Optometry, as an evolving Profession, has two possible directions it can take. Firstly, Follow the way of conventional medicine, where the primary care model is to treat the symptom of the problem. This approach considers the absence of symptoms being good health. The second possibility, is to recognize the real origin of disease and eye problems. A human being that is out of balance. Not only in their physical life, but their emotional and spiritual one too.
This paper draws on 45 years of clinical experience of a vision therapy oriented practitioner, one who has embraced the grandfather principles of functional and behavioural vision concepts. A modern approach that recognizes a new paradigm of vision care that has been born. Can this integrated model be embraced as a second ‘upgraded’ direction for Optometry? Like in biblical times, there are commandments that show the way to enlightenment. These could be the steps to go beyond a symptom based medical model of treatment. An approach that is Holistic in its foundation, and redirects the responsibility for healthy eyes back to the patient.
Raised and educated in South Africa, forty-five years ago I began my career seeing patients as an Optometrist. This was my first and only career choice. To guide people towards healthy seeing. My teachers and colleagues emphasized looking at the whole person when designing a vision care program. There was little interest in being a ‘Junior Ophthalmologist’, only treating the eye problem!
From the beginning, I thrived on the concepts of Functional and Behavioural Vision Care. In spite of my first practice experience being mostly prescribing glasses, each day, I explored the visual findings and considered home based vision training principles for the patient. This was my way of exploring the relationship between the human being and what their deeper perceptual ‘seeing’ was communicating to me through my vision analysis findings. At first, I had no real skill in communicating this Holistic way of dealing with eye problems. Over the years I was able to simplify my communication, such that more patients involved themselves in the Integrated Vision Therapy. I conducted my own clinical trials.
This paper is a result of this process and also includes my 16 year Professorship and clinical research at two Colleges of Optometry in the United States of America. During this time I have observed our profession being politically influenced and pressured to fit into an outdated health care model. One that is driven by the Pharmaceutical and eye, frame and contact lens manufacturers. That is, our vision care delivery is influenced by industry and politics, rather than conscious Holistic health care practice. Even today, there are Optometrists being sucked into being like their medical counterparts, where treating eye disease is the focus. What about good old functional and behavioural approaches, where the well-being of the patient comes first? An approach that has prevention and regeneration at its heart.
The standard Optometric model is for the practitioner to treat disease and eye problems in a standard symptom based approach. It’s an easy model to follow, when the patient is unwilling to take self responsibility for their visual well-being.
However, the ever growing presence of the Internet in people’s lives is accelerating the interest in self-help approaches to health in the U.S. and other countries. Consumer desire for organic and healthy food and complementary healing methods is becoming standard practice. There is easy availability of information via the Internet for the public on alternative and complimentary ways to help their eyes. This opens up the possibility for us as Optometrists to provide a healthy truly therapeutic form of vision care. Our Optometric profession must take a stand for the future – Prevention. If we don’t, we will always be subservient to Medicine and Ophthalmology.
For an effective paradigm shift to occur there needs to be a vision, and a blueprint for steering the direction. The branch of Optometry that evolved on the functional and behavioural principles of Skeffington, and others, archived through the Optometric Extension Foundation, can serve as a beginning point.
The 10 Commandments is a modern extension of these clinical methods, with an upgrade for the complex virtual world and technological time we live in. Primary Care Optometry, modelled after conventional medicine, is not effectively controlling the ever increasing rise of refractive and eye disease problems.
Within these 10 Commandments is the solution. The growing numbers of people interested and committed to a preventive approach to vision care is our opportunity. The clinical know-how is available. It is time for Optometrists to upgrade their model of vision care to bring this possibility into reality. These 10 commandments serve this purpose.
What are the 10 Commandments?
The commandments speak to the wisdom of a functional holistic approach in dealing with patient’s vision problems. By my patients being helped to identify their personal needs, taught and directed me to the ‘know how’? The commandments speak less to a technique or method of use, but more to the way of how to be with the patient. To see their eye problems as part of a continuum of their life struggles and evolution. My eyes were opened to see the eye problem as an entry point to the human being’s way of perceiving themselves more deeply. In this way, they were more able to perceive their life problems from a holistic perspective. This article is a way to present these discoveries as an introduction to the future. A way for Optometry to steer its direction to a truly preventive profession, much like Dentistry has accomplished. Obviously, to administer this approach in a clinical setting will take additional study and practice.
Here are the 10 Commandments:
Commandment 1 – Treat the human who sees not with the eye, but through the eye
There is a scientific myth, that has been heavily conditioned into the thinking of both practitioners and the public alike. We see with the eyes. Light comes into the eye, it is refracted and an upside down image forms on the retina.
From a physical point of view this may be stated so. However, from a psychological perceptual and quantum physics point of view, a revised understanding is necessary.
Light does enter the eye. This light is transformed by refraction. The upgrade in thinking is that the light carries information. It is not the light per say that we are interested in. It is the invisible information with in the light that provides the impetus for perception. It is perception that ultimately determines how and what we see. How skillful and safe is it to extract the information from the light. When the upside down information is correctly received and processed through the brain, an accurate perception is formed. Note, I stated through, not in the brain.
However, there are many variables that can interfere in this processing ability. The main one is the inner state of the person themselves. What exactly is meant by this statement. Recent breakthroughs in understanding the ‘Biology of Consciousness’ helps point the way. How receptive the tissue and structures of the eye is to the incoming light is dependent on how present or aware the person is behind the eye. From brain research one could hypothesize that it is simply a matter of the person’s focus and attention that is needed for the retina and macular to receive the light. If this happens, then the assumption is that the light is transmitted. New evidence suggests that it is not so simple. There are actually two primary variables that affect the functionality of the eyes. One certainly is the brain. A very helpful part, since its primary role is to protect and help the human survive. Survival mechanisms can steer the energy to and through the eye, and we can react very quickly.
New evidence from ‘Monk’s Brain’ studies reveal another phenomenon. Lamas who are trained in mind/spirit matters, like meditation, are more able, and far quicker, able to activate larger surface areas of brain tissue. The resultant effect is that they can process light through the eye in a much more complex way, such as looking and identifying hidden computer driven stereoscopic images. This quiet ‘brain state’ gives them the ability to see more deeply into themselves and life, with less effort and time. Their visual performance far exceeds that of Western intellectual counterparts.
Commandment 2 – How the patient sees, and what we measure in the eye, is a reflection of their perceptions
Seeing is promoted as being primarily an eye function is now a belief in normal eye medicine. Few consider that in the total process of vision, the eye probably only contributes about 10 percent. The brain and the human spirit determines how and what is seen. So, when an abnormality is measured in the eye, such as Myopia, Astigmatism, suppressions, Glaucoma etc., the source of the problem is behind the eye. My clinical findings implicate that what we measure at the level of the eye are misperceptions, actually ‘survival perceptions’, that ultimately in an unaware person, gets programmed into the eye via the nerves and blood supply. We measure these as refractive or binocular anomalies.
So, this means in normal lens prescribing and vision therapy we are providing experiences to reorganize a very deep inner process. It is not enough to just treat a measured refractive ‘error’ or a convergence insufficiency or strabismus. Vision therapy is more than what is accomplished in the training room. It can begin even with their new glasses. The procedures the patient is following must be practiced in their real life, at home. If glasses and vision therapy are modifying perception, then the resulting experiences must have a place to land in their personal life.
Usually, we think of vision therapy as training certain eye and vision skills that effect reading, working at a computer, learning and in sports. At the very core of not seeing is avoidance. The resistance to see issues or problems in patient’s lives can and does show up as measurements of refractive and eye conditions.
In the same way, if new healthy perceptions are encoded during the vision therapy process, then the Myopic and Astigmatic perceptions are modified. This can actually be monitored through changes in visual acuity, binocularity, and over time lowered and modified diopter measurements.
If these perceptions are more healthy, then this new way of seeing can also benefit how the patient sees their choice of career, relationships, family and lifestyle. To take this one step further, clear perceptions directly impact personal problems in patient’s lives. Relationship problems and others addictions are positively affected by this integrated vision therapy.
Commandment 3 – Do not treat or try and fix the diopters, suppressions, lack of visual acuity, eye diseases, phorias, and other eye findings. Use them to define what the eye is communicating about deeper perceptions of the person’s whole existence.
It is a very big step for a practitioner schooled in Optometric and Medical Science to modify their own inner perceptions of the reality they have been conditioned to believe. We are trained to diagnose eye problems and provide treatments. This model is predicated upon the belief that if we measure something in the eye, that deviates from a norm, the eye condition is the problem that has to be fixed. The future of Optometry being a truly preventive discipline, needs a new perception of the eye measurements and what to do about this so called ‘problem’.
Consider that our usual eye measurements, and their relationships to the patient’s symptoms, are a print-out and communication from the brain and beyond. This communication is a ‘call out’ for help. It is not an eye problem. The brain makes adjustments to its vascular and neural messaging to the eyes when it’s in a survival state. This messaging implicates the presence of a survival perceptions, like fear or anger. The most vivid demonstration of this process is the case of retinoscopy. A young patient sees perfect 20/20, and yet the retinoscopy finding already showing a minus projection. The eyeball is fine at this stage, however, this objective finding is showing a survival restrictive perception. Our usual treatment strategy is to tell the patient to come for a progress visit in the future. Then when the eye shows the Myopia, we can ‘correct’ it with minus lenses.
Then the question can be asked, “What exactly does our lens and vision therapies provide for the patient?” In conventional primary vision care our ‘correct the refractive error’ model locks the patients perceptions into the survival mode. Lens compensation is just covering up the symptoms not correcting anything. Except, perhaps preventing the practitioner and patient from dealing with the fear of lowered visual acuity. What this means is that the healthy perceptions of thinking, feeling and emotions are not given the appropriate chance to gain the necessary developmental steps for integration. It could be stated that an eye suppression is a one sided suppression of thinking, feeling or emotional perceptions. Psychiatrist Frederick Schiffer, has identified localized areas of emotional activity related to light coming through one eye. So in vision therapy we are guiding the patient into perceptual experiences of higher and higher levels of fusion or integration of the brain.
However, this is still only a stepping stone towards a human experience through the eye that is akin to a visionary meditative state, like the Lama Monks have demonstrated.
This still state of seeing gives the freedom to deal with life problems from a less reactive position. Less terror, wars, anger and a return to honouring the unity of the human family on this Earth.
Commandment 4 – Prescribe glasses that are preventive and therapeutic because the ‘correct the refractive error’ glasses do not correct anything.
Normal lens prescribing follows the correct the refractive error model of vision care. The measurement in and of the eye is an eye problem, and that is the end of the story. Write the prescription for 20/20 and get the next patient in. We have a new commandment. There are patients who come in to our offices interested in taking more responsibility for their visual well-being. This means that we are needing to upgrade our prescribing approaches to meet this level of consumer interest.
The growing interest in corrective surgery, like Lasik, is raising the awareness of the possibility for improving vision. Not just functional vision skills, but also visual acuity. Growing numbers of patients are investigating natural approaches to lowering their dependency upon strong glasses. What is our position in Optometry on this obvious marketing opportunity? One that can serve the profession of Optometry, but more importantly, help vast number of patients lead a more conscious life through healthier functioning visual systems.
At the core of a new form of lens prescribing is the premise that the visual system is a natural biofeedback system. The interaction between the fovea/macula and retinal input sets the stage for clearness and unclearness of sight. A normal correct the error lens neutralizes the unclearness of perception into an over focused fovea focus. This introduces a perceptual experience for the patient to fear unclearness and label it wrong.
We, as Optometrists, even reinforce this way of thinking. Everybody has to have a sharp focus and be clear, otherwise it is dangerous for them. On the other hand, an integrated vision therapy model of lens prescribing has been birthed and clinically tested for over 30 years. That is, for the self responsible patient (this is emphasized), especially the Myopic patient, provide a reduced lens prescription. In this way, a clear and unclear fovea/retinal relationship is established.
What happens next is where the real patient compliance and self motivation comes into play. The patient is coached to become aware of what circumstances in their life produces changes in visual acuity. That is, when does the visual acuity seem less clear and visa versa, when does it increase. Variables like certain foods, fatigue, excessive computer use, and spending time outside produces changes in visual acuity.
The main advantage of this lens form of integrated vision therapy is that the patient begins monitoring their own vision. They learn very quickly that their eyesight and perception is under their control. Then the Optometrist becomes the teacher, the guide to true prevention.
There is no need to fear that glasses will become obsolete in this model. The opposite is true. Patients will be prescribed more lenses for use in the different parts of their lives.
Commandment 5 – Prescribe minus lenses in the direction of a parasympathetic stimulant (less minus and more plus), since minus lenses that compensate for 20/20, or 100% eyesight, are a sympathetic stimulant, a drug.
It is not very often that we are given a chance to reflect that a lens acts like its prescription drug, that is it has a direct pharmaceutical action on the autonomic nervous system. The fifth commandment is each time a new minus lens prescription is written, REMEMBER, you are ordering the patient to look through glasses that is a stimulant, like ‘speed’.
Yes, you are sharpening visual acuity and giving them a chance to protect themselves from not seeing unclear on a physical level. At the same time you are locking them into survival perceptions of their inner unclearness. This is like supporting an addictive process of not becoming aware. They are in a constant state of Hyper alertness through a Sympathetic dominance nervous system.
The emerging integrated model of vision care supports the patient in looking at their ‘drugged’ way of perceiving. To help them look through lenses that wake up their perceptual consciousness. All inhabitants of our planet Earth need to correctly see themselves and outside in order to restore the survival way we are living. It begins with our perceptions.
As Optometrists, we have a big role to play in the future scenario of people seeing correctly through their eyes. For the Myopic population, lowered minus lens prescriptions introduces a relaxed parasympathetic way of looking. Through the retinal stimulation, having more feeling for what they are looking at is awakened. This feeling over time is called compassion. The logical clear view is softened. Slowly, as the patient lives this way of looking and seeing, so the brain and eye adjust. We measure this more balanced state in the refractive and binocular findings. Prevention is started for the patient and their off spring. They open their ‘Monk like’ meditative way of perceiving.
Commandment 6 – Prescribe glasses, with an integrated vision therapy approach, thus giving the patient the self responsibility for their vision future
While considering this therapeutic way of prescribing, it will be necessary for most patients to be educated about returning for regular visits. In actual fact, the patient can be guided to realize that in-office supervision, say once per month, will be supportive for their new commitment to prevention and regeneration. This approach serves to maintain a high level of self responsibility.
Once the patient makes the decision for regular monthly visits, their integrated vision therapy involvement in their life is more likely to happen. In office visits, can include introduction to conventional vision therapy techniques, however, these visits serve another very important process. It is a chance for the patient to experience the deeper connection between their life processes and change in perceptions.
The functional Optometric findings of refractive status, like astigmatism, suppressions, and fusion will reflect what is happening to the patient’s inner world of perception. In my office sessions, I show the patient these connections and how by using their new perceptions in their life, the measurements in the eyes change. The main variable to monitor is visual acuity in the distance. The second is the level of binocular vision. These findings vary according to the perceptual level of presence and awareness of the patient. If they need to block a certain life experience, there will be lower visual acuity, or they will suppress the view through one eye.
Commandment 7 – Observe and learn how every eye condition of refraction or disease is a view into how the patient is deviating from their fundamental perceptual EyeCode®. (That is their God given way of perceiving)
Every condition or variation that we measure at the level of the eye is a reflection of an avoidance of perception in the inside world of the patient.
The patient is genetically coded with information like phorias, structures on the iris, and fusion abilities. Each person has unique astigmatic axes. One can consider that these findings serve as blueprint for an individual EyeCode®. Over the years, I have categorised these codes into what has become known as the EyeCode® Kaplan Method. The Iris EyeCode® shows the fundamental core perceptual style of the patient, either a logical, feeler or emotional processor. In addition, there is precise information, called perceptual influences, that are passed down from the parents. This forms the basis for the patient to deviate from their core code.
The Diopter and Disease EyeCode® reveal the deviations from the core perceptions that are related to life conditioning. These are the environmental conditions that begin after birth. For example, a child may have genetic influences to show Myopic measurements at the level of the eye, and the interaction with the Myopic parents and fitting into a Myopic conditioned society then exaggerates their moving into Myopia at a faster rate.
On the other hand, a patient with no genetic Myopic influences, has less impetus for Myopic perceptions and development for a Myopic eye. They may however, trigger a Myopic visual style by environmental abuse of their visual system, such as in excessive computer use. In the same way, certain perceptual states, like self imposed pressure, either inherited or learned, can be connected to elevated levels of intra ocular pressure.
My findings suggest that when the patient finds out about this inner and outer connection, they are more motivated to take self responsibility for their eye problems. This is a big relief for us, the practitioner, to have a patient take charge. Our true role in vision care becomes evident. We are then the coach, mentor or guide to the patient opening up to their vision.
Commandment 8 – Consider all treatments for eyes to be connected to where the patient is in their life cycle, that is, the variables before their current chronological age, and the future.
Is it possible, that the within the biological workings of the eyes are changes that show up during different periods of our cycle of life? Clinically, I have observed that as we go through life in 20 year cycles, there is a repeating of certain perceptual experiences. It seems that our perceptions of thinking, feeling and emotions are given repetitive chances to evolve themselves.
At the same time, the code of the eye, reveals changes, for example Presbyopia. Normally, we say the change of lens and ciliary muscle flexibility is just due to the ageing process. Consider that Presbyopia is part of a Biological imperative that is designed to modify thinking perceptions into more feeling and emotional forms. This would make total sense when one’s considers the life cycle of when Presbyopia begins. The patient’s foundation of their life has been concretely built. Usually the career, home and family is established. Now it is time to feel and enjoy life more. Less need to focus and gain knowledge and more time to feel and be touched by life itself.
The implication of this is huge. Preventive and life cycle lens prescribing will then take on a very different form than treating the patient as having something wrong with their eyes.
The eye condition and the patients age guide us to prescribe lenses that will support the patient’s life process rather than just giving them false sense of sharpness of eyesight, such they can continue being unconscious of their fears or need to evolve.
Commandment 9 – Examine the eye and visual findings to reveal how well the patient is integrating their perceptions of thinking, feeling and emotion.
The visual findings follow a coded perceptual developmental path in addition to the environmental conditioning. Evolvement of inner vision is a life process of integrating perceptions of thinking, feeling and emotion. The anatomy of the eye is the first place to observe this fact. The macula is designed to gather focused light in the fastest way possible. The precise information within this focused light is used to build an understanding known as the content of life.
The retinal unfocused light, is slower in being processed by the brain. This information forms the context (Seeing and feeling) of what is looked at. This feeling state supports our perceptual processes of being touched, the beginning basis for healthy emotional states.
During the life cycle these perceptual states integrated to deeper and deeper levels. Of course, the success of this integration is what we measure as the state of fusion between the two eyed inputs. Clinically, I have observed that many patients under life and visual stress lose the ability to keep this integrated Binocular status of multidimensional vision.
If the perceptual state gets stuck in either thinking, feeling or even emotion, a survival state of vision is cemented. This limits the capacity for the eye to receive light and sets up the patient for a lack of fulfilment in their life. Modification of the perceptual state through integrative vision therapy encoding, frees up the natural progression once more to evolve. The patient can be guided how to integrate these three levels of perception, preparing them for a future preventing further destruction of eye tissue.
Commandment 10 – The vision care program must address the reality that at the very core of measured vision problems is an inability for the patient to handle emotional incongruity.
One of the most difficult future steps for the profession of Optometry to take is to recognize and acknowledge that at the very core of measured vision problems is an inability for the patient to handle emotional incongruity.
The implication of the above statement is vast. The alterations of the eyeball length, power, and the tissue changes we see extend beyond just the physical. Biological changes at the level of the eye are printouts of survival nature of the human beings brain state.
The good news is that through re-traveling the journey of thinking, feeling and emotional perceptions, the survival perceptions can be encoded into a healthy pure view. This higher frequency state can be considered to be a kind of essential seeing, like a spiritual view, like the Monks.
Certainly, the brain and mind state investigations of the Monk’s brain testify to this possibility. Is it possible that in primary care Optometry we are missing out on this vast potential we have in our profession? Is our physically oriented vision therapy only just scratching the surface of the potential we can offer patients? My experience of the higher levels of integrated vision therapy has provided me with a deeply fulfilling career as an Optometrist. I offer these commandments to our profession. Upgrade now, it is time and there is a brilliant possibility. Soon, it may be too late.