Ophthalmic & Physiological Optics ISSN 0275-5408

EDITORIAL

The Bates method, elixirs, potions and other cures for

Studies have documented a very high prevalence of author Aldous Huxley (1894–1963).10 The Bates method
myopia among urbanized Asian countries over recent includes palming, visualization, movement (or ‘shifting’)
decades,1 reaching epidemic levels of around 70–80% of and sunning. None of these techniques appear to have any
young adults living in East Asian countries such as plausible rationale for treating myopia.14 For example,
Taiwan, Japan, Hong Kong and Singapore.2 Prevalence although increased time spent outdoors appears to reduce
levels are typically lower in young Western adults at myopia progression,1 Bates’ ‘sunning’ originally involved
around 15–30%, but remain significant.1 Although myo- looking directly at the sun (now well known to cause solar
pia can be relatively easily corrected with spectacles, retinopathy15) although he later changed that advice to
contact lenses or refractive surgery, all can have some allowing direct sunlight onto the ‘white of the eye’ subse-
negative effects on quality of life in younger patients in quent to sunlight exposure to closed eyelids and later books
terms of perceived appearance and convenience (specta- omit this part of the method.10 ‘Palming’ involves covering
cles, especially higher-powered spectacles), convenience the closed eyes with the palms of the hands, without putt-
(contact lenses) and significant symptoms and functional ing pressure on the eye, which he claimed would help the
impairment for those with complications from refractive eyes relax.10–13 Hopefully no pressure would be exerted by
surgery.3 In addition, high myopia is associated with a the palms as short-term mechanical pressure on the eye can
variety of abnormal conditions, including lacquer cracks, increase intra-ocular pressure, leading to transient increases
posterior staphyloma, chorioretinal atrophy, choroidal in axial length and myopia.16
neovascularisation, macular atrophy, retinal detachment,
cataracts, glaucoma and poorer visual acuity.4,5 It is
therefore not surprising that there are large numbers of The placebo effect and memorisation
available treatments. Those treatments that have been This begs the question of what is the cause of the improve-
appropriately assessed to date have shown limited effec- ments in vision reported by people who use these methods?
tiveness in slowing the progression of myopia6–8 and It could be partly due to the placebo effect, in that random-
many of the myopia ‘cures’ available on the internet ized controlled trials have shown significant improvements
(these include vitamins, fish oils, essential oils and in visual acuity and symptoms with placebo ‘treatments’ of
herbs9) have not been assessed. Could some of these glasses with no power17 or ‘sugar pills’.9 Given that the pla-
alternative therapies work, and if so, how? cebo effect appears to be greater the more dramatic the
treatment (four placebo sugar pills a day are more effective
The Bates Method than two for eradicating gastric ulcers, salt water injections
are a more effective treatment for pain than sugar pills),18
One of the most commonly used alternative therapies is the perhaps the regimen proposing the largest array of strenu-
Bates method, developed by the New York ophthalmologist ous eye exercises would provide the largest placebo effect.
William Horatio Bates (1860–1931).10 This is still pro- Part of any improvement may be simply memorisation, in
moted in many books, including the original best-seller that most of the Bates method books include a Snellen let-
‘Perfect sight without Glasses’ (1920) or copies, plus recent ter chart for readers to monitor their visual acuity and with
translations in both Chinese and Spanish, The American repetitive measurements, some learning of the subset of
Vision Institute’s ‘Improve your vision without glasses or letters is likely.19,20
contact lenses’11 and Barnes’ Improve Your Eyesight: A Guide
to the Bates Method for Better Eyesight Without Glasses12
Blur adaptation and perceptual learning
amongst others.13 It also seems to be promoted by some
behavioral optometrists and vision therapists.10,11 Bates However, the most likely causes of improvements in vision
attributed nearly all sight problems to habitual strain of the are blur adaptation21–26 (in the short-term) and perceptual
eyes and felt that glasses were harmful. Many people have learning27–30 (in the longer term and if demanding visual
reported anecdotal improvements in their vision with the tasks are involved in the treatment). Both of these topics are
techniques (take a look at the comments left by readers of discussed in articles in this issue of OPO by Sotiris Plainis
the various books on Amazon websites), most famously the and colleagues of the University of Crete.26,30 It is now well

Ophthalmic & Physiological Optics 33 (2013) 75–77 © 2013 The College of Optometrists 75
Editorial DB Elliott

known that with sudden blur (such as when taking off myo- they take their new spectacles off than their ‘unaided’ vision
pic glasses or when blur lenses are added in research experi- before they got the glasses? Might this make them think
ments), the visual system will adapt to improve visual that the glasses had ‘made their eyes worse’? What advice
acuity,21–26 likely by increasing the gain of high spatial fre- should be given to them? Should blur adaptation and its
quency channels and decreasing the gain of low frequency effects be explained? Could low myopes cope without
channels.23 Improvements of more than two lines of acuity glasses given perceptual learning? Should we be using per-
have been reported22,24,26 and these are typically greater in ceptual learning techniques to improve visual acuity in
myopes22,26 and possibly greatest in high myopes.26 How- myopes, absolute hyperopes, astigmats and presbyopes as
ever, blur adaptation seems short-lasting (the time course of well as amblyopes and others?
the condition is as yet unclear) and long-term improve-
ments may be more likely using perceptual learning (which
Myopia feature issue coming soon
may trigger and/or enhance the process of blur adapta-
tion)29 which has been shown to lead to improvements in Myopia and its treatment are a hot topic at the moment
distance visual acuity in adult amblyopes27,28 and in the and are likely to be so for many years given its high preva-
‘good eye’ of patients with severe impairment in the other lence and currently limited treatment (as opposed to cor-
eye30 and improvements in near visual acuity to a level rection) options. I am therefore delighted to report that
where reading glasses were not necessary in early presbyo- one of the next issues of OPO will be a feature issue entitled
pes.29 The suggestion is that perceptual learning (repeated ‘Understanding and controlling myopia – where we are now’,
practice on a demanding visual task) can increase the effi- which is a compilation to honour the research achieve-
ciency of neural processing in order to perform ‘de-blur- ments and mark the passing of Josh Wallman and will be
ring’ of blurred images and retrieve the information for led by feature issue editors Christine Wildsoet, Debora
further processing.29 Given that the Bates method empha- Nickla, Jeremy Guggenheim and Nicola Logan. It promises
sizes repeated relaxation of the eyes, rather than repeated to be a landmark issue.
practice on a demanding task, it seems likely that its positive
effects are dominated by blur adaptation plus the placebo David B. Elliott
effect and memorisation rather than perceptual learning. Editor-in-Chief, Ophthalmic & Physiological Optics;
Professor of Clinical Vision Science, Bradford School of
Clinical implications? Optometry & Vision Science, Bradford, UK
E-mail address: [email protected]
What clinical implications do these findings have? In the
short-term, optometrists should certainly be well aware of References
blur adaptation, perceptual learning and the placebo effect
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76 Ophthalmic & Physiological Optics 33 (2013) 75–77 © 2013 The College of Optometrists
DB Elliott Editorial

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Ophthalmic & Physiological Optics 33 (2013) 75–77 © 2013 The College of Optometrists 77
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