Eyes – Natural Vision Improvement (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 felt that glasses were harmful and never necessary. Bates self-published a book as well as a magazine (and earlier collaborated with Bernarr MacFadden on a correspondence course) detailing his approach to helping people relax such "strain", and thus, he claimed, improve their sight. His techniques centered around visualization and movement. He placed particular emphasis on imagining black letters and marks, and the movement of such. He also felt that exposing the eyes to sunlight would help alleviate the "strain".

The famed British writer Aldous Huxley, whose corneas had been scarred from the age of sixteen, learned the Bates method from Bates student Margaret Darst Corbett beginning in 1939, and in 1942 wrote his own book about the method. He reported that his eyesight had improved significantly, but admitted that it remained far from normal. Whether his vision had truly improved was frequently questioned.

Despite continued anecdotal reports of successful results, Bates' techniques have not been shown to objectively improve eyesight,  and his main physiological proposition – that the eyeball changes shape to maintain focus – has consistently been contradicted by observation.  In 1952, optometry professor Elwin Marg wrote of Bates, “Most of his claims and almost all of his theories have been considered false by practically all visual scientists.”  Marg concluded that the Bates method owed its popularity largely to "flashes of clear vision" experienced by many who followed it. Such occurrences have since been determined to most likely be a contact lens-like effect of moisture on the eye.

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 neglect conventional eye care, possibly allowing serious conditions to develop

Underlying concepts

Accommodation

Accommodation is the process by which the eye increases optical power to maintain focus on the retina while shifting its gaze to a closer point. The long-standing medical consensus is that this is accomplished by action of the ciliary muscle, a muscle within the eye, which adjusts the curvature of the eye's crystalline lens.  This explanation is based in the observed effect of atropine temporarily preventing accommodation when applied to the ciliary muscle, as well as images reflected on the crystalline lens becoming smaller as the eye shifts focus to a closer point, indicating a change in the lens' shape. Bates rejected this explanation, and in his 1920 book presented photographs which he said showed that the image remained the same size even as the eye shifted focus, concluding from this that the lens was not a factor in accommodation. However, optometrist Philip Pollack in a 1956 work characterized these photographs as "so blurred that it is impossible to tell whether one image is larger than the other", in contrast to later photographs which clearly showed a change in the size of the reflected images, just as had been observed since the late nineteenth century.

Bates adhered to a different explanation of accommodation which had already been generally disregarded by the medical community of his time. This model had the muscles surrounding the eyeball controlling its focus.  In addition to their known function of turning the eye, Bates maintained, they also affect its shape,  elongating the eyeball to focus at the near-point or shortening it to focus at a distance.  Commenting on this hypothesis in an interview with WebMD, ophthalmologist Richard E. Bensinger stated "When we put drops in the eye to dilate the pupil, they paralyze the focusing muscles. The evidence of the anatomical fallacy is that you can't focus, but your eye can move up and down, left and right. The notion that external muscles affect focusing is totally wrong."  Science author John Grant writes that many animals, such as fishes, accommodate in such a manner, "it's just that humans aren't one of those animals."

Laboratory tests have shown that the eyeball is far too rigid to spontaneously change shape to a degree which would be necessary to accomplish what Bates described.  Exceedingly small changes in axial length of the eyeball (18.6-19.2 micrometres) are caused by the action of the ciliary muscle during accommodation. However, these changes are far too small to account for the necessary changes in focus, producing changes of only -0.036 dioptres.

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 consequences of the eye's shape and other basic anatomy, which there is no evidence that any exercise can alter. Bates, however, believed that these conditions are caused by tension of the muscles surrounding the eyeball, which he believed prevents the eyeball from sufficiently changing shape (per his explanation of accommodation) when gaze is shifted nearer or farther. 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 said is "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.

Bates felt that corrective lenses, which he characterized as "eye crutches", are an impediment to curing poor vision. In his view, "strain" would increase as the eyes adjust to the correction in front of them. He thus recommended 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. 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 were often relieved as well.

Palming
 
Bates suggested closing the eyes for minutes at a time to help bring about relaxation. He asserted that the relaxation could be deepened 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 phenomenon, however, was almost certainly caused by Eigengrau or "dark light". In fact, even in conditions of perfect darkness, as inside a cave, neurons at every level of the visual system produce random background activity that is interpreted by the brain as patterns of light and color.

Visualization

Bates placed importance on mental images, as he felt relaxation was the key to clarity of imagination as well as of actual sight. He claimed that one's poise could be gauged by the visual memory of black; that the darker it appeared in the mind, and the smaller the area of black which could be imagined, the more relaxed one was 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.

Movement

Bates felt that the manner of eye movement affected the sight. 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" was experienced, the greater was the benefit to sight. He also indicated that it was 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 mastered this would attain the "universal swing", Bates believed.

Perhaps finding Bates' concepts of "shifting" and "swinging" too complicated, some proponents of vision improvement, such as Bernarr Macfadden, suggested simply moving the eyes up and down, from side to side, and shifting one's gaze between a near-point and a far-point.

Sunning
 
Bates believed that the eyes were benefited by exposure to 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 sungazing—this is at variance with the well-known risk of eye damage which can result from direct sunlight observation.  

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 it 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. In his magazine, Bates later suggested exposing only the white part of the eyeball to direct sunlight, and only for seconds at a time, after allowing the sun to shine on closed eyelids for a longer period.

Eventually Bates concluded that the practice of sunning should only be done with closed eyelids. Posthumous publications of Bates' book omitted mention of the supposed benefits from direct sunlight shining on open eyes.

Results

The purported benefits of Bates' techniques are generally anecdotal, and their supposed effectiveness in improving eyesight has not been substantiated by medical research. Several of Bates' techniques, including "sunning", "swinging", and "palming", were combined with healthy changes to diet and exercise in a 1983 randomized controlled trial of myopic children in India. After 6 months, the experimental groups "did not show any statistically significant difference in refractive status", but the children in the treatment group "subjectively … felt relieved of eye strain and other symptoms."

It has been argued, such as by philosopher Frank J. Leavitt, that the method which Bates described would be difficult to test scientifically due to his emphasis on relaxation and visualization. Leavitt asked "How can we tell whether someone has relaxed or imagined something, or just thinks that he or she has imagined it?" In regards to the possibility of a placebo trial, Leavitt commented "I cannot conceive of how we could put someone in a situation where he thinks he has imagined something while we know that he has not."

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 philosopher Frank J. Leavitt, have argued that due to Bates' emphasis on relaxation and visualization, application of his principles would depend heavily on each individual, as with martial arts and yoga, and that the Bates method is therefore not discredited simply by its failure to become mainstream.

Corrective lenses and safety

Discarding one's corrective lenses, as Bates recommended, or wearing lenses weaker than one's prescribed correction, as some Bates method advocates suggest, poses a potential safety hazard in certain situations, especially when one is operating a motor vehicle.  James Randi related that his father, shortly after discarding glasses on the advice of Bates' book, wrecked his car. Most teachers of the Bates method caution that when driving, one should wear the correction legally required.

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. Such treatment may include exercises, but which are different from those associated with the Bates method, and parents who subscribe to Bates' ideas may delay seeking conventional care until it is too late.  It may further be necessary for a child at risk of developing lazy eye to wear the proper correction.