Correction to This Article
A Sept. 12 Health article misspelled the name of Karla Zadnik, a professor of optometry and physiological optics at Ohio State University.

Eyeballing the Vision Workout

Illustration of an eye doing a push-up
By Ranit Mishori
Special to The Washington Post
Tuesday, September 12, 2006

The sales pitch for the See Clearly Method (SCM) is ubiquitous: An optometrist-created system of eye exercises is so effective at improving vision, according to promotions on local radio stations and across the Internet, that you may be able to throw away your glasses for good. In fact, the ads claim, regular eyeglasses may actually be making your eyesight worse . The SCM kit costs $350.

Iowa's attorney general, Tom Miller, is not buying it. His office filed a consumer fraud lawsuit last summer against Vision Improvement Technologies (VIT), the Iowa company that developed and markets the See Clearly Method. Among other things, the suit says assertions that SCM users can "quickly and easily free themselves of having to wear glasses or contact lenses" are false and misleading.

In addition, the Better Business Bureau (BBB) for northeastern Indiana has put SCM on its watch list. A year ago, Wisconsin's Department of Agriculture, Trade and Consumer Protection issued a warning to consumers after finding that of the more than 1,850 Wisconsin customers who bought the kit, half attempted to return it for a refund.

Also last year, VIT agreed to make a minor modification to its advertising, according to the Electronic Retailing Self-Regulation Program. This BBB-affiliated review group found that almost all the the company's promotional claims had been presented legitimately as opinion. However, it also concluded that one statement -- that the See Clearly Method could "eliminate . . . poor vision due to aging" -- "was not entirely consistent with the opinions espoused by the authors and should be modified accordingly."

Cliff Rose, VIT's founder and marketing director, says the product is effective and many users are satisfied. "You've got to talk to our customers who thank me every day," he says. "Every week I hear from people who thank me from the bottom of their hearts."

The SCM Web site offers a 30-day free trial of the technique for those who pay a shipping/handling fee of $9.95. But the Iowa lawsuit alleges that customers who wanted to return their kits had had trouble arranging their money-back guarantees. In February, an Iowa judge issued a temporary injunction ordering VIT to change its refund system.

According to Dominick Maino, an optometrist and professor in the Pediatrics and Binocular Vision Service of the Illinois Eye Institute and the Illinois College of Optometry, no independent scientific studies have proved SCM's or similar products effective at treating nearsightedness or farsightedness.

Karla Zladnik, professor in optometry and physiological optics at the Ohio State University College of Optometry, says eye exercises to correct vision have been "long out of favor" among most vision professionals. Their use "is not accepted by mainstream optometry," she says.

Henry Ettinger, a New York optometrist who serves as a consultant for VIT, defended the product in an e-mail, arguing that some dissatisfied customers may not be performing the exercises correctly or consistently enough.

"Some of my patients and some other consumers around the country have been pleased with the results using the SCM," Ettinger wrote. "Some have been able to function without glasses; others have been able to reduce or stabilize their prescription."

The Iowa lawsuit states that VIT's promotional materials make selective use of customer satisfaction reports. The lawsuit alleges that in one 54-day sampling of consumer contacts, six were favorable and 49 were complaints.

The lawsuit further alleges that some people whose names appear in ads as satisfied customers had stopped doing the exercises and were back to wearing glasses.

Looking Back

Vision training programs have been around for decades.

Some are loosely based on what's known as the Bates system, named for New York ophthalmologist William Horatio Bates, who, in 1920, published "Perfect Sight Without Glasses," a book of exercises that Bates believed could "normalize vision."

Bates didn't like eyeglasses; he thought they were ugly. He also hypothesized that wearing glasses actually made vision problems worse. His idea spawned an industry -- one that, even while the understanding of the causes and treatments of eye disorders have changed dramatically, continues to attract practitioners. Often they have been accused of quackery and, sometimes, fraud.

The eye works like a camera. The parts in the front of the eyeball, the cornea and lens, focus light on the retina, located on the back inside wall of the eye. Once the retina receives an image, it transmits a signal through the optic nerve to the brain.

In nearsightedness and farsightedness -- considered the most common vision problems -- the eye does not properly bend, or refract, the light directly onto the retina. The image sent to the brain looks blurry. When the eyeball (as seen from the side) is too long, objects farther away are blurry. When the eyeball is too flat, closer images are blurry.

The question is whether these problems can be exercised away.

Exercises and vision therapy are not discounted entirely by the medical mainstream. They are often prescribed for certain eye problems, such as eye movement disorders (those in which the eyes don't work together in a coordinated way) or when one eye is "lazy" (a condition known as amblyopia).

In these cases optometric vision therapy -- exercises supervised and directed by an optometrist -- can make significant improvements. Vision therapy has also been used, though not without controversy, in the treatment of children with learning disabilities and ADHD.

Ohio State's Zladnik says some parts of the See Clearly Method are also found in optometry vision therapy, "but they are not really [intended to] improve your vision."

Maino, of the Illinois Eye Institute, concurs that SCM uses some fairly common vision therapy techniques, but they "have not been shown to take someone who's nearsighted and to eliminate it."

In fact, there is a basic lack of evidence supporting vision training for these problems. SCM spokesmen Ettinger and Rose do not dispute this.

"No knows for certain how it works," Ettinger says. (The See Clearly Web site explains that the exercises "strengthen and relax the eye muscles responsible for focusing so your vision can improve naturally.") Rose adds: "We have never said that it's supported by any research. . . . All we have to go by is the anecdotal evidence that we have from people who have improved their vision."

The first controlled study of SCM, which involved 30 participants, found no benefit. Ohio State graduate student Tracy Bildstein, working with Zladnik, presented her findings at last year's annual conference of the American Academy of Optometry. It has not been published.

The study concluded that "using the SCM for one month did not have a significant effect on distance or near uncorrected visual acuity or refractive error."

Bildstein's participants were asked -- as anyone purchasing the kit off the Internet or over the phone would be -- to follow the manual provided in the SCM kit. It spells out a series of techniques that include biofeedback, eye massage, "palming" techniques (in which the eyes are rested on the palms of the hands), hot compresses over the eyes, visualization and personal affirmations.

The more demanding exercises in this orbital regimen involve focusing and unfocusing on objects and rotating the eyes in clock-like motion. Rose says these exercises "work on the extra-ocular muscles and the ciliary muscle," which are located around the eye. "You have to exercise these muscles to keep them strong and flexible."

States the SCM Web site: "Just as you can improve your health and fitness by exercising your body, we believe you can improve your vision by exercising your eyes."

This doesn't make sense to Eugene Helveston, emeritus professor of ophthalmology at the Indiana University School of Medicine, who wrote a 2005 article in the American Journal of Ophthalmology about visual training.

His conclusion is blunt: "Muscles have nothing to do with problems such as nearsightedness or farsightedness." Though the ciliary muscle controls the movement of the lens, Maino says simply exercising that muscle will have no benefit.

"You've got to get out of your head the idea of training the muscles," he explained in an interview. "There's no such thing as an Arnold Schwarzenegger ciliary muscle."

The consensus of most eye professionals is that nearsightedness and farsightedness are structural problems, correctable only with eyeglasses, contacts or laser surgery.

Rose thinks that the consensus is more like a conspiracy. "People are selling glasses and contact lenses and surgery," Rose says. "This is a multi-billion-dollar market. So some people are very threatened by us. So they are attacking us. . . . Don't be so quick to condemn us just because we can't line up all kinds of research."

But it is clear the lack of research hurts, and Rose says his company has commissioned a formal study of SCM, though he would not discuss details of the study design.

But proof is what the Iowa attorney general wants.

It's what Zladnik believes consumers should ask for before they part with $350.

It's what, Helveston believes, professionals and patients alike should seek.

"All you can do," Maino says, "is state the facts, and the people will decide." ยท

Ranit Mishori last wrote for the Health section about the changing roles of fathers in the delivery room.

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