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The use of exercises and other forms of therapy to affect how our vision system functions has for many years been discussed in both scientific and "wholistic" circles. The discussion of exercises for vision system correction starts with the acknowledgment that there are some eye doctors that will argue that they are ineffective and not true remedies for the conditions for which they are recommended. On the other hand, there is increasing empirical evidence that, for certain conditions, exercises do indeed yield positive results. Furthermore, there are many eye doctors who do routinely recommend such vision system therapy and have many patient "success stories".
Additionally, there is yet another group who believe that most vision problems can be mitigated through various techniques, including the often discussed "Bates Method".
Sorting out all the various issues is, in my opinion, boils down to basic science. The "Bates" program has been tested and found to be, for most vision problems, ineffective. Although there are some aspects of the program that make sense and have some therapeutic value, on the whole it is basically valueless, compared to correctly prescribed exercises for specifically diagnosed conditions.
And likewise, to state that vision therapy is ineffective in the light of numerous daily positive clinical results is simple unscientific.
Now, my editorial completed, let's discuss specific conditions and accepted remedies. Please note that this will be a general discussion. Specific exercises are not included here. I may add that in a later article, but, for purposes of discussion, there are some general ideas mentioned. I would recommend that those who desire to try vision therapy to remedy their vision problems seek out an optometrist or ophthalmologist skilled in the diagnosis and treatment of vision disorders and practicing vision therapy on a regular basis.
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(Note: These conditions are discussed in more detail in other articles within The EyeCare Connection. Click on the links to go there. There is also a glossary there if you come upon a term not described adequately in the text.)
Myopia. (nearsightedness, shortsightedness).
Incipient and early (childhood) onset myopia sometimes respond to therapy which reduces the demand to focus and converge (eyes turning inward) on closely held objects. This, generally, consists of plus powered lenses for near vision tasks, often incorporated in eyeglasses as bifocal lenses. Sometimes, the problem lies with the eye muscles over-converging beyond the required demand, or under-diverging for distance less than the required demand. There are exercises that help the eye muscles to more appropriately respond to these tasks. These are discussed under the topic of "Muscle balance and coordination."
Hyperopia is a condition whereby the eye is deficient in focal power. To some degree, the eyes have to focus somewhat for distance as well as near----with the total near demand sometimes approaching or exceeding what the eye can comfortably produce. The muscles inside the eye can be strengthened to exert a greater force on the crystalline lens and cause a greater degree of focusing, overcoming the hyperopic deficit. This is sometimes a self-defeating process in that realizing the extra focusing demand can cause eyestrain and trouble de-focusing for distance. With the exception of low degrees of hyperopia, exercises are generally not appropriate for this vision condition.
This optical condition causes a distortion of the image and is caused by an unevenly curved cornea or crystalline lens and, more rarely, a retina which is uneven or lens which is suspended off axis. Actually, in a "perfect" human optical system, both the lens and the cornea have astigmatism, existing equal in power and opposite in direction.Thereby canceling each other. But not always.
One explnantion suggests that ometimes the lens is stretched or twisted due to uneven contractions for the near focused position. As this is a stressed-induced condition, relieving the stress sometimes removes the induced astigmatism. This can be accomplished in a number of ways: by reducing the demand to focus using plus power near or reading eyeglasses, exercises to help the eyes work more efficiently, and by learning to allow the eyes to shift focus and position while engaged in concentrated near vision activities. Constantly staring at a computer screen, for example, may cause an induced astigmatism in susceptible individuals.
Another suggested cause is that the muscles that turn the eyes in and out play a role causing astigmatism by stretching the eyeball. Relieving tension caused by the muscles may relieve the astigmatism. This mechanism of action is not proven nor accepted by many eye doctors, although some of us believe that this may be at least contributory to the process, especially in young children. (The rationale there is that the developing human eyeball is still pliable and able to become mishapen by the action of the eye muscles.)
When presbyopia occurs (for most people in their forties), the eyes can no longer focus on closely held objects. Most people have complaints like "my arms aren't long enough anymore!"; Presbyopia occurs as the aging crystalline lens becomes less flexible and the small muscles that control lens flexure become fatigued. Considered a normal part of the aging process, this gradual loss of near focusing power often responds well to exercises which stimulate the muscles to react more strongly. Exercises have been shown to help overcome presbyopia, at least in the beginning stages.
Basically what we try to do is more intensively stimulate the focusing system to overcome the increasing loss of flexibility of the crystalline lens by strengthening the small muscles that cause the lens to flex and change focus. Positive results are often rapid, assuming no other underlying optical correction is required! M aintenance is necessary as the condition progresses. And sooner or later, nature wins and near vision correction will be necessary to view objects held close to the eyes.
Younger, non presbyopic people can have similar symptoms but for different reasons. Sometimes the accommodative (focusing) system or the convergence/divergence (eyes turning in for near, out for distance) system fails to function adequately. This also responds very well to exercises aimed at increasing the focusing ability and controlling the degree of eye turning.
This is a condition where the visual acuity is reduced (e.g.: less than 20/20) even with the best optical correction. There are a number of causes of amblyopia. There could be a structural problem effecting the photoreceptors (rods and cones), a function problem caused by miss-alignment of the eyes, a deficit related to uncorrected optical error in one or both eyes, or a resulting neurological deficit where the information from the photoreceptors is not correctly transmitted to the brain or processed there. Amblyopia almost always occurs as a result of improper neurological development in the newborn.
Sometimes we can re-train the eye to more correctly and intensively stimulate the photoreceptors and/or hyper-stimulate the nerve pathways to encourage more correct "wiring" and more efficient processing by the brain. Amblyopia is one of the more difficult vision problems to fix with vision therapy. Most doctors feel that efforts to correct amblyopia are most successful in early childhood, and very difficult to correct in adults.
Strabismus: This is a group of conditions where the eyes are incorrectly aligned. This could mean eyes that are turned in or turned out, or even occasionally up or down.
Also called "wall eyed", the eyes are turned out and do not align appropriately to allow simultaneous use of the both eyes. One eye fixates (targets) in the correct direction while the other drifts off to the side. Some people can alternate (switch) the fixating eye, but are generally unaware of the condition because the information from the non-fixating eye is ignored by the brain. For some people, the primary reason for dealing with this condition is for cosmetic concerns. The cause can be weak, improperly attached or otherwise misconfigured eye muscles. Surgery to re-position or shorten the eye muscles may be required for most high amounts of exotropia, but sometimes vision therapy (as for exophoria, below) alone may be successful, especially with smaller deviations. As one of the eyes experiences suppression of the information, therapy to counter the suppression is also required.
This is a condition where the eyes prefer to be positioned outward, but the eye muscles successfully overcome this deficiency. But the effort to achieve this coordination sometimes results in eyestrain and even occasional and intermittent double vision. Exophoria is often easily treated with exercises which stimulate the eye muscles to work properly and the focusing system to "lock" onto the object(s) of regard in the visual field. When the eye muscles fatigue, exophoria can become, intermittently, an exotropia. Doctors often use a stereo vision apparatus, such as polarized vectograms (3-D transparencies) with polarized glasses or red-green 3-D cards with red-green glasses, which allow the user to have constant feedback as to the position of the eyes and whether or not they are working together.
This is the opposite of exotropia; the eyes are turned in. Sometimes this is caused by an uncorrected hyperopia. The eyes have to focus so much that the nerve pathways over stimulate the convergence system and the eyes overly turn in. When this is the case, vision correction is required to help align the eyes. And, as with exotropia, sometimes the problem is due to miss-attached or too short eye muscles and surgery is required to correct the condition. Eye exercises for esotropia are sometimes appropriate, but success is somewhat limited and effective only for small degrees of misalignment. More often than not, a combination of surgery and exercises yield the best outcomes.
This is the tendency for the eyes to be turned in, but the eye muscles can overcome the deficit. As with exophoria, this extra effort can cause eyestrain. Sometimes the problem is caused merely by the need for hyperopia correction and eyeglasses or contact lenses fix the problem. But sometimes eye exercises to help re-train the eyes to function more appropriately can work, especially when combined with the proper vision correction.
Phoria conditions are more easily remedied with exercises than tropia conditions. Both require careful diagnosis and evaluation of the problem and specially tailored vision therapy programs.
These conditions cause the eyes to be turned upward or downward. The discussion for exo and eso conditions applies here as well.
The six muscles that move each eye must work in a coordinated fashion so that we can change our vision from one point in space to another smoothly and quickly. Sometimes one or more of the muscles does not work with maximum efficiency and our eyes do not move to the new position quickly enough for good vision system comfort. Or worse, with children, the eyes may not be able to track smoothly across the printed page, or may loose position when returning to the next line down on the page. The child then may have reading problems, or grow to dislike learning to read---not because they can't see or understand the words, but because of the efforts spent to keep the eyes tracking create fatigue or the inability to follow sentance flow.
Exercises are often quite helpful in training the eyes to track smoothly and efficiently, both at near and for far vision. We often recommend monocular (single eye) and binocular (both eyes together) work tracing through a maze, for example.
Exercise can sometimes be effective in enhancing binocular fusion, and therefore increasing stereoscopic 3-D perception. The benefits achieved include better spatial awareness and less clumsiness. Better quality binocular vision has also been shown to improve certain athletic performance. Stereo vision apparatus are used for this condition.
Although occurring in any age group, we see this more often in adults newly engaged in intensive near vision tasks. Technically, this is called accommodative-convergence inflexibility. Sometimes a problem develops where the eye's focusing system ';locks'; on the near focus and fails to de-focus for distance viewing. This creates the appearance of nearsightedness. Typically, the new student, computer user, accountant, dressmaker or others suddenly dealing with increased near vision demands complains of deteriorating distance vision, especially at the end of the day. The problem also results in blurred distance vision immediately following looking away from the near task.
As this is a near stress induced problem, we treat the distance blur by prescribing near vision glasses and use exercises to re-train the eyes to quickly change focus from near to distance upon demand. Often repositioning the near work environment to allow for more comfortable focusing is beneficial. (See the article on Computers and Eyestrain.)
This article was meant to serve as an overview of the various vision system conditions that more traditionally have yielded to vision therapy. In consultation with an eye doctor skilled in vision therapy, an appropriate diagnosis and development of a treatment plan can lead to impressive results. Not every condition is easily treatable and some people (and conditions) respond better than others. You must also consider the time involved in reaching the goal and the possibility that the end result may not justify the time and expense to get there. Then again, you may be able to simply resolve a problem and have comfortable vision and hassle-free use of your eyes! Check with your eye doctor to learn if vision therapy might be appropriate for your situation.
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