by William H. Bates, M. D. Д. БейтсReprinted from New York Medical Journal, February 3, 1917, pp. 200-202.
BLINDNESS RELIEVED BY A NEW METHOD OF TREATMENT.
Report of a Case.
By W. H. Bates, M. D.,
A woman, fifty-four years of age, was first seen by me on May 9, 1915. Her son, who guided her into the office, stated that his mother had been "going blind" for a long time; that she could not see to find her way about the house; that she was unable to see the faces of people around her, and that she could not attend social gatherings with comfort. When out of doors she required the services of an attendant because of her inability to see passing people, obstructions on the sidewalk, or the curbstones or vehicles at street crossings.
The patient's husband, a banker, and a man of intelligence and accurate observation, gave the history of her progressive loss of sight. During the past twenty-five years he had consulted numerous oculists in various parts of the United States, each of whom had pronounced her condition incurable.
I am indebted to G. de Wayne Hallet, M.D., of New York, for the following record of the patient's condition when she was under his care:
July 7. 1910. The patient gave a history of failing vision for twenty years, first in the right eye and later in the left. The patient states that the vision is slightly worse in the left eye than it was two years ago. She said: "Everything is in a mist."
Right vision, fingers counted at two feet. Left vision, 15/200.
This is a case of old neuroretinitis in each eye, a few bloodvessels left, but for the most part only white lines extend off into the retina in place of old vessels. She has also choroiditis disseminata in both eyes.
R Syr. acidi hydriodici, 3i once each day.
July 22, 1910. To read she has used a strong hand magnifying glass besides her spectacles. When tested she read Jaeger No. 2 with +10.00 D. S. with the left eye only and she likes it. This glass was prescribed for the left eye.
September 21, 1011. Left vision, 10/200. Ordered for near vision, +12.00 D. S.
Cocaine was used in each eye to dilate the pupil in order to examine the fundus. Can see no change since the last examination.
Treatment: Continue the use of the hydriodic acid.
Following this period of observation by Doctor Hallet, the patient consulted other physicians as stated, always being given an unfavorable prognosis.
The patient was treated by me for the following conditions: incipient cataract; vitreous, cloudy with floating bodies; neuritis, with partial atrophy of the optic nerves; retinitis, with obliteration of many bloodvessels; choroiditis disseminata; glaucoma of the left eye, connective tissue in the anterior chamber of the left eye, obscuring the iris and pupil; functional myopia; functional divergent and vertical squint.
The vision of the left eye, on May 9, 1915, was 5/200, field contracted. This was reduced to the perception o£ light, two days later, by an attack of acute glaucoma. Miotics, eserine, pilocarpine eye drops failed to relieve the tension and pain after three days; since then they have not been used.
With the assistance of Dr. C. Barnert, an iridectomy was performed. The pain and tension were relieved for a time, but the vision was not improved. Hemorrhages into the anterior chamber occurred on different days during the following week. A mass of connective tissue replaced the blood clots in the anterior chamber, and was large enough to obscure the iris and pupil. Dionin, ten per cent. solution, was instilled six times daily, and the powder once daily in the left eye only. The solution of dionin is still being used in the left eye only.
Later the patient had a number of mild recurrent attacks of glaucoma in the left eye, with pain and increased tension. After three months the tension remained normal. The tension of the right eye subsequently was increased at intervals, always subsiding at once after central fixation was obtained.
My experience with this case, and with others of various degrees of severity, has convinced me that the value of central fixation in the treatment of acute, chronic, and absolute glaucoma should be emphasized. Central fixation, as utilized by me, has relieved the symptom of glaucoma after operative and other treatment had failed. The value of the method employed in this case has been demonstrated in many other cases, and in various conditions other than glaucoma, of organic as well as of functional character.
The treatment described by me (1) with certain modifications, was employed in the case here cited, and was found beneficial, as will be seen. Memory and the imagination were useful. A small black spot or period on the Snellen card was imagined. When the sight vas poor, at the beginning of the treatment, the period imagined was imperfect. The problem for this patient was to imagine the period as perfectly black and stationary at all distances; then to be conscious of seeing a part or all of a letter without losing the period. The memory or imagination of a black period, at all times and in all places, secured for this patient unusual benefit.
It was explained to her that by "central fixation" is meant a passive, receptive, or relaxed condition of the eyes and brain. When the mind is sufficiently at rest the eye sees best the point fixed—in other words, the eye sees best what it is looking at. With the passive, receptive, relaxed condition of the eyes and mind, or with the absence of strain or effort, as manifested by central fixation, the sight was always improved. The myopic refraction produced by all effort to see distant objects and the hypermetropic refraction produced by an effort to see near, were absent when the eyes became relaxed and central fixation was manifest. Color blindness, contracted field, pain and fatigue, and photophobia were also materially benefited or cured. The objective symptoms of increased intraocular tension, squint, strain of the muscles of the face, twitching of the eyelids and eyeballs, all disappeared instantaneously when the patient was conscious of central fixation. The organic lesions were seen to improve. With the boodvessels the changes were slow; but with the cloudiness of the lens, central fixation was followed immediately by an increased transparency readily demonstrated by the ophthalmoscope.
In six days the sight of the right eye had improved to more than one tenth of the normal. Later, the patient became able to travel on the subway alone, to shop in the neighborhood of her home, to read and write letters, and to read hooks, magazines, and newspapers. She became able to see the color of the eyes of her husband, chii1dren, and friends, which she had never been able to do before in her life. Her sight at night also improved, so that she saw the lights across the Hudson River, stationary and moving, more than a mile away. She won first prize at auction bridge twice, enjoyed theatres and moving picture shows, went to parties, receptions, dinners, and other social functions, and had a good time.
January 17, 1916. Patient went out of doors alone or without an attendant, and took a walk on Riverside Drive.
February 23, 1916. She is beginning to distinguish colors. Without an attendant she walked alone from her home at 142nd Street and Broadway to the subway station at 145th Street, thence went by train to the Grand Central Station, walked over to the uptown side, and returned home on the train.
March 3, 1916. Went to the theatre and enjoyed the play.
March 6. 1916. Plays cards. Tells the time with the aid of her small watch without glasses.
April 1, 1916. She won first prize at are auction bridge card party. With the eyes closed she believes that she can now imagine as well with the left eye as with the right, indicating an improved condition of the left retina.
April 6, 1916. Won second prize at auction bridge, 140 players.
April 18, 1916. Read a column of the New York Times, news section.
She sees the Hudson River boats, and houses and trees across the river. Lights on the boats were seen at night, but not the lights on the apposite shore.
April 28, 1916. The patient is beginning to read diamond type, Jaeger No. 1, at six inches, using two of her fingers as a pointer.
May 6, 1916. The new moon and the stars were seen for the first time.
May 15, 1916. The lights across the Hudson River, more than a mile distant, were seen when the room occupied by the patient was dark or the lights turned off. (Later, June 21, she was able to see the distant lights with the room occupied and well lighted.)
May 20, 1916. Patient was able consciously, at will, to produce the illusion of seeing one object as two or more—monocular polyopia, by a strain, eccentric fixation.
June 21, 1916. Did some sewing with a split needle. R., 14/30, without the consciousness of the black period. She runs short distances on the street without difficulty.
July 1, 1916. The patient writes letters without glasses better than with them, because she finds her sight confused with glasses. The imagination or the memory of a perfectly black period relieves or prevents the pain which is usually produced by the instillation of the dionin powder into the left eye.
August 1, 1916. With the right eye a line of diamond type was read in five minutes, without glasses and without the aid of a pointer.
August 8, 1916. The left eye distinguished one letter of diamond type for the first time, without glasses, at six inches.
August 15, 1916. Diamond type, one line read in forty seconds.
August 31, 1916. With the right eye one line of diamond type was read in six seconds, without the aid o£ a pointer. With the left eye after some minutes one letter was seen with the aid of a pointer. For the first time the color of her own eyes was seen with the aid of a mirror.
The progress noted may be sunmarized as follows:
May 9, 1915.
R., p. 1; L., 5/200.
May 11, 1915.
R., p. 1; L., p. 1., glaucoma.
May 17, 1915.
R., 14/200; L., p. 1.
June 6, 1915.
R., 14/50-; L., p. 1.
October 15, 1915.
R., 14/50-; L., 14/200.
November 21, 1915.
R., 14/15+; L., 14/200.
May 12, 1916.
R., 14/10+; L., 14/200.
June 17, 1916.
R., 14/10+; L., 14/50.
July 14, 1916.
R., 14/10+; L., 14/10-.
August 31, 1916.
R., 14/10+ or 20/10-; L., 14/10-.
The vision of the right eye was improved from p. 1. to 14/200 in 8 days; 14/200 to 14/50- in 20 days; 14/50- to 14/15+ in 168 days, or 5 1/2 months; 14/15+ to 14/10+ in 185 days, or 6 months.
The vision of the left eye was improved from p.1. to 14/200 in 157 days, or 5 months; 14/200 to 14/50 in 246 days, or 8 months; 14/50 to 14/10- in 27 days.
In a letter received some months after she left New York, the patient wrote: "I do not think I have gone back any. I see very well indeed. Recently I saw in the garden, about one hundred feet away, a yellow butterfly alight on a red flower. My letters are written without glasses. The right eye really seems improved, but the left eye has not changed. I still use the dionin eye drops in. the left eye only."
This case has been of special interest because it has demonstrated that central fixation, previously utilized in the treatment of functional disease of the eye, is also of distinct value in the treatment of certain organic diseases of this organ. Many such cases, which, treated solely along the lines of the customary ophthalmologic practice, would be consigned to the category of the practically hopeless, may be markedly benefited, and restored to active and useful life.
1. BATES: New York Medical Journal, May 8, 1915 [link].
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