Chapter 5: Review, Conclusions, Discussion and Suggestions

This dissertation consisted of two major sections. The first was an examination of the credibility of Bates’ ideas and the development of a model of myopia based on recent psychophysiological research. The second was a pilot study of myopes to examine trends in refractive error change and to determine the practical implications of future research in the field.

A model was developed through a synthesis of concepts in the field of neuropsychology which supports Bates’ ideas. On the basis of the model, myopia is explained as a cognitive behavior style which relates to Bates’ concept of mental strain and to Pribram’s concept of cognitive stress. The physiological manifestations of mental strain were explained in terms of autonomic and muscular changes in the body which lead to hyperconstriction of the extraocular muscles which lengthen the eyeball and produces myopia.

The second part of the dissertation is related to the first since it outlined a possible method or analysis, described a potential control sample, and examined refractive error changes in a sample of myopes. Kesults of the study showed that females and males were similar with respect to the refractive data. The patients in the sample reduced their myopia. The speed of refractive change was faster in the initial period following refraction but was not statistically related to patient age or refractive magnitude. This was a pilot study of changes in a particular group of patients; it was not an experiment of methods
of curing myopia. The fifty-two patients in the study had been examined by the author in his optometric office on two occasions, were myopic, were in their twenties, and had never worn contact lenses. The method of data analysis was by parametric statistics and by visual inspection of graphs.

THE MODEL COMPARED WITH PREVIOUS STUDIES

Returning to the literature reviewed earlier on the etiology of myopia, the genetic, metabolic, conditions of use, and the psychological factors must be examined in terms of the information presented here.



GENETIC THEORY

What is it that is inherited by the myope? Not necessarily the specific anatomical curvatures, thicknesses, or distances in the eye which develop to form the myopia. Potential styles of brain functioning or propensity for over or under-reaction of autonomic response (fight or flight) systems might be the common factor. It is indeed difficult to separate genetic factors from environmental causes since the cognitive style of a child results from the ways in which he or she has been exposed to learning environments and the specific demands which are placed upon the situation. For example:

. . .Physiological responding during stimulus intake depends entirely upon how a task is constructed and whether it is primarily a categorizing or reasoning problem (Pribram and McGuinness, 1975)

Myopia might be “contagious” and passed on unwittingly by parents and teachers (Bates, 1920). Indeed, myopia seems to be

…precipitated by conflicts involving discipline, poor grades, incongenial associates, unsympathetic supervisors, and other factors indigenous to the educational world (Burch, 1954, P. 17) The nature-nurture question is beyond the scope of this paper, but the evidence contained herein suggests that the issue be considered in a broader light than it has been. That there may exist a genetic factor does not eliminate the possibility of preventing or curing myopia, insofar as it may be the functional reaction, not the anatomical structure, which is inherited (Darwin, 1965/1872).

METABOLIC THEORY

The model which the experimenter has proposed would account for differences in metabolic characteristics between myopes vs. non-myopes. These metabolic differences were found by Bothman (1931), and others (see p. 19); a reexamination of’ the problem is indicated in light of this new information. Wood (1927) and others found that young myopes have depressed levels of free ionic calcium (Ca ++ ) in the blood compared with controls. Low calcium leads to muscle spasm and hyper-excitability of nerve and muscle, especially sympathetic nervous system transmitter chemicals which have been implicated in the special type of isometric contraction referred to above. (Information concerning Ca ++ , Pco 2 *, blood alkalinity, breathing, etc… comes from
Bard, 19610 unless referenced otherwise). Feldman (1950) and others found that the administration or calcium and vitamins did not arrest the progress or myopia, however. Since it is the ratio of bound to free ionic calcium that is important in hyper-excitability of nervous and muscle tissue, and not the overall amount of calcium in the body. It is not surprising that changes in diet did nothing to change refraction. If it is not dietary, what might be causing the decreased blood levels of Ca ++?

The Ca ++ level in the blood is related to blood pH which is determined by the PoO2 in the blood. When the blood is alkaline, the PoO2 is low and the Ca ++ is low as well. Blood alkalinity and PoO2 are also related to respiration, which has been reported to be abnormal in individuals suffering chronic isometric muscle tension (Reich, 1949). The author has observed clinically that myopes exhibit Biot’s breathing (deep breathing for one or two breaths, followed by prolonged breath-holding). It is interesting to note that low PoO2 is related to hyperventilation, which is the opposite of what one would expect in patients with chronic Biot’s breathing. The common factor which relates these two conditions may be explained as follows: -during tasks which involve vigilance and cognitive effort, uncontrolled somatomotor movement is minimized and the sympathetically dominated isometric muscle contraction increases (this form or tonic muscle contraction is anaerobic, whereas the somatomotor muscle contraction is aerobic) (Pribram and McGuinness., 1975). This means that less oxygen is consumed in the metabolic processing
taking place in the body, which would lead to a decrease of Pco 2 in the blood. The decreased breathing (Biot’s breathing) might be a response mechanism designed to increase the blood Pco2 through respiratory control. Watson (1972) reports a mental disorder syndrome in which the patient is continually setting high self-expectancy goals which are rarely met and which keep the patient in a constant state or effort and anxiety in attempting their fulfillment. Pertinent to this discussion, these patients were round to metabolize a deficient amount or oxygen and to have decreased Pco 2 levels.

Kelley’s (1971) description or body characteristics or myopes included an increase in muscle tension at the base or the skull. (This observation has been confirmed in clinical experience). This type of muscle tension at the base of the skull is known to decrease blood circulation to the brain and head (Jones, 1976). It is interesting to note that one of the medical treatments for Biot’s breathing is to decrease blood circulation to the brain (Bard, 1961). The chronic tension at the base of the skull may be a compensatory mechanism to deal with the decreased Pco 2 levels in the blood.

Therefore, if the body is chronically using oxygen during habitual cognitive efforting, it is possible that depressed breathing can exist with low Pco 2 and low Ca ++ blood levels. (The incidence of myopia has been related to the incidence of dental caries) (Hirsch and Levin, 1973) which might also relate to calcium level and Factors just discussed).

The information offered in the above discussion is conjectural, but has been included to emphasize the importance of broadening the bases of investigations of factors related to myopia. Further investigation of the relationships between myopia and the physiological factors discussed could yield important practical information about the myopic response.

CONDITIONS OF USE THEORY

Some past studies (Youngs 1963) have indicated that the major cause of nearsightedness is reading. The model developed in this chapter would predict that reading is a causal factor in myopia. The process of reading has been described earlier as a vigilance task requiring cognitive effort. It has been suggested that the physiological changes which accompany categorizing, while reasoning, lead to a type of visual motor contraction which can result in myopia.

There must be more factors than just reading involved in the production of myopia, because not all chronic readers become ,myopic. The psychophysiological model presented suggests some possible factors which might resolve the apparent paradox. One possible difference between the myopic and the non-myopic readers concerns the relationship between the arousal response and frontal organization. A low threshold of arousal (a hyper-reactivity of arousal) might require more cognitive effort to maintain the brain organization for reading. Evidence supporting this possibility is the enlarged pupil which is so characteristic of myopes. Another possibility might include the calcium level in the blood. It has been indicated that low ionic calcium causes
hyper-reaction in nerve, muscle synapses, and increases the responsiveness of the sympathetic nervous system. The factors relating to calcium level are varied and include blood alkalinity, Pco 2 . breathing, digestion and diet. The psychophysiological model broadens the perspectives for investigating previously isolated relationships and invites research which might lead to remedial and preventive approaches to the problem.

Studies which show a positive relationship of myopia with intelligence., profession and city living have been reported by Borish (1954) and others. These can all be related to aspects of life which encourage the brain organization patterns of self-control and cognitive stress. Farmers for example are not usually in situations which demand the kind of vigilant mental attention which students or highly stressed professionals are used to. Their reality structure is rarely in question. The research by Streff (1974) in which he reported a decrease in expected myopia in a stress and anxiety reduced school environment adds support for the model. If learning can be structured in more meaningful ways, the need for habitual vigilant mental control can be reduced which may lead to the reduced incidence of myopia.

Young’s (1961) work with monkeys who were confined for one year in boxes eighteen inches from their eyes produced myopia. This result is not incompatible with the model since the many variables introduced by this procedure could include emotional and physiological reactions besides the limitation of visual fixation distance. The fact that monkeys held in chairs (with
longer fixation distances) and monkeys in captivity have a greater amount of myopia than do wild monkeys in further evidence against the mere reduction of viewing distance. The casual elements are not clear. Why lighting levels should influence the development or nearsightedness (Luclish, 1939 and Young, 1966) is not clear. This evidence does indicate a possible physiological effect and is not incompatible with this model.

BIOLOGICAL VARIATION THEORY

This theory is refuted by the evidence that ametropia is not a random affair (e.g., Sorsby, 1964). It has been suggested by Van Alphen (1967) and others that an active process involving cortical and subcortical brain centers works to keep the images clear on the retina. When this process is interfered with in some way, ametropia is produced.

The model developed here suggests that extraocular muscle tension can change the refractive state by changing eye length and this might be the mechanism which correlates the ocular components to bring about emmetropization. Other research concludes that eyeball length is highly correlated to ametropia (e.g., Baldwin, 1964). Cognitive states of brain organization have been implicated as causal factors in chronic muscle tensions of the extraocular muscles and cognitive mental states have been shown to influence refraction (Gesell, 1949). Thus, the evidence which refutes the theory that myopia developes due to normal random variation of anatomical structures also is quite compatible with the proposed model.

PSYCHOLOGICAL THEORY

A problem basic to the studies of personality and its relationship to myopia is that most studies are done after the fact, that is, the myopes are measured many years after the onset of the myopia. This is suggested by Zeiger’s (1976) finding that low and medium (under two diopters) myopes measured differently on psychological tests than high myopes who measured more like emmetropes. She conjectured that personality and attitudes of myopes progress through stages as they become more myopic. Low myopes showed a strong aversion to the world which is seen as noxious and irrational. Moderate myopes maintained a similar view of the world but their aversion to it was more moderate. Low myopes were seen to be alert and active in challenging the world, moderate myopes became internal, withdrawing from it by rejection.

Palmer (1966) compared low and high acuity myopes and found that low acuity myopes were more inward and less sensitive to external stimuli than were high acuity patients. His testing involved acuity and not refractive error. His model explains how acuity can change irrespective of refractive error through organization of the contrast enhancement mechanisms of the retina and visual system mediated by the frontal system. If the frontal system were suppressed, awareness or external cues would be reduced and the internal processing mechanisms (posterior system) of reasoning (internally performed actions) would dominate. Palmer (1966) goes on to postulate that myopia is a coping response designed to avoid being overwhelmed by visual overload.

This is consistent with the model in that an over-reaction of the arousal mechanism will cause an emotional reaction which would prevent the individual from seeking information from the environment. Thus a person would tend to avoid situations of uncertainty if possible. Zeiger (1976), however, has found that myopes tend to-view the world as uncertain which would tend to look them into patterns of neurological behavior. They would at first actively attempt to reduce the uncertainty by cognitive effort with the accompanying muscular and metabolic reactions (isometric contraction). once the pattern had become established the peripheral changes would be involuntary and would be maintained in the posture structure, for example, as myopia, even if the overwhelming aspects of the world have been resolved.

Until the more acute aspects of the struggle to establish certainty in the world had been resolved, the myope would be engrossed in active efforts to understand as much information from a disorganized environment as possible. The individual would attempt to categorize, vigilantly maintaining attention as much of the time as possible. This is compatible with the finding of Stevens and Wolff (1965) that myopic cognitive style is that of sharpeners, tending to categorize rather than to synthesize external cues.

An individual who has been brought up in an atmosphere of uncertainty and unrealistic expectations who is eager to succeed and win approval from authority figures would tend to try harder to understand an overwhelming environment. Such individuals would tend to fall into the categories of psychological tendencies
indicated for myopes by various researchers. They would tend to be dependent on approval from external sources rather than from self. Such traits as shyness, introversion, social awkwardness, emotional inflexibility, need for approval, avoiding confrontation, cautious with a high tolerance for anxiety, over-control of emotions, low desire for change, and high need to be good, approved of, and to succeed in high status activities, have been consistently reported in the research (e.g., Lanyon and Giddings, 1964). Myopes were also found to have reduced inclination for motor movement (Mull, 1948) and chronic isometric muscle tension (e.g. in the upper neck, jaws and throat) and distorted posture (Kelley, 1971). This is predicted by the model since cognitive effort requires reduction of motor responses and increases sympathetically dominated isometric contraction of the muscles.

The literature on emotion, personality and psychology thus supports the model. Huxley (1942) summarized the inter-relatedness of psychology with vision.

That a function so intimately related to our psychological life as vision should remain unaffected by tensions having their origin in the conscious “I” is inconceivable. (p. 39)

THE PILOT STUDY COMPARED WITH PREVIOUS RESEARCH

The assumption of this dissertation is in agreement with the statement of Newell and Hirsch (1967) that good vision is important and that it is desirable to increase the state of our knowledge regarding the refractive anomalies or the eye. But it disagrees with Hirsch (1963) when he urges professionals to de-emphasize the possibility of preventing or remediating refractive error. Such an attitude closes us into the present paradigm and fogs our perception of possible evidence to the contrary. There is also disagreement with Hirsch’s (1963) statement that refractive error does not change between the ages of twenty and forty. The data of Slataper (1950), Jackson (1934) and Tassman (1932) also contradict Hirsch.

Figure 1 shows the fraction of people with myopia at various ages. There is a noticeable decrease in the percentage of myopes in the age group from about twenty to about age forty-five. This is an indication that myopia must have improved in at least some of the patients. Figures 2 and 3 indicate data points for individual patients. It is clear that some patients change in the direction of less myopia. Examination of the data from the sample study indicate concordance with the existing information.

Figure 3 compares the mean dioptric velocity or the present study with the results of Hoffstetter’s (1953) study. The data point in this study falls within the general cluster of data points. Figure 4 shows the rate of change of dioptric velocity compared over time (age level). The mean from the present study shows an interesting relationship to the other points.

It is as if they lie on a continuation of the direction established in the late teens. This relationship, if valid, could be interpreted in terms of the altered life style of the sample, i.e., if the alternative life style represents a withdrawal from a culture dominated by cognitive effort, then the disposing factors leading to myopia as discussed in Chapter Two, would be minimized for the myopes in this study. This could allow the continuation of the trend established in the late teens. This is highly conjectural, but does indicate an interesting application of this method of data analysis.

The data in this study agree with Tassman’s, (1932) that myopia improves in the twenties. Bucklers (1952). Hofstetter (1954). and Slataper (1950) all found improvement in some patients. The conclusion, that some patients reduce their myopia, is supported by the historical literature.

RESEARCH QUESTIONS

There are three questions concerning the first part of the study which relate to Bates, the etiology, and the psychophysiology of myopia.

1) Does recent psychophysiological evidence tend to support Bates? The information presented in Chapter Two indicates that Bates’ notions are quite consistent with recently gathered psychophysiological data.

2) Can an etiological model be developed on the basis of Bates? ideas and psychophysiological concepts which is compatible with the literature on nearsightedness? The model developed in this study predicts the literature and integrates information which previously had been considered separately from other information. lt also suggests the existence of clues to aid our understanding of the problem of myopia.

3) Should future research be conducted on the basis of Bates’ conceptions? The purpose and value of Chapter Two has been based on the assumption that Bates made an important contribution to our understanding of vision and refractive problems. The soundness of this assumption is suggested within the presentation of the material and in the predictive value of the model. i:he time is ripe for considering Bates as a major contributor to this field. Technology now exists for examining the details or his statements. Further research should be directed toward this end.

The research questions for the second part or the dissertation, the pilot study, will now be considered.

1) What are the most important variables to consider in analyzing changes in refractive error? The variables considered in this study were age, amount of refractive error, gender, and time after refraction. The mean rate of change and the amount of change was similar for males and females. The amount or change was not compared with the variables since the interval between refractions was not the same for all patients (the interval ranged from five to sixty-four months). The rate of change varied widely according to age in past studies of children and adults (Slataper, 1950). For the relatively narrow range (twenty to thirty years) investigated in this sample, the velocity (change toward less myopia) was slightly greater for the older patients but was only mildly statistically significant. The rate of reduction of myopia increased slightly with increasing refractive error but was not statistically important.

Most rapid change took place within the first ten months following the first examination. This is important to know since it implies that patients should be examined and the prescriptions reduced more often than suspected.

Of those considered, the most important variable in analyzing refractive change is age according to past studies of a large range of ages.

Some patients in the present study improved rather rapidly) up to 0.167 diopters per month) while others did not change at all and suggests other variables not considered in this pilot study are important. The psychophysiological investigation of myopia presented in Chapter Two could increase
an understanding what the most important factors are. Future research with this model recommended.

2) What are the most sensitive methods of measuring refractive change? On the basis of this investigation the author concluded that computing the dioptric velocity will allow the most dynamic interpretation of the data This is true not only for investigation or samples of patients but, once a data base can be established, it is also true when working with individual patients. Emphasizing the dynamic aspect of refractive change (velocity) allows for examination or trends over snort periods or time. Otherwise, the patient and the practitioner might nave to wait for years to prove that refractive error has changed more than an expected amount. The fact that most change takes place in a relatively snort period of time following a new prescription (Figure 21) suggests that frequent refractions could implement increased improvement in myopia. The effectiveness of this strategy can be measured by determining the velocity at each interval.

3) Will the results of the second study refute or support Bates’ ideas as expressed in the first study? What is at issue here is whether myopia is a fixed anatomical condition (like finger length). If it can be shown that myopia can be improved, then Bates’ concepts are supported. If myopia is fixed, then the converse is true. The results of this study indicate that myopia is a flexible condition and does reduce in magnitude (for some Individuals as much as 1.75 diopters). The mean change for the total group was a reduction or O.26 ±0.47 diopters, significant at p .001.

The conclusion is, therefore, that the data do support Bates’ observation that myopia is not a fixed anatomical condition.

4) Can baseline data be established that will be useful in future studies concerning variables which influence changes in refractive error? The data collected in this study represent an historical statement about psychophysiological changes taking place in a sample of’ young adults in Sonoma County, California in the mid-1970’s. The trends suggested in the analysis of the data have established a point of departure for future studies. It is important to consider the possibility of spontaneous remission of the ametropia at the age level under consideration (or at any age level for that matter). This fact must be considered when testing for the effects of manipulating specific variables (e.g.. diet, remedial techniques, under prescribing, lens therapy, psychotherapeutic experience, drugs, life style changes, etc.). The research conducted in this field has been plagued by just such problems in experimental design. Studies using control groups would be a more powerful approach. However, this is time consuming and impractical for private practitioners and it would be suspect for small sample sizes because of individual variation. Definitive statements about results in studies of this kind are not deduced easily. The establishment of baseline data represents a more practical way of attacking the problem. The pilot study of this sample has been conducted in order to define the difficulties and to aid in the design of future research.

Because of the lack of data about aspects of personality, life style, and other variables that might influence refractive changes, the usefulness of this study as baseline data is limited. Nevertheless, it serves a useful purpose in producing certain provocative findings as well as indicating the direction in which future investigation could proceed.

DISCUSSION

Although the model developed here is convincing, there are some aspects of it that are founded more on a synthesis of concepts rather than specific research data. Pribram’s concepts are in fact theories about how things might work. They do not represent the typical thinking in the field. Pribram tends to work intuitively and is involved in establishing a more inclusive paradigm than has been offered in the past. He tends to revise his ideas as new information extends or conflicts with his ideas. This could, of course, reduce the validity of the model developed herein but it is a more far-reaching, more inclusive model than has been developed until now. It fills in an important link between the observed anatomical, behavioral, and theoretical thinking about myopia and it calls attention to the thinking of Bates whose ideas nave so long been ignored.

There are questions the model does not reach, for example, why one eye can be so different from another and why some people differ so greatly from others in refractive responses. There is need to develop measures of the physiological and psychological variables and to measure more precisely the dynamic aspects of the eye’s anatomy.

Questions as to the scientific basis of methods of treatment of myopia have not been discussed. It will be interesting to examine these in conjunction with the psychophysiological evidence and to measure just how far refractive error can change. There may be different myopias not compatible with the ideas suggested in this research. Also the dissertation did not consider the other types of refractive anomalies (hyperopia, astigmatism) which Bates claimed had similar causes (i.e., mental strain due to environmental stresses).

When considering the possible importance or this work within the framework of humanistic psychology, the author would first point out myopia as indicating an adaptation to an unhealthy environment. Myopia represents a constriction in the flexibility of the perceptual, adaptive, and action systems of the organism and therefore, restricts the potential of an individual. If it is true that our ways of seeing determine what we see, what we know, and how we think, then the occurrence of myopia has important ramifications in terms of the more general problem of the effects on humans of modern civilization. The dramatic increase in myopia among the Eskimos in a two to three generation time span (Young, 1969), and the two to three times increase or myopia in Japan over a twenty-five year period which came at a time of industrialization and westernization (Sato, 1964) are certainly grounds for considering myopia an epidemic condition of our time. The study of myopia as a social phenomenon offers a clue to understanding the unhealthiness of cultural ‘progress’.

Recently the paradigm of health care has been called to public attention. Pelletier (1977) emphasizes that personal health is a personal responsibility and that normal stresses imposed upon us by our institutions may be severely affecting our health. He sums up part of the situation as follows:

Both chronic and acute illnesses have been linked to psychological and environmental factors. Psychosomatic disorders due to psychosocial stresses have been in evidence since at least 500 B. C., when Socrates stated “there is no illness of the body apart from the mind.” And yet, despite the pervasiveness of the view that such a connection exists, the precise causal links remain obscure. They seem to involve the entire life style of the afflicted individuals. Each civilization has its own kind of pestilence and can control it only by reforming itself…just as the great epidemics of the nineteenth century were precipitated by environmental factors which favored the activities of pathogenic microorganisms, so many of the diseases characteristic of our times have their origin in some faulty factor of the modern environment. Perhaps the most important of these faulty factors is excessive, free-floating stress which remains unabated and eventually induces psychological, neurophysiological, and endocrine disruption. (P. 156-157) He describes syndromes or personality style which proceed various diseases common in our culture and recommends that individuals can learn to change themselves through self-awareness and change in life style which are reminiscent of’ the approach and thinking of Bates.

In the best sense of the words, Bates was a humanistic psychologist. He was interested in the full development of human potential. He was not satisfied with what seemed to be natural and normal – the increasing dependency on artificial devices to cover up psychophysiological indicators of malfunction in the body. His observation was similar to that of Maslow (1967).

We tend then to get into the situation… in which normalcy from the descriptive point of view, from the value-free science point of view-that this is the best we can expect, and that therefore we should be content with it. From the point of view outlined, normalcy would be rather the kind of sickness or crippling or stunting that we share with everybody else and therefore don’t notice. (p. 155)

Bates (1920) was not content even with what is commonly considered good vision and he described people who could perform amazing acts of outstanding vision such as seeing 20/3 vision, and seeing stars during daylight. He stressed the virtues of perfect vision which included superior memory and highly developed imagination, he formulated a therapeutic approach to problems of vision and perception that resembles contemporary holistic approaches to health. He investigated people who had better than normal vision rather than exclusively studying people with vision problems. He examined the behavioral characteristics of these individuals and compared his findings to those who were less fortunate. His therapeutic methods were designed to teach patients to develop healthy habits of seeing and perceiving. Bates looked for causes, not just within the realm of visual activities, but with regard for the total environment. He was interested in both the individual and the cultural constraints of our society. His observations about the assumptions and methods of our educational institutions are only recently becoming popular in the thinking and literature of humanistic psychology (Harman. 1967). That Bates has been so maligned and misunderstood is a gross injustice and has impeded our investigation of important
problems in the world of health. It is time we take another look at Bates, it is time we stopped paying “lip service” to the ideals of health and prevention; it is time that we seriously investigate concepts and approaches to developing what Teilhard de Chardin (1941) called

…ever more perfect eyes within a cosmos in which there is always something more to see. (p. 226)

IMPLICATIONS FOR FUTURE RESEARCH

This dissertation hopes to establish the beginnings of a new paradigm for understanding and treating problems of the eyes. The concepts expressed here need to be filled in with further investigation of the neurophychological aspects which explain more of the variables involved with development, not only of myopia, but with the whole etiology and treatment of’ all disorders of the eyes.

There is need to measure more precisely the various autonomic functions which might relate to refractive problems. We must expand our viewpoint in seeking the variables which relate to vision. There is need to investigate the validity of the ideas expressed here especially in regard to children.

There exists great opportunity to learn more about the influences or improperly administered educational methods which might lead to problems of vision and the constriction of consciousness which seems to manifest in so many of our children. if a study can show the effects of mental strain on school children (as measured by refractive changes) perhaps it could lead to improvement
in the paradigm which dominates our educational institutions. The work of Streff 1974) mentioned earlier represents a good start in this direction.

There exists a great data pool in the offices of vision professionals. Information about sociological and anthropological influences as measured by refractive conditions can lead to better understanding of the influences of modern civilization on the health of humans. Research is rarely conducted by individual practitioners in the field. Perhaps the pilot study reported herein can lead to more work on small samples of patients and to the establishment of-baseline data for future understanding of refractive changes in our population in terms of life style, cultural shifts, educational methods, and perhaps the improvement and prevention of vision problems. Larger clinics such as those at colleges of optometry could investigate these matters’ and have a great potential for establishing procedures for improving and preventing myopia.

There is a need to investigate methods of eliminating refractive problems by the use of psychological, nutritional, biofeedback and other approaches to’health. Specific techniques already exist (such as Batest) which have received little energy by the established research centers in vision. Other approaches such as the use of biofeedback, various body therapies, acupuncture, and color have been mentioned by individuals interested in improving their vision.

In the author’s work, the information contained in this paper has added greatly to future investigation of the problems. The present pilot study was severely limited due to a lack of data on
psychological and social aspects of the patients. The examiner understands enough background about the relationship of nutrition, breathing, and myopia to formulate meaningful research questions and to open the possibility of including a nutritional element in his practice.

The pilot study will be used to design future research on psychological and life style effects on refractive variations. The author is in the process of designing a questionnaire to be completed by his patients and the patients of other optometrists which will allow him to research various demographic and sociologic factors. The questionnaire is being designed to test not only the possibility of improving vision, but will allow the assessment of the practicality and validity of the psychophysiological model developed here. Research projects on his therapy groups will be conducted with greater elegance and will lead him to develop more effective therapy techniques. From the perspective of the examiner the possible applications of the model are profound. A model, of course, differs from a theory for its intention is to clarify questions, not’. to settle them. This is an important distinction, for as Bates (1920) pointed out:

… I have never been able to formulate a theory that would withstand the test of facts either in my possession at the time, or accumulated later. The same is true of the theories of every other man, for a theory is only a guess, and you cannot guess or imagine the truth. No one has ever satisfactorily answered the question,, “Why?” as most scientific men are well aware,, and I did not feel that I could do better than others who had tried and failed. One cannot even draw conclusions safely from facts, because a conclusion is very much like a theory, and may be disproved or modified by facts accumulated later. In the science of
ophthalmology, theories, often stated as facts, have served to obscure the truth and throttle investigation for more than a hundred years. The explanations of the phenomena or Sight pub forward ‘by Young, von Graffe, Helmholtz and Donders have caused us to ignore or explain away a multitude of facts which otherwise would have led to the discovery of the truth about errors of refraction and the consequent prevention of an incalculable amount of human misery. (preface)

The field of humanistic psychology would do well to remember this line of reasoning.


* Pco (also written pCO) is the partial pressure of carbon 2 dioxide. In blood the principal gasses are oxygen and carbon dioxide. The relationship between these gases determines the pH (acidity or alkalinity) of the blood. Gases in a mixture exert pressure (i.e., tendency to go into solution), each gas exerting part of that pressure (partial pressure).


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