches when the wearer viewed objects off-axis [10]. Although these symptoms are still experienced from time-to-time by some of today's eyeglasses wearers, improvements in modern lenses have generally improved vision quality, such as anti-reflective coatings that have improved image contrast by reduced scattering

Light is the life-blood of the eyes

Bates believed exposure to light was good for the eyes.

Bates' relaxation techniques

Bates claimed to have discovered that people with abnormal vision use their eyes differently than people with normal vision, and then created a system designed to help people to relearn the right vision habits. Advocates of the Bates Method claim that these vision habits are inseparably connected to normal vision. They assert that the Bates Method is a natural method that improves movement, relaxation, and circulation of the whole visual system. It is important to realise that Bates' 'exercises' are not true exercises aimed at muscle strengthening. They are mostly, like many yoga 'exercises', aimed at procuring a state of relaxation.

Relaxation [11] is at the core of the Bates Method, involving a set of practices which Bates advocates term "exercises in relaxation" and "movement exercises" [12]. They emphasise that the term "exercise" is used in the same sense as "memory exercise" and does not imply muscle strengthening.

Swinging involves deliberate movements of the body with relaxed awareness of vision.

Palming or cupping is one technique that advocates claim achieves relaxation of the mind and the eyes. Palming requires a person to gently cup the palms of the hands over the closed eyelids, and attempt to see "perfect black" in order give the mind and the visual system as much rest as possible. Then the person sits for five to fifteen minutes (or as long he or she wants) breathing deeply and easy with a good posture.

Sunlight exposure involves looking at the sun through closed eyelids. Bates considered light to be the 'lifeblood' of healthy eyes. The practice of opening the eyes briefly while looking at the sun is claimed to be effective by some supporters but this is one aspect of the Bates method that must be considered 'potentially dangerous.

Central fixation was considered very important by Bates. Recognizing that only a very small part of the retina is capable of the highest resolution, he claimed that many people, when reading, allow the central fixation needed to maintain a sharp image to wander, so that they are attempting to focus using a low resolution part of the retina. He emphasized that good fixation is about relaxing and allowing the eyes to change gaze rapidly and naturally, rather than straining to fixate, which results in staring. Staring is the result of tension, according to Bates, and very bad.

Aldous Huxley - famous advocate of the Bates method

The British writer Aldous Huxley (author of Brave New World) was one such advocate. Huxley claimed achieving successful results in his book entitled The Art of Seeing. Huxley was among the students of Margaret Corbett, who trained with Dr. Bates in 1930 and later authored Help Yourself to Better Sight.

However, while Huxley undoubtedly believed his vision had improved, Bennett Cerf thought otherwise. In 1952 Cerf was present when Huxley spoke at a Hollywood banquet, wearing no glasses and apparently reading his paper from the lectern without difficulty:

Then suddently he faltered—and the truth became obvious. He wasn't reading his address—he had learned it by heart. To refresh his memory he brought it closer and closer to his eyes. When it was only an inch away he still couldn't read it, and had to fish for a magnifying glass in his pocket to make the typing visible to him. It was an agonizing moment.^[13]

Safety

Advocates believe the Bates Method to be safe. Critics concede that most of the Bates techniques are harmless, apart from the possibility that faith in the Bates system could deter people with eye conditions requiring prompt care from seeking conventional treatment. (One of his original exercises, however, involved looking directly at the sun, which in some situations may be dangerous. In 1940, a posthumous revision of his book modified this by suggesting that the sun shine on closed eyes.)

Criticisms of the Bates Method

Theories of accommodation/focusing and refractive errors

Critics of the Bates Method reject the theory that human eyes accommodate, or focus, due to elongation of the eyeball caused by “squeezing” of the extraocular muscles, as has been claimed to happen in some animals. Critics of the Bates Method instead support the mainstream theory set forth by Hermann von Helmholtz that human eyes accommodate, or focus, due to the actions of the ciliary muscle (an intraocular muscle) and zonules changing the shape of the crystalline lens. To support this theory, critics of the Bates Method point to the action of various cycloplegic agents which temporarily paralyze accommodation by relaxing the ciliary muscle but leave the extraocular muscles, which control eye movements, unaffected. They also note that modern equipment, not available to Bates, has made possible the observation of the eye in great detail; such observations show the lens changing shape when the eye accommodates. [14]

Critics of the Bates Method contend that if the cause of myopia is continuous tensing of the muscles, either ciliary or extraocular, the Bates Method theory is that it should be possible to cure (or noticeably improve) it by causing intentional relaxation of the muscles; a process most commonly done using injections or topical administration of atropine. The mainstream consensus on this, however, is that no significant improvement of the vision is obtained when muscles are relaxed in this manner. Although Bates claimed that the evidence against the orthodox theory of accommodation was "overwhelming", he acknowledged that the effect of atropine supported the orthodox theory in "about nine cases out of ten".[15] [16]

Efficacy

The vast majority of optometrists and ophthalmologists are unfamiliar with the Bates Method. The few that are aware of his work remain skeptical, to say the least. Skeptic Martin Gardner characterizes Bates's book in Fads and Fallacies in the Name of Science, as "a fantastic compendium of wildly exaggerated case records, unwarranted inferences and anatomical ignorance." He suggested that the Bates method may however work, to a limited degree, by increasing the trainee's ability to interpret and extract information from blurred images.

Other eye-exercise methods

In recent years, the growing interest in alternative medicine has led to an increase in the popularity of the Bates Method and other methods claiming success via visual training through eye exercises. One particularly controversial area is the efficacy of eye exercises in the treatment of myopia (near-sightedness) and whether the use of eyeglasses makes myopia progressively worse.

Several points-of-view exist about the use of eye exercises to treat vision problems:

• Traditional mainstream ophthalmologists and optometrists use eye exercises to treat a limited range of problems, particularly problems involving muscular imbalances and problems with coordination of eye movement between the two eyes. (See orthoptics.)
• Functional optometrists and optometric vision therapists are licensed, credentialed doctors of optometry, who specialize in treatment that involves eye exercises. They hold that such exercises are useful in improving a wide range of visual conditions, including focusing problems. The methods used are said to be backed by clinical studies and publications in peer-reviewed journals. (See vision therapy.)
• The Bates method differs from other health systems that use eye exercises in a way that can be categorized as alternative medicine. Like homeopathic medicine, the treatments used and the explanations of how they are said to work are rejected by mainstream medicine, despite personal testimony by people who claim to have been helped by such methods.

Pathogenesis and control of myopia: the modern "debate"

Main article: Myopia

Although not alone in his endeavors, Bates is commonly recognized as one of the first in the modern era to attempt to prevent, arrest, or reverse myopia and other refractive errors. His techniques (designed to eliminate “mental strain”) have been largely rejected by mainstream ophthalmology as ineffective, but certain pharmaceuticals, contact lenses, and surgeries have achieved varying degrees of success, as have vision therapy and plus lenses in the treatment of pseudomyopia.

In direct contrast to research over the past ten to twenty years which has implicated heavy amounts of near-work as a contributing factor to the development of myopia [17] [18], Bates emphasized that that near-work and “overuse of the eyes” were not necessary to cause myopia, and claimed that he “made many dogs myopic by inducing them to strain to see a distance object”. To Bates, refractive errors were due to a “loss of mental control” brought about by “strain”, specifically “strain of the mind”. He wrote: “The remedy is not to avoid either near work or distant vision, but to get rid of the mental strain which underlies the imperfect functioning of the eye at both points.”

Despite considerable evidence that blurred images appear to trigger changes in the axial length of the eyeball through a complex feedback mechanism, some Bates advocates hold the original hypothesis that “mental strain” is ultimately responsible for the development of refractive error through extraocular muscle squeezing of the globe. They contend that various eye exercises could affect a person’s refractive error by altering the structure of the eyeball; however, there is no modern research that directly supports these claims.