Bates method
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{{Articleissues| POV = February 2008| introrewrite = March 2008| refimprove = March 2008| self-published = March 2008| primarysources = March 2008}}
The '''Bates method''' for "better eyesight" is a controversial method developed by [[ophthalmology|ophthalmologist]] [[William Bates|William Horatio Bates]], M.D. ([[1860]]-[[1931]]), which aims to undo what Bates claimed are "strained" vision [[Habit (psychology)|habits]]. Bates described his approach to helping patients relax such strain (and thus, he claimed, improve their [[Visual perception|sight]]) in a [[1920]] book entitled [[wikisource:Perfect Sight Without Glasses|''Perfect Sight Without Glasses'']] (or ''The Cure of Imperfect Sight by Treatment Without Glasses''), and in his monthly magazine entitled [[wikisource:Better Eyesight Magazine|''Better Eyesight'']], published from 1919 to 1930.<ref name="Gardner">{{cite book | last=Gardner | first=Martin | title=Fads and Fallacies in the Name of Science | year=1957 | chapter=Chapter 19: Throw Away Your Glasses! | pages = 230-241 | publisher=Reprint: Courier Dover | ISBN=0-486-20394-8 | url=http://books.google.com/books?id=kWoJ8mEEJ0wC&printsec=frontcover&source=gbs_summary_r#PPA232,M1}}</ref>
Bates believed that various types of habitual strain originating in the mind are responsible not only for [[refractive error]]s which are usually compensated for with glasses (such as [[myopia]], [[hyperopia]], [[astigmatism (eye)|astigmatism]], and [[presbyopia]]), but also for other abnormal eye conditions including [[strabismus]], [[cataract]]s, [[glaucoma]], [[amblyopia]], [[conjunctivitis]], [[blepharitis]], and diseases of the [[optic nerve]] and [[retina]].<ref name="BatesChap10">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 10: Strain | pages=106-113 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA106&source=gbs_toc_r&cad=0_0 }}</ref><ref name="Barrett">{{cite web | url=http://www.quackwatch.org/01QuackeryRelatedTopics/eyequack.html | author=Russell S. Worrall OD, Jacob Nevyas PhD, Stephen Barrett MD | title=Eye-Related Quackery | date=2007-09-12 | accessdate=2008-03-27 | publisher=Quackwatch}}</ref> He also claimed that "strain" was responsible for perfectly normal, and usually harmless, phenomena such as [[floater]]s.<ref name=BEOct1919>{{cite journal | title=Floating Specks | journal=Better Eyesight Magazine | author=William Bates | date=0ct 1919 | url=http://en.wikisource.org/wiki/Better_Eyesight_Magazine/October_1919#FLOATING_SPECKS}}</ref><ref name="pollack"/> To help one's self become aware of and thereby counteract this supposed habitual strain, Bates suggested repeatedly [[#Flashing|closing and opening the eyes]] in front of an [[eye chart]], [[#Memory and Imagination|visualizing]] objects previously seen, regularly [[#Shifting and Swinging|shifting]] one's gaze from point to point, [[#Sunning|exposing the closed eyes to sunlight]], and other activities.
Although some people [[Anecdotal evidence|claim]] to have been helped by following Bates' principles, his ideas remain [[Controversy|controversial]]. His techniques have not been shown to [[Objectivity (science)|objectively]] improve [[visual acuity|eyesight]],<ref name="AAO">{{cite web | year=2008 | url=http://one.aao.org/CE/PracticeGuidelines/Therapy_Content.aspx?cid=d7238b2b-a59f-49f6-9f30-64d1e84efc3b | publisher=American Academy of Ophthalmology | title=Complementary Therapy Assessments: Visual Training for Refractive Errors | accessdate=2008-07-06}}</ref><ref name=Marg>{{cite journal | author=Marg, E. | title="Flashes" of clear vision and negative accommodation with reference to the Bates Method of visual training | journal=Am J Opt Arch Am Ac Opt | year=1952 | volume=29 | issue=4 | pages=167–84 | url=http://brain.berkeley.edu/pub/1952%20April%20Flashes%20of%20Clear%20Vision.pdf | format = [[PDF]]}}</ref><ref name="educators">{{cite news |author=Robyn E. Bradley | title=Advocates see only benefits from eye exercises | publisher=The Boston Globe (MA) | date=2003-09-23 | url=http://www.boston.com/news/globe/health_science/articles/2003/09/23/advocates_see_only_benefits_from_eye_exercises/}}</ref> and his main [[physiological]] theory, that the [[Extraocular muscles|extraocular]] oblique muscles adjust the shape of the eyeball to maintain its focus, was rejected by mainstream ophthalmology and [[optometry]] of his day, and is still rejected today.<ref name=MacRobert>{{cite web | author=Alan M. MacRobert | url=http://www.skeptically.org/thinkersonreligion/id1.html | title=HOCUS FOCUS: modern spiritualism | year=1979}}</ref><ref name=WebMD>{{cite web | url=http://www.webmd.com/eye-health/features/natural-vision-correction-does-it-work | title=Natural Vision Correction: Does It Work? | author=Leanna Skarnulis | publisher=WebMD | date=2007-02-05}}</ref> Although most of Bates' recommendations are harmless, there is some risk that those who follow his suggestions may overexpose their eyes to sunlight, [[#Avoidance of conventional treatment|avoid conventional treatment]], or [[#Eyeglasses and contact lenses|stop wearing their prescribed correction]].
In ''[[Fads and Fallacies in the Name of Science]]'', skeptic [[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, by helping one become better able to recognize blurred images.<ref name="Gardner"/>
== Bates' theories ==
Bates developed many theories regarding vision during his career. Central to most of his theories was the thesis that "mental strain" caused poor vision. Many of his therapies rested on this assumption.
===Accommodation===
[[Accommodation (eye)|Accommodation]] is the process by which the eye increases [[optical power]], while shifting to a closer object, to maintain [[focus (optics)|focus]] on the [[retina]].
Bates claimed that focus is maintained by varying elongation of the eyeball caused using the [[extraocular muscle]]s, rejecting the orthodox view that accommodation is brought about by the action of the [[ciliary muscle]] on the eye's [[lens (anatomy)|crystalline lens]].<ref name="BatesChap6">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 6 | pages=69-74 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA69&source=gbs_toc_r&cad=0_0 }}</ref> He contended that the lens plays no part in accommodation, and asserted that the extraocular muscles, and in particular the superior and inferior oblique muscles, which are wrapped around the eye somewhat like a belt, elongate the eyeball to obtain focus at the near point, and allow the eyeball to shorten again when it looks into the distance.<ref name="BatesChap4">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 4 | pages=38-53 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA38&source=gbs_toc_r&cad=0_0 }}</ref><ref name="Gardner"/>
Critics of Bates reject the theory that human eyes accommodate, or focus, due to elongation of the eyeball caused by “squeezing” of the extraocular muscles, and instead support the mainstream theory set forth by [[Hermann von Helmholtz]] that human eyes accommodate due to the actions of the ciliary muscle (an intraocular muscle) and zonules changing the shape of the crystalline lens. Various [[cycloplegic]] agents can temporarily prevent accommodation by paralyzing the ciliary muscle, but these leave the extraocular muscles unaffected.<ref name="Gardner"/> Bates acknowledged that the effect of [[Atropine#Ophthalmic_use|atropine]] fit the orthodox theory in "about nine cases out of ten", but argued that all "tenth cases" in which (he said) atropine failed to stop accommodation constituted strong evidence that the ciliary muscle is not actually responsible for accommodation.<ref name="BatesChap6"/> Critics respond that it is incorrect to base a theory on rare occurrences rather than typical ones.<ref name="pollack">{{cite book | author=Pollack P. | title=The Truth about Eye Exercises | publisher=Philadelphia: Chilton Co. | year=1956 | chapter=Chapter 3: Fallacies of the Bates System | url=http://www.quackwatch.org/11Ind/bates.html}}</ref>
To boost his theory that the extraocular muscles are responsible for accommodation, Bates cited the apparent ability of some [[aphakia|aphakics]] to accommodate.<ref name="BatesChap6"/> Critics note that these cases are extremely rare, and therefore contend that they should be considered exceptions to the rule rather than the rule,<ref name=Marg/> and also cite research which indicates that there is no change in the [[refractive power]] of the eye in these cases.<ref name=Bettman1950>{{cite journal | author=Bettman, J . W. | title=Apparent Accommodation in Aphakic Eyes | journal=Amer. Jour. Ophthal. | volume=33 | pages=921–928 | year=1950}}</ref><ref name=Hirsch1950>{{cite journal | author=Hirsch, Monroe J. | title=Apparent Accommodation in Aphakia | journal=Amer. Jour. Optom. and Arch. Amer. Acad. Optom. | volume=27 | pages=412–414 | year=1950}}</ref>
Photographic evidence has shown the lens changing shape when the eye accommodates.<ref name="Gardner"/> Optometry professor Elwin Marg, writing in [[1952]] pointed 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"'' if indeed the eyeball itself changed shape to accommodate. He continued: ''"to the writer's knowledge, no corresponding anterior-posterior corneal movement has ever been reported."''<ref name=Marg/>
Modern proponents of the Bates method usually concede that Bates was mistaken in believing that the lens had no role whatsoever in accommodation, but suggest that the traditionally accepted explanation of such may be flawed as well, and maintain that Bates was correct in his central thesis that refractive errors result from habitual strain of the eyes.<ref>{{cite web | last = van der Werf | first = Esther | title = Visions of Joy FAQ | url=http://www.visionsofjoy.org/faq.htm#EyeQ13 | accessdate = 2008-04-17 }}</ref><ref>{{cite web | last = Kiesling | first = David | title = A Response to Philip Pollack's "The Truth About Eye Exercises" | url=http://www.iblindness.org/articles/kiesling-rebuttal.html | accessdate = 2008-04-17 }}</ref>
===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 error]]s. Instead, he maintained that the eyeball's shape responded instantly to the action of the extraocular muscles upon it.<ref name="BatesChap7">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 7 | pages=75-80 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA75&source=gbs_toc_r&cad=0_0 }}</ref><ref name="Time">{{cite journal | url = http://www.time.com/time/magazine/article/0,9171,884800,00.html | title = Exercise v. Eyeglasses | journal = Time | year = 1943 | month = March}}</ref>
Bates regarded refractive errors as directly resulting from visual habits. A "mental 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 effort to see close objects instantly caused the extraocular muscles to shorten the eyeball, producing [[hypermetropia]] (farsightedness) in an eye with previously normal vision, and that effort to see distant objects instantly lengthened the eyeball, producing [[myopia]] (nearsightedness) in an eye with previously normal vision.<ref name="Marg"/> He also stated that [[Astigmatism (eye)|astigmatism]] would be produced if these changes occurred "unsymmetrically".<ref name="BatesChap9">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 9 | pages=89-105 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA89&source=gbs_toc_r&cad=0_0 }}</ref> When such "strain" becomes habitual, Bates believed, the refractive error becomes constant.
Bates' explanation for the [[pathogenesis]] of myopia is in discrepancy with more recent research which has implicated heavy amounts of ''near-work'' as a contributing factor to its development,<ref name="NewScientist">{{cite journal | title=Lifestyle causes myopia, not genes | date=2004-07-08 |journal=New Scientist Print Edition |author=Rachel Nowak | location = Melbourne |url=http://www.newscientist.com/article.ns?id=dn6117}}</ref><ref name="Jiang">{{cite journal | journal=Clin Exp Optom. | year=2005 | volume=88 | issue=3 | pages=153–9 | title=Myopic progression and dark focus variation in optometric students during the first academic year | author=Jiang BC, Schatz S, Seger K. | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15926878&query_hl=11}}</ref> which was also commonly believed in Bates' day. But Bates emphasized his view that near-work and ''"overuse of the eyes"'' did ''not'' directly cause myopia, and 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."''<ref name="BatesChap9"/>
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).<ref name="Preslan">{{cite journal | author = Preslan M, Cioffi G, Min Y | title = Refractive error changes following strabismus surgery | journal = J Pediatr Ophthalmol Strabismus | volume = 29 | issue = 5 | pages = 300–4 | year = 1992 | pmid = 1432517 | url=http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=1432517&cmd=showdetailview&indexed=google}}</ref>
The concept that "mental strain" causes sight problems is crucial to Bates' work, but is perhaps the most vague aspect of his theory. "[[wiktionary:strain#Verb|Strain]]" can refer to fatigue, stress, concentration, or any other of a number of factors, making this a virtually [[Pseudoscience#Use_of_vague.2C_exaggerated_or_untestable_claims|untestable]] hypothesis. For example, Bates believed that the "strain" of lying could cause temporary myopia.<ref name="Lying">{{cite journal | title=Lying a cause of myopia | author=William Bates | journal=Better Eyesight | year=1919 | issue=September | url=http://en.wikisource.org/wiki/Better_Eyesight_Magazine/September_1919#LYING_A_CAUSE_OF_MYOPIA}}</ref><ref name=BEApr1930>{{cite journal | journal=Better Eyesight Magazine | author=William Bates | title=Lying as a cause of Myopia | year=1930 | issue=March | url=http://en.wikisource.org/wiki/Better_Eyesight_Magazine/April_1930#LYING_AS_A_CAUSE_OF_MYOPIA}}</ref><ref name="Gardner"/>
===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. 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 reasoned, 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.)<ref name="BatesChap8">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 8 | pages=81-88 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA81&source=gbs_toc_r&cad=0_0 }}</ref> He thus advised that anyone wanting to improve their eyesight not wear glasses.<ref name="Gardner"/><ref name="BatesChap9"/> In particular, for those attempting to apply his method on their own without the personal help of someone who had successfully used it already, he emphasized that glasses must never be worn, in any [[Eyeglass_prescription|prescription]].<ref name="BatesChap24">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 24 | pages=242-245 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA242&source=gbs_toc_r&cad=0_0 }}</ref>
For children, following Bates' advice not to wear glasses could jeopardize visual development. In humans the eye and brain development continues throughout childhood and into the teens. Depending on the situation, it may be necessary to correct a child's [[refractive error]] promptly in order to prevent the development of [[amblyopia]].<ref name=Donahue>{{cite journal | title=Prescribing Spectacles in Children: A Pediatric Ophthalmologist's Approach | author=Donahue, Sean P. | journal=Optometry and Vision Science | year=2007 | month=February | volume=84(2) | pages=110–114 | url=http://www.optvissci.com/pt/re/ovs/fulltext.00006324-200702000-00009.htm | doi=10.1097/OPX.0b013e318031b09b}}</ref><ref name=Daw>{{cite journal | title=Critical Periods and Amblyopia | author=Nigel W. Daw | journal=Arch Ophthalmol. | year=1998 | volume=116 | pages=502–505 | url=http://archopht.highwire.org/cgi/content/full/116/4/502 | pmid=9565050 | doi=10.1001/archopht.116.4.502 | doi_brokendate=2008-06-21}}</ref>
Bates did not address the use of [[contact lenses]], as they were not generally available in his day. But modern-day Bates method 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.<ref>{{cite web | last = Keilman | first = Kate | title = Reduced Lenses for Eyesight Improvement | url=http://www.visioneducators.org/reducedlenses.htm | accessdate = 2008-04-17 }}</ref>
==Bates' treatments==
In his writings, Bates discussed several techniques which he reported helped patients to improve their sight, first temporarily and then, he claimed, permanently. But 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"'',<ref name="BatesChap9"/> emphasizing that no single approach would work for everyone. His techniques were all designed to help dissociate strain from seeing (and were not, as is commonly misperceived, intended to build ocular muscle ''strength''.) Bates' approach centered around learning to control ''thoughts'', ''as they relate'' to seeing. He explained that, in his view, ''"You can teach people how to produce any error of refraction, how to produce a squint, how to see two images of an object, one above another, or side by side, or at any desired angle from one another, simply by teaching them how to think in a particular way. 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."'' ''"If the relaxation is only momentary, the correction is momentary. When it becomes permanent, the correction is permanent."''<ref name="BatesChap10"/><ref name="Gardner"/>
===Central fixation===
Only a very small part of the [[retina]], the ''[[Fovea|fovea centralis]]'', is capable of resolving high detail, and resolution falls off with distance from the fovea.<ref name=WebvisionRetina>"Webvision: Simple Anatomy of the Retina" (definition of terms), University of Utah, Webvision: The Organization of the Retina and Visual System, September 2005, Webvision.med.utah.edu webpage: [http://webvision.med.utah.edu/sretina.html Med-UtahEdu-retina].</ref><ref name=IOVSnomen>"Relation Between Superficial Capillaries and Foveal Structures in the Human Retina" (with nomenclature of fovea terms), Masayuki Iwasaki and Hajime Inomara, ''Investigative Ophthalmology & Visual Science'' (journal), volume 27, pages 1698-1705, 1986, IOVS.org, webpage: [http://www.iovs.org/cgi/reprint/27/12/1698.pdf IOVS-fovea-capillaries].</ref> Bates asserted that ''"The eye with normal vision, therefore, sees one part of everything it looks at best, and everything else worse, in proportion as it is removed from the point of maximum vision; and it is an invariable symptom of all abnormal conditions of the eyes, both functional and organic, that this '''central fixation''' is lost."'' When central fixation is lost, he claimed, at some distances the point directly regarded appears as blurry as parts of the periphery, or even blurrier, a phenomenon he termed '''''eccentric fixation''''', which he characterized as a ''"symptom of strain"'' and claimed could be relieved by ''"any method that relieves strain"''. Bates believed that "eccentric fixation" occurs when one attempts to see an area larger than a very small point equally well at once (which he believed those with sight problems are constantly doing unconsciously),<ref name="BatesChap11">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 11 | pages=114-122 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA114&source=gbs_toc_r&cad=0_0 }}</ref> and regarded "central fixation" as naturally occurring when one is not straining to see.<ref name="Gardner"/>
===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 chart|Snellen test card]] for a second or less.<ref name="BatesChap12"/> 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 the strain resurfaced.<ref name=BEMar1922>{{cite journal | author=William Bates | title=Fundamentals of Treatment | journal=Better Eyesight Magazine | year=1922 | issue=March | url=http://en.wikisource.org/wiki/Better_Eyesight_Magazine/March_1922}}</ref> Skeptics acknowledge that such "clear flashes" do actually occur, but claim that they are not the result of any change in [[refractive power]].<ref name="Marg"/> One explanation sometimes offered is that these flashes are a [[contact lens]]-like effect of moisture on the eye (such as from tears.)<ref name="AAO"/><ref name=Balliet>{{cite journal | author=Balliet R, Clay A, Blood K. | title=The training of visual acuity in myopia | journal=J Am Optom Assoc | year=1982 | month=September | volume = 53(9) | pages = 719–24 |url=http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=7130612&cmd=showdetailview }}</ref>
===Palming===
Although he did not believe that even very bright light is ''inherently'' bad for the eyes, Bates reported that most people with sight problems strain in response to light. Hence he 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 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"'', since light was excluded by the palms. However, he reported 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 (see the following subsection on memory and imagination.)<ref name="BatesChap12">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 12 | pages=123-135 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA123&source=gbs_toc_r&cad=0_0 }}</ref>
The "''illusions of lights and colors [and] kaleidoscopic appearances''" reported by some of Bates' patients, and which he concluded were caused by his ubiquitous "strain", were almost certainly caused by [[eigengrau]] or "dark light". It is impossible to see absolutely "perfect" black, as the [[neuron]]s 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 colour and light in the visual field.<ref name="pollack"/> Similar hallucinations can be invoked by visual deprivation using a [[Ganzfeld effect|Ganzfeld]].<ref name=Holt>{{cite journal | author=R.R. Holt | year=1964 | title=Imagery: the return of the ostracized | journal=Am. Psychol. | volume=19 | pages=254–264 | doi=10.1037/h0046316}}</ref>
===Memory and Imagination===
Bates reasoned that if a given object could be [[Mental image|visualized]] without strain, it could likewise be ''seen'' without strain, if the strain was not reasserted as soon as the eyes were opened. 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.<ref>{{cite journal | journal=Better Eyesight Magazine | author=William Bates | title=Memory | year=1926 | issue=February}}</ref> He reported that some patients were benefited by thinking of the large letters on a test card and then working down to the smaller letters, and eventually to a period.<ref name="Gardner"/> But he emphasized that the clear visual memory of black ''"cannot be attained by any sort of effort"'', explaining that ''"the memory is not the cause of the relaxation, but must be preceded by it"'',<ref name="BatesChap13">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 13 | pages=136-147 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA136&source=gbs_toc_r&cad=0_0 }}</ref> and cautioned against "concentrating" on black, as he regarded an attempt to ''"think of one thing only"'' as a strain.<ref name="BatesChap12"/>
While Bates claimed that ''"black is, as a rule, the best color to remember"'', he also acknowledged that ''"some patients are bored or depressed by it, and prefer to remember white or some other color. A familiar object, or one with pleasant associations, is often easier to remember than one which has no particular interest. One patient was cured by the memory of a yellow buttercup, and another was able to remember the opal of her ring when she could not remember a period. Whatever the patient finds easiest to remember is the best to remember, because the memory can never be perfect unless it is easy."''<ref name="BatesChap13"/><ref name="Gardner"/> Skeptics reason that the only "improvement" in 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.<ref name="pollack"/>
===Shifting and Swinging===
It is often said that Bates was opposed to [[staring]],<ref name="pollack"/> but his meaning may be misunderstood. By ''staring'', Bates meant locking one's attention somewhere, even for an extremely short time, in an attempt to accomplish something. ''"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."''<ref name="BatesChap10"/> Bates reported that ''"in some cases remarkable results have been obtained simply by demonstrating to the patient that staring lowers the vision and shifting improves it."'' He linked this "staring" to "eccentric fixation" (see [[#Central fixation|above]]), and suggested consciously shifting to help restore "central fixation", and experience what he termed the '''swing''', which he defined as the illusion of everything seen apparently moving in the direction opposite to which the eyes move.<ref name="Gardner"/> The "swing", he claimed, is always experienced (usually unconsciously) when the sight is normal, but is inhibited by staring.<ref name="BatesChap15"/>
Bates suggested at first shifting slowly, at the distance where the sight is most clear, over areas wide enough that one can easily let go of the previous point regarded, and allowing it to develop from there. He said that ''"it is usually impossible, however, to realize the swing if the shifting is more rapid than two or three times a second"'', and felt that an overt attempt to shift rapidly would just produce more strain. He also indicated that it is usually helpful to ''imagine'' something swinging. By alternating actual and mental shifting between letters on an eye chart, Bates reported, many patients were quickly able to shorten the swing to a point where they could ''"conceive and swing a letter the size of a period in a newspaper."''<ref name="BatesChap15">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 15 | pages=159-171 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA159&source=gbs_toc_r&cad=0_0 }}</ref><ref name="Gardner"/>
In his ''Better Eyesight'' magazine, Bates suggested several methods of realizing and then shortening the "swing". One such technique is the '''long swing'''.<ref name="Time"/><ref>{{cite book | url=http://books.google.com/books?id=Y-kSAAAAIAAJ&q=%22long+swing%22&pgis=1#search | title=The Proceedings of the Iowa Academy of Science | page=264-267 | year = 1947}}</ref>
''"LONG SWING: Stand with the feet about one foot apart. Turn the body to the right, at the same time lifting the heel of the left foot. The head and eyes move with the movement of the body. Do not pay any attention to the apparent movement of stationary objects. Now place the left heel on the floor, turn the body to the left, raising the heel of the right foot. Alternate. Pain and fatigue are relieved promptly while practicing this swing. When done correctly, relief is felt in a short time. The long swing, when done before retiring, lessens eyestrain during sleep."''<ref name=BEJan1926>{{cite journal | journal=Better Eyesight Magazine | author=William Bates | title=Swinging | year=1926 | issue=January | url=http://en.wikisource.org/wiki/Better_Eyesight_Magazine/January_1926}}</ref> 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."''<ref name=BEApr1930-2>{{cite journal | journal=Better Eyesight Magazine | author=William Bates | title=The Optimum Swing | year=1930 | issue=March | url=http://en.wikisource.org/wiki/Better_Eyesight_Magazine/April_1930#The_Optimum_Swing}}</ref>
Bates' recommendations regarding the practice of "swinging" or "shifting" could be seen as implying that the subject can improve their vision simply by moving their eyes. This seems unlikely since the eyes are in constant, and sometimes unconscious, motion - even when we believe that we are "fixating." If the retinal image is ''genuinely'' stabilised, it fades to nothing within seconds.<ref name=Stevens>{{cite journal | author= Stevens, J. K. et al | title=Paralysis of the awake human: visual perceptions | journal=Vision Research | issue=1 | pages=93–8 | url=http://wexler.free.fr/library/files/stevens%20(1976)%20paralysis%20of%20the%20awake%20human.%20visual%20perceptions.pdf | format = [[PDF]] | volume=16 | doi=10.1016/0042-6989(76)90082-1 | year=1976}}</ref> Due to the oculomotor and [[nystagmus]] reflexes, which attempt to stabilise the image on the retina, it is likely that Bates' recommendation of swinging the upper body (or "the long swing"), would result in many small [[saccades]] punctuated by micro-fixations. It is not clear from Bates' writings what this practice is intended to achieve specifically.
===Sunning===
Because he believed that people who strain to see tend to strain in response to light, Bates suggested exposing the eyes to sunlight to help unlearn that strain. He claimed that ''"persons with normal sight can look directly at the sun, or at the strongest artificial light, without injury or discomfort"'',<ref name="Sungazing"/> and gave several examples of patients' vision allegedly improving after having done so,<ref name="BatesChap17">{{cite book | last=Bates | first=William H. | title=Perfect Sight Without Glasses | year=1920 | chapter = Chapter 17: Vision Under Adverse Conditions a Benefit to the Eye | pages=183-197 | publisher=New York: Central Fixation Publish Co. | url=http://books.google.com/books?id=Vl3SiyXmZVMC&pg=PA183&source=gbs_toc_r&cad=0_0 }}</ref> which in some situations [[Sun#Observation and eye damage|may be dangerous]].<ref name="pollack"/> 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.<ref name="Sungazing">{{cite journal | journal=Better Eyesight Magazine | author=William Bates | title=Sun-gazing | year=1920 | issue=June}}</ref> He acknowledged that looking at the sun could have ill effects, but claimed they were ''"always temporary"'' (at least in the sense of being reversible) and were actually the effects of strain in ''response'' to the sunlight. He claimed to have cured people who believed that the sun had caused them permanent eye damage.<ref name="BatesChap17"/><ref name="Marg"/>
Of bright sunlight shining directly on open eyes, Bates remarked that ''"persons with imperfect sight usually find it impossible to accustom themselves to such a strong light until their vision has been improved by other means"'', though he also reported that in rare cases, [[sungazing]] alone had brought about complete cures of sight problems.<ref name="BatesChap17"/> Although he never renounced the claim that open-eyed "sunning" was safe, Bates did temper his suggestions regarding this activity in later editions of his magazine, ''Better Eyesight.'' From the August 1924 edition:
<blockquote>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.<ref>{{cite book | last = Quackenbush | first = Thomas R. | title = Better Eyesight: The Complete Magazines of William H. Bates | publisher = North Atlantic Books | date = 2000 | pages = page 299 | isbn = 1-55643-351-4 |url = http://books.google.com/books?id=ufOSikwYsrwC&printsec=frontcover#PPA299,M1}}</ref></blockquote>
==Modern variants==
Many "[[self-help]]" books and "programs" exist claiming to improve eyesight "naturally" by various means, most having some basis in the Bates method.<ref name="Barrett"/><ref name=MacRobert/><ref name="educators"/><ref name=WebMD/><ref>[http://www.museumofquackery.com/devices/eye.htm Museum of Quackery]</ref> Modern approaches place more emphasis on [[breath]]ing and [[posture]] than Bates did. [[Nutrition]] is also often mentioned as a factor in vision habits.<ref>{{cite book | last = Quackenbush | first = Thomas R. | title = Relearning to See | publisher = North Atlantic Books | date = 1997 | pages = page ix to 521 | isbn = 1-55643-205-4 |url=http://books.google.com/books?id=yWf9GgAACAAJ&dq=relearning+to+see}}</ref>
==="Natural Vision Improvement"===
"Natural Vision Improvement" markets itself as a lifestyle method of improving eyesight by [[holism#Medicine|holistic]] means.<ref>{{cite news | url=http://archive.mailtribune.com/archive/99/sept99/92099n2.htm | title=Ditch those glasses | author=Jonel Aleccia | publisher=Mail Tribune}}</ref> It uses aspects of the Bates method "merged" with modern theories of brain function, character, and responsibility for one’s self and state of being.<ref name="Goodrich"/> "Natural vision teachers" often claim that the "correct vision habits" must be "relearned".
According to Janet Goodrich : <blockquote>Improving vision naturally is an internal transformation, not a treatment, cure or makeover by external forces.<ref name="Goodrich">{{cite book | last = Goodrich | first = Janet. | title = Natural vision improvement | publisher = Cellestialarts | date = 1986 | page = 2 | isbn = 0-89087-471-9 |url= http://books.google.com/books?id=NRYEAAAACAAJ&dq=natural+vision+improvement }}</ref></blockquote>
"Natural vision teacher" Thomas R. Quackenbush defines the Bates method thus: <blockquote>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.<ref>{{cite book | last = Quackenbush | first = Thomas R. | title = Better Eyesight: The Complete Magazines of William H. Bates | publisher = North Atlantic Books | date = 2000 | pages = page 643 | isbn = 1-55643-351-4 |url=http://books.google.com/books?id=ufOSikwYsrwC&pg=PA643&lpg=PA643&dq=&source=web&ots=6h_kRZAKCc&sig=b9N5xGyUbpoSFzQtla6B4EaVWKI}}</ref></blockquote>
===The "See Clearly Method"===
{{See also|Eye exercises}}
The commercial [[See Clearly Method]], marketed by the "American Vision Institute", was shut down by a court order in November 2006.<ref name=AllAboutVision>{{cite web | url=http://www.allaboutvision.com/buysmart/see_clearly.htm | title=The See Clearly Method: Do Eye Exercises Improve Vision? | date=December 2006 | publisher=AllAboutVision.com | author=Rob Murphy, Marilyn Haddrill}}</ref><ref name=Shin>{{cite web | author=Annys Shin | url=http://blog.washingtonpost.com/thecheckout/2006/11/hold_onto_those_eyeglasses.html | title=Seeing the See Clearly Method for What It Is | date=2006-11-06 | publisher=washingtonpost.com}}</ref><ref>[http://www.casewatch.org/ag/ia/seeclearly/complaint.shtml Casewatch]</ref><ref name="Barrett"/> While it included "palming" and "light therapy", the American Vision Institute doctors emphasized that they did not endorse the Bates method overall.<ref>{{cite web | author = Steven M. Beresford, David W. Muris, Mara Tableman, Francis A. Young | url=http://www.visiontherapy.net/RESEARCH%20MASTER.pdf | title=Clinical Evaluation of the See Clearly Method | pages = 13}}</ref> Likewise, Bates method proponents have distanced themselves from the See Clearly Method.<ref name=VOJ>{{cite web | last = van der Werf | first = Esther | url=http://www.visionsofjoy.org/faq.htm#EyeQ18 | title=Visions of Joy FAQ with statement on SCM}}</ref>
==Ophthalmological research==
A review of research on "visual training" for refractive errors by the American Academy of Ophthalmology (AAO) concluded that there is ''"level I evidence"'' (from randomized controlled trials) ''"that visual training for control of accommodation has no effect on myopia."'' Other studies have shown weaker (level II/III) evidence of improvements in ''subjective'' visual acuity for patients with myopia who have undertaken visual training, but no corresponding physiological cause for the observed improvements has been demonstrated.<ref name="AAO"/> A [[1946]] study reported that out of 103 patients, 30 showed a "small improvement" in subjective [[visual acuity]], 31 showed "inconsistent improvements", 32 had no change, while 10 demonstrated a worsening of acuity after visual training. Of the 61 total patients who demonstrated any improvement, 17 returned for a five-month follow-up, where it was found that two had maintained this improvement, while the other 15 had not.<ref name=Woods>{{cite journal | author=Woods AC. | title=Report from the Wilmer Institute on the results obtained in the treatment of myopia by visual training | journal=Am J Ophthalmol | year=1946 | volume=29 | pages=28–57}}</ref>
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."''<ref name="AAO"/>
===Biofeedback training===
In the [[1980s]] and [[1990s]], interest in [[biofeedback]] stimulated some research into whether it could affect eyesight (as might be expected if "strain" were the cause of sight problems, as Bates believed.) It was found in one study that [[Myopia|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.<ref name=Randle>{{cite journal | author=Randle RJ | title=Responses of myopes to volitional control training of accommodation | journal=Ophthalmic Physiol Opt | volume=8 | pages=333–340 | year=1988 | url=http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=3269512&cmd=showdetailview&indexed=google}}</ref> 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.<ref name=Gallaway>{{cite journal | author=Gallaway M, Pearls SM, Winkelstein AM, et al. | title=Biofeedback training of visual acuity and myopia: A pilot study | journal=Am J Optom Physiol Opt | volume=64 | pages=62–71 | year=1987 | url=http://www.ncbi.nlm.nih.gov/pubmed/3826280}}</ref> Finally, in an evaluation of a training system designed to improve acuity, ''"no significant difference was found between the control and experimental subjects"''.<ref name=Koslowe>{{cite journal | author=Koslowe KC, Spierer A, Rosner M, et al. | title=Evaluation of accommotrac biofeedback training for myopia control | journal=Optom Vis Sci | volume=68 | year=1991 | pages=252–4 | url=http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&list_uids=1852394&cmd=Retrieve&indexed=google}}</ref> A [[1997]] review of this biofeedback research concluded that ''"controlled studies to validate such methods ... have been rare and contradictory."''<ref name=Rupolo>{{cite journal | author=G Rupolo, M Angi, E Sabbadin, S Caucci, E Pilotto, E Racano and C de Bertolini | journal=Psychosomatic Medicine | volume=59 | issue=3 | pages=313–317 | year=1997 | title=Treating myopia with acoustic biofeedback: a prospective study on the evolution of visual acuity and psychological distress | url=http://www.psychosomaticmedicine.org/cgi/reprint/59/3/313.pdf | format = [[PDF]] }}</ref>
==Claimed success==
As their strongest evidence for the effectiveness of the Bates method, proponents point to the many [[Anecdotal evidence| stories]] of people claiming to have improved their eyesight. Skeptics generally do not accuse these people of lying, but rather suggest that they have wrongly interpreted the results, have made incorrect extrapolations, or are just fooling themselves. Skeptics do acknowledge that some apparent myopia can be reduced by relaxation, but claim it is only [[pseudomyopia]].<ref>{{cite book | author=Klaus Schmid | title=Myopia Manual | publisher=Pagefree Pub Inc | year=2004 | chapter=Chapter 3: Myopia - Observations and Experimental Results | page=34-35 | url=http://books.google.com/books?id=BX2r1F-GQREC&printsec=frontcover&source=gbs_summary_r&cad=0#PPA34,M1}}</ref> Also, as noted [[#Flashing|above]], the "clear flashes" often spoken of by Bates enthusiasts<ref name="Marg"/> are sometimes explained by skeptics as a [[contact lens]]-like effect of moisture on the eye.<ref name="Balliet"/> It is further suggested that one who stops wearing glasses will in time become better able to interpret the blur and recognize familiar objects, which could lead to the erroneous conclusion that the sight itself has improved.<ref name="AAO"/><ref name=Rosenfield>{{cite journal | title=Blur Adaptation in Myopes | year=2004 | author=MARK ROSENFIELD, SUSAN E. HONG and SINI GEORGE | url=http://www.optvissci.com/pt/re/ovs/fulltext.00006324-200409000-00009.htm | volume=81 | issue=9 | pages=657–662 | journal=Optometry And Vision Science | doi=10.1097/01.opx.0000144743.34976.da}}</ref>
===The case of Huxley===
Perhaps the most famous individual to claim successful results with the Bates method was the British writer [[Aldous Huxley]]. At the age of sixteen Huxley had an attack of ''[[keratitis]] punctata'', 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 [[cornea]]s, complicated by [[hyperopia]] and [[astigmatism]]. He was able to read provided he dilated his better pupil with [[atropine]] and used glasses.<ref name=Art>{{cite book |title= [[The Art of Seeing]]|last=Huxley |first=Aldous |authorlink= Aldous Huxley|year=1942 |publisher=Macmillan}}</ref>
In 1939, at the age of 45, his eyesight began to deteriorate, and he sought the help of [[Margaret Corbett]], a "Bates Practitioner" who had trained with Dr. Bates.<ref name=Marg/> Three years later he wrote: ''"At the present time, my vision, though very far from normal, is about twice as good as it used to be."''<ref name=Art/>
His case attracted wide publicity. Ophthalmologist Walter B. Lancaster commented:<blockquote>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.<ref name=Marg/></blockquote>
If his ability to see had actually improved, it remained imperfect and variable. Ten years later, in 1952, [[Bennett Cerf]] was reportedly present when Huxley spoke at a Hollywood banquet, wearing no glasses and apparently reading his paper from the lectern without difficulty. According to Cerf:
<blockquote>"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."<ref name="Gardner"/></blockquote>
This incident may exemplify Huxley’s own words in ''[[The Art of Seeing]]'':<blockquote>"The most characteristic fact about the functioning of the total organism, or any part of the organism, is that it is not constant, but highly variable. ... People with unimpaired eyes and good habits of using them possess, so to speak, a wide margin of visual safety. Even when their seeing organs are functioning badly, they still see well enough for most practical purposes. Consequently they are not so acutely conscious of variations in visual functioning as are those with bad seeing habits and impaired eyes. These last have little or no margin of safety; consequently any diminution in seeing power produces noticeable and often distressing results.”<ref name=Art/></blockquote>
==General Criticisms==
The purported benefits of Bates' techniques are generally [[anecdotal evidence|anecdotal]], and their claimed effectiveness in improving eyesight has not been substantiated by medical research.<ref name="Marg"/> The medical community is often critical of the Bates method due to a lack of evidence-based support.<ref name="pollack"/>
=== Avoidance of conventional treatment ===
Critics warn that faith in the Bates method could deter people with eye conditions requiring prompt care from seeking necessary medical treatment.<ref name="Gardner"/><ref name="pollack"/> Bates method teachers often issue a disclaimer stating that the information and instruction they provide is "for educational purposes only", explaining that they are not eye doctors and cannot diagnose or medically treat any specific eye problem.<ref>{{cite web | last = van der Werf | first = Esther | title = Visions of Joy Disclaimer | url=http://www.visionsofjoy.org/disclaimer.htm | accessdate = 2008-07-16 }}</ref><ref>{{cite web | last = Marsh | first= Greg | title = Vision Improvement Center: Waiver and Disclaimer | url=http://visionimprovementcenter.com/disclaimer.htm | accessdate = 2008-07-16 }}</ref>
== Further reading ==
*{{cite book|title=[[Wikisource:Perfect Sight Without Glasses|The Cure of Imperfect Sight by Treatment Without Glasses]]|first=William Horatio |last=Bates|year=1920|publisher=Central Fixation Publishing Co}}
*[http://en.wikisource.org/wiki/Better_Eyesight_Magazine ''Better Eyesight'' magazine published by Bates (from 1919 to 1930)]
*[http://www.quackwatch.com/01QuackeryRelatedTopics/eyequack.html ''Eye-Related Quackery''], from [[Quackwatch]]
*[http://brain.berkeley.edu/pub/1952%20April%20Flashes%20of%20Clear%20Vision.pdf ''"Flashes" of clear vision and negative accommodation with reference to the Bates Method of visual training''] by Elwin Marg
==See also==
* [[The Art of Seeing]]
* [[Eye examination]]
* [[Eyeglass prescription]]
* [[Matthew Luckiesh]]
* [[See Clearly Method]]
* [[Pseudomyopia]]
* [[Eye exercises]]
==References==
{{reflist|2}}
[[Category:Alternative medicine]]
[[Category:Ophthalmology]]
[[Category:Optometry]]
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[[he:שיטת בייטס]]
[[hu:Bates-módszer]]
[[nl:Batesmethode]]