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The effect of eye exercises on visual acuity and refractive error of myopics

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DOI: 10.5455/ijtrr.000000274

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 International Journal of Therapies and Rehabilitation Research 2017; 6 (2): 249-254

Original Research Article doi: 10.5455/ijtrr. 000000274

International Journal of Therapies & Rehabilitation

E-ISSN
Research
2278-0343
http://www.scopemed.org/?jid=12

Effect of Eye Exercises on the Visual Acuity and Refractive Error of

Myopics

HAYATI JOSHI1, DR. SEEMI RETHAREKAR2*, DR. SAVITA RAIRIKAR3, DR.

ASHOK SHYAM4, DR. PARAG SANCHETI5

1
Bachelor of Physiotherapy (B.P.Th), Sancheti Institute College of Physiotherapy.
2
Master in Cardiovascular and Pulmonary Sciences, Associate Professor, Cardiovascular and
Pulmonary Sciences, Sancheti Institute College of Physiotherapy.
3
Principal and Professor, Sancheti Institute College of Physiotherapy.
4
Master in Orthopedics (M.S. Ortho), Sancheti Institute College of Physiotherapy, Sancheti Institute
of Orthopaedics and Rehabilitation.
5
Master in Orthopedics (M.S. Ortho), Sancheti Institute of Orthopaedics and Rehabilitation.
.
ABSTRACT

Myopia, due to the spasm of the ciliary muscles, makes the distant vision blur. Individuals spending
considerable time on close visual work are likely to develop this, requiring some preventive or corrective
eye exercises.60 subjects (18-35 years) with Myopia less than -3 diopters were divided into 2 groups:
Experimental and Control group using a computerized randomizer. A double blinded study by an
Optometrist who assessed the Refractive error and visual acuity of subjects using Snellen’s chart and Auto
refractometer, pre and post intervention period of 6 weeks, and author taught the eye exercises. P value
was found non-significant for Refractive error in Experimental group (R-0.54, L-0.61) using paired T test,
unpaired T test gave non-significant P values between both groups for Refractive error (R-0.45, L-0.49) and
Visual acuity (0.52, L-0.51);making these eye exercises ineffective in improving the Visual acuity and
Refractive Error in Myopics.

Key words: Myopia, Refractive error, Visual acuity, Eye exercises, Snellen’s chart, Autorefractometer.

INTRODUCTION visual disability throughout the world. In India

uncorrected refractive errors are the most common
cause of visual impairment and second major cause of
Myopia, also known as near-sightedness and short-
avoidable blindness. [2] Demographically, myopia shows
sightedness, occurs if the eyeball is too long or the
a racial predilection towards Asians; African Americans
cornea is too curved as a result, light that comes in
tend to show the least amount of myopia.[3] The earliest
does not directly focus on the retina but in front of it
survey conducted in India in the 1970's by Jain et al.,
(Figure III), therefore, causing the image that one sees
has shown a prevalence of myopia of 4.79% among the
when looking at a distant object to be out of focus or
school children in Chandigarh. It was higher in urban
blurry, although close objects are seen clearly. [1]
population (6.9%) in comparison to rural population
Myopia, a form of refractive error is a leading cause of
(2.77%).[4] Murthy et al., assessed the prevalence of
 International Journal of Therapies and Rehabilitation Research 2017; 6 (2): 249-254
refractive error and related visual impairment in school
going children 5-15 years of age, in an urban population
in New Delhi and reported a prevalence of 7.4% of
myopia.[5]
The retina is at the back of the eyeball. The lens in-front
focuses light from far or nearby objects onto the retina
(Figure I). This is where the signal is processed and
sent on to the visual cortex in brain.
To focus light, eye uses a flexible lens, and a circular
muscle (the ciliary). For distance vision the shape of the
lens allows the muscle to be relaxed. When you look up
close the ciliary muscle becomes tense or contracted to
change the lens shape to give clear close-up vision.
(Figure II)
Eventually there is spasm of ciliary muscle due to its
constant contraction when looking at close objects.
When it fails to fully relax, the lens cannot entirely
return to focus on distant objects. This is when your
distance vision becomes blurred, often referred to as
“Pseudo myopia” or NITM (near-induced transient
myopia). [6]
Individuals who spend considerable time reading,
working at a computer, or doing other intense close
visual work may be more likely to develop myopia due
to spasm of ciliary muscles. [1]
Pseudo myopia is a focusing muscle spasm. The eye
lens is still in close-up mode, because the focusing
muscle has failed to relax. One is looking at a distance,
but lens is still shaped for close-up. As a result, distant
images don't focus correctly on the retina causing a
blurred distant vision. Glasses and contact lenses
move the focal plane further back in your eye, i.e. on
Retina giving back clear distance vision. [6]
Myopia is most commonly corrected through the use
of corrective concave lenses. (Figure III) It may also be
corrected by refractive surgery, though there are cases
of associated side effects. [1] While glasses work in the
short term to suppress the myopia symptom, it also
creates a stimulus in the eye by moving the light back
further inside the eyeball. This causes the eyeball to
gradually elongate to compensate for this change in
focal plane. This is what is often referred to as lens-
induced or progressive myopia or Axial Myopia.[6] [7]
Myopia is measured in Diopters and its value depends
on the severity of myopia and the strength required to
focus at distant objects. [8]
Myopia can be classified as:[9]
 Low Myopia (<3.00 D)
 Medium Myopia (3.00 D - 6.00 D)
 High Myopia (>6.00 D)
In 1920, William Bates wrote a book “Perfect sight
without glasses” where he states that the eye does not
focus by changing the power of the lens, but rather by
elongating the eyeball, through use of the extra-ocular
oblique muscles. He believed that refractive errors of
eye are caused by tension of these extra-ocular
muscles surrounding the eyeball, which he believed
prevents the eyeball from sufficiently changing shape
(per his explanation of accommodation) when gaze is
shifted nearer or farther. According to him, this
supposed muscular tension is a consequence of a
"mental strain", the relief of which he claimed would
instantly improve sight. [10] Bates felt that corrective
lenses, which he characterized as "eye crutches", are
an impediment to curing poor vision. In his view, "strain"
would increase as the eyes adjust to the correction in
front of them. He thus recommended that glasses be
discarded by anyone applying his method. [11] Thus, he
came up with an educational method intended to
improve vision by reducing the strain after performing
few exercises, but the efficacy of this method is
questionable and his theory was contradicted by
mainstream ophthalmology and optometry of his day
and still is today. [12]
Vision therapy is an option for people whose blurred
distance vision is caused by a spasm of the muscles
that control eye focusing i.e. ciliary muscles. Various
eye exercises can improve poor eye focusing ability
and regain clear distance vision. [1] Hence, is the need
to test the effect of such eye exercises. In this era of
technology there is increased screen viewing time, i.e.
Focusing time on small screens has considerably
increased. This leads to spasm of the ciliary muscles
and causing Myopia, which can further lead to serious
problems like cataracts and macular degeneration.
METHODOLOGY
Subjects: 60 subjects, both males and females,
between 18-35 years of age with Myopia less than -
3.00 diopters were chosen for the study. Those
subjects with Myopia more than -3.00 diopters, eye
injury, other visual disorders and eye diseases were
excluded from the study.
Methodology: Simple random sampling was done and
subjects were divided into 2 groups, 30 in each:
Experimental group and Control group using a
computerized randomizer to perform a Randomized
controlled trial. A double blinded study by an
Optometrist who assessed the Refractive error and
visual acuity of subjects using Snellen’s chart and Auto
refractometer respectively, pre intervention period and
post intervention period. The experimental group had to
perform a set of specified eye exercises for 6 weeks
from 4th June 2016 – 15th July 2016, which were taught
by the author to the subjects.
RESULTS
Statistical analysis was done using Microsoft Office-
Excel 2007. For Intra-group analysis, paired T test was
used. Level of significance was set to 0.05.
Table I: Pre-post P value of Experimental & Control
group.
The above table reveals that no significant difference
was obtained for both eyes in the Experimental group
and control group, when pre and post intervention
readings for Refractive Error were compared, similar
were the results for Visual acuity.
For Inter-group analysis, unpaired T test was used.
Table II: Post intervention P values of Control and
Experimental group.
 International Journal of Therapies and Rehabilitation Research 2017; 6 (2): 249-254

The above table reveals that no significant difference

was obtained in both eyes between the groups, when
post intervention readings for Refractive Error were
compared, similar were the results for Visual acuity.

Table I: Pre-post P value of Experimental & Control group

Experimental group Control group

R eye L eye R eye L eye
Visual acuity 1 1 1 1
Refractive error 0.54 0.61 0.35 0.91

Table II: Post intervention P values of Control and Experimental group

Right eye Left eye

Visual acuity 0.52 0.51

Refractive error 0.45 0.49

Figure I: Components of the Human Eye.

Figure II: Mechanism of Eye focusing with Ciliary muscles

Figure III: Elongation of eye with shifting of focus in front of Retina, and with correction using
 International Journal of Therapies and Rehabilitation Research 2017; 6 (2): 249-254
DISCUSSION
The exercises and relaxation techniques performed in
this current study were expected to reduce the spasm
of Ciliary muscles, which was the causative factor for
Near-induced Transient Myopia (NITM) or Pseudo
Myopia. The reduction in this spasm of ciliary or the
focusing muscles of eyes would in turn reduce the
NITM or Pseudo Myopia, thus improving vision.
However, the current study showed that these eye
exercises were not as effective in reducing the
Refractive error as seen by the non-significant P value
of 0.54 and 0.61 for the Right and Left eye respectively
in the experimental group after the completion of six-
week intervention period.
No significant difference was found in the Visual acuity
pre and post interventional readings in the Experimental
group when taken at an interval of six weeks with the P
values of 1 for both the eyes.
When Intra group i.e. between Experimental and
Control group, readings were evaluated with an
unpaired T test after the intervention period, it showed
similar results of non-significance.
Similar studies previously have shown varied results.
Rathod Vandana J. et al. studied the effect of eye
exercises on Myopia and concluded that visual training
improves Near point of convergence (NPC) but not
Visual acuity, which could be due to an improved
accommodation power as a result of eye exercises,
which in turn improves the NPC. [13]A different set of eye
exercises was to be performed thrice a day for 4 weeks
in their study, whereas in the current study it was twice
a day for 6 weeks which could contribute to this
discrepancy. Li SM. et al evaluated the efficacy of
Chinese eye exercises on reducing the accommodative
lag in school-aged children and found that those
exercises do transiently alleviate the accommodative
lag but at an insignificant level, and would probably be
insufficient to prevent the progression of myopia in
long-term. [14]This suggests that although the eye
exercises are effective in bringing about a change, but
a higher amount of near work load could also make
these exercises insufficient, which could have been a
possibility in our present study. Another study
performed on adolescents with Myopia by Samia A.
showed an improvement in the Visual acuity in Saudi
Female adolescents by performing a certain set of eye
exercises.[15]The set included a combination of home
and office exercises which were to be performed in 24
minutes once a day for a period of six weeks. Thus we
can imply that in the current study, the probability of
effectiveness of eye exercises could increase if a
combination of home and work place exercises were
added. A study conducted by Lin Z et. al. on the impact
of eye exercises of acupoints on the refractive error and
visual symptoms in Chinese urban children proved to
have a modest effect in relieving near vision symptoms,
with no effect on reducing myopia [16], which goes in
hand with the results of current study of no significant
improvement in reducing Myopia.
As a result, these eye exercises do not hold true for
improving the Visual acuity or to correct the Refractive
error in Myopia. This could be as a result of certain
variables which could not be controlled during the
course of this study like the diet of subjects, their
sleeping patterns, stress on eyes, exposure to near
objects, improper repetition of exercises and poor
accuracy of exercises. Another possibility to improve
the effectiveness of these eye exercises could be by
increasing the interventional period longer than 6
weeks. The subjects in these study were not of pure
Myopia as some of them had combined Astigmatism
(Cylindrical power), thus another study if done on
subjects with pure myopia could also lead to an
improved effectiveness of these eye exercises on
Refractive error and Visual acuity.
Conclusion:
This study concludes that although eye exercises do
bring about minor improvements in the Refractive error
after the intervention period in the Experimental group,
but these changes are not statistically significant in
improving the Refractive Error as well as Visual acuity
in subjects of Myopia.
Future Scope:
• The study of the effect of eye exercises on
Myopia could be done with a longer
intervention period.
• Effect of these eye exercises could be
assessed on subjects with Myopia without
Astigmatism. (Cylindrical power)
• Combined home and work place exercises
protocol could be given to the subjects.
ACKNOWLEDGEMENTS
I would like to thank Mr. Nilesh Rambhia, the
optometrist who assessed the Refractive error and the
Visual acuity of all the subjects in the study for Pre and
Post interventional readings.
I would also like to thank Dr. Rachana Dabadghav (PT),
Dr. Surendra Wani (PT) for their guidance and support.
I would also like to thank our Management and Ethical
Committee for permitting me to undertake this study.
Conflict of Interest: None
References
1. American Optometric Association
(AOA);Myopia (Nearsightedness); Available
from: http://www.aoa.org/patients-and-
public/eye-and-vision-problems/glossary-of-
eye-and-vision-conditions/myopia?sso=y
2. Saxena R, Vashist P, Menon V. Is Myopia a
Public Health Problem in India? Indian Journal
of Community Medicine : Official Publication of
Indian Association of Preventive & Social
Medicine. 2013; 38(2):83-85. doi:10.4103/0970-
0218.112436.
3. Hyman, L., J. Gwiazda, M. Hussein, T.T.
Norton, Y. Wang, W. Marsh-Tootle and D.
Everett, 2005. Relationship of age, sex and
ethnicity with myopia progression and axial
elongation in the correction of myopia
evaluation trial. Arch. Ophthalmol., 123: 977-
987.
4. Jain IS, Jain S, Mohan K. The epidemiology of
high myopia: Changing trends. Indian J
Ophthalmol. 1983; 31:723–8.PMID: 6676252
5. Murthy GV, Gupta SK, Ellwein LB, Muñoz SR,
Pokharel GP, Sanga L, et al. Refractive error in
children in an urban population in New Delhi.
Invest Ophthalmol Vis Sci. 2002; 43:623–
31.PMID: 11867576
6. Jake S. Myopia: A misunderstood symptom.
Available from: http://endmyopia.org/end-
myopia-home/
7. Jake S. Myopia the short version. Available
from: http://endmyopia.org/the-myopia-lie/
8. Grosvenor T. A review and a suggested
classification system for myopia on the basis of
age-related prevalence and age of onset. Am J
OptomPhysiol Opt. 1987 Jul; 64(7):545-54.
9. Goss D. Care of the patient with myopia. St.
Louis, MO: American Optometric Association;
1997. Available from:
http://www.aoa.org/documents/optometrists/CP
G-15.pdf
10. Bates, William H. (1920). "Chapter 9: The
Cause and Cure of Errors of
Refraction". Perfect Sight Without Glasses.
New York: Central Fixation Publishing Co.
pp. 89–105. ISBN 88-900756-3-5.
View publication stats
11. Gardner, Martin (1957). "Chapter 19: Throw
Away Your Glasses!”. Fads and Fallacies in the
Name of Science. Courier Dover Publications.
pp. 230–241. ISBN 0-486-20394-8.
12. Marg, E. (1952). “Flashes" of clear vision and
negative accommodation with reference to the
Bates Method of visual training" .Am J Opt Arch
Am Ac Opt 29 (4): 167–
84. doi:10.1097/00006324-195204000-00001
13. Vandana J Rathod, Devanshi P Desai,
Jagatheesan Alagesan. Effect of Eye Exercises
on Myopia- Randomised controlled study. J
Pharm Biomed Sci. 2011, 10(12). Available
from:
https://www.researchgate.net/publication/52005
328_Effect_of_Eye_Exercises_on_Myopia_-
_Randomized_Controlled_Study
14. Li SM, Kang MT, Peng XX, Li SY, Wang Y, Li
L, Yu J, Qiu LX, Sun YY, Liu LR, Li H, Sun
X, Millodot M, Wang N. Efficacy of Chinese eye
exercises on reducing accommodative lag in
school-aged children: a randomized controlled
trial. 2015 Mar 5 ;10(3):e0117552. Available
from : doi: 10.1371/journal.pone.0117552.
eCollection 2015. PMID:25742161.
15. Samia A. Abdel Rahman Mohamed. Vision
Therapy-Based Program for Myopia Control in
Adolescents. Middle-East Journal of Scientific
Research. 2013;13 (3): 390-396. Available
from: DOI: 10.5829/idosi.mejsr.2013.13.3.46.
16. Lin Z, Vasudevan B, Jhanji V, Gao TY, Wang
NL, Wang Q, Wang J, Ciuffreda KJ, Liang
YB.Eye exercises of acupoints: their impact on
refractive error and visual symptoms in Chinese
urban children. BMC Complement Altern Med.
2013 Nov 7; 13: 306. doi: 10.1186/1472-6882-
13-306.PMID: 24195652