Science & Pseudoscience Review in Mental Health

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Eye-Related Quackery

Authors:

Russell S. Worrall, O.D.
Jacob Nevyas, Ph.D.
- used with permission from Quackwatch

Since ancient times, many people have held the mistaken belief that poor eyesight can be cured by special eye exercises. This belief was brought to its highest state of fruition by a one-time reputable physician, William Horatio Bates, M.D., who in 1920 published The Cure of Imperfect Eyesight by Treatment Without Glasses.

In 1917, Bates teamed up with Bernarr Macfadden, a well known food faddist who published the magazine Physical Culture. Together they offered a course in the Bates System of Eye Exercises for a fee that included a subscription to the magazine. This venture met with considerable success and led many people to believe in the Bates System. However, the big impact of Bates's work materialized after publication of his book. This book attracted large numbers of charlatans, quacks, and gullible followers who then published scores of unscientific books and articles of their own on the subject of vision. Extolling the Bates System, these authors urged readers to "throw away" their glasses. Some of these writers even established schools.

Contrary to scientific fact, Bates taught that errors of refraction are due, not to the basic shape of the eyeball or the structure of the lens, but to a functional and therefore curable derangement in the action of the muscles on the outside of the eyeball. All defects in vision, he said, were caused by eyestrain and nervous tension; and perfect vision could be achieved by relaxing the eyes completely. Bates warned that eyeglasses cause the vision to deteriorate; he also deplored the use of sunglasses. Bates claimed his exercises could correct nearsightedness, farsightedness, astigmatism, and presbyopia (the inability of older people to focus their eyes on nearby objects). They could also cure such diseases as cataracts, eye infections, glaucoma, and macular degeneration. His exercises included palming (covering the eyes and attempting to see blackness) and shifting or swinging the gaze from object to object.

It should be obvious that these exercises cannot influence eyesight disorders as Bates claimed. Nearsightedness, farsightedness, astigmatism, and presbyopia result from inborn and acquired characteristics of the lens and the eyeball -- which no exercise can change. As for eye diseases, the only thing the exercises can do is delay proper medical or surgical treatment and result in permanent impairment of vision.

After Bates died in 1931, his office and teaching practices were taken over very successfully by his wife Emily with the help of Dr. Harold M. Peppard. Mrs. Bates had worked with her husband for a number of years, and Peppard was an ardent advocate of the Bates System. An edited version of Dr. Bates's book was published in 1940 as Better Eyesight Without Glasses. This version was revised several times and is still in print. Its recommendations include "sun treatment" in which the sun is permitted to shine on closed eyes and then on the sclera (white portion of the eye) while looking downward. The book states: "One cannot get too much sun treatment."

Other dubious promoters followed Bates's path. One of the best known was Gayelord Hauser, popular food faddist and Hollywood favorite, who in 1932 published Keener Sight Without Glasses. By combining eye exercise and diet theories, Hauser furthered the sale of his own dietary products.

The Bates method still has many advocates today. Some cling to traditional Bates techniques, while others use expensive computerized biofeedback machines. Their promotion is not limited to books and magazine articles but includes direct-mail campaigns with glossy brochures and toll-free numbers, pitching similar programs with new gadgets and mail-order videos. Beware of "Institutes" using well-known college towns in their names or "doctors" with dubious credentials, such as one we encountered with a degree from the "University in California" (not the University of California).

Vision Therapy

"Vision therapists" claim to strengthen eyesight through a series of exercises and the use of eyeglasses. Their training sessions may take place several times a week and amount to thousands of dollars for a series. In contrast to Bates's use of relaxation, vision therapists promote active exercises. They emphasize exercising hand-eye coordination, watching a series of blinking lights, focusing on a string of objects, and even sleeping in a certain position. Often they prescribe bifocal and prism glasses for nearsightedness. They claim that these methods can improve school and athletic performance, increase I.Q., help overcome learning disabilities, and help prevent juvenile delinquency. However, there is no scientific evidence to support these claims.

Vision therapists who refer to themselves as "developmental" or "behavioral" optometrists adhere to the belief that most vision disorders are the result of learned or environmental factors and can be corrected through training. Often they prescribe low-power glasses ("learning lenses") with bifocals to children. The initials C.O.V.D. after a practitioner's name refers to the College of Optometrists in Vision Development, which is a national organization that provides training, promotional, and referral services for its members. Another proponent group is the Optometric Extension Program (O.E.P.), which organization began as the Oklahoma Extension Program in the 1920s and has contributed greatly to advancing the optometric profession by provide practicing optometrists with postgraduate continuing education. In recent years, however, its programs have emphasized vision therapy. Even though there is no scientific evidence that vision therapy can improve academic performance, the public relations activities of these two organizations have persuaded many teachers and counselors to refer children with dyslexia to a behavioral or developmental optometrist.

Dyslexia, a term that is often misunderstood, simply refers to severe reading problems in an otherwise normal person. Because reading involves sight, teachers and parents often incorrectly assume that vision problems are the cause of reading problems. Vision and eye-coordination problems, however, are not the cause of dyslexia. Glasses will be helpful if a child has trouble focusing on words, but they are often prescribed unnecessarily. Muscle-strengthening exercises (orthoptics) may help if a mild strabismus ("crossed eyes") due to muscle imbalance interferes with focusing, but exercises to improve "coordination" are not helpful for dyslexia. Reading experts have identified many causes of dyslexia, with the majority related to the brain's ability to interpret the sound of spoken words or (rarely) to process visual information.

The preponderance of studies have found that vision-related training has no effect or even a negative effect on reading skill. For example, a study by Dr. J. David Grisham, an optometrist at the University of California, compared three groups of seventh-grade remedial reading students. One group received vision training, another was tutored in reading, and the third group played computer games. Over a ten-week period, the vision training group improved their eye-coordination skills, but all three groups progressed equally in reading.

A few years ago, a vision training program was promoted in supermarkets with "tear-off" advertisements targeted to unsuspecting parents. The practitioner, boasting that vision training is a low-cost, high-profit specialty, claims he generated close to $950,000 in new billings during the first twelve months of the supermarket campaign. There also are many self-help books aimed at people who want to improve their eyes "naturally" without glasses. Two popular ones sold at grocery checkout stands are Dr. Friedman's Vision Training Program and Lisette Scholl's Visionetics: The Holistic Way to Better Eyesight.

Other Unproved Methods

Pressing on the eyes or surrounding bones has been a perennial favorite for all manner of eye disease. John Quincy Adams once wrote a paper claiming this method could return the "convexity of youth" and eliminate the need for reading glasses. Small "eye-stones" placed under the lids were popular until the early 1900s. Chiropractors who use "craniopathy" or "neural organization technique" claim that vision and eye coordination can be improved by manipulating ("adjusting") the eyes and skull. Current devices include the "Natural Eye Normalizer" for massaging the eyelids, and a pneumatic bag for placement over the head to cure all visual problems.

The use of color to treat various ailments, including those affecting the eye, has been promoted for many years. Edwin Babbit popularized the use of colored light with his book The Principles of Light and Color: The Healing Power of Color published in 1878. Today's practice of "syntonics"- -- also called "photoretinology"- -- evolved from these theories. Its practitioners use expensive machines to direct various pulsating colored lights into the eyes, claiming to cure optical errors, eye coordination problems, and even general health problems! There is no scientific evidence to support these claims.

Another approach involving color has been popularized by Helen Irlen, a psychologist who has appeared on CBS-TV's "60 Minutes" and franchised more than two thousand individuals and clinics nationwide. She claims that "scotopic sensitivity syndrome" is a leading cause of dyslexia and other school problems, and can be remedied by treatment with colored eyeglasses. Her recommended treatment costs more than $500. As is typical with extraordinary claims, neither Irlen or her supporters offer any scientific evidence that it can improve reading or any other visual skill.

Several entrepreneurs have marketed "pyramid" or "pinhole" glasses consisting of opaque material with multiple slits or perforations. The "technology" involved has been known for centuries and was used before glass lenses were invented. Light passing through a small hole (or holes) is restricted to rays coming straight from the viewed object; these rays do not need focusing to bring them to a point. Modern promoters claim their products are better than conventional lenses. Actually, both reduce the focus effort needed to read, but pinhole glasses are much less useful because they restrict contrast, brightness, and the field of view [1]. Worn as sunglasses, they can even be harmful because the holes allow damaging ultraviolet rays to reach the eye.

In 1992, the Missouri Attorney General obtained a consent injunction and penalties totaling $20,000 against a New York company that sold "aerobic glasses." These glasses, which sold for $19.95 plus postage and handling, had black plastic lenses with tiny holes. The company's ads had falsely claimed that its "Aerobic Training Eyeglass System exercises and relaxes the eye muscles through use of scientifically designed and spaced 'pin dot' openings that change the way light enters the eye." The company had also advertised that continued wear and exercises should enable eyeglass wearers to change to weaker prescription lenses and reduce the need for bifocals or trifocals.

In 1997, the FTC obtained a consent agreement banning misleading claims optometrists were making for orthokeratology devices and "Precise Corneal Molding" ("PCM") services, which involved the use of a series of contact lenses purportedly to reshape the cornea gradually for the treatment of nearsightedness, farsightedness, and astigmatism. No such device can permanently reshape the cornea.

Stick with Proven Treatment!

There is one rational method of eye training and eye exercises -- orthoptics -- carried out under competent optometric and medical supervision to correct coordination or binocular vision problems such as "crossed eyes" and amblyopic or "lazy" eyes. If the muscles that control eye movements are out of balance, the function of one eye may be suppressed to avoid double vision. (The suppressed eye is called an "amblyopic" eye.) Covering the good eye can often stimulate the amblyopic eye to work again to provide binocular vision for the patient. Orthoptics, surgery, or a combination of the two often can improve problems in pointing and focusing the eyes due to poor eye-muscle control.

Remember: no type of eye exercise can improve a refractive error or cure any ailment within the eyeball or in any remote part of the body. If you are considering a vision training program, request a written report detailing the problem, the proposed treatment plan, an estimate of the time and costs involved, and the prognosis. If the plan is not targeted toward a specific visual problem (such as amblyopia), or if it includes a broad promise such as improving I.Q., forget about it. If you are not sure what to do, invest in a second opinion, preferably from a university-affiliated practitioner.

References

Wittenberg S. Pinhole eyewear systems: A special report. Journal of the American Optometric Association 64:112-116, 1993.


This article was adapted from The Health Robbers: A Close Look at Quackery in America. Dr. Worrall, who practices optometry in Colfax, California, is assistant clinical professor at the School of Optometry, University of California, Berkeley, and is a board member of the National Council Against Health Fraud. Dr. Nevyas, now deceased, taught biochemistry at the Pennsylvania College of Optometry and edited scientific publications.

Healthy Skepticism

By Tim Gorski, M.D., October 1992

Dr. White's "Vision Therapy"

For some time now, optometrist Leonard R. White has been advertising his "Vision Therapy Center" in Fort Worth. His newspaper ads offer "Vision Neurological Assessment & Therapy" for "Learning Disabilities, Dyslexia, Attention Deficit Disorders, and At Risk Students." The "visual skills" of convergence, accommodation, and tracking are authoritatively said to be among the "prerequisite" and "functional" abilities necessary to reading that, it is implied, are deficient in children who experience difficulties in school, say Dr. White's ads. Fortunately, we are told, Dr. White is among those who are "specialists in neuro-optometry [who] are putting the senses together (vision, auditory, tactile, proprioception and vestibular) so that the brain can indeed coordinate and integrate."

Dr. White's "vision therapy" is said to "help clients utilize all the elements of vision so that they can find success in reading." Accompanying photographs show how Dr. White's therapy works. In one, he's shown swinging a ball in front of a reclining youngster, apparently an exercise intended to improve tracking. In another, a patient is looking at a vision chart of some kind while standing on a trampoline, presumably a kind of balance training.

Dr. White also distributes material from the Optometric Extension Program Foundation, Inc. in Santa Ana, California. One of these, a brochure entitled "I Was Nearly a Dropout," is a lengthy testimonial of a young woman who "was an underachiever in school and had been most of [her] life. But, luckily, an optometrist was able to diagnose her problem "as a reaction to stress created by the use of the eyes for close work and [which], in turn, brings about an interference in the coordination of the visual system." With the institution of a "visual training course," her school grades "rose a grade point per subject and then kept on rising!" In another brochure, A.M. Skeffington, "the originator of behavioral optometry," explains "'Learning Lenses' in the Beginning School Grades." Here it is asserted that "vision is usually acquired well by the child, until the culture faces him with the printed page.... But the child cannot avoid all reading. So what may happen is a distortion of the visual system structures.... If we could live as our prehistoric ancestors did, avoiding all near tasks, there would be no problem...." It is assured as fact that "underachievers in the classroom usually have better than average standard acuity (clear sight). yet ... over 70% of this group have problems in using their vision, even though they have 20/20 eyesight or better." The solution, it is said, is to put "a convex spherical plus spectacle lens" on youngsters to "protect the child from developing eye problems' and 'ocular defects.' Without such protective lenses, 80% of children develop a measurable 'ocular' defect by grade five." Thus, it is concluded, "there is little question that every child would benefit from using learning lenses in the classroom."

Neither brochure gives citations, though Skeffington claims the support of scientific studies for his assertions. He lists 21 "For Further Reference" works, five of which are from the same Optometric Extension Program Foundation. Only one appears to be from the medical literature and of dubious relevance to the claims being made. But there's a certain sold of reasonableness about it all, nevertheless. After all, it's not like you're being expected to believe in psychic powers, the Loch Ness Monster, or UFOs shanghaiing people. Neither do optometrists have a reputation in most people's minds for quack entrepreneurialism.

Someone whose child is doing poorly in school, and especially one who may be afraid of their child becoming a dropout, might very well take a flyer on "vision therapy." Parents who feel that their kids may not be living up to their academic potential might also decide to give it a try. And who could blame them for being glad to see their medical insurance carrier being sent the bills? Moreover, children who are given the attention and are able to comply with the discipline of a "visual training program" might very well show some improvement in their school behavior and performance, regardless of any change in their ocular health.

But the real questions are simply these: 1) Whether measurable visual problems can account for learning disabilities, and 2) Whether "vision training," "learning lenses," and the like are effective in preventing and/or correcting such problems. No amount of arguing about these other things or about whether our prehistoric ancestors "avoid[ed] all near tasks" - they did gather roots and berries and make simple stone tools, after all - will answer these simple questions. Only the facts can.

Here' s what the American Academy of Ophthalmology, the American Academy of Pediatrics, and the American Association for Pediatric Ophthalmology and Strabismus had to say about the claims of Drs. White and Skeffington in a recent joint statement: "Children with dyslexia or related learning disabilities have the same ocular health statistically as children without such conditions. There is no peripheral eye defect that produces dyslexia or other learning disabilities, and these is no eye treatment that can cure dyslexia or associated learning disabilities. ...Ocular defects should be identified as early as possible and, when correctable, managed by the ophthalmologist ... but if no ocular defect is found, the child should be referred to a pediatrician to coordinate required multidisciplinary care. ...No scientific evidence supports claims that the academic abilities of dyslexic or learning disabled children can be improved with treatment based on (a) visual tracking. including muscle exercises, ocular pursuit, tracking exercises, or 'training' glasses (with or without bifocals or prisms); (b) neurological organizational training (laterality training, crawling, balance board, perceptual training); or (c) tinted or colored lenses.

Some controversial methods of treatment result in a false sense of security that may delay or even prevent proper instruction or remediation [emphasis added]. The expense of these methods is unwarranted, and they cannot be substituted for appropriate remedial educational measures." The D/FW Council Against Health Fraud issued a press statement on August l9th calling attention to these facts. Coincidentally, (what else could it be?) an issue of the Journal of the American Medical Association came out the same day and carried an article entitled "The Biology of Developmental Dyslexia." The author, a member of the Child Psychiatry Branch of the National Institute of Mental Health, mentions a number of misconceptions that "deserve mention because of their popularity, despite their lack of scientific support and, in some cases, evidence to the contrary." These include the notions that "visual-spatial deficits underlie dyslexia," and that "therapies designed to improve visual perception, such as optometric training for binocular coordination and eye-tracking exercises, are effective." "In fact," notes the article, "such treatments are unsubstantiated and frequently costly." A total of 48 citations, most from the peer-reviewed medical scientific literature, are given in the joint statement and the JAMA article.

Clearly, if quackery is "the promotion of medical schemes or remedies known to be false, or which are unproven, for a profit," as a 1984 Congressional report put it, "vision therapy" is quackery. The professional societies know it, ophthalmologists know it, and now you know it. But the general public may be a long time in figuring it out. Why? It's because the media, and the regulatory bodies, political creatures that they are, need victims that know they're victims and who kick and cry and scream bloody murder about it. That's something that health fraud victims rarely do, as they're either too embarrassed or, more commonly, they don't even know that they've been ripped off. That's because a large part of medical quackery is a confidence game. Quacks gain the trust and confidence of their patients in exactly the same way that ethical and legitimate practitioners of medical science do. and there is no way for a patient/victim to tell the difference based on their feelings. Indeed, the most successful quacks are often supersalesmen. It's just that they base what they say and do on unsupported claims, pseudoscience, and out-and-out fantasy. But how are people who aren't experts to know?

Several ophthalmologists that I spoke to, including one in academic medicine, agreed with this assessment of the situation. But, incredibly, most disdained any interest or inclination in publicly calling attention to such an open practice of medical quackery as "vision therapy." They are afraid of becoming embroiled in civil litigation or of drawing fire from antitrust enforcers who might see them as engaging in anticompetitive activity under some twisted theory of law.

So what's the lesson here? Just because the government takes your money to supposedly regulate medical professionals as well as drugs, devices, and other medica] services, don't think that you can rely on being told the truth. If you don't want to get ripped off, here's some advice: "buyer beware!"


This article previously appeared in the October 1992 issue of The Skeptic, the newsletter of the North Texas Skeptics. It is provided here with permission of the author and of the publisher. "All articles are copyright-protected, but may be freely reproduced and distributed provided that they are not sold and full credit is given."


Additional Web References on Vision Therapy

The American Academy of Ophthalmology has a variety of materials on Learning Disabilities including "How should learning disabilities be treated?" and a statement on the ineffectiveness of Vision Therapy for learning disabilities on their website, which states in part:: "However, regardless of the vision therapy method, NONE of them have been proven to improve or correct learning disabilities. Many vision therapy methods have no medical basis and can even cause a delay in getting children the educational assistance they need. Children with learning disabilities benefit from remedial exercises given by qualified educators in a one-to-one setting at school. Learning disabilities are caused by the brain - not vision." In addition they have a referral service and provide access to a variety of reference materials online.

There is also an article on one instance of Vision Therapy being marketed for ADD and Learning Disabilities that previously appeared in the October 1992 issue of The Skeptic, by Tim Gorski, M.D.

Who Needs Vision Therapy?
The Vision Help Network Philosophy

"Vision is more than just the ability to see clearly. It is the ability to understand and respond to what is seen. Basic visual skills include the ability to focus our eyes, use both eyes as a team, track objects and move across a written page. More extensive perceptual skills include the ability to tell the difference between “b” and “d”, the ability to see the tree from the forest, and the ability to “picture” in our mind what we see, as in the task of spelling."

"Vision develops over time: Motor control, emotions, and cognition develop over time; the same is true for visual skills. There is an orderly unfolding of visual anatomy, physiology and the ability to perceive. Different visual skills are explored, acquired, and refined at different age levels. Vision development does not cease at a given age, but continues throughout life."

"Visual testing can be done at any age, and should begin as early as possible (by six months). With early detection and treatment, problems such as crossed eyes and nearsightedness can be controlled and prevented."

"Proper development takes place where there is adequate and appropriate interaction with the environment. When the correct developmental framework is woven, vision truly becomes an individual's dominant and leading sense."

In The Eye Bone's Connected to the . . . Brain Bone Leonard Press, OD, FCOVD states that:

"Your eye is basically a very smart receiver and transmitter. What makes your eye so smart is that it's retina, or screen, is a direct outgrowth of brain tissue. In fact, the optic nerve which enters and exits the back of your eye feeds information directly to the brain. Some well-meaning professionals mistakenly argue that the eyes have nothing to do with learning problems because learning disabilities are caused by faulty brain function. These professionals admit that eye muscle control problems can cause secondary problems such as headaches or double vision, but plenty of people are able to learn despite these challenges. Well ... if your child is one of those people who is distracted by focusing or eye muscle problems, we think you should have an important say in determining how significant these challenges are. And further, if the problem lies in processing incoming visual information, specialized help will be needed. If you inquire about your child's vision, and are told that vision problems don't contribute to learning problems, just remember the jingle ("The Eye Bone's Connected to the ... Brain Bone") while you head to the nearest informed developmental or behavioral optometrist."

Vistion Therapy - a "miracle" cure for Autism?
Appeared in "Sensory Integration Quarterly" Summer 1996

Reprinted here under the "fair use" clause of copyright law

"Our family began vision therapy in April, 1994. It was recommended to us by our son's speech therapist and audiologist, along with other therapies. At that time our son was receiving many other therapies to help him deal with autism, including allergy medications, music therapy, auditory training (three times), speech therapy, sensory integration therapy, craniosacral therapy, and the medications Naltrexone, Trilafon, vitamin C, and a multivitamin. All of these therapies helped him in their own way, and doing them all frequently helped even more. We were leery of adding a new therapy that we did not understand, but followed the advice of a valued and trusted therapist. Our first visit was an eye-opener. We did nor believe that our 12 year old son would tolerate wearing the glasses because he is very touch sensitive. As soon as his eye exam was over and the doctor told Jimmy to pick himself out a pair of glasses, he did it! He tried glasses on and even looked in the mirror to see how he looked in them!"

The Vision Therapy and Sensory Integration Connection
Taken from Dr. Stanley A. Appelbaum, O.D., F.C.O.V.D., Optometrist's webpage

Q. Do children with Sensory Integration Dysfunction or Binocular Vision Dysfunction have brain damage?

A. Most of these children do not have actual brain damage as diagnosed by electro-physiological testing. Certainly children with brain damage would show some problems in the areas of sensory integration or visual processing, but the reverse is seldom the case. A.J. Ayres, O.T.R., Ph.D., in her book SENSORY INTEGRATION AND LEARNING DISORDERS states that "learning is a function of the brain; learning disorders are assumed to reflect some deviation of neural function." The problem is generally not brain damage but that the nervous system does not operate in an efficient manner. Once certain processes are developed through the therapeutic use of proper types of sensory stimulation in a well organized environment, the child's brain frequently operates much more efficiently.

Who is Dr. Stanley Applebaum? Some Amazing Claims!

"Dr. Stanley A. Appelbaum has changed the lives of former juvenile delinquents and professional athletes, babies and grandparents. Through vision therapy, people strengthen their eye muscles, train their eyes, improve depth perception, eliminate blurry vision, improve eye control - and then they work better, play better, look better and feel better. For example, students with inadequate eye control lose their place when they read or skip lines or see each page as a blur. With the exercises Dr. Appelbaum prescribes and after working with his sophisticated vision therapy equipment, they read better and relate better to their peers and their world. People who work with computers feel more productive when his exercises reduce their eye strain and fatigue. And people with good visual skills are pleased to find those get even better. The Bethesda (Maryland) Vision Fitness Center is constantly updating examination capabilities. For example, Dr. Appelbaum is now providing routine infant vision examinations and if potential problems are discovered, an enhancement program may be recommended. The link between vision and juvenile delinquency has been shown through research studies to be very strong. Think of kids & young adults who can't read and can't learn, so they drop out of school and get into trouble, just for something to do. "It is so rewarding to work with these youths, to get them to a point where they are able to achieve in school and they don't continue to get into trouble." Yet only about half of Dr. Appelbaum's practice is vision therapy. The rest is fitting contact lenses, glasses and treating eye disease. Throughout his work he emphasizes preventive optometry, helping people avoid problems. That's why he urges that adults have their eyes checked every two years or any time their employment or their requirements for their eyes, change. Children should begin eye exams at six months and school children should visit an eye doctor annually. Dr. Appelbaum has served on the Maryland Board of Examiners in Optometry and as a National Director for COVD, the certifying body for optometrists specializing in vision therapy. In addition, Dr. Appelbaum is a member of The Board of Directors of Sensory Integration International, the certifying body for Occupational Therapists specializing in Sensory Integration Therapy. Dr. Appelbaum turned to an optometrist in college when he found he could not keep up with his reading. "All of a sudden I was doing something I had never done before: I was reading for pleasure. I like to do that for other people: I like to make a difference in people's lives. "