CHAPTER IX
EYESTRAIN
IN THIS chapter we will leave the field of the technical specialist, and come out among facts that ire familiar to people of general intelligence. I hope the reader will deliberately put aside for the moment the vague, thoughtless attitude of mind which is so common on this subject. I ask that the reader remember eyes as they were a few years ago, when most plain people did not think of wearing glasses. It is worth while to let the mind dwell on the fact that, among those we see around us today, the majority live unconscious of their eyes, because they never have any trouble with them. It will make it easier to grasp the meaning of the facts, if one will ponder the description of the man with the three story intellect, which is quoted from Dr. Oliver Wendell Holmes in the August, 1936, Readers Digest, and let a little illumination come in, right through the skylight, and light up the imagination.
A specialist of high standing, at an annual convention of ophthalmologists, made a very interesting official speech. In that speech he declared that the word eyestrain' is a great asset to eye specialists. He went on to say that to the patient it has a definite and satisfying meaning, but to the doctor employing it, the word—strain", applied to the eye or any part of the eye, is almost, if not quite, meaningless, so that by its use he does not really commit himself in any way.
Coming from an eye specialist that is a remarkable declaration. Such a statement might easily be misunderstood. Certainly it could not be considered scientific. It is not a fair accusation against the men who specialize in the treatment of the eye, and who are constantly offering that explanation to their patients, as the speaker himself pointed out.
This speaker explained also that a knowledge of psychology is useful to the ophthalmologist in many ways, both in the making of a diagnosis and in the making of an explanation to the patient.
That statement is also interesting, and could form the basis for profitable discussion. If psychology is so important in the diagnosis of the condition, and also of such importance in explaining the condition to the patient, why is it that psychology is allowed no part in the treatment of the abnormal condition the physician finds affecting the eyes of the patient?
The same speaker further gave it as his opinion that the importance of errors of refraction has been, and still is, greatly exaggerated by ophthalmologists. He even pointed out that the opinions of ophthalmologists themselves are responsible for the prevalent belief that incorrectly fitted glasses are a menace to the integrity of the eyes.
That incorrectly fitted glasses are often prescribed for patients is a claim constantly found in articles written by specialists on the eye. They mean that the doctor, or optometrist who fitted them made a faulty computation in estimating the degree of refraction that would suit the defect in the eye. Because such glasses would make functioning even harder for the eye which is already having difficulty in seeing, the ophthalmologists believe that glasses which do not suit those eyes are likely to damage them. The speaker seemed to assert that such a statement is not true.
In a small booklet, one of a series of popular health instructions written by recognized medical specialists, an ophthalmologist makes a very different comment on the affection called eyestrain. He describes the condition as one causing suffering, and claims that other numerous reflex disturbances arise from it. He emphasises, as an established fact, that the great relief which correctly fitted glasses give to those suffering from eyestrain, and from the numerous reflex disturbances that arise from it, is a matter of daily experience in the work of ophthalmologists. It is his opinion that eyes suffering from eyestrain are physically unfitted for their work, and that properly fitted lenses are the only corrective measure.
One might wonder what would be the outcome of a debate between these two men who are medical specialists in the same field. They express what are apparently two different and contradictory views upon a fundamental principle in their profession. It is probable that between them they each would neutralize the others contentions. Such a solution is often the result when two opinions meet that are at the extreme opposite ends of any subject upon which there is such a wide difference of opinion.
In a book which has perhaps the highest rating as a standard text-book of ophthalmology, the word "asthenopia" is defined as a sense of strain and weariness in the eyes and head, incurred by the use of the eyes. The patient feels that the eyes give out. This may be accompanied by actual pain in the eyes and in the head, and even in various parts of the body, by irritation, redness, or burning of the eyes and lids. In some eases there may be muscular spasms, digestive disturbances, nausea, and interference with general nutrition. The condition, as is explained in the book, may be caused by refractive errors; or the symptoms may be caused by abnormal functioning of the muscles of the eye; or by some specific nervous condition, as neurasthenia, or hysteria; or by unsuitable light; or produced by morbid conditions of other organs, for example, the nose and teeth. Or again, these symptoms may be produced by attendance at a theatre, or a game, in shopping, motoring, train riding, or walking on a street—so occasioned by moving objects. As other symptoms of which the patient may complain, the book mentions blurred vision, which may be temporary or permanent. The object seen may be blurred, or several objects seen, where there is only one. Print may run together and separate again. There may be great inequality of vision in the two eyes. There may be flashes of light, or floating specks before the eyes.
We are told in that article in the text book that asthenopia is the most common of all eye symptoms, and the one that is most readily relieved by proper treatment, which treatment, it is stated, consists essentially in the removal of the cause.
Upon the substance of that accepted statement in the text book, the system of Dr. Bates is founded. The symptoms described in that text book are those which Dr. Bates constantly discussed. His explanation also is that those symptoms are to be relieved by removing the cause.
In the text book some specific conditions in the system are tamed as the causes, as, for instance, nasal or teeth conditions, or some plain and definite conditions of the general nervous system. The meaning is that these other conditions of the system, through an abnormal nervous reaction, produce the disturbances in the conduct of the eyes. No doubt that is often true. But in many cases, if not in most cases, of abnormal visual function, no other abnormal condition in the system is apparent. Most of those patients who are told by the ophthalmologists that their disturbed vision is due to eyestrain are otherwise in apparently good health.
It is explained in the text-book that the symptoms, the sense of strain and weariness, and so forth, set up by the use of the eyes, may be caused by the errors of refraction, or by abnormal functioning of the muscles of the eye. But both of those abnormal conditions are themselves caused by abnormal nerve reflexes. They are themselves symptoms caused by an abnormal condition. They are absolutely nerve-controlled muscle functions.
The specific contention of Dr. Bates is that these different kinds of abnormal vision, including the described sense of strain and weariness, and the abnormal functioning of the eye muscles and the consequent errors of refraction, are all and several caused primarily by an abnormal condition of unnatural tension in the central nerve control of the brain.
This claim furnishes a reasonable and a satisfactory explanation for all the various aspects and considerations involved in this question. This vital problem has been discussed and disputed as long as the mechanism of the eye has been investigated. That it is still being discussed and disputed, is well illustrated by the opposing views held by ophthalmologists of today, as already quoted.
When a camera film receives a picture which is "out of focus", the rays of light were so directed that they did not meet properly on the film. There was an error in refraction. This was done by the brain of the camera—that is, by the hand of the photographer.
The human eye is not as simple as the camera, but its muscles and its consequent refraction are likewise dominated by a force which determines exactly what those muscles will do. We do not blame the camera when the lens is placed at the wrong spot on the slide. When the eye muscles function so that the rays are improperly refracted, the muscles are not at fault. The impulse that was produced through the current in the nerve gave the muscles a wrong command.
Sometimes such an order simply makes the muscles fix a wrong focus. The difficulty then is that the rays do not meet where they should, and a clear image cannot be perceived. Many who are nearsighted, or farsighted, or astigmatic, have no discomfort. Often, however, there are different kinds of sensations with vision, and there may be pain present even when the power to see is at the same time very good. These different symptoms are caused by varying abnormal impulses from the nerve centers of the brain.
What is called eyestrain, or asthenopia, is the same kind of a condition as the various abnormal conditions of the nervous system, which physicians refer to as nerve tension. We all have experienced some kind of a feeling which could be described as tense. Perhaps a feeling of straining in the mind, or perhaps an actual fixed tension of the muscles of the body.
It is very easy to produce such a condition in the eyes by a deliberate effort. If we do this with a strong enough will it is possible with normal eyes to produce blurring and an indistinctness of objects, and even to develop severe pain.
Thus far it is quite simple. No one knows what tension is, or what relaxation is, or what sleep is. But we all have experienced these different feelings. We all understand that tense muscles do not box well, or play tennis well; and this helps us to realize that when eye muscles behave likewise, they have the same success in refracting rays of light as the muscles of a tennis player have when his mind is in a state of "jitters". just as tennis players have their goad days and bad days, have brilliant plays and wretched flunks, so the work of the eye varies, too. A nervous, uneven, unreliable athlete can be relaxed and developed into a fine, consistent performer. Even more so, an eye which is poor and unreliable, only because there is an abnormal tension in the visual center in the brain, will function with a new power when the controlling mechanism in the brain has recovered a condition of normal relaxation.
It is difficult to describe a condition which is recognized only as an experience. But it is possible to discuss its presence, and to consider results that are apparently caused by its influence. The offices of specialists in the diseases and dysfunctions of the nervous system are not filled with patients suffering from organic conditions with structure changes. The majority of those they are treating are afflicted with many varieties of abnormal sensations and functions for which no cause can be found except an unusual conduct of the central control of the nerves of the body. As examples, consider those who suffer from nervous indigestion, insomnia, neuralgia, nerve-tire, spasmodic contractions of various muscles, extreme irritability and even remarkable mental attitudes. The majority of those who are wearing artificial lenses are simply examples of the same type of dysfunction, affecting the visual center and disturbing the normal function of the eyes. Their variable symptoms, changeable conduct, sensitiveness to environment, unaccountable occurrence, and frequent spontaneous disappearance, all classify them as only one, and perhaps the most frequent, of the conditions commonly spoken of as nervous disturbances.
When one considers the extremely complicated mechanism of vision, its uninterrupted ceaseless functioning, the very different and constantly changing environment and diversity of its work, one wonders, not that it so often falters, but that the visual center resists so well, and fails so seldom to sustain a perfect equilibrium. This consideration is surely most typically exemplified under the stress the human eye has to meet in the environment of those who live in the places where the multitude of wearers of artificial lenses is found. We know very little about the astigmatism and errors of refraction of those who do not live convenient to the office of the eye specialist. But it is not hard to realize that the great mass of the population of the globe seems to have no difficulty with its eyes. This is true of the uncivilized man, whose life constantly depends upon good vision; and it is true of the civilized man who must have good normal sight for figures, or print, or operating machines, or fine detail discrimination. It is easy to accumulate incidents which apparently support this conception of a tension in the visual center as being the cause of eyestrain. It is just as easy to support the claim that it is possible, in a simple manner to relieve the strain, so that the eyes will again function in a normal manner.
Examining twelve hundred scholars in a large school, Dr. Bates demonstrated normal vision in a boy who was known to be quite nearsighted. The doctor's explanation that he read the ten-foot line at ten feet meant nothing to his teacher, because she knew he had not been able to read the words on the blackboard, nor the figures on the face of the clock. But when the boy presently succeeded in reading the clock and reading whatever she wrote on the board, she was astonished to see such a change in one minute, and she was interested enough to ask for a Snellen Chart to hang in the school room. The change in the power of the boy's vision was accomplished by the influence Dr. Bates had been able to exert upon the tension in the boy's mind. The tension was an abnormal reaction, produced by some stress consequent upon difficulties the boy found in his work. The presence of a new personality, impressing his mind with encouraging information, changed the attitude of apprehension, and permitted the normal function to return. Such mental reactions are seen constantly in children. Why should it seem unreasonable to have them occur where the eyes are concerned?
In my own work, a similar case was a boy of nine whose parents had been told by an optometrist that the reason he had constantly poor vision as well as pain, was because his eyes had not developed, and he was nearly blind. That diagnosis by an optometrist seemed so serious that they took him to a certain eye specialist in San Francisco, and he agreed with the diagnosis of the optometrist. Some weeks later, when I first saw the boy, he read without glasses, at a ten-foot distance, the forty-foot line on the Snellen Chart. This demonstrated that the diagnosis was certainly wrong. His vision was not even very poor, and there was no warrant for the claim that his eyes were undeveloped. He had nearsighted eyes with astigmatism. Having relieved the distress of his mothers mind by this proof that his eyes were not undeveloped, I directed a system of daily practices for the purpose of relaxing the tension which was so seriously disturbing the functions of the muscles of his eyes. The condition was relieved so rapidly that in ten days he was reading, at ten feet, the ten-foot line. He kept on improving and has had fine normal vision ever since. His mother was a great help by interesting his mind constantly in the Bates method of practicing relaxation.
A boy who stuttered was brought to me, and he stuttered badly when we began to talk to each other. I could see he was quite embarrassed by the evident annoyance of his parents. When I found that he was the best basket-ball player in the school, I told him some stories of the days when I played center, many years before he was born, and told him why and how the Y. M. C. A. started the game. It was most gratifying to listen to him talk and question, with flashing eyes, for fifteen minutes, and never a stutter. When presently I asked him why he stuttered when he played basket-ball, he replied, in an astonished voice and without a falter, "I never stutter when I play basket-ball." And I answered, "I knew you didn't," and told him why I knew it. He began right there to shed the tension that had hampered his speech, and his greatest help was to think of his basket-hall game. It was exactly the same mental process which relieved the tension that caused the astigmatism in the case of the younger boy with the defective vision.
A man of forty-two came to me with the explanation that he had had better than average eyes until he was thirty-five. During seven years he had tried three specialists. They agreed that his condition was a compound astigmatism caused by eyestrain, and that nothing could be done but continue to try new lenses. When he came to me he was quite concerned about his condition. I agreed that eyestrain was the cause of the trouble, and he was apparently quite disappointed. But when I followed with the remark, that this itself was really caused by a mental tension, he was surprised and then amused. He said he had nothing to worry about; that everything with him was "hunkydory." He couldn't believe his brain had anything to do with it, and could hardly get the distinction between worry and mental tension. When I asked him what it could be that worried the children who are being suddenly fitted with glasses for the remainder of their lives, because they have eyestrain only, he began to see the light. He was so much concerned about the discouraging condition of his eyes, and so much interested in the entirely different kind of treatment proposed, that he kept the subject in mind all day long, and he reserved three or four hours a day for the practice that was directed. In a few days he had personal evidence of the truth of the explanation he had been given, and in a few weeks his eyes were in a normal condition, with too unpleasant symptoms. He was seeing without glasses, and was quite well pleased with his success.
A young woman of twenty was brought to me by the young man she was engaged to marry, and gave a most interesting history. She was working in a home where there were three young children. Both the parents had been employed for years, leaving the children largely to the care of the young woman.
Some weeks previously a strange trouble had disturbed the vision of her left eye, and had gradually grown worse. I found that she had normal vision with the right eye, and could see just as well with the left eye the letters on the right hand end of the top five lines on the Snellen Chart. But she could not see with the left eye, any of the letters to the left of the last letter on any line, although she could see the large two-hundred-foot letter in the middle of the card at the top. There was no abnormal sensation in either eye, but there were increasing recurrences of vague, unpleasant sensations in her head.
She had gone to an optometrist to learn if glasses would relieve the difficulty, but he had refused to consider lenses, and had urged her to consult an ophthalmologist, explaining that the condition was serious.
The couple agreed to return to my office in the evening, when there would be quiet and time for deliberate inquiry. By careful questioning it was developed that the mother of the children was agreeable enough to contact, but the father was a peculiar type who encouraged and seemed to enjoy open insubordination on the part of the children to the girl's management while he was present. He would then comment cynically, in their presence, upon her handling of the situation. She was an earnest and evidently capable girl, and was very anxious not to lose the position during the next few summer months. There was no apparent abnormal condition of health. The ophthalmoscope showed no apparent abnormality in the left eye.
Having explained that I believed the condition of her eye was caused entirely by a mental tension, and given some of the reasons which seemed to warrant such a diagnosis, I began an effort to correct the fault. Seating the patient comfortably, I turned out the lights, and for half an hour we three remained in quiet darkness while I endeavored with suitable conversation to impress on her mind such ideas as I felt would influence her own train of thought and produce a condition of mental relaxation to displace the abnormal strained condition of tension.
When I then turned on a strong reflected light, which left the room in darkness except the Snellen Test Chart ten feet from her left eye, with a patch covering the good right eye, and helped her with some encouraging directions, she soon was able to read all the letters on all the lines of the card. The condition which had been developing for some weeks was relieved in one hour, and was a fine demonstration of the usefulness of the method of Dr. Bates in curing imperfect sight by relieving the tension which controls the whole mechanism of the perception of visible objects.
Temporary errors of refraction caused by straining to see are certainly quite common, and are dysfunctions resulting from some temporary condition of the mind. It would be easy to recall illustrations of this. For instance, the well-known classroom experiment with students in psychology, where they are warned to use their eyes well when an incident is suddenly introduced a few moments later. Perhaps a young man, or a young women coming suddenly into the room, goes through a series of startling movements and disappears in some unique way. Generally, no one out of a number of students will see the incident precisely as any other student sees it. Frequently some of them report the same incident differing from any other account, and there will be several divergent statements.
It is a common experience in a court room to have several disinterested and sincere witnesses leave out, or contradict, details which were easily and plainly visible to other witnesses. If it is contended that some of these illustrations are not proved errors of refraction, the answer is: first, we do not know whether they are or not; and further, the fault is in the mechanism of sight perception, and it proves a defective functioning by some eyes which would not have occurred under ordinary conditions of deliberate observation. It is not unusual for a spectator at a football game to miss entirely a movement that was plainly seen by others on the same spot, although the one who missed it had just as good, or even better, eyesight than the others. Some patients report such imperfect perceptions as recurrent experiences, and can even designate certain circumstances under which they will occur.
In those cases where there is fixed and constant error of refraction, the common experience is that a condition of abnormal sight begins imperceptibly, without any cause or influence or sensations of which the patient is conscious, and develops to a degree which necessitates relief.
In children, an unconscious tension is often developed by the false, and almost worthless, methods of driving young minds as operators in a line of piece-work machinery are driven to keep the pace mechanically set by the machine. That experience commonly stultifies the other faculties of the workers; and, of course, similar treatment has the same effect on the children, and in some of them it originates the unconscious urge which makes the mental tension that reacts against their eyes. There are mental tensions developed in some children even before they go to school. Possibly there is some inherent nervous tendency. In one case under my observation it was obviously a thoughtless mother who "got on the child's nerves." When adults ask me how and why it happened that some unconscious strain came into their mind and gave them chronic poor eyes, I answer that it is not necessary to know the cause of the tension. The evidence of it is enough. No thoughtful person questions the common occurrence of some kind of a mental tension. It is reasonable enough to accept this specific and only tangible and positive cause that has ever been given as the background of these cases.
The real question is whether or not the patient is interested in a simple and practicable course of effort to secure the priceless faculty of a pair of fine, happy eyes with which to go on through life.
When one is told that there is no apparent change in the structure of the eye, but that it simply does not work properly now, and the cause of the dysfunction is eyestrain, and there is no further explanation available, one is left with the natural and simple question in his mind: Can this condition be cured, and if so, what must I do to regain a pair of ordinary good eyes that will remain normal and see things the way the eyes of other people around me are seeing?
The answer, the same as the answer given by the nerve specialist in other similar conditions, is that the details of treatment in different cases are as varied as the differences in the details found in each case. Certainly eyes differ in power. But it is as natural for eyes to work in a normal way as it is for lungs to inhale and exhale air.
The cause is a strain. The purpose of the Bates method of treatment is to relax the strain. The eye with normal sight never tries to see. Its function is simply to receive the rays of light. At rest, it is adjusted to all but the rays from nearby objects. To meet those it makes a simple adjustment. The light rays do the work. The adjustment is an unconscious automatic function. Any conscious urge serves to disturb and strain that function. When a tension exists unconsciously the effect is the same. To correct that fault, it is necessary, therefore, only to have that tension cease.
The method of Dr. Bates will be described. It involves essentially that the subconscious mind be interested and impressed through the medium of ideas in the conscious mind. There are many simple practices which serve to enlist the attention of the visual center in the brain by directed conduct of the eyes. These practices will be fully explained.
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