And Combined with the Bates Method on the Management

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How to cite this thesis

Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD. (Chemistry)/ M.Sc. (Physics)/ M.A. (Philosophy)/M.Com. (Finance) etc. [Unpublished]: University of Johannesburg. Retrieved from: https://ujdigispace.uj.ac.za (Accessed: Date). THE EFFECTS OF PHYSOSTIGMA 30CH

AND COMBINED WITH THE BATES

METHOD ON THE MANAGEMENT OF

MYOPIA

By

Debbie Smith

9444728

A dissertation submitted to the Faculty of Health and Biotechnology, Technikon

Witwatersrand, Johannesburg, in partial fulfilment of the requirements for. the degree:

Master in Technology: Homoeopathy.

Date ofSubmission: May 2000

Supervisor: Mrs. S. Eagleton

Signed:

Co-supervisor Mr. J\.,~n Pletzen

Signed:

Co-supervisor: Dr. M.R.A. Moiloa

Signed: DECLARATION

I, Debbie Smith, declare thatthis dissertation is my own work. It is being submitted for the Master Degree: in Technology: Homoeopathy in the Faculty of Health and Biotechnology at Technikon Witwatersrand, Johannesburg. It has not been submitted before for any degree or examination in any other institution.

~ y__ day of J UUY...5I..- 2000 \

11 DEDICATION

This study is dedicated to my father, Demetreos and my two sisters, Lelanie and Issie.

... III ACKNOWLEDGEMENTS

The author would like to sincerely thank the following people who made contributions to this project and the writing ofthis research report. » My supervisor, Mrs. S. Eagleton of the School of Biotechnology at the Technikon Witwatersrand, for her time, caring and guidance. » Mr. A.I.I. van Pletzen, of the School of Optometry at the Technikon Witwatersrand, who assisted me greatly in the following through and completion ofthis project, for his endless time and insight. » Dr. M.R.A. Moiloa, of the School of Homoeopathy at the Technikon Witwatersrand, for his assistance and homoeopathic ~?wledge in the assistance of this research project. » D. Hayler and G. Garden who gave freely of their time for the optometric examinations. » R. Luwes who had the ability to always manage to organise the research appointments. » To all the subjects who participated in this research project. » To Advanced Cabling for the use oftheir computer facilities.

A special thanks to: • My father for believing in me and supporting me throughout my years ofstudying. • My two wonderful sisters for their motivation and support during this research project and during my years ofstudying. • My wonderful companion and friend, Malcolm. • My friends for supporting and encouraging me throughout this study.

IV ABSTRACT

Spectacles and contact lenses are the most widely used optical appliances to manage myopia. Surgical techniques are an alternative but the outcome of surgery can be unpredictable and the procedures are costly. Myopia, or nearsightedness, is a condition characterised by blurred distant vision. Both a more lasting cure and a more cost-effective alternative solution in the treatment of myopia are desirable. The effectiveness of the homoeopathic remedy, Physostigma 30CH on its own, the Bates method on its own and a combination ofthe homoeopathic remedy and the Bates method in reducing myopia were determined.

Thirty suitable myopic subjects between the ages of21 - 34 years were selected. Subjects were paired in terms ofage, race and sex on a double-blind basis.

This research was conducted in three stages of thirty days each. During stage one the experimental group performed the Bates method, while the control group performed the modified Bates method. During stage two the experimental group received the .homoeopathic remedy, Physostigma 30CH, whilst the control group received a placebo. During stage three the experimental group performed the Bates method and received the homoeopathic remedy, Physostigma 30CH, whilst the control group performed the modified Bates method and received the placebo.

Each subject underwent an optometric examination before and after each of the above­ mentioned stages. During the eye examination, the aided and unaided visual acuity, left and right refractions, accommodative flexibility and accommodation amplitude were determined by a qualified optometrist. After each eye examination a questionnaire was completed to determine the patient's subjective feelings ofthe treatment.

The data was analyzed using a 2-sample t-test (incorporating the Levence test) for determining the statistical significance within each different stage of the research. The significant (2-tailed) p-values for the statistical significance between the two groups were obtained in order to indicate whether there was a reduction in myopia in either the experimental or the control group or both.

v No significant refractive and accommodative changes were observed in the control and experimental group during any of the three stages of the research. Regarding the questionnaire, no significant differences were detected in the subject's subjective feelings.

Further research is required over a longer time duration and the use of different potencies of the homoeopathic remedy, Physostigma, in order to determine the efficacy of the homoeopathic remedy, Physostigma, and the Bates method in the treatment ofmyopia.

vi DEFINITIONS OF TERMS

1. Dioptre (D) It is the unit ofmeasurement ofthe refractive power ofthe lens, thus specifying the power of a spectacle lens (Tray & Grosvenor, 1996: 54) or ofan optical system (Millodot, 1985: 40).

2. Homoeopathic remedy A remedy or medicine made according to the principles of homoeopathy which includes dilution and succussion (Eizayaga, 1991 : 176 - 186).

3. Myopia Myopia is defined as an error ofrefraction, causing parallel rays oflight to be focused in front ofthe retina (McDonough, 1993 : 666). The result ofthis is blurred vision.

4. Potency(ies) A stage ofdilution and succussion ofthe homoeopathic remedy or medicine (Eizayaga, 1991 : 177).

5. Potency scale A scale or series of homoeopathic dilutions and succussion of the remedy or medicine (Eizayaga, 1991 : 177).

6. Physostigma venenosum This is a great twining climber plant belonging to the family Leguminosa. Its common name is the calabar bean. The chiefconstituent is the alkoloid physostigmine (Lockie, 1989 : 156).

7. Refractive power The change in vergence that occurs when light passes through a lens (Troy & Grosvenor, 1996, : 54).

vii 8. Retinoscopy An instrument for determining objectively the refractive state of the eye (Millodot, 1985 : 229).

viii TABLE OF CONTENTS

Page

Declaration 11

Dedication 111

Acknowledgements IV

Abstract V

Definition oftenns Vll

Table ofcontents IX

List oftables Xll

List offigures XIll

List ofappendices XIV

1.0 LITERATURE REVIEW 1

1.1 AIM OF RESEARCH 2 1.2 INTRODUCTION 2 1.3 INCIDENCE OF MYOPIA 3 lA AETIOLOGY OF MYOPIA 3 1.5 MANAGEMENT OF MYOPIA 5 1.5.1 Allopathic treatment ofmyopia 5 1.5.1.1 Spectacles 6 1.5.1.2 Contact lenses 7 1.5.2 Refractive eye surgery 9 1.5.2.1 Radial keratotomy 10 1.5.2.2 Photorefractive keratectomy (pRK) 12 1.5.2.3 Laser in-situ keratomileusis (LASIK) 12 1.5.2.4 Refractive keratoplasty 13 1.5.3 Natural vision therapies 13 1.5.3.1 The Bates method 13 1.5.3.2 Progressive optometry 14 1.5.3.3 Eclectic school 15

IX 1.5.3.4 Other less well known treatments 15 1.5.4 Homoeopathic treatment 16 1.5.4.1 Principles ofhomoeopathy 16 1.5.4.2 The homoeopathic treatment ofmyopia 16 1.6 SUMMARY 17

2.0 MATERIALS AND METHODS 19

2.1 HYPOTHESES 20 2.2 ASSUMPTIONS 20 2.3 METHODOLOGY 21 2.3.1 Stage one 21 2.3.2 Stage two 21 2.3.3 Stage three 22 2.3.4 Questionnaire 22 2.3.5 Optometric eye examinations 22 2.4 STATISTICAL ANALYSIS 23 2.4.1 T-test 23 2.4.2 Levence's test 23 2.4.3 Significant p-value (2-tailed) test 23

3.0 RESEARCH ANALYSIS AND RESULTS 25

3.1 GRAPHS 27 3.1.1 Unaided visual acuity 27 3.1.2 Refraction ofright eye 28 3.1.3 Refraction ofJeft eye 29 3.1.4 Accommodative flexibility 30

x 3.1.5 Accommodation amplitude 31 3.1.6 Questionnaire 32 3.2 ANALYSIS OF RESULTS 33 3.3 .1 Stage one 33 3.2.2 Stage two 34 3.2.3 Stage three 36 3.2.4 Summary 37

4.0 DISCUSSION OF RESULTS AND RECOMMENDATIONS 38

4.1 STAGE ONE 39 4.2 STAGE TWO 40 4.3 STAGE THREE 40 4.4 OTHER VARIABLES 41 4.5 POSSffiLE REASONS FOR THE OUTCOME OF THE RESEARCH 41 4.6 RECOMMENDATIONS 42

. Xl LIST OF TABLES

3.1 T-values for stage one 33 3.2 Levence's p-values for stage one 34 3.3 Significant p-values for stage one 34 3.4 T-values for stage two 35 3.5 Levence's p-values for stage two 35 3.6 Significant p-values for stage two 35 3.7 T-values for stage three 36 3.8 Levence's p-values for stage three 36 3.9 Significant p-values for stage three 37 3.10Significant p-values (2-tailed) for independent two sample test 37

.. Xli LIST OF FIGURES

3.1. Mean unaided visual acuity for both eyes for the initial consultation and for each stage 27 3.2 Mean unaided visual acuity for both eyes for the final findings for each stage 27 3.3 Mean refraction ofright eye for the initial consultation and for each stage 28 3.4 Mean refraction ofright eye for the final firidings for each stage 28 3.5 Mean refraction ofleft eye for the initial consultation and for each stage 29 3.6 Mean refraction ofleft eye for the final findings for each stage 29 3.7 Mean accommodative flexibility for the initial consultation and for each stage 30 3.8 Mean accommodative flexibility for the final findings for each stage 30 3.9 Mean accommodation amplitude for the initial consultation and for each ~age 31 3.10Mean accommodation amplitude for the final findings for each stage 31 3.11 Mean questionnaire total for the initial consultation and for each stage 32 3.12 Mean questionnaire total final findings for each stage 32

... XIII LIST OF APPENDICES 43

3.1 Instruction sheet ofthe Bates method 44 3.2 Instruction sheet ofthe modifiedBates method 46 3.3 Questionnaire to subjects on level ofsatisfaction 48 3.4 Unaided visual acuity for both eyes for the initial consultation and for each stage 49 3.5 Unaided visual acuity for both eyes - final findings for each stage 50 3.6 Refraction ofright eye for the initial consultationand for each stage 51 3.7 Right eye refraction - final findings for each stage 52 3.8 Refraction ofleft eye for the initial consultationand for each stage 53 3.9 Refraction ofleft eye -final findings for each stage 54 3.10 Accommodativeflexibility for the initial consultationand for each stage 55 3.11 Accommodative flexibility - final findings for each stage 56 3.12 Accommodationamplitude for the initial consultationand for each stage 57 3.13 Accommodation amplitude - final findings for each stage 58 3.14 Questionnairetotal for the initial consultation and for each stage 59 3.15 Questionnairetotal - final findings for each stage 60 3.16 Questionnaireresults for individualquestions 61 3.17 Aided visual acuity for the initial consultation and for each stage 63 3.18 Pupillary distance ofeach subject 64 3.19 Pupillary size of each subject 65

REFERENCES 66

xiv to II11MIIBIBII 1.0 LITERATURE REVIEW

1.1 AIM OF RESEARCH

The aim ofthis study was threefold • To test for the effectiveness ofthe Bates method in isolation as a technique for reducing myopia - stage one.

• To test for the effectiveness of the homoeopathic remedy Physostigma 30CH In . isolation as a technique for reducing myopia- stage two. • To test for the effectiveness of the Bates method combined with the homoeopathic remedy, Physostigma 30CH, as a technique for reducing myopia - stage three.

1.2 INTRODUCTION

According to Borish (1975 : 83), Aristotle (384 - 322 BC) was credited with first identifying myopia while Galen (131 - 201 AD) coined the term myopia. Myopia or nearsightedness results in an individual who is unable to see clearly at a distance. The prevalence of myopia varies with age, population groups, environmental conditions and medical anomalies (Michaels, 1985 : 457).

For vision to be clear, light rays must be focused on the retina. Myopia causes light rays from distant objects to focus in front of the retina. Distant objects appear to be blurred, while near objects are seen clearly (Bienz, 1997). The retina converts the light rays into impulses that are sent via the optic nerve to the brain, which interprets the images.

Besides the visual impact that myopia has on an individual, it also has a psychological impact. Myopic children may experience social problems due to negative peer pressure. The refractive error also limits their participation in contact sports (Curtin, 1985 : 10 - 15).

2 According to Wildsoet (1999 : 16 - 22), there are various options available to improve myopia or to slow the rate of its progression. Vision can be improved by optical means, using spectacles or contact lenses. More heroic alternatives include orthokerotolgy, radial keratotomy, and more recently, laser surgery (Wildsoet, 1999 : 16 - 22). Each of the above-mentioned options has its own advantages and disadvantages. Other techniques with limited success include vision training, biofeedback training and undercorrection of the refractive error (Grosvenor, 1989: 415 - 419).

1.3 INCIDENCE OF MYOPIA

There is considerable controversy regarding the incidence ofmyopia. According to Lockie (1989: 156), myopia affects one person in six, or 17% ofthe population. In contrast to this, are the statistics given by Crawford and Hammer (1941), cited if' Borish (1975 : 21). According to these figures, 3% ofthe Hawaiian population are myopes compared to 18% of the Chinese population. Hirsch cited in Borish (1975 : 7), reported in 1964 that 25% to 35% of adults exhibited myopia. Figures quoted in Borish (1975 : 6) revealed myopia in 55% of orphanaged children between the ages of seven and fourteen. From the varying statistics given it would appear as if a sizeable proportion of the population suffers from myopia.

1.4. AETIOLOGY OF MYOPIA

The causes of myopia are even more controversial than the incidence. Different and contradictory theories regarding the aetiology of myopia have been proposed and evidence has been presented to support each theory. For every researcher who has proven something, there is another who has disproved it (Rehm, 1981 : 116 -120). Some of the theories regarding the aetiology ofmyopia will be discussed next.

According to Curtin (1985 : 104).Kepler first observed the concept ofprolonged reading as a cause of myopia in 1611, when the latter noted that the onset or progression of myopia

3 increased with schooling. Nadell & Hirsh (1958 : 321 - 326), found no significant difference in the amount oftime spent on near work by myopic and non-myopic high school students. Young, Beattie, Newby & Swindell (1954 : 192 - 203), on the other hand presented evidence that myopia is more likely in school children that do the most near work. The authors studied the prevalence of myopia in Eskimo families. The parents were illiterate, whilst their children had learned to read and were required to attend schools. Only 1% ofthe parents were myopic, compared to 60% ofthe children (Young et al. 1954 : 192 - 203). One study postulated that Chinese children were myopic due to near point stress caused by poor reading habits. This sounded reasonable until it was pointed out that 90% ofthe children studied were illiterate (Michaels, 1985 : 463). Santacreu (1995 : 147 - 150), considered scholars in their teens to be a high-risk group for myopia development. This author's model is based on years of study and contends that school goers have increased demands for near work and a consequent decrease in outdoor activities.

It would appear as if myopia has a racial bias (Borish, 1975 : 23). The highest incidence of myopia appears to be present amongst Chinese, Japanese, Egyptians, Germans, Jews and Middle Eastern people. The lowest incidence seems to be among Blacks, Eskimos and Indians. Europeans exhibit more myopia than do Americans. The results of the study of racial differences are complicated by the contribution of geographical and environmental factors (Borish,1975 : 45).

The conclusions of the studies done during puberty are indecisive and different studies totally contradict each other (Borish, 1975 : 45). It should be noted that myopia does not seem to increase or decrease between the ages of21 to 34 years (Borish, 1975 : 19)

That hereditary factors play a role in the development of myopia is beyond question (Michaels, 1985 : 463). In a hereditary twin study by Yashimoto (1960), cited in Curtin (1985 : 65), the levels of refraction were more concordant in monozygotic twins (sharing the identical gene pool) compared to diozygotic twins (non-identical gene pool) and the control group (Curtin, 1985 : 65).

4 1.5. MANAGEMENT OF MYOPIA

The management of myopia can be classified into allopathic or conventional optometric methods and, secondly, into the more controversial techniques. The latter includes vision therapy and naturopathic approaches. These naturopathic approaches are based on theories and have no scientific evidence (Michaels, 1985 : 476).

1.5.1. ALLOPATHIC TREATMENT OF MYOPIA

In this case vision is improved by optical means such as contact lenses and spectacles, or alternatively by a growing number of surgical options (Wildsoet, 1999 : 16 - 22). The minus power ofcontact lenses or spectacle lenses diverges the light rays, thereby correcting the myopic refractive error (Curtin," 1985 : 156). Surgical procedures alter the shape ofthe cornea so that a clear image can be formed on the retina.

According to Richard (1992 : 8 - 27), most ophthalmologists regard vision as a passive mechanical and an optical phenomenon. It is genetically pre-determined and correctable with lenses or surgery.

The allopathic approach contends that it is the action of the ciliary muscle on the lens that permits the eye to focus. The purpose ofthe extra ocular muscles is to turn the eyes. The majority ofophthalmologists agree that the core ofany myopia prevention program should be the inhibition of accommodation when doing close work. The Bates method doesn't include the inhibition of accommodation and, therefore, logic would indicate that it would do little, if anything, to prevent or improve myopia (Rehm, 1981 : 116 - 122).

5 There are other different approaches attempting to control the progression ofmyopia or to decrease the existing amount ofmyopia. Methods to control the progression ofmyopia are more valuable in young myopes. The methods include the wear of bifocals and conventionally fitted contact lenses as well as orthokeratology where the contact lens flattens the cornea (Grosvenor, 1989: 415 - 419).

1.5.1.1 Spectacles Spectacles are an effective, predictable and economically acceptable method of correcting myopia. They are also safe, especially now that impact-resistant lenses are available. Unfortunately spectacles do have cosmetic drawback for some patients (Anderson, 1993 : 1102 - 1113).

According to Sherman (1993 : 16 - 21), investigations into the use of bifocals to control myopia have contradictory results. Oakley and Young (1975 : 738 - 764), concluded that bifocals control the progression of myopia. A study by Grosvener, Perrigin, Perrign and Maslovitz (1987 : 482 - 498), revealed no significant progression of myopia with the use of bifocals. Other studies contradict this work.

Rehm (1981 : 23 - 40), contends that spectacles for myopes are harmful because they maintain a constant degree of refractive error which, according to this author, would otherwise not be there. Most of the damage occurs when distant spectacles are used for reading (Rehm, 1981 : 26). These spectacles forces the myope to use increased accommodation to see clearly at near. This increased accommodation causes further lengthening of the eye, resulting in the myope requiring even stronger minus lenses to see clearly at distance (Rehm, 1981 : 26). The prescription of minus overcorrection has the same effect. The patient sees distant objects more clearly and more intensely and eventually perceives that it is not possible to function without his spectacles. Spectacles now become a crutch and the myope is dependent on it (Kavner & Dusky, 1978 : 176 - 178).

Spectacles only compensate for the myopia but do not improve the condition. Thus the patient is visually handicapped when the spectacles are not worn (Cinc, 1995).

6 1.5.1.2. Contact lenses Hardcontact lenses were first introduced in 1827 and soft contact lenses in 1962 (Phillips & Stone, 1989 : 555 - 594). Personal appearance and the inconvenience of spectacles are common reasons for patients demanding contact lenses. Contact lens technology continues to improve, and often patients considered incapable ofcontact lens wear only a few years ago, can now be fit effectively (Anderson, 1993 : 1102 - 1113).

There are several types ofcontact lenses that can be grouped into three main categories: 1) Non-gas permeable hard contact lenses: These lenses are made ofpolymethylmetahcrylate, which is not permeable to gasses, such as oxygen or carbonioxide, or to liquids such as tears. Continuous wear of hard contact lenses is not possible because the eye would become hypoxic. However, these lenses have the advantage ofrequiring less lens care (Curtin, 1985 : 205 - 207; Elkington, 1988 :.36). 2) Gas permeable hard contact lenses: These lenses allow the passage ofoxygen to the cornea. However these lenses are more prone to contamination and are more fragile when compared with non-gas permeable type (Curtin, 1985 : 205 -207; Elkington, 1988 : 36). 3) Soft contact lenses: These lenses are permeable to gasses and liquids and may be worn for longer periods. They are also less durable when compared with the above-mentioned lenses and are even more prone to contamination by proteins and salts (Elkington, 1988 : 36).

Contact lenses have some definite advantages when compared to spectacles. This includes inter alia the elimination ofthe small eye phenomenon, produced by the minification effect of the negative spectacle lenses (Curtin, 1985 : 205 - 207). In addition, participation in sport, especially contact sports becomes possible with soft contact lenses. Optical advantages of contact lenses include an increased retinal image size resulting in slightly clearer vision (Lakra & Gimbel, 1997 : 42 - 48). Contact lenses also improve peripheral vision (Segal, 1997). There is also a cosmetic advantage for most patients (Anderson, 1993 : 1102 - 1113).

7 The extended wear of soft contact lenses is an attractive prospect for future contact lens wearers, because the patient can now be totally free of spectacles (Phillips & Stone, 1989 : 555 - 594). Extended wear contact lenses can be defined as the wearing oflenses, without removal during eye closure, for periods ranging from occasional overnight wear up to thirty days or more ofcontinuous wear. Lammer (1984 : 828), concluded in a study that extended wear ofsoft lenses represent a safer form ofvisual rehabilitation than radial keratotomy. In this study of 400 myopes, who were fitted with soft lenses, 95% achieved 20/20 vision. Furthermore, lens breakage or loss occurred in only 26% ofthis sample. The most common adverse reaction was hyperaemia of the conjunctiva, which was prevalent in 27.5% of this sample (Lammer, 1984 : 828).

Binder (1983 : 623), recommended the use ofcontact lenses by the myope. In this study by Binder (1983 : 623), 1099 subjects where fitted with extended wear soft contact lenses. Only 2% failed to achieve a corrected vision of20/30 or better.

A review of the literature on the effects of hard contact lenses on myopia progression showed that contact lenses can actually control myopia, resulting in corneal flattening that reduces myopia. KemmetmulIer (1972 : 75 - 83), found that patients wearing contact lenses showed a significantly slower progress in myopia than those in the same age group who wear spectacles. Stone conducted a study in 1973, which determined how contact lenses affected myopic changes in myopic children. From this data, growing myopic children who were wearing contact lenses appear to have stabilised myopia, even though myopia usually increases in this age group (Stone, 1973 : 90 - 134). Stone & Powell-Cullingford (1974), concluded in a four year study that the rate of myopia progression may be expected to be slowed down up to 10 by extended contact lens wear (Phillips & Stone, 1989 : 555 -594). A five-year study by Stone (1976), reported a mean rate of myopia progression of only 0.100 per year for contact lens wearers as compared to 0.350 per year for spectacle wearers (Grosvenor, 1989: 415 - 419).

Contact lens wear is dependent on the motivation of the patient, the correct wearing schedule of the contact lenses and the physiological and psychological adaptation of the patient (Curtin, 1985 : 163). The contact lens wearer must spend considerable time and money both in maintenance and in the application oftheir contact lenses.

8 Contact lenses are not totally risk-free, they may cause complications, which may require discontinuation ofthe lens wear and may even lead to visual loss (Anderson, 1993 : 1102 ­ 1113). Martin & Stark (1984 : 67), reported a variety of viral, bacterial and chlamydial conjunctivitis and epithelial hypertrophy in contact lens wearers. Weissman, Mondino & Petit (1984 : 476 - 481), treated nine myopic patients who developed corneal ulcers during extended soft lens wear. In six of these patients the ulcers were caused by the bacteria Pseudomonas aeruginosa. In two patients the infection reduced visual acuity to the perception ofmovement.

Other risks include oxygen deprivation of the cornea, mechanical problems and infections, as discussed above. The health ofthe cornea is dependent on receiving an adequate oxygen supply from the atmosphere. A decrease ofoxygen will lead to hypoxia, which in turn leads to corneal oedema. In the early stages this oedema is asymptomatic but as it progresses it causes a visual haze and halos (Micheals, 1985 : 598). The cornea is also mechanical at risk due to trauma caused by the wrong insertion of contact lenses and abrasion by fingernails. The chances for infection are bigger in the traumatised cornea. Wearing contact lenses can thus put the health ofthe cornea at risk (Lakra & Gimbel, 1997 : 42 - 48). The contact lens can also provide a surface to which bacteria may attach and on which they can proliferate. This is especially true in cases where patients are negligent with the cleaning procedures of contact lenses (Michaels, 1985 : 603).

To conclude with, it should be mentioned that contact lenses only improve the visual refraction at the time ofwear, but the patient is still visually handicapped when not wearing contact lenses. Thus a more permanent cure is preferable.

1.5.2. REFRACTIVE EYE SURGERY

In contrast to spectacles and contact lenses, corneal surgical procedures attempt to alter the refractive state of the eye permanently. This allows the patient to be independent of spectacles or contact lenses. Some individuals have difficulty in adjusting to spectacles or contact lenses, which may be due to the image distortion caused by the lenses and the

9 spectacles being uncomfortable. Corneal surgical refractive procedures improve performance in work and sport, and improve cosmetic appearance. At times the surgery is performed so that the candidate can meet the visual requirements of certain occupations such as law enforcement and firefighting. However, refractive eye surgery doesn't alter the aging process ofthe eye thus dependence for reading glasses after the age offorty may be required (Anderson, 1993 : 1102 - 1113).

Surgical procedures include radial keratotomy, Laser in-Situ Keratomileusis,' photorefractive keratectomy and refractive keratomy. With technological progress surgical techniques have changed and become more advanced. Ultra modem second-generation excimer lasers have superceded the original lasers.

Some complications of this type of surgery are treatable, whilst others are not. The latter includes damage to the optic nerve, perforation of the eye and blockage of the blood vessels, leading to hypoxia and the possibility oflosing the eye (Segal, 1997).

1.5.2.1 Radial keratotomy This used to be the most commonly used surgical technique. According to Segal (1997), Fyodorov performed the first radial keratotomy in 1973 and the technique was introduced to the United States in 1978.

A special diamond blade scalpel. is used for the radial keratotomy procedure that is performed under topical anaesthesia. The procedure is concluded in twenty minutes. Radial incisions are made into the corneal stroma. This results in a flattening ofthe central portion of the cornea due to scar tissue contraction when healing takes place (Elkington, 1988 : 36; Ward, 1996 and Lakra & Gimbel, 1997 : 146 - 148). Minimal pain is experienced during the procedure and recovery takes about one week (Lakra & Gimbel, 1997: 146 - 148).

Radial keratotomy was generally used for mild to moderate myopia between -ID and -4D (Lakra & Gimbel, 1997 : 145, McFadden, 1999). The most suitable candidates for radial

10 keratotomy should have stable, non-progressive myopia and this was established by examining the patients' past refraction state (Anderson, 1993 : 1102 - 1113).

A disadvantage of radial keratotomy was that the outcome of the surgery could not be precisely predicted for an individual's eye. Additional surgery might have been required to obtain the desired results (Anderson, 1993 : 1102 - 1113). Spectacles and contact lenses may stillbe necessary for best vision after surgery.

In 1990, the Prospective Evaluation of Radial Keratotomy (PERK), a multi-centre trial designed to assess the efficacy, predictability, safety and stability of radial keratotomy was established. This study analysed about 400 patients, most of whom had initially been followed for four years. About two-thirds ofthe patients achieved their goal ofeliminating spectacles or contact lenses. Nearly all ofthe remainder had considerably improved vision. Five years later 70% ofthe patients did not use corrective lenses for distance and 53% had 20/20 vision without spectacles. Improved vision was not always obtained after radial keratotomy (Waring, Lynn, Nizam, Kutner, Cowden, Culbertson, Laibson, McDonald, Nelson, Obstbaum, Rowsey, Salz & Bourque, 1991 : 1164 - 1174).

There are a few possible complications that can be caused by radial keratotomy. A common complication being under- or overcorrection ofmyopia. Hyperoptic shift may be a possible anticipated side effect one-year after radial keratotomy. This hyperoptic shift has been detected in 20 - 50% of radial keratotomy eyes. An eye that was perfectly corrected to piano, six months after surgery, may continue a slow drift toward hyperopia. The reason for this shift may be corneal instability. The surgical treatment of this hyperoptic shift is even more complicated (Lakra & Gimbel, 1997 : 148 - 159).

Corneal ulcers as well as endophthalmitis are risks of radial keratotomy, although the chance ofdeveloping a corneal ulcer following this surgery is less than 111000 (McFadden, 1999). Another common complication is that the vision may fluctuate throughout the day (Lakra & Gimbel, 1997: 157 - 158).

11 1.5.2.2 Photorefractive keratectomy (PRK) This procedure has been used since 1991. This technique is suitable for moderate to low myopia. In most cases good visual acuity is obtained. This method involves the scraping of the corneal epithelium in the treatment area. Excimer laser is used to ablate the cornea. The corneal epithelium regrows over the treated area. Pain may be experienced for up to one week post-operatively. The flatter cornea focuses light on the retina, thus resulting in clear distant vision (Gordon, 1999). However the procedure is not always 100% effective and some people require a second operation (Lakra & GimbeI, 1997 : 73 - 116).

At present complications of this technique remain unknown (Bienz, 1997 and McFadden, 1999). Seiler and Wollensak (1991 : 1156 - 1163), reported significant night glare experienced by patients after undergoing PRI<. Recovery varies from one to six months.

1.5.2.3 Laser in-situ keratomileusis (LASIK) LASIK is the most advanced method and is presently the procedure ofchoice for correction of refractive errors (Gordon, 1999). LASIK is much more dependant on computerized precision than the surgeon's operating skills of photorefractive keratectomy (McFadden, 1999). LASIK uses an excimer laser"to reshape the cornea. This involves the taking of a thin flap ofthe cornea which is folded back. The cornea is then ablated and the corneal flap is replaced over the treated cornea. The flatter cornea focuses light on the retina, thus resulting in clear distant vision (Lakra & Gimbel, 1997 : 117 - 141; Gordon, 1999).

LASIKhas several advantages compared with radial keratotomy. Some of these advantages include less corneal scarring in the long term and thus greater stability of the cornea (McFadden, 1999). LASIK-treated patients cornea also heal quicker. In addition there is a decreased incidence ofglare and hazy vision. LASIK is suitable for both low and high myopia. Another important advantage is that vision is improved immediately after the surgery. The visual acuity continues to improve during the first five to seven days after the procedure (Lakra & Gimbel, 1997 : 117 - 141; Gordon, 1999).

12 1.5.2.4. Refractive keratoplasty These surgical treatments are not often used today. This technique involves the reshaping of the cornea to correct vision problems. Procedures include keratomileusis, keratophakia and epikeratoplasty. In keratomiluesisthe front ofthe cornea is removed, frozen, reshaped, and stitched back on the eye. In keratophakia the donor's cornea is reshaped, and then inserted into the patient's eye. In epikeratoplasty a donor's cornea is used and applied to the anterior surface ofthe cornea from which the epithelium has been removed (Grosvenor, 1989: 415 - 419; Ward, 1996).

Keeping the above-mentioned in mind, despite the success of some of these surgical procedures, these procedures are not always complicationfree.

1.5.3. NATURAL VISION THERAPIES

There are three main schools ofvision therapy. These are the Bates approach, progressive optometry and the eclectic school. Each school has its own approach regarding the treatment ofmyopia (Richard, 1992: 8 - 27). These approaches will be discussed next.

1.5.3.1 The Bates method This method is based on Bates' clinical observations gained during forty years as a practising ophthalmologist. This author never accepted the view that the ocular lens changes its curvature to accommodate. Bates also contented that the mechanism of focusing was more complex and theorized that the whole eyeball changes shape according to the tension in the six extra ocular muscles. Accommodation took place in this way. According to this approach this meant that myopia could be reversed (Bates, 1943 : 6 - 8). This viewpoint was, and still is, controversial and is not widely accepted by conventional ophthalmologists (Bates, 1943 : 138).

Bates also had a theory of the variability ofrefraction that stated that the eye is dynamic and subject to daily and even to hourly shifts in refractive status. Bates' contention was that

13 spectacles injure the eyes by forcing them into continually maintaining the same refractive error and that would make the myopic condition worse (Bates, 1943 : 27).

The Bates exercises induce relaxation, both mentally and physically. According to Bates this is the key for the prevention and resolution ofrefractive errors. Palming is thought to relax the eye, increase blood circulation and relieve extra ocular muscular rigidity. Bates (1943 : 95), further states that blinking rests the eyes, stretches the extra ocular muscles and forces the pupil to contract and dilate. Swinging ofthe body makes the eyes more mobile, increases blood circulation and relaxes neck, shoulder, back and spine tension (Bates, 1943 : 98).

As to the scientific nature of the Bates method, Holtz (1973 : 33 -38), commented that Bates' theories are as fanciful in application, as they are bizarre in contemplation. One of the more extensive and controversial studies of the effect of the Bates method on myopia has come to be known as the Baltimore project. Woods, cited in Michaels (1985: 476), reported the results in 1946. At the end ofthe training period 59% of patients showed an improvement in visual acuity. This improvement was attributed to an enhanced interpretation of blurred visual images by the patient. A further 30% did not show a consistent improvement, whilst 31% 'showed practically no change, and 9% showed a decrease in visual acuity. What is ofgreat importance here is that no measurable change in myopia could be detected, even in cases where visual acuity improved. The accepted view of most eye care practitioners remains that techniques such as the Bates method can not change the refractive error (Michaels, 1985 : 476).

1.5.3.2 Progressive optometry Progressive optometry or behavioral optometry originated in the vision therapy called orthoptics. Orthoptics is the field in optometry that is concerned with straightening of the visual axis. This is achieved by means of ocular muscle-strengthening exercises (Richard, 1992: 8 - 27; Worral & Nevyas, 1995).

According to Richard (1992 : 8 - 27), Skeffington, a highly controversial optometrist in the 1920's, became known as the father of modern vision therapy. Skeffington stated that the

14 primary purpose of vision is to process information. This involves the entire visual system, from the eye to the brain. In addition Skeffington proposed that full natural vision can be compromised by environmental factors such as intense near point demand. Skefington, cited in Richard (1992 : 8 - 27), stated that full natural vision can be retrained. Skeffington, cited in Rosenfield (1994 : 3 - 11), stated that humans are biologically unsuited to the near vision tasks imposed by modem society. Skeffington was also of the opinion that natural vision can thus be achieved and natural vision can be retrained through a program of optometric visual therapy.

In a study ofprogressive optometry by Leber and Wilson (1993 : 87 - 92), it was found that of seven visually trained subjects, all seven displayed improved visual acuity in at least one eye. According to these authors the improvement in visual acuity is the result of both an increased ability to interpret blur and by decreases in refractive error (Leber and Wilson, 1993 : 87 - 92).

1.5.3.3 Eclectic school Benjamin (1992 : 13 - 18), a British Naturopath was the pioneer of the eclectic school. Benjamin restored his own vision by using the Bates method. This author expanded the basic approach, of the Bates method, to include dietary recommendations (Benjamin, 1992 : 64 - 69). In the 1960's this method became extremely popular incorporating ideas from naturopathy, yoga and psychology. Eclectic vision therapy looks at the whole person and thus treats natural vision holistically(Richard, 1992 : 8 - 27).

1.5.3.4. Other less well known treatments Chiropractors use a technique called craniopathy or neural organization and claim that vision and eye coordination can be improved by manipulation of the skull and vertebrae (Worral & Nevyas, 1995).

Colour therapy uses a process called photoretinology. Various pulsating coloured lights are directed into the eye. There is no scientific basisfor this (Worrall & Nevyas, 1995).

15 1.5.4. "HOMOEOPATHIC TREATMENT

1.5.4.1 Principles of homoeopathy Homoeopathy acts on the law of similars and is a gentle healing method. Each homoeopathic remedy is capable ofprovoking pathological symptoms in the healthy person and, ofmaking those same symptoms disappear in the sick person (Eizayaga, 1991 : 161 ­ 168).

Physostigma is a homoeopathic remedy prepared from the Calabar bean and is indicated for myopia (Lockie, 1989 : 156). Physostigma produces the following symptoms: a condition ofshortsightedness, contraction ofpupils, twitching and irritability of extra ocular muscles, and spasm ofthe ciliarymuscle (Vermeulen,1994 : 1295 - 1299).

1.5.4.2. The homoeopathic treatment of myopia A study on the use of Physostigma venenosum in the treatment of simple myopia by Basu (1980 : 224 - 231) concluded that the use of this substance resulted in a significant improvement in vision. Physostigma venenosum of different potencies were used. The entire study was over a duration of 180 days. There were 45 subjects who took the homoeopathic remedy. One drop ofthe remedy was taken orally on each of the treatment days. On the first three days a 30 potency was taken, from day 40 to 42 the 200 potency, from day 85 to 87 the 1000 potency and from day 130 to 132 the 10 000 potency. On the days not mentioned the subjects did not take the remedy (Basu, 1980 : 224 - 231). In the experimental group the biggest improvement in vision was observed in the age group 28 ­ 30 years (67.,7% cases), a moderate improvement in the age group 29 - 35 years (27,7% cases), and whilst a poor improvement in age group 0 - 7 years (5,4% cases). In contrast in the control group a decrease in acuity was observed in 77,5% of cases whilst there was no improvement in 22,5% of cases (Basu, 1980 : 224 -231). The results obtained by Basu (1980 : 224 - 231), indicate that the treatment with Physostigma venenosum is very successful in the myopia refractive error.

16 In a study by Pillay (1994 : 24 - 25), the subjects received a dose of Physostigma venenosum once a week. After each phase the potency increased. Phase one was devided into groups offour weeks. Week one to four subjects took Physostigma venenosum 5CH, week four to eight the potency 7CH, and week eight to 12 the potency 9CH. Phase two lasted for eight weeks. The potency 15CH was taken every second week. Phase three was two weeks after phase two where one dose of 30CH was taken. Twenty Subjects were involvedin the study (pillay, 1994 : 24 -25).

In contrast to Basu study (1980 : 224 - 231), Pillay's study (1994 : 24 -25), showed no significant change in the refraction. Regarding the level of satisfaction regarding improvement in visual acuity (which was obtained in a questionnaire before and after treatment) the following results were obtained: nine patients reported a greater level of satisfaction (45% of the sample), seven reported a decrease and four remained unchanged (pillay, 1994 : 26 - 35).

1.6 SUMMARY Myopia is a widely researched topic by various different disciplines. These include the conventional optometry, the natural vision therapy and homoeopathy. Each field has its own viewpoint on the aetiology and the management ofmyopia.

The allopathic management of myopia includes spectacles, contact lenses and surgery. Spectacles are the most cost effective and most practical method. Spectacles and contact lenses only correct the eyesight, while these optical appliances are in use. Surgical procedures attempt to provide the patient with permanent better eyesight. However the outcome of the surgical procedures are sometimes unpredictable and the procedures are costly.

Natural vision therapies include the Bates method, the progressive and eclectic approach of optometry. The Bates method is based on theories that have no apparent scientific proof

17 and concern testimonials from patients as proof. Only two homoeopathic studies regarding myopia have been done. These include Basu (1980 : 224 - 231) and Pillay's (1994), research. These two studies have contradictory results.

18 1,0 IITEBIIIS &1111,8BS 2.0 MATERIALS AND METHODS

2.1 HYPOTHESES

La) Hypothesis: It is hypothesised that the Bates method is effective in reducing myopia. 1.b) Null hypothesis: It is hypothesised that the Bates method is not effective in reducing myopia. 2.a) Hypothesis: It is hypothesised that Physostigma 30CH is effective in reducing myopia. 2.b) Null hypothesis: It is hypothesised that Physostigma 30CH is not effective in reducing myopia. 3.a) Hypothesis: It is hypothesised that Physostigma 30CH combined with the Bates method is effective in reducing myopia. 3.b) Null hypothesis: It is hypothesised that Physostigma 30CH combined with the Bates method is not effective in reducing myopia.

2.2ASSUMPTIONS

It is assumed that: 1. Physostigma venenosum was preparedcorrectly according to homoeopathic principles. 2. The Optometrist's examinations ofthe eye were reliable and accurate. 3. The subject followed the prescribed naturopathic exercises accurately and took the medication as prescribed. 4. The patient's perceptions ofthe treatment were honest and unbiased.

Data from this quantitative research were used to determine the hypothesis.

20 2.3 METHODOLOGY

An advertisement was placed in a local newspaper inviting individuals of different sexes, races, occupation and different ages between 21 and 34 years to participate in this research project.

The 30 suitable subjects were divided into a control and an experimental group. These subjects were paired in terms ofage, race and sex on a double blind basis by a person not involved in the research. This research was conducted in three stages.

Subjects eye refractions varied between -Q.25D and -4.00D to ensure a more homogenous group. To ensure this subjects were examined optometrically at the beginning ofthe study and after completion ofeach stage ofthe research. Furthermore no patients with ocular or systemic pathologies present in the .eye were included. Also no subjects on allopathic drugs were included.

The initial optometric consultation served as the baseline for each group. Follow-up visits occurred every 30 days for three months. The full duration of the research was over a period of90 days.

2.3.1 Stage one From day one to day 30, the control group completed the modified Bates method whilst the experimental group completed the Bates method. Each subject received an instruction sheet with the applicable routine to be followed. Both instruction sheets for the experimental and control group were named the naturopathic method, to maintain a double blind standard. To distinguish between the two different instruction sheets, the experimental group sheet was marked by stars (****) at the bottom left of the page. See appendix 3.1 and 3.2 for the routines. Both groups completed their exercises for ten minutes in the mornings and ten minutes in the evening on a daily basis.

2.3.2 Stage two From day 31 to day 60, the control group took a placebo, whilst the experimental group took the homoeopathic remedy, Physostigma 30CH. Neither group did the above

21 mentioned exercises during this period. The presentation of the medication, both the experimental and control, were in a small, white oval shape tablet. All medication, whether placebo or Physostigma 30CH were taken twice daily, one tablet in the mornings and one tablet in the evenings. Food or beverages were avoided at least 15 minutes before and after taking the remedy. This ensured proper absorption of the remedy via the oral mucousa. These instructions were labeled on both the homoeopathic medication and placebo bottles.

2.3.3 Stage three From day 61 to day 90, the control group took a placebo but in addition also followed the routine for the modified Bates exercises. The experimental group took the homoeopathic remedy, Physostigma 30CH, and combined this with the Bates exercises. The modified Bates and Bates method remains as for stage one. The placebo and homoeopathic medication remains as for stage two.

2.3.4 Questionnaire A questionnaire on the subjective feelings of the patient regarding his eyesight and the treatment, was given to the subject on the first day ofthe study. This was repeated on day 30, day 60 and on day 90. The questionnaire was based on a Liekert scale and and graded from 1 (poor) to 5 (excellent). - see appendix 3.3.

.2.3.5 Optometric eye examinations There were four optometric eye examinations in total. The initial eye examination served as the baseline for each group. Follow-up visits occurred every 30 days. This was done to monitor the progress, ifany, ofthe subjects. There were three follow-ups.

The optometric eye examination included: Visual acuity - la) Aided visual acuity. This was determined from the size of the smallest line of letters on the test chart that can be read by the patient after refractive errors were corrected (Bennett & Rabbetts, 1984 : 30). 1b) Unaided visual acuity. This was determined from the size ofthe smallest line ofletters on the test chart that can be read by the patient with the naked eye (Bennett & Rabbetts, 1984: 30).

22 2) Autorefraction. Was done with a RM-A7000 topcon model aut0 refractor. 3) Subjective refraction. This was done by a qualified optometrist using standarised optometric techniques. 4) Accommodative flexibility. This measured how quickly the eye accommodated from far to near and then relaxing accommodation. This was determined with +2 and -2D flippers which measures the accommodation flexibility in cycles per minute. 5) Amplitude ofaccommodation. This was determined using a reduced 6/9 Snellen chart. 6) Measure pupil size. The size, shape and symmetry of the pupils were inspected and measured.

2.4 STATISTICAL ANALYSIS As mentioned previously the research was conducted in three stages. The progress, ifany, at the end of stage one was obtained by subtracting the values found in the second visual evaluation from those obtained in the initial visual evaluation. In a similar way the result of stage two was obtained by subtracting the values of the third visual examination from those ofthe initial visual examination. For stage three the results of the fourth and final visual examination was once again subtracted from the initial visual examination.

2.4.1. T-test This test is used to calculate the correct values for small samples when testing or constructing intervals for the mean of a normal distribution. T-values become smaller as the sample size grows larger, reflecting increased precision in the sample standard deviation as an estimate of the population standard deviation (Siegal & Morgan, 1988 : 355).

2.4.2 Levence's test Levence's test is used to test for the homogeneity ofvariances (SPSS, 1988 : 58).

2.4.3 Significant p-values (2-tailed) test This test is used to indicate ifthe hypotheses are accepted or rejected (Siegal & Morgan, 1988: 355). .

23 Data obtained from this study will be analysed statistically during above-mentioned examinationsand presented and analyzed in chapter three and discussed in chapter four.

24 l -.,,~f"g. BE·e.U·~. ~ ~ 9'e,. a-, _; _. < •• ..... & STATI8TIOA~ ANALV.I,S 3.0 RESULTS AND STATISTICAL ANALYSIS

This study researched the efficacy ofthe Bates method in isolation and the homoeopathic remedy, Physostigma 30CH, in isolation and the two methods combined in the management ofmyopia. In this chapter the data collected is presented and analyzed. The results ofthis study are given in the form ofbox plot graphs. Box-plots are used as it is an effective method to display several samples on the same graph for the purpose of visual comparison. The solid center bar indicates the median. Ifthere is no extension line from the central box, this indicates that the value is out of range, to be presented on the graph (Johnston & Tsui, 1998 : 72).

Each variable that was measured during the optometric examination will be presented during each stage. These include the unaided visual acuity, the refraction, accommodative flexibility and accommodative amplitude. Questionnaire results will also be presented. The initial consultation is regarded as the baseline. The baseline is used to obtain the changes, if any, of each stage and thereby after statistical analysis to accept or reject the hypotheses.

26 3.1 Graphs 3.1.1 Unaided visual acuity 1000 ,.------,

100

200

200 "'------~- ----J Stag e 3 s . I. I. I. I. " ...... Ex perimenta l C ontrol

GRO UP

Figure 3.1 Mean unaided visual acuity for both eyes for the initial consultation and for each stage

*..

--- -tt;~. ! --.. *" Sta ge I final find ings tage 2 final findin g .. .. Stage 3 final findings Exp erime ntal Control GR OUP Figure 3.2 Mean unaided vi ual for both eyes for the final findin g for each tage

27 3.1.2 Refraction of right eye

)

O · O · N . I. 16 16 16 ...... Ex peri menta l C o ntr ol GROUP Figure 3.3 Mean refraction of right eye for the initi al consultation and for each tage

.- 1.0 -e ~ ...::: *" '" ~ .5 *" *,1

~ -M" -If'' ~ *" .Co;: ) .0 '- 0 *,0 0 ...... *'. *" ...or. u ~ ..::<: c- -.5 O ' ~ tage I final findin gs _ .-.:;l::: • *" • tage 2 final findin gs -1.0 tag e 3 final findin g N . ,. I. I...... • Experimental C ontrol GROUP Figure 3.4 Mean right eye refraction for the final finding for each tage

28 3.1.3 Refraction of left eye 0.....------,

N . 16 16 . 6 ' 6 " .. "" Ex perimental Co ntrol GROUP Figure 3.5 Mean left eye refraction for the initial consultation and for each tage

*'" -11" *'" *"

*,0 *"

" .. " Co ntrol GRO UP Figure 3.6 ean left eye refrac tion final finding for each tage

29 3.1.4 Accommodative flexibility 30 or------, .... ~ c.. ~ U ;... W o '-' .f' s: =~ 10

O'

N . 16 16 •• " 14 14 Exp erim ental Control GROUP Figure 3.7 Mean accommodative flexibility for the initi al con ultation and for each stage

~ O ..------....,

-g o =..-- -::: ~ Q . 0 ' . , tage I final findi ngs C "5 u ·=- < E , tage 2 final findings · 10 .I------~------~------' . tage 3 final findin gs N. .. " '. Experimen tal Contro l GROUP Figure 3.8 Mean accommodative flexibilit y final finding for each tage

30 3.1.5 Accommodation amplitude

7.91------,

N . ' 6 .6 ' 6 ' 6 " " " Ex peri me ntal Control

GROUP Figure 3.9 Mean accommodation amplitude for the initial con ultation and for each stage

0.4,...------,

o.

-0. tage I final findings • tage 2 final findings ~~------~------l . --0.4J-- rage 3 final findings N. '. '. Experimental Control

GROUP igure 3.10 Mean accommodation amplitude final findin g for each tage

31 3.1.6 Questionnaire 11 ..------,

~ 10 -= "5 ..8 9 <1:l enV> 8 .s C3 .3 7 . ~ U 6 v :5' Dlnitial consultati on =: 5 V> ~ V> - ..-" ~ 5 § 4 0"::: co: c': 3 g .I------_------J N . 16 16 16 \6 " " " Expe rimenta l C ontrol GROUP Figure 3.11 Mean questionnaire total for the initial consultation and for each tage

6

<:) -5 4

E<:: enVl 2 ::: C3 .3 0 <:) > u <:) :B' -2 5l Vl C3 Stage I final findin gs ::: -4 .~ ::: fj Stage 2 final findings .=, c.: -6 j...- ~------~----.l . Stage 3 final findin gs N. •• '. 16 Expe rime ntal Control GROUP Figure 3.12 Mean questionn aire total final findin g for each tage

32 The differences in the mean values among the experimental and control group for graph 3.1 to 3.12 are not big enough to exclude the possibility that the differences are due to random sampling variability. There is statistically no significant change in the mean value for the initial consultation, for each stage, and neither in the final findings ofthe different stages, indicating statistically no significant change in any ofthe variables.

3.2 ANALYSIS OF RESULTS The experimental and control groups' values are presented as one figure, from table 3.1 to 3.9.

3.2.1 Stage one The hypothesis that myopia was improved by the Bates method was tested against the null hypothesis that the Bates method was not effective in reducing myopia. A paired sample t­ test was performed. The t-values for the experimental and control group for stage one are presented in table 3.1.

Table 3.1 T-values for stage one Unaided visual acuity 0,428 Right eye refraction 0.902 Left eye refraction 0.403 Accommodative flexibility 4.317 Accommodation amplitude 0.382 Questionnaire 4,839

In addition, the Hest was used in conjunction with Levence's test for the equality of variances for an independent t-test. In all cases, equal variances are assumed except for accommodative flexibility. The p-values are derived from Levence's test are presented in table 3.2.

33 Table 3.2 Levence's p-values for stage one Unaided visual acuity 0,038 Right eye refraction 0,965 Left eye refraction 0.097 Accommodative flexibility 0,045 Accommodation amplitude 0,724 Questionnaire 0,387

Therefore it can be concluded that there is no statistically significant difference except for accommodative flexibility where 0,045 is greater than 0,05. For the other variables the p value was not big enough to exclude the possibility that the differences are due to random sampling variability. The significant p-values (2-tailed) for the independent 2-sample test results are given in table 3.3.

Table 3.3 Significant p-values for stage one Unaided acuity 0,171 Right eye refraction 0,725 Left eye refraction 0,979 Accommodative flexibility 0,097 Accommodation amplitude 0,677 Questionnaire 0,753

From this table it can be concluded that the first hypothesis was rejected and the null hypothesis accepted.

3.2.2 Stage two The hypothesis that myopia was improved by the homoeopathic remedy, Physostigma 30CH was tested against the null hypothesis that the homoeopathic remedy, Physostigma 30CH was not effective in reducing myopia. A paired sample t-test was performed. The t­ values for the experimental and control group for stage two are presented in table 3.4.

34 Table 3.4 T-values for stage two Unaided acuity 0,949 Right eye refraction 0,779 Left eye refraction 0,571 Accommodative flexibility 5,636, Accommodation amplitude -0,760 Questionnaire 3,350

In addition the t-test was used in conjunction with Levence's test for the equality of variances for an independent t-test. In all cases, equal variances are assumed. The p­ values derived from Levence's test are presented in table 3.5.

Table 3.5 Levence's p-values for stage two Unaided acuity 0,104 Right eye refraction 0,741 Left eye refraction 0,077 Accommodative flexibility 0,192 Accommodation amplitude 0,051 Questionnaire 0,480

Therefore it can be concluded that there is no statistically significant difference. The p-value was not big enough to exclude the possibility that the differences are due to random sampling variability. The significant p-values (2-tailed) for the independent 2­ sample test are given in table 3.6.

Table 3.6 Significant p-values for stage two Unaided acuity 0,181 Right eye refraction 0,741 Left eye refraction 0,824 Accommodative flexibility 0,168 Accommodation amplitude 0,980 Questionnaire 0,359

From this table it can be concluded that the second hypothesis was rejected and the null hypothesis accepted.

35 3.2.3 Stage three The hypothesis that myopia was improved by the homoeopathic remedy, Physostigma 30CH combined with the Bates method was effective in reducing myopia was tested against the null hypothesis that the homoeopathic remedy, Physostigma 30CH combined with the Bates method was not effective in reducing myopia. A paired sample t-test was performed. The t-values for the experimental and control group for stage three are presented in table 3.7.

Table 3.7 T-values ofstage three Unaided acuity -0,348 Right eye refraction 0 Left eye refraction 0,926 Accommodative flexibility 6,287 Accommodation amplitude -0.297 Questionnaire 5,207

In addition the t-test was used in conjunction with Levence's test for the equality of variances for an independent t-test. In all cases, equal variances are assumed. The p­ values are presented in table 3.8.

Table 3.8 Levence's p-values for stage three Unaided acuity 0,386 Right eye refraction 1,000 Left eye refraction 2,008 Accommodative flexibility 0,217 Accommodation amplitude 0,141 Questionnaire 0,594

From this table it can be concluded that there is no statistically significant difference. The p value was not big enough to exclude the possibility that the differences are due to random sampling variability. The significant p-values (2-tailed) for the independant 2­ sample test results are given in table 3.9.

36 Table 3.9 Significant p-values for stage three Unaided acuity 0,611 Right eye refraction 1,000 Left eye refraction 0,904 Accommodative flexibility 0,123 Accommodation amplitude 0,757 Questionnaire 0,635

From this table it can be concluded that the third hypothesis was rejected and the null hypothesis accepted.

3.2.4 Summary

Table 3.10 Significant p-values (2-tailed) for independent two sample test Stage one Stage two Stage three Unaided acuity 0,171 0,181 0,611 Right eye refraction 0,725 0,741 1,000 Left eye refraction 0,979 0,824 0,904 Accommodative 0,097 0,168 0,123 flexibility Accommodation 0,677 0,980 0,757 amplitude Questionnaire 0,753 0,359 0,635

37 to DIS8USI01 OF BlS,UiIS UD BEOOIIEIIAIIOIS 4.0 DISCUSSION OF RESULTS AND RECOMMENDATIONS

The results ofthe different stages ofthis study are discussed in this chapter. In interpreting the results of this study, the following should be kept in mind. Firstly, the sample was small, the duration of the research was over a short time period, the factor of random sampling variability can possibly influence the results, and finally this study focused only on the lower degrees ofmyopia.

4.1 STAGE ONE The significant p-value for the refractive error in table 3.3 on page 34 rejects the hypothesis stating that the Bates method is effective in reducing myopia.

According to Rehm, (1981 : 116 - 121), there are two reasons why individuals perceive the Bates method to have been effective. in improving myopia. Firstly, the correcting lenses force the eye to accommodate more at near. Thus there is a possibility of an accommodative spasm developing. If the glasses were removed for several weeks the accommodation would relax and an improvement in vision can be expected at distance. Secondly, mental attitude plays a major part. People might have perceived that their eyesight improved. This could be caused by the power of suggestion, because a visual examination revealed no change in the refractive error (Rehm, 1981 : 116 - 121). Michaels, (1985: 476), and Leber & Wilson (1993 : 87 - 92), state that the improvement in visual acuity, could be attributed to an enhanced interpretation of blurred visual images. Like Rehm, (1981 : 116 - 121), the mentioned authors also detected no change in the refractive error.

It should be mentioned that Bates mistook testimonials for proof and rare anomalies for typical cases (Michaels, 1985 : 476). Holtz (1973 : 33 - 38), considered Bates' theories to be as fanciful in application, as they are bizarre in contemplation (see literature review 1.4.3.1).

The other variables for stage one, two and three ofthis study will be discussed in 4.4. These variables include unaided visual acuity, accommodative flexibility, accommodation amplitude and the questionnaire.

39 4.2 STAGE TWO The significant p-value for the refractive error in table 3.6 on page 35 rejects the hypothesis that the homoeopathic remedy, Physostigma 30CH, is effective in reducing myopia.

These results of this study are in contrast to Basu's results, (1980 : 224 - 231), see literature 1.5.4.2 on page 16. The author ofthis study found no decrease in myopia when using the homoeopathic remedy, Physostigma 30CH. This finding is supported by Pillay's work (1994).

Both Basu, (1980 : 224 - 231), and Pillay, (1994), used ascending homoeopathic potencies and their studies had similar duration. This study used the same homoeopathic concentration throughout, and was also of shorter duration. In addition the time duration . - between the administration of the medication was different. In this research medication was administrated twice daily each day for a period of two months. Basu (1980 : 224 ­ 231), administrated medication to his patients on the first three days, days 40 to 42, days 85 - 87 and days 130 to 132. In Pillay's study (1994), medication was administrated once a week for the first three weeks, and then once every three weeks.

From the above, the author of this study tentatively concludes that the homoeopathic remedy, Physostigma 30CH, has no effect on myopia in the short term.

4.3 STAGE THREE The significant p-value for the refractive error in table 3.9 on page 37, also rejects the hypothesis that the homoeopathic remedy, Physostigma 30CH, combined with the Bates method is effective in reducing myopia.

Once again the author of this study tentatively concludes that the combination of the homoeopathic remedy, Physostigma 30CH, and the Bates method is not effective in reducing myopia.

40 Therefore it can be concluded that statistically there is no significant differences between the experimental and control group in terms oftheir improvement on days 30, 60 and 90. The p- value was not big enough to exclude the possibility that the differences are due to random sampling variability. Thus there is statistically no significant change in the refraction in the different stages ofthe experiment and all null hypotheses are accepted for all three stages.

4.4. OTHER VARIABLES The only statistical significant difference in the variables in all the stages was in the accommodative flexibility in stage one. A possible explanation for this according to Bates (1943 : 6 - 8), is that eye exercises strengthen and tone all the muscles associated with eye movement and focus. This increase agility will give better, more accurate control when focusing.

There were no statistically significant changes during any of the three stages for the accommodation amplitude, unaided visual acuity and the questionnaire.

4.5 POSSIBLE REASONS FOR THE OUTCOME OF THE RESEARCH There are a few possible reasons why the homoeopathic medication or the Bates method apparently did not work: 1) Different methods are available to prepare homoeopathic remedies (Eizayaga, 1991 :161 - 168). No mention of Basu's (1980 : 224 - 231), method of preparation of the homoeopathic remedy is made. It is possible that Basu used a different method to the method used in this study.

2) Homoeopathic treatment is specific to an individual with a unique set of symptoms. These symptoms are taken in totality leading to a single remedy being presented. Even though a specific disease may produce similar symptoms, each patient reacts in a different way and as such produces unique symptoms, which are peculiar to the disease itself (Sankaran, 1985: 161- 168). In this research the remedy administered was the same for all the subjects. Every individual expresses different symptoms, even in a

41 condition such as myopia. The results could have been more promising if a single individualised remedy was used.

3) Myopia has been categorised into many systems. This research focused on low and medium degrees of myopia. Low medium includes myopia less than 3D, and medium .myopia less than 6D. Higher degrees ofmyopia could have possibly yielded different results. Other alternative systems to categorise myopia are ocular pathology, age of onset, optical origin and aetiology, all of which are not applicable to this research (Wildsoet, 1999 : 16 - 22).

4) The research duration was very short.

5) The sample size was small.

4.6 RECOMMENDATIONS The above-mentioned factors could be considered as possible reasons for the homoeopathic remedy and the Bates method apparently not working in the short term. These factors should be further investigated. 1) Prepare Physostigma according the Korsakovian method. This method uses only one jar to prepare all the potentising and dilutions whilst the Hahnemannian method requires a new jar for each dilution step (Eizayaga, 1991: 165).

2) Treat each patient constitutionally, thus use a specific remedy for each patient.

3) Focus on a different classification of myopia other than used in this research. Another possible classification of myopia could be by origin. This is subdivided into axial and refractive myopia. In axial myopia the length of the myopic eye is too long. In refractive myopia the corneal curvature is to steep, the refractive index of the aqueous humour is too high or the power of the lens is too high or a combination of them (Borish, 1975 : 90). These can be detected with optometric instrumentation.

4) Increase the duration ofthe research.

42 5) Increase the sample size.

43 < "~J , ••' ," ' "... • ".; " _ j ! ; -. ;-';,",~ J I__ ...._"PE-N-DI'OES- .. '. -. --' ..'c'" ... " ...... ::' APPENDIX 3.1

INSTRUCTION SHEET - NATUROPATHIC METHOD

A few general guidelines regarding the routine:

~ It is best to do the technique when relaxed. Try to relax the shoulder muscles and to loosen the neck. ~ Do not wear glasses or contact lenses while doing your routine. ~ Do not overwork or strain your eyes while doing your routine - the aim is to ease tension and relax them, not to force them. ~ Please complete the seven steps as explained below as a set in the mornings and as a set in the evenings. ~ In the mornings start with exercise no (7a) and in the evenings start with no (1). ~ This routine to be followed from day one to day thirty, and again from day sixty to day ninety.

Here follows the routine to be completed in the mornings and in the evenings:

1) Remembering Sit comfortably at a desk or where you could rest your elbows. Rub your hands vigorously together for a few seconds, take your left hand and put it over your left eye gently, and your right hand over your right eye gently. Cover the eyes without touching them, with cupped palms. (This is called palming). Without straining try to recall an object or experience in great detail and bright colours. If you visualise a three-dimensional picture try to rotate it in your imagination. Do this exercise until you feel satisfied that you could clearly imagine the object or experience you wanted to remember.

2) Shifting Look in a circle around in your room or the area you are in. Try to move your eyes constantly from one point to another. Do no stare at an object. Do this exercise for two minutes.

44 3) Blinking Blink your eyes twice every ten seconds. Do this exercise for one minute.

4) Palming Again sit comfortable with your hands as described in no (1). Close your eyes. Rest your elbows on a cushion on the table, keeping your back and neck straight and your head level. Think ofsomething pleasant and relax. Do this exercise for 5 minutes.

5) Near and far focusing Hold two pencils in front ofyour face - the one about 75mm away, and the other at arm's length. Focus on one pencil with both eyes, then blink and focus on the other pencil. Repeat 20 times.

6) Swinging Stand with the feet shoulder distance apart and sway gently from side to side. Let your eyes swing along with your body's movement. Note the visual movement as this relaxes your eyes and helps them to become more flexible. Swing to each side 20 times.

7) Splashing It is important to note that the mornings and the evenings exercise differ. a) For mornings: splash the eyes 10 times with warm water and then 10 times with cold water. b) For evenings: splash the eyes 10 times with cold water and then 10 times with hot water ****

45 APPENDIX 3.2

INSTRUCTION SHEET - NATUROPATHIC METHOD

A few general guidelines regarding the routine:

~ It is best to do the technique when relaxed. Try to relax the shoulder muscles and to loosen the neck. ~ Do not wear glasses or contact lenses while doing your routine. ~ Do not overwork or strain your eyes while doing your routine - the aim is to ease tension and relax them, not to force them. ~ Please complete the seven steps as explained below as a set in the mornings and as a set in the evenings. ~ In the mornings start with exercise no (7a) and in the evenings start with no (1). ~ This routine to be followed from day one to day thirty, and again from day sixty to day ninety.

Here follows the routine to be completed in the mornings and in the evenings:

1) Remembering Sit comfortably at a desk or where you could rest your elbows. Rub your hands vigorously together for a few seconds, take your left hand and put it over your left eye gently, and your right hand over your right eye gently. Cover the eyes without touching them, with cupped palms. (This is called palming). Try without straining to recall an object or experience in great detail and bright colours. If you visualise a three-dimensional picture try to rotate it in your imagination. Do this exercise until you feel satisfied that you could clearly imagine the object or experience you wanted to remember.

2) Shifting Look in a circle around in your room or the area you are in. Move your eyes from one point to another and stare at objects for a few seconds. Do this exercise for two minutes.

6 46 3) Blinking" Blink your one eye then the other eye - twice every ten seconds. Do this exercise for one minute.

4) Palming Again sit comfortable with your hands as described in no (1). Close your eyes. Rest your elbows on a cushion on the table, keeping your back and neck straight and your head level. - Thinkofsomething pleasant and relax. Do this exercise for 5 minutes.

5) Nearand far focusing Hold two pencils, (one pencil in the right hand and the other in the left hand) shoulder length from your face. Look at the left side, then the right side - keep your head still while doing the exercise. Repeat 20 times.

6) Swinging Stand with the feet shoulder distance apart and sway gently from side to side. Let your eyes swing along with your body's movement. Note the visual movement as this relaxes your eyes and helps them to become more flexible. Swing to each side 20 times.

7) Splashing It is important to note that the mornings and the evenings exercise differ. a) Formornings: splash the eyes 10times with warm water. b) Forevenings: splash the eyes 10times with cold

47 6 APPENDIX 3.3

QUESTIONAIRE ON EYESIGHT

NAME : _

PLEASE ANSWER THE FOLLOWING QUESTIONS MAKE A TICK IN THE COLUMN SELECTED (RANK THEM FROM 1 TO 5)

1 =POOR 5 = EXCELLENT EXCELLENT .1 2 3 4 I 5 11. How do you feel in general regarding your health?

12. How do you cope with stress?

3. When looking at a distance and then at a book - howwell can you focus onthe words quickly? with glasses I contact lenses without glasses I contact lenses

4. How well do you observe distant objects (e.g.• Television)? with glasses I contact lenses without glasses I contact lenses

5. How well do you observe near objects (reading a book)? with glasses I contact lenses without glasses I contact lenses

6. How well can you distinguish colours (e.g.. The robot)? with glasses I contact lenses without glasses I contact lenses

48 APPENDIX 3.4

UNAIDED VISUAL ACUITY FOR BOTH EYES FOR THE INITIAL CONSULTATION AND FOR EACH STAGE (Measurement in feet)

EXPERIMENTAL Initial consultation Stage 1 Stage 2 Stage 3 1 50 50 50 50 2 200 200 50 50 3 20 15 15 15 4 60 60 70 70 5 400 300 200 200 6 200 200 200 200 7 400 400 400 400 8 20 20 20 20 9 50 50 40 40 la 40 40 40 40 11 60 60 200 200 12 50 20 20 20 13 25 20 20 20 14 20 20 20 20 15 100 100 200 200 16 300 300 300 300

CONTROL Initial consultation Stage 1 Stage 2 Stage 3 1 400 300 400 200 2 200 400 400 200 3 200 200 200 200 4 20 20 20 20 5 40 40 60 60 6 200 200 200 200 7 300 300 300 300 8 15 15 15 15 9 25 25 25 30 la 70 70 70 100 11 400 400 400 400 12 80 80 50 50 13 30 30 25 25 14 30 200 40 40

49 APPENDIX 3.5

UNAIDED VISUAL ACUITY FOR BOTH EYES - FINAL FINDINGS FOR EACH STAGE

EXPERIMENTAL

Stage 1 - initial consultation Stage :% - initial consultation Stage 3 - initial consultation 1 0 0 0 2 0 -150 -150 3 -5 -5 -5 4 0 10 10 5 -100 -200 -200 6 0 0 0 7 0 0 0 8 0 0 0 9 0 -10 -10 10 0 0 0 11 0 140 140 12 -30 -30 -30 13 -5 -5 -5 14 0 0 0 15 0 100 100 16 0 0 0

CONTROL Stage 1 - initial consultation Stage:% - initial consultation Stage 3 - initial consultation 1 -100 0 -200 2 200 200 0 3 0 0 0 4 0 0 0 5 0 20 20 6 0 0 0 7 0 0 0 8 0 0 0 9 0 0 5 10 0 0 30 11 0 0 0 12 0 -30 -30 13 0 -5 -5 14 170 10 10

50 APPENDIX 3.6

REFRACTION OF RIGHT EYE FOR THE INITIAL CONSULTATION AND FOR . EACH STAGE (Measurement indiopters) (Retinoscopy closer to 0 indicates improvement) EXPERIMENTAL Initial consultation Stage 1 Stage 2 Stage 3 1 -1.25 -1.25 -1.5 -1.5 2 -1.5 -1.5 -1.5 -1.5 3 -0.5 -0.5 -0.25 -0.5 4 -1.5 -1.5 -1.5 -1.5 5 -2 -2 -2 -2 6 -1.75 -1.75 -1.5 -1.5 7 -2.5 -2.5 -2.5 -2.5 8 -0.5 -0.5 -0.5 -0.5 9 -1 -1 -1 -1 10 -1 -1 -1 -1 11 -1.25 -1.2~ -1.25 -1.5 12 -1 -0.5 -0.25 -0.5 13 -0.5 -0.75 -0.5 -0.5 14 -0.25 0 -0.25 -0.5 15 -2 -2 -2 -2 16 -3.5 -3.75 -3.75 -3.5

CONTROL Initial consultation Stage 1 Stage 2 Stage 3 1 -3 -2.75 -3 -3 2 -3 -3.25 -3.75 -3.5 3 -2.25 -2.25 -2.25 -2.25 4 -0.75 -0.5 -0.5 -0.5 5 -0.75 -0.5 -0.5 -0.5 6 -2.25 -2.25 -2.25 -2.25 7 -3.75 -3.75 -3.75 -3.75 8 -0.25 -0.25 -0.25 -0.25 9 -1 -1 -0.75 -1.25 10 -1.75 -1.75 -1.75 -1.5 11 -3.75 -3.75 -3.75 -3.75 12 -1.5 -1.5 -1.25 -1.25 13 -1 -1 -1 -1.25 14 -1.5 -1.5 -1.5 -1.5

51 APPENDIX 3.7

RIGHT EYE REFRACTION - FINAL FINDINGS FOR EACH STAGE (Measurement in diopters)

EXPERIMENTAL Stage 1 - intial consultation Stage 2 - intial consultation Stage 3 - intial consultation 1 0 -0.25 -0.25 2 0 0 0 3 0 0.25 0 4 0 0 0 5 0 0 0 6 0 0.25 0.25 7 0 0 0 8 0 0 0 9 0 0 0 10 0 0 0 11 0 0 -0.25 12 0.5 0.75 0.5 13 -0.25 0 0 14 0.25 0 -0.25 15 0 0 0 16 -0.25 -0.25 0

CONTROL Stage 1 - intial consultation Stage 2 - intial consultation Stage 3 - intial consultation 1 0.25 0 0 2 -0.25 -0.75 -0.5 3 0 0 0 4 0.25 0.25 0.25 5 0.25 0.25 0.25 6 0 0 0 7 0 0 0 8 0 0 0 9 0 0.25 -0.25 10 0 0 0.25 11 0 0 0 12 0 0.25 0.25 13 0 0 -0.25 14 0 0 0

52 APPENDIX 3.8

REFRACTION OF THE LEFT EYE FOR THE INITIAL CONSULTATION AND FOR EACH STAGE (Measurement in diopters) (Retinoscopy closerto 0 indicates improvement) EXPERIMENTAL Initial consultation Stage 1 Stage 2 Stage 3 1 -1.75 -1.75 -2 -1.5 2 -1.25 -1.5 -1.25 -1.25 3 -0.75 -0.5 -0.25 -0.5 4 -1.5 -1.5 -1.5 -1.5 5 -2 -2 -2 -2 6 -2 -2 -1.75 -1.75 7 -2.5 -2.5 -2.5 -2.5 8 -0.25 -0.5 -0.5 -0.5 9 -1 -1 -1 -1 10 -0.75 -0.25 -0.5 -0.25 11 -1.5 -1.5 -1.5 -1.5 12 -0.75 -0.25 -0.25 -0.5 13 -0.5 -0.5 -0.5 -0.5 14 -0.25 -0.25 -0.5 -0.75 15 -2.25 -2 -2 -1.75 16 -3 -3.75 -3.75 -3.5

CONTROL Initial consultation Stage 1 Stage 2 Stage 3 1 -2.75 -2.5 -2.75 -2.5 2 -3.25 -3.25 -3.25 -3.5 3 -1.5 -1.75 -1.5 -1.5 4 -0.75 -0.75 -0.75 -0.75 5 -1 -0.75 -0.75 -0.5 6 -2.25 -2.25 -2.25 -2.25 7 -2.5 -2.5 -2.5 -2.5 8 -0.25 -0.25 -0.25 -0.25 9 -1.25 -1.25 -1 -1.25 10 -1.25 -1.25 -1.5 -1 11 -2.75 -2.75 -2.75 -2.75 12 -1.25 -1.25 -1 -1:25 13 -1 -1 -1 -1.25 14 -1 -1 -1 -1

53 APPENDIX 3.9

LEFT EYE REFRACTION - FINAL FINDINGS FOR EACH STAGE (Measurement in diopters)

EXPERIMENTAL Stage 1 - initial consultation Stage 2 - initial consultation Stage 3 - initial consultation 1 0 -0.25 0.25 2 -0.25 0 0 3 0.25 0.5 0.25 4 0 0 0 5 0 0 0 6 0 0.25 0.25 7 0 0 0 8 -0.25 -0.25 -0.25 9 0 0 0 10 0.5 0.25 0.5 11 0 0 0 12 0.5 0.5 0.25 13 0 0 0 14 0 -0.25 -0.5 15 0.25 0.25 0.5 16 -0.75 -0.75 -0.5

CONTROL Stage 1 - initial consultation Stage 2 - initial consultation Stage 3 - initial consultation 1 0.25 0 0.25 2 0 0 -0.25 3 -0.25 0 0 4 0 0 0 5 0.25 0.25 0.5 6 0 0 0 7 0 0 0 8 0 0 0 9 0 0.25 0 10 0 -0.25 0.25 11 0 0 0 12 0 0.25 0 13 0 0 -0.25 14 0 0 0

54 APPENDIX 3.10

ACCOMMODATIVE FLEXIBILITY FOR THE INITIAL CONSULTATION AND FOR EACH STAGE (Measurement in cycles per minute (each reading +2 or -2))

EXPERIMENTAL Initial consultation Stage 1 Stage 2 Stage 3 1 9 9 15 6 2 10 21 21 21 3 10 12 18 20 4 7 14 14 16 5 16 16 16 19 6 10 14 16 19 7 7 10 12 12 ·8 4 8 11 15 9 18 16 20 19 10 1.5 7 12 16 11 10 11 4 12 12 10 18 23 20 13 13 15 12 13 14 8 25 20 25 15 8 20 21 18 16 16 16 20 23

CONTROL Initial consultation Stage 1 Stage 2 Stage 3 1 8 14 14 17 2 12 13 17 16 3 10 11.5 12 13.5 4 9 13 12 13 5 15 13 11 14 6 12 13 15 15.5 7 5 7.5 8 12 8 4 5 6 6 9 7 13 20 22 10 14 18 20 19 11 10 11 9 9 12 8 4 13 15 13 10 14 13 8 14 12 15 17 17

55 APPENDIX 3.11

ACCOMMODATIVE FLEXmILITY - FINAL FINDINGS FOR EACH STAGE (Measurement in cyclesperminute (eachreading+2 or -2»

EXPERIMENTAL Stage 1 - initial consultation Stage 2 - initial consultation Stage 3 - initial consultation 1 0 6 -3 2 11 11 11 3 2 8 10 4 7 7 9 5 0 0 3 6 4 6 9 7 3 5 5 8 4 7 11 9 -2 2 1 10 5.5 10.5 14.5 11 1 -6 2 12 8 13 10 13 2 -1 0 14 17 12 17 15 12 13 10 16 0 4 7

CONTROL Stage 1 - initial consultation Stage 2 - initial consultation Stage 3 - initial consultation 1 6 6 9 2 1 5 4 3 1.5 2 3.5 4 4 3 4 5 -2 -4 -1 6 1 3 3.5 7 2.5 3 7 8 1 2 2 9 6 13 15 10 4 6 5 11 1 -1 -1 12 -4 5 7 13 4 3 -2 14 3 5 5

56 APPENDIX 3.12

ACCOMMODATION AMPLITUDE FOR THE INITIAL CONSULTATION AND FOR EACH STAGE (Measurement in diopters)

EXPERIMENTAL Initial consultation Stage 1 Stage 2 Stage 3 1 6.75 5.5 5.75 5.5 2 4 4 4.5 4.75 3 7 7.5 7.5 7.75 4 5 10 5.5 5.75 5 9.75 8 8.25 8 6 5.5 5.5 6 6 7 5 5 5 5 8 7 7.5 7.5 7.5 9 7.5 8 7 8.5 10 5.75 6.25 6.25 6.5 11 8 6 6 7.25 12 5.75 6.75 6.75 7 13 8.5 8 8 8 14 7 7.5 6.5 6.5 15 7.25 7.25 6 6.75 16 7 7 7.5 6

CONTROL Initial consultation Stage 1 Stage 2 Stage 3 1 5.75 6.25 6 6 2 9 6.5 7.5 8 3 6.25 7 6.75 6.5 4 6 6.5 7.5 7.5 5 6 6.75 7.25 7 6 7 7 8.5 7.75 7 10 10 7 6.5 8 8 8 7 6.75 9 6.5 8 8.75 9.25 10 5.75 6 6 6.5 11 8 7 6.5 7.5 12 8.25 7 6.25 6.25 13 6.25 5.5 6 5.75 14 8 9 7.5 7.5

57 APPENDIX 3.13

ACCOMMODATION AMPLITUDE - FINAL FINDINGS FOR EACH STAGE (Measurement indiopters)

EXPERIMENTAL Stage 1 - initial consultation Stage 2 - initial consultation Stage 3 - initial consultation 1 -1.25 -1 -1.25 2 0 0.5 0.75 3 0.5 0.5 0.75 4 5 0.5 0.75 5 -1.75 -1.5 -1.75 6 0 0.5 0.5 7 0 0 0 8 0.5 0.5 0.5 9 0.5 -0.5 1 10 0.5 0.5 0.75 11 -2 -2 -0.75 12 1 1 1.25 13 -0.5 -0.5 -0.5 14 0.5 -0.5 -0.5 15 0 -1.25 -0.5 16 0 0.5 -1

CONTROL Stage 1 - initial consultation Stage 2 - initial consultation Stage 3 - initial consultation 1 0.5 0.25 0.25 2 -2.5 -1.5 -1 3 0.75 0.5 0.25 4 0.5 1.5 1.5 5 0.75 1.25 1 6 0 1.5 0.75 7 0 -3 -3.5 8 0 -1 -1.25 9 1.5 2.25 2.75 10 0.25 0.25 0.75 11 -1 -1.5 - -0.5 12 -1.25 -2 -2 13 -0.75 -0.25 -0.5 14 1 -0.5 -0.5

58 APPENDIX 3.14

OUESTIONAIRE TOTAL FOR THE INITIAL CONSULTATION AND FOR EACH STAGE

EXPERIMENTAL Initial consultation Stage 1 Stage 2 Stage 3 1 47 49 49 53 2 40 42 42 50 3 45 45 41 45 4 41 45 44 42 5 47 46 53 56 6 39 39 37 44 7 33 39 36 47 8 39 44 46 39 9 51 53 54 56· 10 34 42 42 48 11 39 42 42 46 12 38 40 49 44 13 47 51 40 42 14 41 49 51 54 15 42 38 42 48 16 46 44 42 48

CONTROL Initial consultation Stage 1 Stage 2 Stage 3 1 45 48 44 42 2 50 52 49 49 3 53 52 52 55 4 48 50 53 50 5 42 46 55 53 6 38 44 48 48 7 44 50 49 51 8 44 46 51 53 9 53 53 53 55 10 39 44 45 41 11 45 50 49 51 12 36 41 55 55 13 49 48 46 47 14 46 47 46 49

59 APPENDIX 3.15

QUESTIONNAIRE TQTAL - FINAL FINDINGS FOR EACH STAGE

EXPERIMENTAL Stage 1 - initial consultation Stage 2 - initial consultation Stage 3 - initial consultation 1 2 2 6 2 2 2 10 3 0 -4 0 4 4 3 1 5 -1 6 9 6 0 -2 5 7 6 3 14 8 5 7 0 9 2 3 5 10 8 8 14 11 3 3 7 12 2 11 6 13 4 -7 -5 14 8 10 13 15 -4 0 6 16 -2 -4 2

CONTROL Stage 1 - initial consultation Stage 2 - initial consultation Stage 3 - initial consultation 1 3 -1 -3 2 2 -1 -1 3 -1 -1 2 4 2 5 2 5 4 13 11 6 6 10 10 7 6 5 7 8 2 7 9 9 0 0 2 10 5 6 2 11 5 4 6 12 5 19 19 13 -1 -3 -2.. 14 1 0 '"

60 APPENDIX 3.16) .. L---1--l._-l I L-l_L_J-----_ Ql!~~!I.Q~~~IR~_C;;9l:!~T_~

2 5__'_k. 4__ 4 3 4 1 4 3 4 3 5 2 42 5 4 4 5 5' 50 ~ 5 3 5 2 5 4 3 . -_.~ .~_.- __..... _-, •._._o __ • ·_·'w_ ...... ' ...... -... - ...... _--'._-._---,-- -~-- -_.-.-. - _.---_. ----._.-..--,_..- ..------3 4 . 3 3 4 3 4 3 4 4 4 4 4 44 4 3 4 4 4 2 4 4 4 4 4 4 45 4 4 3 4 3 4 3 4 4 4 4 4 3 44 4 3 4 4 4 2 4 4 4 3 4 2 42 5 5 4 4 5 5 3 4 5 5 4 5 4 53 5 4 5 5 5 4 4 5 5 5 5 4 56 --'------_.------1------._------_.-- _..._.------f---1-· '--- 6 4 3 4 4 4 1 4 3 4 1 4 1 37 5 3 4 4 5 1 4 4 4 4 3 3 44 7 3 3 4 2 4 1 5 4 5 1 3 1 36 4 2 5 4 5 2 5 5 5 2 5 3 47 8 5 4 4 3 4 3 4 3 5 4 5 2 46 5 4 4 2 4 2 4 2 4 2 4 2 39 9 5 3 5 5 5 3 5 5 5 5 4 4 54 5 3 5 5 5 4 5 5 5 5 4 5 56 10 5 3 4 4 3 3 4 3 3 3 5 2 42 5 4 5 4 5 4 4 4 4 4 3 2 48 11 5 3 4 2 5 3 5 2 5 3 4 1 42 4 4 4 2 5 3 5 3 5 4 5 2 46 12 4 4 5 4 5 4 5 4 4 3 4 3 49 4 4 5 4 4 3 3 3 4 3 4 3 44 13 4 3 4 4 3 1 4 4 4 4 3 2 40 4 3 4 3 3 2 4 4 5 3 4 3 42 14 3 4 5 4 5 3 5 5 5 5 4' 3 51 4 4 5 4 5 4 5 5 5 5 4 4 54 ------15 4 4 3 2 4 2 5 4 5 3 4 2 42 5 4 4 3 4 2 4 4 4 2 4 2 90 16 4 5 3 4 2 4 3 4 4 2 5 2 42 5 4 4 3 3 5 4 4 5 3 5 3 48 Questionnaire 3 - stage 2 Total Questionnaire 4 - stage 3 Total CONTUOI. 1 23a 3b 4a 4b Sa 5b 6a 6b 7a 7b 1 23a 3b 4a 4b Sa 5b 6a 6b 7a 7b 1 5 4 4 3 4 2 3 4 5 4 4 2 44 4 3 4 4 4 2 4 4 4 3 4 2 42 2 4 4 5 4 4 2 5 5 4 4 4 4 49 4 4 5 4 4 2 5 5 4 4 4 4 49 3 5 3 5 4 5 2 5 5 5 4 5 4 52 5 5 4 5 5 2 5 5 5 5 5 4 55 .. _... -_._, . _. .~. _.-._.". ._..•._..-. _._0 __._. ..••.. -._._-_. ..._----. ._-- _.- -_ ------_. --1 --- - 4 5 3 5 5 5 4 5 5 5 5 5 1 53 5 3 5 5 5 3 4 5 5 54 1 50 ---- - 1--.---~- -_.1-- 5 5 4 5 4 5 4 5 5 5 4 5 4 55 5 4 5 5 5 3 5 4 5 4 5 3 53 ---,- ---" ----- _ ..- ._._------_.- _.- ---- _. 5 6 5 2 5 3 53 5 4 5 4 4 3 48 5 4 4 3 5 3 3 5 4 5 2 48 7 4 34343445555 49 4 4 4 3 4 3 5 4 5 5 5 5 51 8 4 3 4 4 5 4 5 4 5 4 5 4 51 5 4 5 4 5 4 5 4 5 4 5 3 53 9 5 5 4 4 5 4 4 5 4 5 5 3 53 5 5 4 4 5 4 5 5 4 5 5 4 55 -- r------10 4 4 4 3 5 2 5 4 4 4 4 2 45 4 4 4 3 4 2 4 3 4 3 4 2 41 ------,- ---_.- ---,------~-_ .._--- _._-----, f- .- _.------11 4 3 5 4 5 1 5 3 5 S 5 4 49 4 4 5 4 5 1 5 4 5 5 5 4 51 ------._------,._------

___ 4 ____• 4 5 4 55 4 4 5 4 5 5 5 5 5 4 5 3 54 12 4 5 5 4 5 5 5 4 5 .. ._-- -_._------._-_._------. .- ---~------_ _- 1----._- 13 4 4 3 3 4 4 4 4 4 4 4 4 46 5 5 4 3 4 2 4 4 4 4 4 4 47 -[.4-- -_.~ ---=- 5 4 4 3 -5 25 5 --S 3 4 -f 46 5 3 5 3 5 -2 5 5 5 4 4 3 49

62 APPENDIX 3.17

AIDED VISUAL ACUITY FOR THE INITIAL CONSULTATION AND FOR EACH STAGE

EXPERIMENTAL Initial consultation Stage 1 Stage 2 Stage 3 1 15 15 15 15 2 20 20 15 15 3 25 25 15 15 4 20 20 15 15 5 15 15 15 15 6 15 15 15 15 7 20 20 15 15 8 15 15 15 15 9 15 15 15 15 10 20 20 20 20 11 20 20 20 20 12 20 20 20 20 13 15 15 15 15 14 20 20 20 20 15 20 20 20 20 16 25 25 25 20

CONTROL Initial consultation Stage 1 Stage 2 Stage 3 1 15 15 15 15 2 20 20 15 15 3 20 20 20 20 4 20 20 20 20 5 15 15 15 15 6 20 20 20 20 7 20 20 20 20 8 15 15 15 15 9 15 15 15 15 10 20 20 20 20 11 20 20 20 20 12 15 15 15 15 13 20 20 20 20 14 15 15 15 15

63 APPENDIX 3.18

PUPILLARY DISTANCE FOR EACH SUBJECT

EXPERIMENTAL 1 62 2 72 3 63 4 67 5 68 6 62 7 63 8 70 9 68 10 62 11 64 12 70 13 64 14 59 15 70 16 72

CONTROL 1 65 2 63 .)'" 64 4 61 5 61 6 61 7 65 8 68 9 64 10 62 11 68 12 66 13 66 14 62

64 APPENDIX 3.19

PUPILARY SIZE FOR EACH SUBJECT

EXPERIMENTAL 1 6mrn 2 4mrn 3 5mrn 4 6mrn 5 6mrn 6 4mrn 7 6mrn 8 5mrn 9 5mrn 10 5mrn 11 4mrn 12 4mrn 13 4mrn 14 5mrn 15 4mrn 16 6mm

CONTROL 1 6mm 2 5mm 3 6mm 4 6mm 5 4mm 6 6mm 7 6mm 8 4mm 9 5mm 10 6mm 11 5mm 12 5mm 13 5mm 14 6mm

65

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