Glaucoma: Its Cause and Cure

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Glaucoma: Its Cause and Cure

By W. H. Bates, M.D.

Glaucoma is a condition in which the eyeball becomes abnormally hard,
and theories as to its cause are endless. The hardness is supposed to
be due to a rise in intraocular pressure, and the other symptoms,
chief among which is an excavation of the optic nerve, forming in
advanced cases a deep cup with overhanging edges, are supposed to be
the results of this pressure. Yet all the symptoms commonly associated
with increased tension have been found in eyes in which the tension
was normal.

The increased tension is supposed to be due to an excess of fluid in
the eyeball, and this is commonly attributed to an impeded outflow.
The aqueous humor, which is secreted very rapidly, is supposed to
escape at the angle formed by the junction of the iris with the
cornea, and in glaucoma it is believed that the iris adheres to the
cornea so that this angle is obstructed. Yet it is a well-known fact
that in many cases no such obstruction can be found.

For more than fifty years iridectomy held the field as the only
treatment which gave any hope of relief in glaucoma. The operation,
which means the removal of a piece of the iris, was introduced by von
Graefe, and often gives relief for a longer or shorter time. If the
patient lives long enough, however, the condition always returns. I
have seen this happen after the tension had been normal for fifteen
years. It is a fact mentioned by all the text-books, moreover, that it
often fails to give even temporary relief, and sometimes the condition
is made worse than it was before.

The beneficial results of the operation, when it does succeed, have
never been satisfactorily explained, but the accepted opinion at the
present time is that they are due to the formation of a scar which is
more pervious to the fluids of the eye than the normal tissue, and the
object of modern operations is to obtain such a scar. For this reason
sclerotomy, usually performed by the method of Elliott has gained
great vogue. A piece of the entire thickness of the sclera is removed,
and thus a permanent fistula covered only by the conjunctiva is
formed. Through this the fluids of the interior escape. Like
iridectomy this operation sometimes succeeds temporarily, but,
according to Elliott himself, it may fail to check the optic atrophy
and decline of vision even when the relief of tension is complete.

Although it is the concensus of medical opinion that a glaucomatous
eye must eventually be operated upon, and that the sooner this is done
the better, some men have attempted to hold the process at bay by the
use of myotics. These drugs, by contracting the pupil and thus
stretching the iris, are believed to draw the latter away from the
"filtration angle" and allow the excess of fluid to escape. They are
commonly employed for the purpose of giving temporary relief, but some
specialists advise their continuous use. Posey claims that such
treatment gives a larger proportion of successes than iridectomy.

Until a few years ago I always treated glaucoma by the old methods,
not knowing anything better to do; but I never used the Elliott
operation, having early learned that it is very dangerous to allow the
fluids of the eyeball to escape, and having seen glaucoma produced by
fistula of the cornea. I would not have ventured to predict that the
condition could be relieved by relaxation, and only learned by
accident that it was amenable to such treatment.

On May 9, 1915, a patient (mentioned in 'Blindness Relieved by a New
Method', N. Y. Med. Jour. Feb. 3, 1917) came to me with a complication
of diseases which had reduced the vision of the right eye to light
perception and that of the left to 20/100 (the field also being
contracted). She was fifty-four years of age, and had been wearing
since 1910 the following glasses: both eyes, convex 2.00 D.S. combined
with convex 1.50 D.C., axis 90. As her pupils were much contracted, I
prescribed atropine to dilate them, two grains to an ounce of normal
salt solution, one drop three times a day.

On the afternoon of May 10, she had an attack of acute glaucoma in the
left or better eye. As atropine and other mydriatics are thought
sometimes to produce glaucoma, the fact that the disease attacked only
one eye and that the better of the two is interesting. The condition
got worse as the day advanced, and during the night the pain was so
intense that the patient vomited repeatedly. The next morning she came
to the office, and I noted that there was blood in the anterior
chamber. The vision had been reduced to light perception, and the pain
again produced vomiting. I prescribed eserine—two grains to the ounce,
one drop three times a day. Afterward I visited her three or four
times a day in her home, and as there had been no improvement, I
increased the strength of the eserine solution to four grains to the
ounce and alternated it with a three per cent solution of pilocarpine,
both of these drugs being myotics. Still there was no improvement, and
after a few days I decided upon an operation. It was performed on May
15, and was accompanied by considerable hemorrhage. Mild hemorrhages
also occurred at different times during the following week. When the
blood cleared away an opaque mass was left covering the pupil. On May
23, the tension was normal and there was no pain; but, owing to the
opaque matter covering the pupil, there had been no improvement in the
vision.

After the operation the patient resumed the relaxation treatment.
Under its influence the vision of the right eye improved, and when a
few weeks after the operation there was an increase of tension in this
eye, it was at once relieved by palming. For some months the vision of
the left eye remained unchanged, owing to the opacity of the pupil.
Then the obstruction began to clear away, and the vision improved. In
a year there was normal vision in both eyes. From time to time during
this period, and up to the present time, the patient had attacks of
increased tension in both eyes; but they were always relieved in a few
minutes by palming.

Since then I have used the same treatment in many cases, and I have
never seen one in which the pain and tension could not be relieved in
a few minutes by palming, while permanent relief was obtained by more
prolonged treatment.

One of the worst cases of glaucoma I ever met with came to me on Feb.
2, 1920. The patient was sixty years of age, and his vision in the
right eye or better eye was only 20/100, with marked contraction of
the field on the nasal side. In the left he had only light perception.
The eyeballs felt as hard as the glass shell of an artificial eye,
which, technically, is tension plus 3. The glaucomatous excavation of
the optic nerve was so marked that it seemed as if the whole nerve had
been pushed backward. The patient had been under treatment for a long
time, but had received no benefit.

On March 2, after swinging and palming, the vision of the right eye
was 20/20—while that of the left was 20/100 in the eccentric field. On
March 4, the field of the left eye had improved, and by alternating
the universal swing with palming he became able, for short periods, to
read diamond type with the right eye at six inches. This was twelve
days after he had begun the treatment. On March 7, he flashed 20/40
with the left eye, and by the aid of the universal swing read fine
print at five inches with the right, while the field of both eyes was
normal. For the first time in several years he became able to see the
food on his plate. Previously he had had to be fed, which was very
humiliating to him. He also became able to go out without an
attendant, to attend to his correspondence at the office, and to read
letters without glasses. At this point he stopped the treatment
against my advice, and I have not seen him since. He was greatly
helped by the universal swing, which he practiced all day.

The truth about glaucoma is that it is a functional neurosis caused by
strain, and as such is curable. You can produce hardness in a normal
eye by having the patient strain to see (see page 2), and you can
soften a glaucomatous eyeball by relief of strain. These changes are
so rapid that no change in the contents of the eyeball could account
for them. I therefore concluded, before I had any experimental
evidence of the fact, that they were due to muscular action. Later I
was able to produce glaucoma in a rabbit's eye by operations upon the
muscles. I shorted the superior rectus by tucking, and thereby
produced a tension of plus 1. I repeated the operation upon the
superior oblique, and the tension increased to plus 2. I did the same
to the inferior oblique, and the tension increased to the maximum,
plus 3. All this time the tension of the other eyeball remained
normal.
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Glaucoma Number
Better Eyesight
A monthly magazine devoted to the prevention and cure of imperfect
sight without glasses
Copyright, 1920, by the Central Fixation Publishing Company
Editor—W. H. Bates, M.D.
Publisher—Central Fixation Publishing Co.
$2.00 per year, 20 cents per copy
342 West 42nd Street, New York, N. Y.
Vol. III - December, 1920 - No. 6
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