A CASE OF MYOPIC REFRACTION RELIEVED BY EYE EDUCATION.
By W. H. BATES, M.D.,
For more than ten years the method of eye education in relieving functional disorders of vision has impressed me with its value. The following case is a type of many hundreds benefited and is described in some detail in order to illustrate the method of treatment.
An intelligent man, aged 25, was seen August 30, 1912. Right vision 1/5 normal. Has been wearing constantly for this eye—1.00 D. S.—0.50 D. C. at 180 deg., vision normal. Left vision, 2/3 normal. Wearing a plane glass for this eye.
After an ophthalmoscopical examination the patient was told that he was not near sighted and did not need glasses to improve his vision but that his eye defect was due to improper use and was curable by a little instruction in the art of seeing. To this method of treatment he agreed, followed instructions and obtained normal vision without glasses in forty minutes, which pleased him more than a prescription of glasses.
First, the right or defective eye was covered by a screen. Then the better eye, the left, was instructed in the proper methods of obtaining normal vision with the aid of a Snellen test card at 20 feet. He was told that perfect sight was only possible by regarding one letter of the distant card at a time or by regarding a small part of each letter in turn. It was important to regard one letter on a line in such a manner that the one following it appeared less distinct. This was in the beginning difficult for him to do because he said he could see all the letters of the same size on one line equally well and at the same time or simultaneously. He was convinced that he did not see with the same distinctness all the letters on one line after he tried to read them when regarding a point several feet to one side of the card. He was urged to make an effort to see clearly one letter while its neighbor appeared less distinct. In a few minutes this was accomplished. The next step required more concentration, namely, to acquire the ability to see the top of a small letter better than the bottom or to see the left side of a small letter better than the right side of the same letter. It was difficult for him to accomplish this because he had a strong tendency or inclination to attempt to see a number of letters simultaneously or to regard all parts of one letter at the same moment. He was anxious to do the proper thing and tried to understand and carry out my suggestions. He was liable to forget the directions and try something else which might occur to him. But by insisting that he try my methods instead of experimenting with his own inclinations he was soon able to say that when he regarded closely one part of a small letter the other parts of the same letter were less distinct. He was learning the proper methods of obtaining normal vision and became conscious of the methods practised by the normal eye, usually unconscious, to see properly and perfectly.
Having now learned the necessity of directing the eye accurately to distant objects in order to obtain good vision, his attention was next called to the importance of a proper focus. He was requested to hold his fore finger at ten inches from his left eye with the tip of the finger placed close to a line from the eye to the large letter on the Snellen card. When he regarded the tip of his finger closely he was unable to distinguish the distant letter at the same time. He was told that this phenomenon was one of great importance as the cause of the defective vision of the other eye, the right, was the fact that the eye was focussed for near vision when regarding distant objects. He learned that he could not see even large letters on the Snellen card at 20 feet when the better eye, the left, was focussed for the near or reading distance. Although self evident to many people he had not realized this fact before. I believe that the few minutes devoted to demonstration that the normal eye could not see distant objects clearly when focussed for near vision was an important factor in the subsequent rapid relief of the defective vision of the poorer eye, the right, by education. The demonstration was made quickly and in less time than one might expect, about five minutes. At this time it was found that the vision of the left eye had improved from vision of 2/3 to vision normal.
The left or normal eye was then covered by a screen during the time that the right was exercised. He was shown how the vision of the right eye was further lowered when the gaze was directed to one side of the distant card. When he regarded a point three feet or further to one side of the card he was unable to distinguish the large letter. The point of eccentric fixation was brought closer and closer to the card until he was convinced that he saw the letter worse when he looked only a few inches to one side instead of directly at the letter. Central fixation or the ability to direct the eye directly at one point and to hold the eye steady was difficult and was not accomplished immediately. He was surprised when told that he did not practise central fixation. When the effort was made to see a small letter unsuccessfully the eye was seen to move in various directions. I come now to a description of an original procedure which gave him complete relief in some few minutes. It has proved of such great value in so many of my cases of real and functional myopia that I feel that it should be emphasized. It has never done harm. It has always been beneficial. All oculists may disagree or oppose my facts with theories while they are unable to stop the increase of many cases of myopia even with glasses. The procedure is as follows:
He was directed to make an effort to see a small object held so close to his eye that it was impossible for him to see it clearly.
For convenience a fine point on the end of my finger nail was the visual object employed. It was held about three inches in front of his eye while he made strenuous efforts to see it, but was not successful. In a short time his vision for distance was tested and found improved. By alternately regarding the finger nail at three inches and the Snellen card at 20 feet the vision rapidly improved from vision 1/5 to the normal. The good result was obtained in less than twenty minutes. He was told that the relief was not due to suggestion, hypnotism, or to some unknown agency, but that he became able to see as he should, normally, because he had learned how to use the eye properly by education.
To prevent a relapse he was recommended to practise daily regarding small letters or small objects at a distance in such a way that he would see one part better than another part of a small letter or other small object. He was to do this with each eye separately, covering or closing the other eye. He was given a Snellen test card for exercises in distant vision.
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