Fallacies of the Bates System

Phillip Pollack, O.D.

In "De Oculis," a medieval handbook consisting of lectures to medical students, Benevenutus Grassus of Jerusalem, foremost oculist and surgeon of the Middle Ages, described his cure for a "fog over the pupil" as follows:

For this condition, I will prescribe, for your information, a marvellous cure, the result of my experience in such cases. Take a precious stone we call sapphire. Powder it most thoroughly in a metal mortar and store it in a golden vase. Put a little into the patient's eye every day and he will soon be cured [1].

To a remarkable extent, this quotation resembles many passages in "Perfect Sight Without Glasses." Benevenutus lived in a prescientific age when objective methods of medical investigation were little known or practiced. His lectures are full of ex cathedra judgments, unsupported by the opinion or the observations of other investigators. They bristle with dogmatic claims of miraculous cures in private practice—claims that must be taken on faith, as he offers little proof or evidence beyond the authority of his reputation.

The same qualities characterize the book by Dr. Bates. As we shall show in this chapter, the few experiments he describes are demonstrably crude; he did not seem to understand how to use the retinoscope for the detection of refractive errors; his methods of treatment are not consistent with each other; he uses the trick of making rare anomalies appear typical so as to confound the claims of orthodox authorities; and he shows a bland disregard of the findings of distinguished scientists whose conclusions are opposed to his own. Like Benevenutus, he equates scientific "proof" with testimonials and case histories of successful treatments in his office.

Let us begin our analysis of the Bates system with a consideration of his theory of accommodation.

Is the crystalline lens responsible for accommodation, as orthodox eye specialists claim; or has it nothing to do with accommodation, as Dr. Bates asserted?

It is relatively easy to settle this argument by a simple experiment. If you look into a person's eyes by candlelight, you will see two tiny images of the flame caused by reflection on the cornea of each eye. There are other images, though they are not seen so easily. The one that concerns us in this discussion is formed by reflection at the front surface of the natural lens.

As far back as 1837, a surgeon had observed that this image becomes smaller when a person shifts his gaze to a nearer point. This would indicate that the curvature of the lens must have changed, for it is a well-known fact that the image of an object reflected in a convex mirror becomes smaller in proportion as the curvature of the mirror is increased. It is hard to see the lens image with the naked eye and it was not until the latter part of the nineteenth century, when very bright light sources were used in conjunction with special optical devices to magnify the image, that observers could see it clearly for the first time. Careful investigations by Helmholtz, Tscherning, and Gullstrand (among others) confirmed the fact that the lens bulges forward when the eye accommodates, as shown by changes in the size of the image.

In 1940, the images were photographed clearly for the first time. It was then possible to make measurements of the changes in size of the image when the eyes accommodated, on the photographic record. Finally, in 1955, Wulfeck successfully photographed the image with infrared rays [2].

Figure 1 shows photographs taken by J. W. Wulfeck by this method. He used two light sources instead of one. Note that when the eye accommodates, not only are the images smaller but also they are closer together—which is another consequence of the increase in curvature of the lens.

The Bates theory of accommodation collapses on other grounds. It would be theoretically impossible for the extrinsic muscles to alter the structure of the eyeball so as to meet the requirements of accommodation. The outside, white coat of the eyeball (the sclera) is not resilient and elastic, as shown by tests in the laboratory. Furthermore, when pressure inside an eye is increased by more than 500 per cent, the volume of the eyeball hardly changes, as shown by measurements (the increase is only 0.007 per cent of the original volume). This proves that the sclera does not yield very easily to pressure. Finally, the sclera becomes even more rigid and less resilient with age, especially after the age of 40 [3].

As stated by Duke-Elder, all authorities are in agreement that the lens increases in thickness during the act of accommodation. All, that is, with the exception of Dr. Bates!

Dr. Bates told in his book how he struggled for four years to obtain a photograph of the lens image, while the eye was at rest and while it was accommodating. He succeeded at last and found that the images were the same in size—showing, as he stated, that the lens is not a factor in accommodation.

It is easy to understand why Dr. Bates failed to get the same results as those obtained by all other modern investigators. His apparatus and techniques were obviously crude. The photographs of the lens images shown in his book are so blurred that it is impossible to tell whether one image is larger than the other. Dr. Bates himself wrote that it was often "difficult or impossible" to obtain a clear image of a filament on the front surface of the lens [4].

That Dr. Bates' findings were undependable is shown by two other photographs. In the caption, Dr. Bates pointed out that the photograph of the eye accommodating shows more of the sclera (white of the eye) below the iris because of the "elongation" of the eyeball while it is accommodating. If we compare the two photographs, however, we can see the real reason. The eyeball had obviously turned up a trifle, thus exposing more of the white of the eye below the iris. This is proved by the fact that the upper margin of the pupil is much closer to the upper lid than in the other photograph!

In another experiment, Dr. Bates removed the crystalline lens in a rabbit's eye and then stimulated the oblique extrinsic muscles by means of an electric current. When he looked into the eye through a retinoscope, he reported, he detected a change in refraction, showing that contraction of the oblique muscles had caused the eye to accommodate, "as in the normal eye." He stated that a "number of ophthalmologists" had witnessed this demonstration and corroborated his finding. However, in the Winter Issue, 1949, of Sight-Saving Review, published by the National Society for the Prevention of Blindness (vol.19, p.233), Dr. Walter B. Lancaster reported that he was present when Dr. Risley, ophthalmologist from Philadelphia, examined the rabbit's eye through a retinoscope and told Dr. Bates he could detect no sign of a change of refraction. Dr. Bates looked again and said, according to Dr. Lancaster: "It isn't working today."

Throughout the book, Dr. Bates describes rare anomalies and, presenting them as typical, uses them to justify his theories. For example, it is true that, in an insignificant minority of cases, people whose lenses have been extracted because of cataracts can read small print through their distance glasses. This seems impossible since they have lost their power of accommodation and therefore should require reading glasses that are stronger than the distance pair. In studies of such cases, ophthalmologists concluded that the patients were able to do this by moving their distance glasses a trifle away from their eyes (which has the same effect as increasing the power) or by looking through the lenses obliquely, which has the same effect. In no case was there evidence of true accommodation [5].

Characteristically, while Dr. Bates referred to such cases as being in a "minority," this did not prevent him from writing in a later paragraph that the phenomenon occurs "often" and with "many people"—and offering it as evidence that the lens has nothing to do with accommodation in normal eyes!

Dr. Bates used the same trick of making the rare appear typical, in his discussion of the effects of atropine. This drug paralyzes the ciliary muscle and therefore the accommodation, so that a person cannot read without reading glasses until the effect of the "drops" wears off. Dr. Bates, however, cited cases reported in medical journals in which accommodation remained active in spite of the drug. Dr. Bates wrote that the evidence against the orthodox theory of accommodation in cases like these is "overwhelming." Apparently, he forgot that, only a few pages previously, he had stated that in "about nine cases out of ten," the effects of atropine agree with the orthodox theory of accommodation. In other words, In only one out of ten cases do the results support his theory. Yet he calls this "overwhelming" evidence! There is nothing mysterious about the failure of a single dose of atropine to paralyze the accommodation in all cases. As stated in authoritative works on the eye, repeated doses of the drug are sometimes necessary.

On the basis of such "science" was the Bates movement built.

The Bates theory of accommodation is not only fallacious; it is not even a new theory-as claimed by his supporters. The idea that the eyeball elongates when it accommodates was held by Sturm, Listing, and other scientists in the early nineteenth century. They abandoned it, however, when studies of the lens image proved beyond a shadow of a doubt that accommodation is produced by changes in the curvature of the lens. Dr. Bates is regarded as a discoverer of new truths by his disciples [6]. Yet all he did was to resuscitate a discredited, early-nineteenth-century theory, moving not forward to the future but backward to the past.

Dr. Bates' interpretations of his findings are not always consistent throughout the book. During most of it, he seems to base his system of treatment on his theory of accommodation; but when he discusses "wrong thoughts" as the cause of nearsightedness and farsightedness, the argument shifts. It is not the extrinsic muscles in this case that are responsible for the refractive errors, but disturbances in the circulation of the blood! Nor do these muscles seem to enter the picture when it comes to staring—which produces poor vision, according to Dr. Bates, because the eyes are used to continual movement and staring causes a loss of vision in the macula.

Let us consider the latter explanation for a moment. If there is loss of vision in the macula, the most sensitive spot on the retina, this is a serious matter. It means that there is inflammation, degeneration of the macula, or atrophy of part of the optic nerve that connects the eyeball to the brain. The statement that such a pathological condition can be created by staring is another link that connects "Perfect Sight With-out Glasses" with "De Oculis."

Not a single exercise in the Bates system has any value whatsoever as far as reducing refractive errors is concerned. Take "palming." According to Dr. Bates, when you close your eyes and palm them, you see a perfect black if your eyes are normal, and gray shapes or colors if you are farsighted or nearsighted.

The truth is: nobody, whether his eyes are normal or otherwise, can see a perfect black when his eyes are closed. As stated by Duke-Elder, even a healthy eye is never free from luminous sensations under these conditions. What one sees is a slightly luminous field that is neither black nor white but a "subdued 'mean gray.'" Besides, there are fluctuations between darker and lighter tones, the changes corresponding to the respiratory rhythm [7]. There may be spots or ribbons of light, or floating luminous clouds. This is all due to the intrinsic light of the retina"—caused, according to scientists, either by mechanical pressure of the blood against certain cells of the retina, or by other factors. It has no possible relationship with nearsightedness or farsightedness.

One of the strangest things in this strange book is Dr. Bates' methods of determining whether or not a person's vision is normal. He can tell by merely looking at him or at his photograph! If a person is staring or squinting a little, he is ipso facto myopic at that particular moment. Captions beneath photographs in his book of primitive people refer to individuals in the group who have "temporarily imperfect sight" or are "probably myopic." It need hardly be pointed out that a person with normal vision may also stare or squint as well as a nearsighted person. Only a careful, scientific eye examination can reveal whether eyes are normal or not.

On other occasions, however, Dr. Bates seems to be more scientific, and bases his findings on the retinoscope. Unfortunately, his method of using this valuable instrument (which determines objectively whether a person is nearsighted or farsighted) is as bizarre as his other methods. The retinoscope is simply a piece of plane mirror with a peephole in the center, and a handle. The examiner reflects light from it into the interior of the patient's eye, which is fixed at a distant point. Watching behind the peephole, he sees the area of the pupil illuminated by an orange glow. By wiggling the mirror slightly, he may perceive a shadow moving across the area, either in the same direction as the movement of the mirror or in the opposite direction, depending on whether the eye is farsighted or nearsighted. For the best results, the examiner must be either 25 or 40 inches away from the patient.

Dr. Bates claimed that, when the examiner is so close, the patient is rendered nervous, and this, according to his theory, is enough to make him nearsighted or farsighted. Hence, he taught that the examiner should be six feet or more away from the patient. It is a simple fact, easily verified, that at this distance it is difficult, if not impossible, to perform accurate retinoscopy because the pupillary area seen is markedly reduced and the shadow is barely perceptible. It is difficult enough even at the usual distance to see the shadow clearly in many cases, especially when the pupils are small and the patient is old. One can only marvel at Dr. Bates' dogmatism regarding his findings under these conditions!

There is another, more serious criticism. When performing retinoscopy, it is important that the examiner make sure that the eye of the patient is fixed steadily on a distant point; otherwise the findings will be false. For example, if the patient is farsighted and he looks at a nearer object while being examined, the shadow will indicate nearsightedness instead. Was Dr. Bates careful to see that his patient's eye was fixed steadily at a distant point? He tells us that he used the retinoscope when the subjects were stationary and in motion; while they were sleeping and even under ether or chloroform; when the eyes were "partly closed"; when the pupil was contracted to a "pinpoint" by a drug; when the eyes were "oscillating" from side to side; and that he had examined the eyes of thousands of animals, including cats and dogs, with a retinoscope. These statements are a measure of the dependability of Dr. Bates' scientific research methods. It is impossible to get a reliable "shadow" when the pupil is as small as a pinpoint. There is obviously no shadow at all when the patient is asleep—unless he sleeps with his eyes open. Nor can the doctor get other than fluctuating findings when the eyes of the patient are oscillating; and how can he ask a chloroformed patient to keep looking at a distant spot? How can he ask it of a dog or a cat and then make sure the animal does not shift his gaze?

The reader may now begin to understand how it was that Dr. Bates obtained his weird findings. Take the case of the girl with normal vision who suddenly became nearsighted, according to the retinoscope, when she told a lie. What probably happened was that she shifted her gaze to a near point, unknown to the doctor, while he was reflecting the light into her eye. Apparently, since Dr. Bates used the retinoscope on oscillating eyes, it did not matter to him whether or not the patient shifted his eyes during the examination. That would explain the rapidly changing refractive findings he found in so many cases-fluctuations that were due, not to tension or emotions, as he claimed, but simply to the fact that he did not use the retinoscope properly!

The daily and cumulative experience of eye specialists everywhere contradicts Dr. Bates' claim that refractive errors change from day to day and even from minute to minute. Glasses rarely have to be changed oftener than from one to two or even three years, depending on the age of the patient and other factors. In all but a tiny minority of cases, the emotional state of a patient has no effect on the nature or the degree of the refractive error, which depends chiefly on the structure of the eyeball. Eye specialists frequently tell their patients reporting for re-examination after a lapse of one or two years that their glasses are still correct and require no changing. Yet, since seeing the doctor last, the patient may have told innumerable lies; staggered through more than one emotional crisis; or gone through bankruptcy or divorce. To experienced eye specialists, Dr. Bates' claim that eye defects are ephemeral by-products of strain is utterly fantastic. Many people whose eyes need strong glasses are normal and adjusted, while others who do not need glasses are tense and neurotic.

This is not to deny that emotional shock or strain can cause serious disturbances in vision. In some cases, temporary blindness may result (hysterical amblyopia), or the patient may complain of blind spots in his field of vision. Fear and tension have been known to afflict soldiers on combat duty with night blindness so that they see poorly under twilight conditions.

These disturbances, however, have nothing to do with refractive errors. The reader should keep this distinction firmly in mind. During such attacks, a person does not become nearsighted, as Dr. Bates claimed; his loss of vision is not refractive, but results from disturbances in the brain and the sympathetic nervous system.

On the other hand, sudden changes in refraction may be caused by disease or the use of drugs. If you have diabetes, you may have to change your glasses more than once during the year. Then again, in the initial state of cataract, the crystalline lens swells up before becoming opaque, making a normal eye temporarily nearsighted. "Transient myopia," as it is called, also may be caused by high altitude, drugs, or a spasm of the ciliary muscle. None of these effects disproves the orthodox theory of accommodation; on the contrary, they support it.

As to staring into the sun, an important part of the Bates therapy—this is positively dangerous to sight. It may cause an inflammation of the retina ("solar retinitis") resulting in permanent damage to the delicate tissue. That is why eye specialists warn the public not to watch an eclipse of the sun without using dark sunglasses. According to Dr. Paul Tower, distinguished ophthalmologist: "Even a reflecting white surface or lightning may produce permanent damage." [8] Dr. Tower reported nine cases of solar retinitis among school children within two weeks of a solar eclipse. The children suffered a permanent loss of vision to a considerable extent. Dr. Tower wrote: "Permanent reduction of vision is also observed among anti-spectacle faddists who believe they will strengthen their eyes by gazing directly into the sun."

Dr. Bates admitted in his book that organic changes may result from staring into the sun. He claimed, however, that they are temporary, and that the blind spots experienced are "mental illusions." This is dangerous nonsense. The nine children cited by Dr. Tower would receive scant comfort if they were told that their loss of vision is nothing but a mental illusion!

Equally dangerous is the Bates method of treating glaucoma. This is one of the most serious of all eye diseases. It has been called the "sneak thief of sight" because it is often difficult to detect and may destroy sight little by little. If caught in time by the ophthalmologist, treatment can prevent loss of vision; a delay of a few days in an "acute" attack may result in blindness. It has been estimated that 1,000,000 people over the age of 40 have glaucoma without knowing it. There is only one method of treating the disease, and that is the use of drugs or surgery or a combination of both. The Bates treatment is worse than useless, for, while the patient is palming and trying to see black, pressure on the optic nerve, caused by the disease, continues unabated, and the damage to sight may be irreparable. If you have glaucoma and are thinking of trying the Bates system of treatment, you should ponder the words of Dr. Glen R. Shepherd, who stated that many people with glaucoma have wasted precious time and have become blind while exercising their eyes in a vain attempt to cure the condition [9].

Consider another eye disease treated by Dr. Bates: cataract, which is an opacity of the lens that prevents light from reaching the retina, so that vision is blurred or abolished. No measures of any kind, apart from surgery—neither exercises, diathermy, medicine, nor drugs—can reduce a cataract or make it disappear. The only effective treatment is surgical extraction of the lens itself. People with cataracts, as we shall show in the next chapter, can be persuaded that they see better after treatment by the Bates method, but their "improvement" in vision is illusory.

Dr. Bates' book abounds in misstatements, some of which even an intelligent schoolboy can refute. Stars, he wrote, do not twinkle for people with normal vision; twinkling is an "optical illusion." If an astronomer had explained to Dr. Bates that the twinkling of stars is caused by heat waves radiating from the earth, would he have stared incredulously? Probably not, since he was opposed to staring.

Again, consider his statement that floating specks ("muscae volitantes") are optical illusions resulting from eyestrain. It is an incontrovertible fact that these specks are caused by translucent or opaque bodies floating in the vitreous humor of the eye and casting shadows on the retina. Far from being optical illusions, they are physical bodies that can be seen, when sufficiently large, by means of the ophthalmoscope. Dr. Bates claimed that they are illusions because he could not find them after a careful search. Perhaps the reason was that he used a "magnifying glass"—and one cannot see the deep interior of the eye with a magnifying glass.

On the same medieval-science level in his statement that glasses make a woman color-blind. This simply does not make sense, as color-blindness is an inherited defect which is unaffected by glasses. He claimed that colors appeared dull through corrective lenses, but the reverse is true. To a nearsighted person without glasses, colors are vague and dull. With glasses, the colors appear clear and brilliant, the reason being that colors as well as forms are blurred when they are not focused sharply on the macula of the retina.

As to memory and familiarity with an object, which, according to Dr. Bates, can eliminate refractive errors, all they do is enable us to interpret blurred shapes more easily. If you are not familiar with the Greek alphabet and you see a slightly blurred character that is really delta, you will not be able to guess what it is, but your familiarity with English will enable you to identify most English letters that are blurred to the same extent. This does not mean, as Dr. Bates contends, that your vision is normal for English letters and myopic for Greek letters!

It hardly seems necessary to refute any more of the misstatements in the book, such as the claim that movements of an object produce nearsightedness or farsightedness. We have said enough to indicate that the book is, in the words of Martin Gardner, "a fantastic compendium of wildly exaggerated case records, unwarranted inferences and anatomical ignorance." [10]

The claims made by Dr. Bates in advertising his book were so dubious that, on May 28, 1929, the Federal Trade Commission issued a complaint against him for advertising "falsely or misleadingly." [11]

As stated by the National Society for the Prevention of Blindness: "There is no basis in fact for extravagant claims of 'curing' such eye defects as nearsightedness, farsightedness or astigmatism (all of which are related to structural conditions) by means of eye exercises." [12]

Despite the fact that Dr. Bates' book was published over 35 years ago, in the words of Dr. Louis H. Schwartz, ophthalmologist: "Nowhere in the world has the medical profession accepted them." He added: "Many patients supposedly cured by the Bates method had later to fall back on glasses again." [13]

Dr. Sidney A. Fox, another ophthalmologist, has pointed out that nearsightedness, farsightedness and astigmatism are "static, anatomic conditions" and, as such, cannot be affected by eye exercises. He added that changes in refraction take place as a result of growing older [14].

The matter is summed up succinctly by Dr. Glen R. Shepherd, who stated that eye exercises cannot reduce or eliminate any condition caused by "structural defect of the eyeball"—hence they cannot possibly reduce or eliminate any refractive errors [15].

As we have seen, Dr. Bates attached much importance to memory. Years before his book appeared, he had published a paper in a medical journal entitled: "Memory as an Aid to Vision."

The reason for this emphasis may be found, perhaps, in the obituary that appeared in the July 11, 1931 issue of the New York Times, when Dr. Bates died. Under the subhead, "Victim, Many Years Ago, of a Strange Form of Amnesia, He Disappeared Twice," the obituary tells the strange story of how Dr. Bates had vanished seven years after graduation from the College of Physicians and Surgeons and how his wife found him later in London in a state of nervous exhaustion, with no recollection of recent events. She took him to a hotel but, after two days, he disappeared again. His wife sought him in different European countries but died without being able to locate him. Dr. Bates later reappeared in the Middle West. He started a practice in New York and married again.

A strange man—and a strange book.

References

  1. "De Oculis," by Benevenutus Grassus of Jerusalem, translated by Casey A. Wood, p.58, Stanford, Stanford University Press, 1929.
  2. "Infrared Photography of the So-Called Third Purkinje Image," by Joseph W. Wulfeck, Journal of the Optical Society of America, 45:950, November 1955.
  3. "Textbook of Ophthalmology" by W. S. Duke-Elder, Vol.1, p.744 St. Louis, Mosby, 1946.
  4. Op. cit., W. H. Bates, p. 61.
  5. "Apparent Accommodation in Aphakic Eyes," by J. W. Bettman, American Journal of Ophthalmology, June, 1950.
  6. In his book. Dr. Harold M. Peppard wrote that, until the discoveries of Dr. Bates at the beginning of this century, the eye was like a country that had not yet been discovered. (See "Sight Without Glasses." pp.4, 5, New York, Perma Books. 1955.)
  7. Op. cit., Duke-Elder, p.807.
  8. "Differential Diagnosis of Common Diseases of the Eyeground," by Paul Tower, M.D., p. 173, New York, Grune & Stratton, 1953.
  9. 'Exercises Are Not a Cure for Structural Eye Defects," by Glen R. Shepherd, M.D., Des Moines (Iowa) Tribune, September 8, 1955, p.5.
  10. "Fads & Fallacies In the Name of Science," by Martin Gardner, p. 231, Putnam, 1952.
  11. "Federal Trade Decisions," Vol. 14, p.510. The complaint was dismissed on January 13, 1931.
  12. Publication 22, National Society for the Prevention of Blindness, Inc., p.1.
  13. "Your Eyes Have Told Me," by Louis H. Schwartz, M.D., p. 106, New York, Dutton, 1945.
  14. "Your Eyes," by Sidney A. Fox, M.D., p.138, New York, Knopf, 1944.
  15. Op. cit., Glen R. Shepherd, p.5.

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This article was originally published as Chapter 3 in Dr. Pollack's book The Truth about Eye Exercises, published in 1956 by the Chilton Co of Philadelphia.

This page was posted on July 8, 2000.

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