Presbyopia: Its Cause and Cure

By W. H. Bates, M.D.

Presbyopia is the name given to the loss of power to use the eyes at
the near point, without the aid of glasses, which usually occurs after
the age of forty.

The text-books teach that this change is a normal one: but it is a
noteworthy fact that many other eye troubles often date from the time
of its appearance, or develop a little later. Many cases of glaucoma
start about this time, and so do many cases of cataract and
inflammation of the interior of the eye. Patients with presbyopia are
very likely to have conjunctivitis. They are also subject to
congestion and hemorrhages of the interior of the eye. One patient
developed a lot of muscular trouble and a marked degree of double
vision at the time he became presbyopic, and suffered three nervous
breakdowns in quick succession. He was operated on for the muscular
condition, and took prism exercises, but obtained very little relief.
In another case a patient began to suffer, at the time she became
unable to read without glasses, from a contraction of the muscles of
the face, congestion of the conjunctiva and continual headaches. The
strain was so great that she had to keep her eyes partly closed, and
glasses did nothing to relieve her discomfort. Up to the time when her
presbyopia appeared she had had none of these troubles.

The accepted explanation for the loss of near vision with advancing
years is that it is due to the hardening of the lens, but it is quite
impossible to reconcile the facts with this theory; for not only does
presbyopia occur much below the age of forty and even in childhood,
but it is often delayed beyond the age of fifty, and sometimes does
not occur at all. There are also cases in which near vision is
restored after having been lost. We are told that presbyopia comes
early in the hypermetropic (farsighted) eye, and late in the myopic
(nearsighted) eye; that premature hardening of the lens and weakness
of the ciliary muscles (supposed to control the accommodation) may
cause it to appear in youth; and that the swelling of the lens in
incipient cataract may account for the restoration of near vision
after it has been lost; but there are still many cases in which these
explanations cannot be made to apply.

It is true that hypermetropia does hasten and myopia prevent or
postpone the advent of presbyopia, and as myopia may exist in only one
eye, without the patient's being aware of it, he may think that his
vision is normal both for the near-point and the distance. There are
cases, however, in which the vision has remained absolutely normal in
both eyes long after the presbyopic age, and a considerable number of
these cases have been brought to my attention. One of them, a man of
sixty-five, examined in a moderate light indoors, was found to have a
vision of 20/10. In other words he could see twice as far as the
normal eye is expected to see. He also read diamond type at less than
six inches, and at other distances, to more than eighteen inches. In
reply to a query as to how he came to possess visual powers so unusual
at his age, or, indeed, at any age, he said that when he was about
forty he began to experience difficulty, at times, in reading. He
consulted an optician who advised glasses. He could not believe,
however, that the glasses were necessary, because at times he could
read perfectly without them. The matter interested him so much that he
began to observe facts, a thing that people seldom do. He noted,
first, that when he tried hard to see either at the near-point or at
the distance, his vision invariably became worse, and the harder he
tried the worse it became. Evidently something was wrong with this
method of using the eyes. Then he tried looking at things without
effort, without trying to see them. He also tried resting his eyes by
closing them for five minutes or longer, or by looking away from the
page that he wished to read, or the distant object he wished to see.
These practices always improved his sight, and by keeping them up he
not only regained normal vision but retained it for twenty-five years.
   "Doctor," he said, in concluding his story, "when my eyes are at
rest and comfortable, my vision is always good and I forget all about
them. When they do not feel comfortable I never see so well, and then
I always proceed to rest them until they feel all right again."

The fact is that presbyopia is due to a strain. It is a strain similar
to the one that produces hypermetropia, but differs from it in the
fact that it affects chiefly vision at the near-point. This can be
demonstrated with the retinoscope. When a person with presbyopia tries
to read, the retinoscope will show that he has hypermetropia, but when
he looks at a distant object the retinoscope will show either that his
eyes are normal, or that the hypermetropia is less. Simultaneous
retinoscopy is difficult in the case of a reading patient, for not
only is the pupil small, but in order to find the shadow it is
necessary for the patient to look in one general direction all the
time, and this is not easy. It is also difficult to hold a glass at
one side of the eye for the measurement of the refraction in such a
way that the observer can look through it while the patient does not.
With a sufficient zeal for the truth, however, these difficulties can
be overcome.

The strain which produces presbyopia is accompanied by a strain, more
or less pronounced, of all the other nerves of the body. Hence the
many distressing symptoms from which presbyopic patients suffer.
Glasses, by neutralizing the effect of the imperfect action of the
muscles, may enable the patient to read; but they cannot relieve any
of these strains. On the contrary they usually make them worse, and it
is a matter of common experience that the vision declines rapidly
after the patient begins to wear them. When people put on glasses
because they cannot read fine print they often find that in a couple
of weeks they cannot, without them, read the coarse print that was
perfectly plain to them before. Occasionally the eye resists the
artificial conditions imposed upon them by glasses to an astonishing
degree, as in the case of a woman of seventy who had worn glasses for
twenty years, in spite of the fact that they tired her eyes and
blurred her vision, but was still able to read diamond type without
them. This however is very unusual. As a rule the eyes go from bad to
worse, and, if the patient lives long enough, he is almost certain to
develop some serious disease which ends so frequently in blindness
that nearly half of our blind population at the present time is
believed to be over sixty years of age. Persons with presbyopia who
are satisfied with the relief given to them by glasses should bear
this fact in mind.

Presbyopia is cured just as any other error of refraction is cured, by
rest. But there is a great difference in the way patients respond to
this treatment. Some are cured very quickly, even in as short a time
as fifteen minutes; others are very slow; but as a rule relief is
obtained within a reasonable time.

One of my earliest cures of presbyopia was accomplished in less than
fifteen minutes by the aid of the imagination. The patient had worn
glasses for reading for ten years. When I showed him a specimen of
diamond type and asked him to read it without glasses, he said he knew
the letters were black but they looked grey.
   "If you know they are black, and yet see them grey," I said, "you
must imagine that they are grey. Suppose you imagine that they are
black. Can you do that?"
   "Yes", he said, "I can imagine that they are black," and
immediately he proceeded to read them.

In another case a patient was cured simply by closing his eyes for
half an hour. His wife was cured in the same way, and when I saw the
couple six months later they had had no relapse. Both had worn reading
glasses for more than five years.

While it is sometimes very difficult to cure presbyopia, it is,
fortunately, very easy to prevent it. Oliver Wendell Holmes told us
how to do it in "The Autocrat of the Breakfast Table", and it is
astonishing, not only that no attention whatever should have been paid
to his advice, but that we should have been warned against the very
course which was found so beneficial in the case he records.
   "There is now living in New York State," he says, "an old gentleman
who, perceiving his sight to fail, immediately took to exercising it
on the finest print, and in this way fairly bullied Nature out of her
foolish habit of taking liberties at the age of forty-five or
thereabouts. And now this old gentleman performs the most
extraordinary feats with his pen, showing that his eyes must be a pair
of microscopes. I should be afraid to say how much he writes in the
compass of a half-dime, whether the Psalms or the Gospels, or the
Psalms and the Gospels, I won't be positive."

Persons whose sight is beginning to fail at the near-point, or who are
approaching the presbyopic age, should imitate the example of this
remarkable old gentleman. Get a specimen of diamond type, and read it
every day in an artificial light, bringing it closer and closer to the
eye till it can be read at six inches or less. Or get a specimen of
type reduced by photography until it is much smaller than diamond
type, and do the same. You will thus escape, not only the necessity of
wearing glasses for reading and near work, but all of those eye
troubles which now so often darken the later years of life.
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Presbyopia Number
Better Eyesight
A monthly magazine devoted to the prevention and cure of imperfect
sight without glasses
Copyright, 1921, by the Central Fixation Publishing Company
Editor—W. H. Bates, M.D.
Publisher—Central Fixation Publishing Co.
$2.00 per year, 20 cents per copy
300 Madison Avenue, New York, N. Y.
Vol. IV - April 1921 - No. 4
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