Bates method

The Bates method for better eyesight is a system developed by ophthalmologist William Horatio Bates, M.D., which aims to relearn the correct relaxed vision habits and reverse the habitual strain. Bates described the method in a 1920 book entitled Perfect Sight Without Glasses, and in his monthly magazine entitled Better Eyesight (1919-1930).^[1]

Bates claimed that his system improves sight and reverses ocular disorders to normal. It is argued by proponents that it works by eliminating "mental strain" of any kind which inhibits the "natural habits" of seeing.

Bates believed that various types of strain originating in the mind are responsible not only for refractive errors which are usually compensated for with glasses (such as myopia, hyperopia, astigmatism, and presbyopia), but also for other abnormal eye conditions including strabismus, cataracts, glaucoma, amblyopia, conjunctivitis, blepharitis, and diseases of the optic nerve and retina.^[2]

Since the batesmethod is controversial an explanation is given below from three different points of view.

An educational program created by ophthalmologist William H. Bates, M.D., in which natural, correct vision habits—based on relaxation of the mind and body—are taught; optional self-healing activities and games are often included to accelerate integration and self-healing; commonly misunderstood as only "eye exercises"—even by many "Bates Method" teachers.^[3]

the batesmethod is a fantastic compendium of wildly exaggerated case records, unwarranted inferences and anatomical ignorance." Bates theory of accommodation suggested the contraction of the ocular muscles resulted in changes in focusing power rather than changes in the lens and contraction of the lens zonules. Gardner argues that current high-resolution dynamic ultrasonic biomicroscopy has shown Bates' theory of accommodation (by elongation of the eyeball) to be false.

As yet there is no clear scientific evidence published in the mainstream literature supporting the use of eye exercises in the remainder of the areas reviewed, and their use therefore remains controversial.^[4].

Because the copyrights are over 70 years old, the original version of Perfect Sight Without Glasses is available free on the internet (see links). In 1943 Bates' widow, Emily Bates, published an abridged version under the title Better Eyesight Without Glasses. These abridged versions removed many of the more controversial claims, such as "perfectly remembering black" being a suitable substitute for anaesthesia^[5] or claims related to looking at the sun (see below).^[6] But many Bates advocates prefer the original 1920 version, regarding it as the leading authority in explaining the method.^[7][8]

Although many people claim to have been helped by the method, the efficacy of the Bates method is controversial. 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, was contradicted by mainstream ophthalmology and optometry of his day and is still today.^[6][9]

Thomas Quackenbush says about the eye focus-mechanism.

In the February 1922 "Better Eyesight" magazine, someone asked Bates about the role of the ciliary (lens) muscle:

• Q—2. What is the function of the ciliary muscles?

• A—2. I do not know.

Not a great answer from someone who wants to overturn the Helmholtz lens theory of accommodation. Bates, as a result of his research and experiments on the two oblique, external eye muscles, believed that these muscles, which are wrapped around the eye somewhat like a belt, produced accommodation. More specifically, when the eyeball is "at rest" the two oblique muscles were relaxed, the eyeball was in a round shape and a person sees clearly in the distance. When the two oblique muscles contracted, the eyeball became elongated, and a person was then accommodating to see clearly up close. It is his opposition to Helmholtz' lens theory of accommodation that probably led many conventional eye doctors to reject much if not all of Bates' work. (Bates also believed that when the two oblique muscles are chronically tense, they elongated the eyeball to produce myopia, or nearsightedness: chronic accommodation!). ^[10]

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Bates' theories

Accommodation

Accommodation is the process by which the eye increases optical power to maintain focus on the retina. So when the eyes shift from a distant point to a near point, 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^[11], and claimed that focus was maintained by varying elongation of the eyeball caused by the extraocular muscles. Bates claimed that the lens played no part in accommodation and reported that the extraocular muscles, and in particular the oblique muscles, elongate the eyeball to obtain focus at the near point.

Bates regarded the superior and inferior oblique muscles as "the muscles of accommodation".^[12]

Physiological cause of refractive errors

Bates regarded the refractive state of the eye as variable and disregarded the notion that irreversible changes in the shape of the eyeball caused refractive errors. Instead, he stated that the shape of the eyeball responded instantly to the action of the extraocular muscles upon it.^[13]

Bates regarded refractive errors as directly resulting from visual habits. A strain to see, he asserted, would inhibit the eyeball from sufficiently changing shape (per his explanation of accommodation) when shifting its focus nearer or farther. He claimed that straining to see at the near-point instantly shortened the eyeball, producing hypermetropia (farsightedness) in an eye with previously normal vision, and that straining to see at the far-point instantly lengthened the eyeball, producing myopia (nearsightedness) in an eye with previously normal vision. "Anatomically the results of straining to see at a distance may be the same as those of regarding an object at the near point without strain; but in one case the eye does what the mind desires, and in the other it does not." He also stated that astigmatism would be produced if these changes occurred "unsymmetrically".^[14]

Psychological cause of refractive errors

To Bates, refractive errors were ultimately due to "strain of the mind" which brought about a "loss of mental control".^[14] In asserting hypermetropia was caused by "straining to see at the near-point", Bates did not mean excessive close-work; he meant a mental effort to see close objects. He made this clear in his chapter entitled Strain where he wrote, "Mental strain of any kind always produces a conscious or unconscious eyestrain and if the strain takes the form of an effort to see, an error of refraction is always produced."^[2]

In discrepancy with more recent research which has implicated heavy amounts of near-work as a contributing factor to the development of myopia^[15][16], Bates emphasized that near-work and "overuse of the eyes" were not a direct cause of myopia, and claimed that he "made many dogs myopic by inducing them to strain to see a distant object."^[14] 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."^[14]

"The eye with normal sight never tries to see. If for any reason, such as the dimness of the light, or the distance of the object, it cannot see a particular point, it shifts to another. It never tries to bring out the point by staring at it, as the eye with imperfect sight is constantly doing."^[2]

Eyeglasses and contact lenses

Bates cited many disadvantages to eyeglasses made in his day, maintaining that they adversely affected color perception, contracted the field of vision, and caused dizziness and headaches when the wearer viewed objects off-axis. He wrote: "At their best it cannot be maintained that glasses are anything more than a very unsatisfactory substitute for normal vision."^[17] Moreover, he maintained that the refractive condition of the eye is constantly changing, from day to day, hour to hour, and minute to minute; consequently, he said, the prescribing of corrective lenses can only ever be right at the time they are fitted, after which, when they are too strong, the eye is encouraged to adjust to them (which in Bates' view meant straining more.)^[17]

Bates said that those who have never worn glasses are generally cured of sight problems more easily than those who have, and recommended that patients who sought a cure completely discard their glasses from the outset. He acknowledged that it may not always be practical to do so, but said that continuing to wear them would delay the cure.^[14] For those wanting to cure themselves without the personal help of a competent vision teacher, however, he emphasized that completely discarding glasses was a non-negotiable. From the chapter entitled Home Treatment: "It is absolutely necessary that the glasses be discarded. No half-way measures can be tolerated, if a cure is desired. Do not attempt to wear weaker glasses, and do not wear glasses for emergencies. Persons who are unable to do without glasses for all purposes are not likely to be able to cure themselves."^[18]

Bates did not address the use of contact lenses, as they were not generally available in his day. But modern day Bates advocates point out that contacts are not normally removed when not needed, making them an even larger impediment to improvement than glasses, from a Bates perspective.^[19]

Bates' treatments

Bates wrote that "The ways in which people strain to see are infinite, and the methods used to relieve the strain must be almost equally varied"^[14], emphasizing that no single approach would work for everyone, or even those whose sight problems are physiologically the same. His techniques are all methods designed to help dissociate strain from seeing (and are not, as is commonly misperceived, "exercises" in the sense of building muscle strength.)

Relaxation

Bates advocated relaxation and thinking relaxing thoughts as a way to reduce errors of refraction or squint: "When the disturbing thought is replaced by one that relaxes, the squint disappears, the double vision and the errors of refraction are corrected; and this is as true of abnormalities of long standing as of those produced voluntarily." Bates was of the opinion that the cause of "any error of refraction, of a squint, or of any other functional disturbance of the eye" was simply "wrong thoughts" and these "wrong thoughts" (and therefore the resulting pathology of the visual system) could be cured by relaxing thoughts. "In a fraction of a second the highest degrees of refractive error may be corrected, a squint may disappear, or the blindness of amblyopia may be relieved. If the relaxation is only momentary, the correction is momentary. When it becomes permanent, the correction is permanent."^[2]

Central fixation

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.

Palming

Bates noted that most patients, though not all, found it easiest to relax with their eyes shut. He reported that some obtained temporary improvement in vision by alternately closing their eyes for a few minutes and then looking at a Snellen test card for a second or less. Since he believed that most people with sight problems strain in response to light (though he did not believe that even very strong light was inherently bad for the eyes), he suggested that an even greater degree of relaxation could be obtained in most cases by palming, or covering the closed eyes with the palms of the hands, without putting pressure on the eyeballs. If the eyes did not strain to see while palming, he said, they would see "a field so black that it is impossible to remember, imagine, or see anything blacker, as one ought normally to do when the optic nerve is not subject to the stimulation of light". However, he stated that even while palming, many people continue to strain visually, and thus see "illusions of lights and colors ranging all the way from an imperfect black to kaleidoscopic appearances so vivid that they seem to be actually seen with the eyes." Some such patients, he reported, were helped by the memory of a black object.^[20]

Bates emphasized that an attempt to "concentrate" on black is an effort, in other words, more strain. "As popularly understood, concentration means to do or think one thing only; but this is impossible, and an attempt to do the impossible is a strain which defeats its own end. The human mind is not capable of thinking of one thing only. It can think of one thing best, and is only at rest when it does so; but it cannot think of one thing only." He reported that a patient who tried, while palming, to see black only and ignore all other colors "which intruded themselves upon her field of vision, becoming worse and worse the more they were ignored", went into convulsions from the strain. When she was able to resume the treatment, Bates advised her to "stop palming, and, with her eyes open, to recall as many colors as possible, remembering each one as perfectly as possible." He explained that this was a way of "consciously making the mind wander more than it did unconsciously", and reported that she then became able to palm for short periods of time.^[20]

Bates did acknowledge that not everyone was helped by palming, and said that in some cases it is "better and more expeditious to drop the method until the sight has been improved by other means."^[20]

Swinging

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

Sunlight exposure

Sunning involves looking at the sun through closed eyelids. Bates considered light to be the "lifeblood" of healthy eyes. See the discussion on safety below regarding this controversial aspect of his system.

Aldous Huxley and Margaret Corbett

The British writer Aldous Huxley was a famous advocate of the Bates method, claiming to have achieved successful results in his book entitled The Art of Seeing. Huxley was among the students of Margaret Corbett, a "Bates Practitioner", 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 reportedly present when Huxley spoke at a Hollywood banquet, wearing no glasses and apparently reading his paper from the lectern without difficulty. Martin Gardner quotes Cerf:

"Then suddenly 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."^[21]

It should be noted that Bates believed that relapses do occur, even years after the improvement is obtained, which is consistent with his belief that refraction is variable.^[22] Thus Cerf's account does not disprove Huxley's claimed success.

In 1941, Margaret Corbett was brought to trial in California on a charge of practicing medicine without a license, but was acquitted. Later, together with others, including Huxley, she successfully fought a State Bill which would have banned teaching methods of sight improvement without a medical or optometric license. ^[23]

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. Bates critics 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, they point to the action of various cycloplegic agents which temporarily paralyze accommodation by relaxing the ciliary muscle, but which leave the extraocular muscles, which control eye movements, unaffected. Modern equipment, not available to Bates, has made possible the observation of the eye in great detail. Modern observations have shown the lens changing shape when the eye accommodates.^[24] Elwin Marg, writing in 1952 points out that "it would take about one millimeter change in axial length of the eyeball for each three diopters change of refractive power. Hence, a youth accommodating 15 D would shorten his globe by five millimeters." He continues: "to the writer's knowledge, no corresponding anterior-posterior corneal movement has ever been reported."^[6]

To boost his theory that the extraocular muscles are responsible for accommodation, Bates noted the apparent ability of some aphakics to accommodate.^[11] Critics note that these cases are extremely rare, and therefore contend that they should be considered exceptions to the rule rather than the rule,^[6] and also cite research which indicates that there is no change in the refractive power of the eye in these cases.^[25][26]

The concept that relaxing the extraocular muscles can reliably or predictably reduce refractive error has not been substantiated by patients whose muscles are loosened during strabismus surgery. Although small refractive changes may occur following this type of muscle loosening surgery (recession), these alterations are generally small, clinically insignificant, transient, and occur in both directions (stronger and weaker).^[27]

Skeptics of the Bates method contend that if the cause of myopia is continuous tensing of the muscles, either ciliary or extraocular, then it should be possible to noticeably improve it by causing artificial loosening 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 vision is obtained when muscles are loosened 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".^[11][24]

Efficacy

The purported benefits are generally anecdotal and medical research often shows no clinical benefit. The medical community is often critical of the Bates method due to a lack of evidence-based medical support.^[24][28][29]

In the eighties and nineties, interest in biofeedback in turn stimulated some research into the Bates method. It was found in one study that myopes could improve their visual acuity with biofeedback training, but that this improvement was "instrument-specific" and did not generalise to other measures or situations. ^[30] In another study an "improvement" in visual acuity was found but the authors concluded that this could be a result of observers learning the task.^[31] Finally, in an evaluation of a training system designed to improve acuity, "no significant difference was found between the control and experimental subjects". ^[32] A 1997 review of this biofeedback research concluded that "controlled studies to validate such methods ... have been rare and contradictory." ^[33]

Safety

Avoidance of conventional treatment

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. Professional Bates Method teachers use a disclaimer, which must be signed by the student, that emphasizes that a Bates Method teacher is not an Ophthalmologist.^[34]

In humans the eye and brain development continues until approximately 8-10 years of age. For proper development of the visual pathways in the brain it is essential that clear images fall on the retina. Therefore it is very important that any refractive error is fully corrected in childhood in order to prevent the development of amblyopia.

Sunlight exposure

Bates gives several examples of patients' vision improving after having looked directly at the sun,^[35] which in some situations may be dangerous. Figures in Chapter 17 of Bates' 'Perfect Sight Without Glasses' show several individuals looking at the Sun "without discomfort" and figure 48 shows somebody "Focussing the Rays of the Sun Upon the Eye of a Patient by Means of a Burning Glass" implying that this is a safe thing to do.^[35] Regarding "sun-gazing" as beneficial he goes so far as to say that: "In some rare cases... complete cures have been effected by this means alone."^[35] Regarding looking directly at the sun, Bates also remarks that:

"In my experience such light has never been permanently injurious. Persons with normal sight have been able to look at the sun for an indefinite length of time, even an hour or longer, without any discomfort or loss of vision. Immediately afterward they were able to read the Snellen test card with improved vision, their sight having become better than what is ordinarily considered normal."^[35]

According to Thomas R. Quackenbush, Bates modified this suggestion after having written Perfect Sight Without Glasses by stating that the sun should only be allowed to shine on closed eyes.^[36]

Other 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 in improving eyesight via visual training. 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.)
• Advocates of the traditional Bates method often assert that "eye exercises" are not necessary to improve eyesight, nor are they particularly helpful in doing so.^[37][38][39] According to them, most sight problems are the result of eyes being strained, not weak, and the underlying problem is in the mind, not the eyes themselves.

A 2005 review of the literature on eye exercises concluded that: "Small controlled trials and a large number of cases support the (use of eye exercises in) treatment of convergence insufficiency. Less robust, but believable, evidence indicates visual training may be useful in developing fine stereoscopic skills and improving visual field remnants after brain damage." However, the report also concluded that "no clear scientific evidence" exists for the efficacy of eye exercises in the treatment of "vergence problems, ocular motility disorders, accommodative dysfunction, amblyopia, learning disabilities, dyslexia, asthenopia, myopia, motion sickness, sports performance, visual acuity, and general well-being."^[4]

The See Clearly Method

The commercial See Clearly Method, marketed by the "American Vision Institute", was shut down by a court order in November 2006. While it included a few elements of the Bates method, Bates practitioners are keen to distance themselves from it.^[40]

Prior to the "See Clearly Method", the American Vision Institute doctors authored the book Improve Your Vision Without Glasses Or Contact Lenses : A New Program Of Therapeutic Eye Exercises, in which they stated: "Pretending that the traditional use of 'corrective' lenses is safe and effective is no longer acceptable. The public must be told the truth and given accurate information about the alternative methods of treatment now available."^[41] The book does not mention Bates, however.

Natural Vision Improvement

"Natural Vision Improvement" markets itself as a lifestyle method of improving eyesight by holistic means. It uses the Bates method "merged" with modern theories of brain function, character, and responsibility for one’s self and state of being.^[42] Various self-help books and programs exist claiming to improve vision "naturally" by various means.^[43][44][45]

An educational program created by ophthalmologist William H. Bates, M.D., in which natural, correct vision habits—based on relaxation of the mind and body—are taught; optional self-healing activities and games are often included to accelerate integration and self-healing; commonly misunderstood as only "eye exercises"—even by many "Bates Method" teachers.^[3]

See also

• The Art of Seeing
• Eye examination
• Eyeglass prescription
• Wikisource:Perfect Sight Without Glasses
• Matthew Luckiesh
• See Clearly Method

References

Advocates of the Bates Method / Natural Vision Improvement

• International Society for the Enhancement of Eyesight