by William H. Bates, M. D. Better Eyesight is a monthly magazine published in the period July 1919 to June 1930.
When the imagination is perfect the mind is always perfectly relaxed, and as it is impossible to relax and imagine a letter perfectly, and at the same time strain and see it imperfectly, it follows that when one imagines that one sees a letter perfectly one actually does see it, as demonstrated by the retinoscope, no matter how great an error of refraction the eye may previously have had. The sight, therefore, may often be improved very quickly by the aid of the imagination. To use this method the patient may proceed as follows:
Look at a letter at the distance at which it is seen best. Close and cover the eyes so as to exclude all the light, and remember it. Do this alternately until the memory is nearly equal to the sight. Next, after remembering the letter with the eyes closed and covered, and while still holding the mental picture of it, look at a blank surface a foot or more to the side of it, at the distance at which you wish to see it. Again close and cover the eyes and remember the letter, and on opening them look a little nearer to it. Gradually reduce the distance between the point of fixation and the letter, until able to look directly at it and imagine it as well as it is remembered with the eyes closed and covered. The letter will then be seen perfectly, and other letters in its neighborhood will come out. If unable to remember the whole letter, you may be able to imagine a black period as forming part of it. If you can do this, the letter will also be seen perfectly.
If you look at the big "C" on the Snellen test card (or any other large letter of the same size) at ten, fifteen, or twenty feet, and try to see it all alike, you may note a feeling of strain and the letter may not appear perfectly black and distinct. If you now look at only one part of the letter, and see the rest of it worse, you will note that the part seen best appears blacker than the whole letter when seen all alike, and you may also note a relief of strain. If you look at the small "c" on the bottom line of the test card, you may be able to note that it seems blacker than the big "C." If not, imagine it as forming part of the area of the big "C." If you are able to see this part blacker than the rest of the letter, the imagined letter will, of course, appear blacker also. If your sight is normal, you may now go a step further and note that when you look at one part of the small "c" this part looks blacker than the whole letter, and that it is easier to see the letter in this way than to see it all alike.
If you look at a line of the smaller letters that you can read readily, and try to see them all alike-all equally black and equally distinct in outline-you will probably find it to be impossible, and the effort will produce discomfort and, perhaps, pain. You may, however, succeed in seeing two or more of them alike. This, too, may cause much discomfort, and if continued long enough, will produce pain. If you now look at only the first letter of the line, seeing the adjoining ones worse, the strain will at once be relieved, and the letter will appear blacker and more distinct than when it was seen equally well with the others.
If your sight is normal at the near-point, you can repeat these experiments with a letter seen at this point, with the same results. A number of letters seen equally well at one time will appear less black and less distinct than a single letter seen best, and a large letter will seem less black and distinct than a small one; while it the case of both the large letter and the, several letters seen all alike, a feeling of strain may be produced in the eye. You may also be able to note that the reading of very fine print, when it can be done perfectly, is markedly restful to the eye.
The smaller the point of maximum vision, in short, the better the sight, and the less the strain upon the eye. This fact can usually be demonstrated in a few minutes by any one whose sight is not markedly imperfect; and in view of some of our educational methods, is very interesting and instructive.
Probably every man who has written a book upon the eye for the last hundred years has issued a warning against fine print in school books, and recommended particularly large print for small children. This advice has been followed so assiduously that one could probably not find a lesson book for small children anywhere printed in ordinary reading type, while alphabets are often printed in characters one and two inches high. The British Association for the Advancement of Science does not wish to see children read books at all before they are seven years old, and would conduct their education previous to that age by means of large printed wall-sheets, blackboards, pictures, and oral teaching. If they must read, however, it wants them to have 24- and 30-point type, with capitals about a quarter of an inch in height. This is carefully graded down, a size smaller each year, until at the age of twelve the children are permitted to have the same kind of type as their elders. Bijou editions of Bible, prayer-book and hymnals are forbidden, however, to children of all ages.1
In the London myope classes, which have become the model for many others of the same kind, books are eliminated entirely, and only the older children are allowed to print their lessons in one- and two-inch types?2
Yet it has just been shown that large print is a strain upon the eyes, while the retinoscope demonstrates that a strain to see at the near-point always produces hypermetropia3 (commonly but erroneously called "farsight"). We should naturally expect, therefore, to find hypermetropia very common among small children; and it is. Of children eight and a half years old in the public schools of Philadelphia, Risley found4 that more than eighty-eight per cent were hypermetropic, and similar figures may be found in all statistics of the subject. The percentage declines as the children become older, but hypermetropia, or hypermetropic astigmatism, remains at all ages the most common of all errors of refraction. Hypermetropia is, in fact, a much more serious problem than myopia, or nearsight. Yet we have heard very little about it, for the specialists have concluded, from its prevalence and its tendency to pass away or become less pronounced with the growth of the body, that it is the normal state of the immature human eye and therefore beyond the reach of preventive measures. It is true that many young children are not hypermetropic, but this fact is easily disposed of by the theory that the ciliary muscle alters the shape of the lens in such cases sufficiently to compensate for the shortness of the eyeball.
The baselessness of this theory, as well as the relation of large print to the production of hypermetropia, may be demonstrated by the fact that the condition can be relieved, and has been relieved in numerous cases, by the reading of fine print, combined with rest of the eyes. A child of eight was cured in a few visits by this means. Yet according to the British Association she should not, at this age, have been allowed to read any type larger than 12-point, with capitals more than an eighth of an inch in height. Many grown people have been cured of hypermetropia in the same way, and in all forms of functional imperfect sight the reading of fine print, when it can be done with comfort, has been found to be a benefit to the eyes. Even straining to see fine print is sometimes a benefit in myopia.
When the eye with normal vision regards a letter either at the near-point or at the distance, the letter may appear to pulsate, or move in various directions, from side to side, up and down, or obliquely. When it looks from one letter to another on the Snellen test card, or,from one side of a letter to another, not only the letters, but the whole line of letters and the whole card, may appear to move from side to side. This apparent movement is due to the shifting of the eye, and is always in a direction contrary to its movement. If one looks at the top of a letter, the letter is below the line of vision, and therefore appears to move downward. If one looks at the bottom, the letter is above the line of vision and appears to move upward. If one looks to the left of the letter, it is to the right of the line of vision and appears to move to the right. If one looks to the right, it is to the left of the line of vision and appears to move to the left.
Persons with normal vision are rarely conscious of this illusion, and may have difficulty in demonstrating it; but in every case that has come under my observation they have always become able, in a longer or shorter time, to do so. When the sight is imperfect the letters may remain stationary, or even move in the same direction as the eye.
It is impossible for the eye to fix a point longer than a fraction of a second. If it tries to do so, it begins to strain and the vision is lowered. This can readily be demonstrated by trying to hold one part of a letter for an appreciable length of time. No matter how good the sight, it will begin to blur, or even disappear, very quickly, and sometimes the effort to hold it will produce pain. In the case of a few exceptional people a point may appear to be held for a considerable length of time; the subjects themselves may think that they are holding it; but this is only because the eye shifts unconsciously, the movements being so rapid that objects seem to be seen all alike simultaneously.
The shifting of the eye with normal vision is usually not conspicuous, but by direct examination with the opthalmoscope5 it can always be demonstrated. If one eye is examined with this instrument while the other is regarding. a small area straight ahead, the eye being examined, which follows the movements of the other, is seen to move in various directions; from- side to side, up and down, in an orbit which is usually variable. If the vision is normal, these movements are extremely rapid and unaccompanied by any appearance of effort. The shifting of the eye with imperfect sight, on the contrary, is slower, its excursions are wider, and -the movements are jerky and made with apparent effort.
It can also be demonstrated that the eye is capable of shifting with a rapidity which the ophthalmoscope cannot measure. The normal eye can read fourteen letters on the bottom line of a Snellen test card, at a distance of ten or fifteen feet, in a dim light, so rapidly that they seem to be seen all at once. Yet it can be demonstrated that in order to recognize the letters under these conditions it is necessary to make about four shifts to each letter. At the near-point, even though one part of the letter is seen best, the rest may be seen well enough to be recognized; but at the distance it is impossible to recognize the letters unless one shifts from the top to the bottom and from side to side. One must also shift from one letter to another, making about seventy shifts in a fraction of a second.
A line of small letters on the Snellen test card may be less than a foot long by a quarter of an inch in height; and if it requires seventy shifts to a fraction of a second to see it apparently all at once, it must require many thousands to see an area of the size of the screen of a moving picture. with all its detail of people, animals, houses, or trees, while to see sixteen such areas to a second, as is done in viewing moving pictures, must require a rapidity of shifting that can scarcely be realized. Yet it is admitted that the present rate of taking and projecting moving pictures is too slow. The results would be more satisfactory, authorities say, if the rate were raised to twenty, twenty-two. or twenty-four a second. The human eye and mind are not only capable of this rapidity of action. and that without effort or strain, but it is only when the eye is able to shift thus rapidly ,that eye and mind are at rest, and the efficiency of both at their maximum. It is true that every motion of the eye produces an error of refraction; but when the movement is short. this is very slight, and usually the shifts are so rapid that the error does not last long enough to be detected by the retinoscope, its existence being demonstrable only by reducing the rapidity of the movements to less than four or five a second. The period during which the eye is at rest is much longer than that during which an error of refraction is produced. Hence, when the eye shifts normally no error of refraction is manifest. The more rapid the unconscious shifting of the eye, the better the vision; but if one tries to be conscious of a too rapid shift, a strain will be produced.
Perfect sight is impossible without continual shifting, and such shifting is a striking illustration of the mental control necessary for normal vision. It requires perfect mental control to think of thousands of things in a fraction of a second; and each point of fixation has to be thought of separately, because it is impossible to think of two things, or of two parts of one thing, perfectly at the same time. The eye with imperfect sight tries to accomplish the impossible by looking fixedly at one point for an appreciable length of time; that is, by staring. When it looks at a strange letter and does not see it, it keeps on looking at it in an effort to see it better. Such efforts always fail, and are an important factor in the production of imperfect sight.
One of the best methods of improving the sight, therefore, is to imitate consciously the unconscious shifting of normal vision, and to realize the apparent motion produced by such shifting. Whether one has imperfect or normal sight, conscious shifting and swinging are a great help and advantage to the eye; for not only may imperfect sight be improved in this way, but normal sight may be improved also.
Detailed instructions for improving the sight by this method will be given in my forthcoming book, The Cure of Imperfect Sight by Treatment without GlassesBy.
In nearly all cases of imperfect sight due to errors of refraction there is some object, or objects, which can be regarded with normal vision. Such objects I have called optimums. On the other hand, there are some objects which persons with normal eyes and ordinarily normal sight always see imperfectly, an error of refraction being produced when they are regarded, as demonstrated by the retinoscope. Such objects I have called pessimums. An object becomes an optimum, or a pessimum, according to the effect it produces upon the mind, and in some cases this effect is easily accounted for.
For many children their mother's face is an optimum, and the face of a stranger a pessimum. A dressmaker was always able to thread a No. 10 needle with a fine thread of silk without glasses, although she had to put on glasses to sew on buttons, because she could not see the holes. She was a teacher of dressmaking, and thought the children stupid because thev could not tell the difference between two different shades of black. She could match colors without comparing the samples. Yet she could not see a black line in a photographic copy of the Bible which was no finer than a thread of silk, and she could not remember a black period. An employee in a cooperage factory, who had been engaged for years in picking out defective barrels as they went rapidly past him on an inclined plane, was able to continue his work after his sight for most other objects had become very defective, while persons with much better sight for the Snellen test card were unable to detect the defective barrels. The familiarity of these various objects made it possible for the subjects to look at them without strain—that is, without trying to seem them. Therefore the barrels were to the cooper optimums; while the needle's eye and the colors of silk and fabrics were optimums to the dressmaker. Unfamiliar objects, on the contrary, are always pessimums.
In other cases there is no accounting for the idiosyncracy of the mind which makes one object a pessimum and another an optimum. It is also impossible to account for the fact that an object may be an optimum 1or one eye and not for the other, or an optimum at one time and at one distance and nut at others. Among these unaccountable optimums one often finds a particular letter on the Snellen test card. One patient, for instance, was able to see the letter K on the forty, fifteen and ten lines, but could see none of the other letters on these lines, although most patients would see some of them, on account of the simpilicity of their outlines, better than they would such a letter as K.
Pessimums may be as curious and unaccountable as optimums. The letter V is so simple in its outlines that many people can see it when they cannot see others on the same line. Yet some people are unable to distinguish it at any distance. although able to read other letters in the same- word, or on the same line of the Snellen test card. Some people again will not only be unable to recognize the letter V in a word. but also to read any word that contains it, the pessimum lowering their sight not only for itself but for other objects. Some letters, or objects, become pessimums only in particular situations. A letter, for instance, may be a pessimum when located at the end. or at the beginning of a line. or sentence, and not in other places. When the attention of the patient is called to the fact that a letter seen in one location ought logically to be seen equally well in others, the letter often ceases to be a pessimum in any situation.
A pessimum, like an optimum, may be lost and lard become manifest. It may vary according to the light and distance. An object which is a pessimum in a moderate light may not be so when the light is increased or diminished. A pessimum at twenty feet may not be one at two feet, or thirty feet, and an object which is a pessimum when directly regarded may be seen with normal vision in the eccentric field—that is, when not directly regarded.
For most people the Snellen test card is a pessimum. If you can see the Snellen test card with normal vision, you can see almost anything else in the world. Patients who cannot see the letters on the Snellen test card can often see other objects of the same size and at the same distance with normal sight. When letters which are seen imperfectly, or even letters which cannot be seen at all, or which the patient is not conscious of seeing, are regarded, the error of refraction is increased. The patient may regard a blank white card without any error of refraction; but if he regards the lower part of a Snellen test card, which appears to him to be just as blank as the blank card, an error of refraction can always be demonstrated, and if the visible letters of the card are covered the result is the same. The pessimum may, in short, be letters or objects which the patient is not conscious of seeing. This phenomenon is very common. When the card is seen in the eccentric field it may have the effect of lowering the vision for the point directly regarded. For instance, a patient may regard an area of green wall-paper at the distance, and see the color as well as at the near-point; but if a Snellen test card on which the letters are either seen imperfectly, or not seen at all, is placed in the neighborhood of the area being regarded, the retinoscope may indicate an error of refraction. When the visiod imnroves,the number of letters on the card which are pessimums diminishes and the number of optimums increases, until the whole card becomes an optimum.
A pessittium, like an optimum, is a manifestation of the mind. It is something associated with a strain to see, just as an optimum is something which has no such association. It is not caused by the error of refraction, but always produces an error of refraction; and when the strain has been relieved it ceases to be a pessimum and becomes an optimum.
It is not always possible for patients to go to a competent physician for relief. As the method of treating eye defects presented in this magazine is new, it may be impossible to find a physician in the neighborhood who understands it; and the patient may not be able to afford the expense of a long journey, or to take the time for treatment away from home. To such persons I wish to say that it is possible for a large number of people to be cured of defective eyesight without the aid either of a physician or of anyone else. They can cure themselves, and for this purpose it is not necessary that they should understand all that has been written in this magazine, or anywhere else. All that is necessary is to follow a few simple directions.
Place a Snellen test card on the wall at a distance of ten, fourteen, or twenty feet, and devote half a minute a day, or longer, to reading the smallest letters you can see, with each eye separately, covering the other with the palm of the hand in such a way as to avoid touching the eyeball.
Keep a record of the progress made, with the dates. The simplest way to do this is by the method used by oculists, who record the vision in the form of a fraction, with the distance at which the letter is read as the numerator and the distance at which it ought to be read as the denominator. As already explained, the figures above the lines of letters on the test card indicate the distance at which these letters should be read by persons with normal eyesight. Thus a vision of 10/200 would mean that the big C, which ought to be read at 200 feet, cannot be seen at a greater distance than ten feet. A vision of 20/10 would mean that the ten line, which the normal eye is not ordinarily expected to read at a greater distance than ten feet, is seen at double that distance. This is a standard commonly attained by.persons who have practiced my methods.
Children under twelve years who have not worn glasses are usually cured of defective eyesight by the above method in three months, six months, or a year. Adults who have never worn glasses are benefited in a very short time—a week or two—and if the trouble is not very bad, may be cured in the course of from three to six months. Children or adults who have worn glasses, however, are more difficult to relieve, and will usually have to practice the various methods of gaining relaxation which have been presented from month to month in this magazine and will be described in more detail in my forthcoming book, The Cure of Imperfect Sight by Treatment without Glarses.
It is absolutely necessary that the glasses be discarded. No half-way measures can be tolerated, if a cure is desired. Do not attempt to wear weaker glasses, and do not wear glasses for emergencies. Persons who are unable to do without glasses are not likely to be able to cure themselves.
Children and adults who have worn glasses will have to devote an hour or longer every day to practice with the test card and the balance of their time to practice on other objects. It will be well for such patients to have two test cards, one to be used at the near-point, where it can be seen best, and the other at ten or twenty feet. The patient will find it a great help to shift from the near card to the distant one, as the unconscious memory of the letters seen at the near-point helps to bring out those seen at the distance.
If the patient can secure the aid of some person with normal sight, it will be a great advantage. In fact, persons whose cases are obstinate will find it very difficult, if not impossible, to cure themselves without the aid of a teacher. The teacher, if he is to benefit the patient, must himself be able to derive benefit from the various methods recommended. If his vision is 10/10, he must be able to improve it to 20/10, or more. If he can read fine print at twelve inches, he must become able to read it at six, or at three inches. He must also have sufficient control over his visual memory to relieve and prevent pain.
Parents who wish to preserve and improve the eyesight of their children should encourage them to read the Snellen test card every day. There should, in fact, be a Snellen test card in every family; for when properly used it always prevents myopia and other errors of refraction, always improves the vision, even when this is already normal, and always benefits functional nervous troubles. Parents should improve their own eyesight to normal, so that their children may not imitate wrong methods of using the eyes and will not be subject to the influence of an atmosphere of strain.
1. Report on the Influence of School Books upon Eyesight, second revised edition, 1913.
2. Pollock: The Education of the Semi-Blind, Glasgow Med. Jour., Dec., 1915.
4. School Hygiene, in System of Diseases of the Eye, edited by Norris and Oliver, vol. II, p. 353.
5. An instrument for viewing the interior of the eye. When the optic nerve is observed with the ophthalmoloscope, movement can be noted that are not apparent when only the exterior of the eye is regarded.
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