Bates method

The Bates method is an alternative therapy aimed at improving eyesight. Eye-care physician William Horatio Bates, M.D., (1860–1931) attributed nearly all sight problems to habitual strain of the eyes, and self-published a book as well as a magazine detailing his approach to helping patients relax such "strain", and thus, he claimed, improve their sight.

Although some people experience that they have been helped by following Bates' principles, his techniques have not been shown to objectively improve eyesight, and his main physiological proposition, that the eyeball changes shape to maintain focus, is demonstratively false. In Fads and Fallacies in the Name of Science, mathematical journalist Martin Gardner characterized Bates' book as "a fantastic compendium of wildly exaggerated case records, unwarranted inferences, and anatomical ignorance". Gardner suggested that Bates' techniques may seem to work, to a limited extent, due to the eyes adjusting to seeing without glasses when they are put aside.

Critics of the Bates method not only deny its efficacy, but go on to cite potential negative consequences for those who attempt to follow it, namely that they might overexpose their eyes to sunlight, put themselves and others at risk by not wearing their corrective lenses while driving, or develop serious ophthalmological problems by neglecting conventional eye care.

Underlying concepts

Accommodation

Accommodation is the process by which the eye increases optical power, while shifting its gaze to a closer point, to maintain focus on the retina. This is accomplished by action of the ciliary muscle, a muscle within the eye, which adjusts the shape of the eye's crystalline lens. As early as 1837, the lens had been observed thickening as focus moved to a nearer point, and in 1940 this was demonstrated by clear photographic evidence.

Bates denied that the lens had any role in accommodation, and in his 1920 book presented his own photographs which he interpreted as indicating that the lens did not change shape when the eye shifted focus. These images, however, were very unclear. He also cited rare instances in which individuals with lens-less eyes seemed to be able to focus at the near-point without the aid of reading glasses. However, examination of such cases has found no actual change in the optical power of the eye.

Bates instead reaffirmed an already discredited model which had the muscles surrounding the eyeball controlling its focus. In addition to their known function of turning the eye, Bates maintained, they also affected its shape, elongating the eyeball to focus at the near-point and shortening it again to refocus at the distance. He described experiments on the eyes of animals by which he believed he had verified this, but such results were never replicated independently. Moreover, such shape-changing is implausible due to the structure of the eyeball.

Causes of sight problems

Medical professionals characterize refractive errors such as nearsightedness, farsightedness, astigmatism, and presbyopia (the age-related blurring of near-point vision) as "static, anatomic conditions" caused by "structural defect of the eyeball", which as such cannot be altered by relaxation or exercise. Bates, on the other hand, regarded these conditions as directly resulting from tension of muscles surrounding the eyeball, which he believed would inhibit the eye from sufficiently changing shape (per his explanation of accommodation) when shifting its gaze nearer, farther, or both. Bates characterized this supposed muscular tension as the consequence of a "mental strain" to see, the relief of which he claimed would instantly improve sight. He also linked disturbances in the circulation of blood, which he characterized as being "very largely influenced by thought", not only to refractive errors but also to double vision, crossed-eye, lazy eye, and to more serious eye conditions such as cataracts and glaucoma. His therapies were based on these assumptions.

Eyeglasses

Bates felt that eyeglasses, which he characterized as "eye crutches", were an impediment to curing poor vision, because the eyes adjust to them, which in Bates' view meant an increase in "strain". He thus advised that glasses be discarded by anyone applying his method.

Treatments

In his writings, Bates discussed several techniques which he claimed helped patients to improve their sight, first temporarily and then, according to him, permanently. He 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", emphasizing that no single approach would work for everyone. His techniques were all designed to help dissociate this "strain" from seeing and thereby achieve "central fixation", or seeing what is in the central point of vision without staring. He asserted that "all errors of refraction and all functional disturbances of the eye disappear when it sees by central fixation" and that other conditions are often relieved as well. However, the purported benefits of Bates' techniques are generally anecdotal, and their supposed effectiveness in improving eyesight has not been substantiated by medical research.

Flashing

Bates noted that most patients, though not all, found it easiest to relax with their eyes shut. He reported that some quickly obtained "flashes" of temporarily improved vision by alternately closing their eyes for a few minutes or longer and then opening them to a Snellen test card for a second or less. In these cases, Bates believed, the eyes were rested by being closed for a while, and the patients were eventually able to open them without immediately reasserting the "strain", and were further benefited by closing their eyes again before this "strain" resurfaced. While such "clear flashes" do actually occur, observation of subjects attaining them has found using retinoscopy that they are not the result of any change in refractive error. A 1982 study determined that these flashes are best explained as a contact lens-like effect of moisture on the eye, based on increased tear action exhibited by 15 out of 17 subjects who obtained them.

Palming

Photo of someone "palming", from Perfect Sight Without Glasses.

Bates suggested that, in addition to simply closing the eyes, 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 covered eyes did not strain, he said, they would see "a field so black that it is impossible to remember, imagine, or see anything blacker", since light was excluded by the palms. However, he reported that some of his patients experienced "illusions of lights and colors" sometimes amounting to "kaleidoscopic appearances" as they "palmed", occurrences which he attributed to his ubiquitous "strain" and which he claimed disappeared when one truly relaxed. This phenomena, however, was almost certainly caused by eigengrau or "dark light". In fact, it is impossible to see entirely "perfect" black, as the neurons of the retina and optic nerve have a "resting level" of activity, which, if the viewer succeeds in achieving total darkness, is interpreted by the brain as patterns of color and light in the visual field.

Memory and imagination

Bates reasoned that any given object could be seen as clearly as it was visualized, until the "strain" increased, as he felt relaxation was the key to clarity of imagination as well as of actual sight. He claimed that one's poise can be gauged by the visual memory of black; that the darker it appears in the mind, and the smaller the area of black which can be imagined, the more relaxed one is at the moment. He recommended that patients think of the top letter from an eye chart and then visualize progressively smaller black letters, and eventually a period or comma. But he emphasized his view that the clear visual memory of black "cannot be attained by any sort of effort", stating that "the memory is not the cause of the relaxation, but must be preceded by it", and cautioned against "concentrating" on black, as he regarded an attempt to "think of one thing only" as a strain.

While Bates preferred to have patients imagine something black, he also reported that some found objects of other colors easiest to visualize, and thus were benefited most by remembering those, because, he asserted, "the memory can never be perfect unless it is easy". Skeptics reason that the only benefit to eyesight gained from such techniques is itself imagined, and point out that familiar objects, including letters on an eye chart, can be recognized even when they appear less than clear.

Shifting and swinging

Bates felt that the manner of eye movement is key to how well one sees. He suggested "shifting", or moving the eyes back and forth to get an illusion of objects "swinging" in the opposite direction. He believed that the smaller the area over which the "swing" is experienced, the greater the benefit to sight. He also indicated that it is usually helpful to close the eyes and imagine something swinging. By alternating actual and mental shifting over an image, Bates wrote, many patients were quickly able to shorten the "shift" to a point where they could "conceive and swing a letter the size of a period in a newspaper." One who masters this will attain the "universal swing", Bates believed.

In his Better Eyesight magazine, Bates set forth several techniques designed to help realize and then shorten the "swing". One such method was the "long swing", which consisted of standing with the feet a foot apart, slowly turning the body alternately from left to right and right to left while raising the opposite heel off the ground, allowing the head and eyes to move with the body, without paying attention to the apparent movement of stationary objects. Bates said that at first, the long swing is the "optimum swing" because it is wide, but indicated that it can be shortened down to "the normal swing of the normal eye."

Perhaps finding Bates' concepts of "shifting" and "swinging" too complicated, some proponents of vision improvement have suggested simply moving the eyes up and down, left and right, and shifting one's gaze between a near-point and a far-point.

The terms "shift" and "swing" are not used in this fashion outside of a Bates context. Bates provided no evidence of any correlation between visual acuity and eye movement beyond his own clinical experience, which is effectively anecdotal.

Sunning

Bates believed that the eyes were benefited by exposure to direct sunlight. He stated that "persons with normal sight can look directly at the sun, or at the strongest artificial light, without injury or discomfort", and gave several examples of patients' vision purportedly improving after having done so, which in some situations may be dangerous, as direct sunlight exposure can cause damage to the retina known as solar retinopathy, which has been observed in individuals who have watched eclipses. Photographs in Chapter 17 of Bates' Perfect Sight Without Glasses portray multiple individuals allegedly sungazing with "no sign of discomfort", and one features somebody "Focussing the Rays of the Sun Upon the Eye of a Patient by Means of a Burning glass."

Bates cautioned that, just as one should not attempt to run a marathon without training, one should not immediately look directly at the sun, but he suggested that could be worked up to. He acknowledged that looking at the sun could have ill effects, but characterized them as being "always temporary" and in fact the effects of strain in response to sunlight. He wrote that he had cured people who believed that the sun had caused them permanent eye damage. However, Bates did temper his suggestions regarding this activity in later editions of his magazine, recommending instead that direct sunlight be allowed to shine on closed eyelids. He also clarified that he regarded the benefit as being in the solar light rays rather than the heat rays, and thus suggested "sunning" in the early morning, moving the head from side to side.

Sunning : Let the sun shine on your closed eyelids for short intervals. Choose preferably the early morning sunlight. It is the light rays which benefit the eyes rather than the heat rays. The sun loses some of its effect when it comes through glass.

Modern books about the Bates method or natural vision improvement only speak about closed eyelid sunning or do not speak about sunning at all.

After Bates

After Bates died in 1931, his methods of treatment were continued by his widow Emily and other associates, some of who incorporated exercises and dietary recommendations. Most subsequent proponents did not stand by Bates' discredited explanation of how the eye focuses mechanically, but nonetheless maintained that relieving a habitual "strain" was the key to improving sight.

Margaret Darst Corbett

Margaret Darst Corbett first met Dr. Bates when she consulted him about her husband’s eyesight. She became his pupil, and eventually taught his method at her School of Eye Education in Los Angeles. She was of the stated belief that "the optic nerve is really part of the brain, and vision is nine-tenths mental and one-tenth only physical."

In late 1940, Corbett and her assistant were charged with violations of the Medical Practice Act of California for treating eyes without a licence. At the trial, many witnesses testified on her behalf. They described in detail how she had improved their sight and had enabled them to discard their glasses. One witness testified that he had been almost blind from cataracts, but that, after receiving treatment, his vision had improved to such an extent that for the first time he could read for eight hours at a stretch without glasses. Mrs. Corbett explained in court that she was practising neither optometry nor ophthalmology and represented herself not as a doctor but only as an “instructor of eye training”. Describing her method she said "We turn vision on by teaching the eyes to shift. We want the sense of motion to relieve staring, to end the fixed look. We use light to relax the eyes and to accustom them to the sun."

The trial attracted widespread interest, as did the “not guilty” verdict. The case spurred a bill in the Californian State Legislature which would have then made such vision education illegal without an optometric or medical licence. After a lively campaign in the media, the bill was defeated.

The case of Huxley

Perhaps the most famous proponent of the Bates method was the British writer Aldous Huxley. At the age of sixteen Huxley had an attack of keratitis, which left him with one eye just capable of light perception and the other with an unaided Snellen fraction of 10/200. This near-blindness was mainly due to opacities in both corneas, complicated by hyperopia and astigmatism. He was able to read only if he dilated his better pupil with atropine and used glasses.

In 1939, at the age of 45 and with eyesight which continued to deteriorate, he happened to hear of the Bates method and sought the help of Margaret Corbett, who gave him regular lessons. Three years later he wrote The Art of Seeing, in which he related: "Within a couple of months I was reading without spectacles and, what was better still, without strain and fatigue... At the present time, my vision, though very far from normal, is about twice as good as it used to be when I wore spectacles".

His case attracted wide publicity. Ophthalmologist Walter B. Lancaster commented:

It is often pointed out that Huxley’s visual acuity has not improved in any extraordinary way. He admits that. The point is that he has learned how to use what he has to better advantage. It is not the primary retinal sensation that is improved; it is the neglected, but vitally important, cerebral part of seeing that has been trained.

If his ability to see had actually improved, it remained imperfect and perhaps variable. Ten years later, in 1952, Huxley spoke at a Hollywood banquet, wearing no glasses and, according to Bennett Cerf, apparently reading his paper from the lectern without difficulty. In Cerf's words:

Then suddenly he faltered—and the disturbing truth became obvious. He wasn't reading his address at all. He had learned it by heart. To refresh his memory he brought the paper closer and closer to his eyes. When it was only an inch or so 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.

In response to this, Huxley pointed out that he had "never claimed to be able to read except under very good conditions", and explained that he often did "use magnifying glasses where conditions of light are bad", underscoring that he had not regained anything close to normal vision, and in fact never claimed that he had.

Modern variants

See also: Eye exercises

Today, many self-help books and programs exist claiming to improve eyesight naturally by various means, most having some basis in the Bates method. The heavily advertised "See Clearly Method" (of which sales were halted by a court order in November 2006, in response to what were found to be dishonest marketing practices) included "palming" and "light therapy", both adapted from Bates. The creators of the program, however, emphasized that they did not endorse Bates' approach overall.

Also, individual consultation is offered by many "Natural vision educators".

Ophthalmological research

In 2004 the American Academy of Ophthalmology (AAO) published a review of various research regarding "visual training", which consisted of "eye exercises, muscle relaxation techniques, biofeedback, eye patches, or eye massages", "alone or in combinations". The review found "level I evidence", meaning that it was taken from randomized controlled trials, "that visual training for control of accommodation has no effect on myopia." While some of the reviewed studies did report improvements in the visual acuity of myopes, these were seen as subjective rather than objective gains, perhaps resulting from a learned ability to interpret blurred images, or other factors detailed below. Furthermore, no evidence was found that visual training had any effect on hyperopia or astigmatism, on the progression of myopia, or on vision loss due to eye diseases.

The AAO report states that "mainstream medicine is recognizing a need to learn more about alternative therapies and determine their true value." However, they also conclude that "the Academy believes that complementary therapies should be evaluated similarly to traditional medicine: evidence of safety, efficacy, and effectiveness should be demonstrated."

"Natural vision educators" argue that they lack the funds to carry out formal, controlled tests of their methods.

Claimed success

As their strongest evidence for the effectiveness of the Bates method, proponents point to the many accounts of people allegedly having improved their eyesight by applying it. While these anecdotes may be told and passed on in good faith, several potential explanations exist for the phenomena reported other than a genuine reversal of a refractive error due to the techniques practiced:

• Some cases of myopia are recognized as due to a transient spasm of the ciliary muscle, rather than a misshapen eyeball. These are classed as pseudomyopia, of which spontaneous reversal may account for some reports of improvement.
• As noted above, the "clear flashes" often spoken of by Bates enthusiasts have been determined experimentally to most likely be a contact lens-like effect of moisture on the eye.
• Research has confirmed that when nearsighted subjects remove their corrective lenses, after a while blur adaptation develops to produce an improvement in their unaided visual resolution, even though autorefraction shows no significant change in refractive error. One who has been practicing Bates' techniques and notices such improvement may not realize that simply leaving the glasses off would have had the same effect, which may be especially pronounced if the prescription was too strong to begin with.
• Some eye defects may naturally change for the better with age or in cycles. As well, a cataract when first setting in sometimes results in much improved eyesight for a short time. One who happens to have been practicing the Bates method would likely credit it for any such improvements, though they are unrelated.

The other factor which applies here is the potential for selection bias, the effect whereby spurious relationships can appear to exist due to selective reporting. In this case, many people have tried the Bates method, some of who may believe they were successful. But for others no noticeable change occurred; still more may have had their eyesight worsen further. If only the first of these groups publicize their experience, and the other two groups keep silent or are ignored, it will appear that the Bates method has been very effective, whereas in actuality it may not have been.

General criticisms

Dead-end

A frequent criticism of the Bates method is that it has remained relatively obscure, which is seen as proof that it is not truly effective. Writer Alan M. MacRobert concluded in a 1979 article that the "most telling argument against the Bates system" and other alternative therapies was that they "bore no fruit". In regards to the Bates method, he reasoned that "If palming, shifting, and swinging could really cure poor eyesight, glasses would be as obsolete by now as horse-drawn carriages." Others, including author Frank J. Leavitt, have argued that due to Bates' emphasis on relaxation and visualization, application of the method would depend heavily on each individual, as with martial arts and yoga, and that the Bates method is therefore not discredited simply by the continued prevalence of glasses.

Avoidance of conventional treatment

One of the greatest potential dangers of faith in the Bates method is that a believer may be disinclined to seek medical advice regarding what could be a sight-threatening condition requiring prompt treatment, such as glaucoma. Also, children with vision problems may require early attention by a professional in order to successfully prevent lazy eye, and parents who subscribe to Bates' ideas may delay seeking conventional care until it is too late. It may also be necessary for a child at risk of developing lazy eye to wear the proper correction.

See also

• Eye examination
• Matthew Luckiesh
• Vision therapy

Internal links

• Bates, William Horatio (1920). The Cure of Imperfect Sight by Treatment Without Glasses . Central Fixation Publishing Co.
• Better Eyesight magazine published by Bates (from 1919 to 1930)

External links

• Complementary Therapy Assessments: Visual Training for Refractive Errors American Academy of Ophthalmology, 2004.